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Sun Nov 5 13:47:57 GMT 2006

In a message dated 11/5/2006 7:15:19 AM Central Standard Time,  
tangentcarrot at hotmail.com writes:

you  said-
"Problem being that he's now upright and relatively  coherent..."
well, the problem was that if he did crash, there was little I  could do, 
since the only medical equipment I had was disposeable gloves (I  don't 
usually carry an Ambu bag when I go out on friday nights...) .  Morever, the 
ambulance could drive to the hospital faster.

I was  immediately concered that he might have an epidural hemaetoma, and so  
should any EMT-B be.

As I noted in my message, I was also concerned about the possibility of an  
intracerebral bleed, in particular, an epidural. I also pointed out at least 
one  point (the pain at the back of the head) that argued against it being an  
epidural, which typically involves a blow to the temple. A second thing that  
argued against it being an epidural was the amount of time he was spending on  
his feet. Rapidly expanding epidural hematomas (which, after all, are arterial 
 bleeds), would be expected to be showing localizing signs fairly quickly 
after  the patient regains consciousness, and to become unconscious again shortly 
 thereafter.

It comes down to the recognition that every mentally competent adult is  
generally considered to have the right to self determination....including the  
right to accept the chance of death under most circumstances.

Something that is among the toughest things for new doctors (as well as new  
medics and nurses) to accept.

You did what you could....why beat yourself up about something over which  
you had no control?
ck
Charles S. Krin, DO FAAFP

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