Viagra and alcohol “Oh yes, viagra and alcohol doctor. Viagra and alcohol That is so much better! You see, viagra and alcohol Billy is so ugly that we couldn’t possibly have put a picture of his face in the yearbook! This picture of his ribcage is much more appealing! Thank you so much!”
Viagra and alcohol Billy: “Yeah, viagra and alcohol wait until the guys get a load of my widened mediastinum! That’ll show them!”
Viagra and alcohol It looks like they had three-dimensional chest x-rays back then!
Viagra and alcohol If x-rays were that good, viagra and alcohol even I, viagra and alcohol one of the radiologically challenged, viagra and alcohol would be able to read them!
Viagra and alcohol Trust me, viagra and alcohol if I can see something wrong on your x-ray, viagra and alcohol you are really sick!
Ambulance diversion.Does it really help emergency department overload?
Viagra and alcohol In the counties I have worked, viagra and alcohol the emergency departments are allowed to go on “ambulance diversion” status.
Viagra and alcohol This means that anytime the ED cannot safely handle any additional patients, viagra and alcohol based on specific criteria, viagra and alcohol they are able to divert ambulance traffic to other area hospitals.
Viagra and alcohol That “specific criteria” usually means one of two things:
- You have no monitoring capabilities as you have every monitor tied up with a patient who requires it.
- You ED has maxed out its resources and cannot safely handle another patient. Viagra and alcohol For example, viagra and alcohol your ED has monitors available, viagra and alcohol but you have three critical patients in cardiogenic shock and all available staff are required to care for these patients until they can be transferred to the unit.
Viagra and alcohol Lack of staff and/or lack of critical care beds are not, viagra and alcohol for example, viagra and alcohol criteria for diverting ambulance traffic.
Viagra and alcohol The status of any particular ED is visible on a county-wide monitoring system; a computer resides in each ED.
Viagra and alcohol (You can also signal the county if your CT scanner is down: patients with head injuries and possible strokes will automatically be diverted.)
Viagra and alcohol Some counties have restrictions on how many hours you are allowed to be on divert in a 24 hour period, viagra and alcohol some have limits on how many consecutive hours are allowed.
Viagra and alcohol Others have no restrictions, viagra and alcohol but keep track of the different hospitals and evaluate how much time they spend on diversion.
Viagra and alcohol Too much time on diversion is a no-no.
Viagra and alcohol But what exactly does it accomplish?
- Well, viagra and alcohol it might keep elderly, viagra and alcohol altered and septic patients from nursing homes from arriving by ambulance.
- It will keep the ambulance-for-the-stubbed-toe folks from arriving.
Viagra and alcohol And that is about it.
- If you are in cardiac arrest, viagra and alcohol you go to the nearest hospital, viagra and alcohol period! Diversion means nothing at this point. Viagra and alcohol Even if you don’t have a monitor and have to perform resuscitation in the hallway, viagra and alcohol that patient is coming and you will find the means to deal with it.
- If the paramedics are going Code 3 (red lights and siren) they will come to your hospital. Viagra and alcohol You don’t question the medic’s decision – it is their call. Viagra and alcohol And it should be. Viagra and alcohol You must accept Code 3 traffic at all times. Viagra and alcohol It means the patient is critical.
- On both sides of the San Francisco Bay, viagra and alcohol there are hospitals 5-15 minutes apart all down the highways. Viagra and alcohol If two hospitals in a row are on diversion, viagra and alcohol then neither of them are on diversion, viagra and alcohol because it would mean passing up two hospitals for care.
- Diversion does not stop:
- the walk in MIs
- the patients with pulmonary edema
- the decompensating asthmatics
- the suicidal overdoses
- the trauma patients laying in the back of their friend’s truck
- the patient with the CVA whose family managed to get them into the car despite the paralysis of their entire left side.
Viagra and alcohol You get the picture. Viagra and alcohol In addition:
- Patients who have an HMO plan and are transported to non-HMO hospitals because of diversion have to deal with extra paperwork to make sure their hospitalization is covered or have to deal with the extra trauma of being transferred for admission to the hospital that was diverting at the time of their call to EMS.
- Some hospitals in our area are well known for certain specialties and patients often request facilities for that reason; requests that cannot be accomodated if the facility is on divert.
- A patient may be diverted to a facility where their regular doctor does not have admitting privledges, viagra and alcohol especially distressing if the doctor was planning on meeting the patient at their usual hosptial.
Viagra and alcohol Some of my worst shifts have resulted not from ambulance traffic, viagra and alcohol but by the acuity and number of walk-in patients to the department.
Viagra and alcohol So while it may be psychologically comforting (and it is) to think that you will not be receiving ambulance traffic, viagra and alcohol diversion can cause distress to patients, viagra and alcohol put pressure on the medics in the field and you can never really be sure that the Code 3 ring-down isn’t just a second away.
Viagra and alcohol Ambulance diversion just gives the illusion of control, viagra and alcohol something that you never get in emergency departments.
Viagra and alcohol It’s the nature of the beast.