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Kiwiology

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About Kiwiology

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Kiwiology's Activity

  1. Kiwiology added a post in a topic Patient dies during discharge   

    Fuckwits ... absolute fuckwits. I disclaim little knowledge of tracheostomy care or maintenance but even me, who is dumb as a box of rocks, knows better not to tape the thing.

    I wonder why they taped it to begin with and what they were trying to achieve?

    I can understand if they were administering positive pressure ventilation for example then occluding the trach would be beneficial to create a closed ventilation circuit but in the absence of this .... WHAT THE HELL MAN?

    Looks like this might be a legit win of the lawsuit lottery.
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  2. Kiwiology added a post in a topic Whatcha Gonna Do?   

    Put him on 100% oxygen and see if that fixes his SpO2.

    If not and he won't take an OPA then call for an RSI capable Officer provided they can locate significantly faster than we can take him on to hospital; unless backup is very close (a few minutes away) I'd take him to the hospital.

    The VT could be hypoxia related; see if some oxygen fixes it to start with.
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  3. Kiwiology added a post in a topic Anaphylaxis   

    There is good evidence that clinical people administer adrenaline for anaphylaxis poorly; i.e. not giving it at all, giving too much or too little, not giving it frequently enough, giving it too frequently or giving it by a suboptimal route e.g. SQ.

    There is also good evidence that adverse effects of adrenaline is isolated to supratherapeutic IV dosing.

    Early and appropriate administration of adrenaline is the cornerstone of treatment for anaphylaxis. All the other stuff like steroids and antihistamines are not well supported by the literature.

    Give patients > 50kg 0.3 mg of IM adrenaline early and give another 0.3 mg in 5-10 minutes if the patient has not significantly improved.

    There seems to be a bit of irrational fear about giving people adrenaline, particularly if they are older or they have cardiac disease. Well, there is nothing to fear, the balance of risk is always going to be in favour of administering adrenaline.
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  4. Kiwiology added a post in a topic UK transfer to USA   

    Because there is no mandate for higher education for a US Paramedic they are considered third preference for a third preference work visa; basically considered an unskilled (or "other") worker.

    So, I hope you're not thinking being a UK Paramedic will allow you to get a work visa because it won't.

    You must also consider that what you see on American TV shows like Chicago Fire is not reality.

    Having worked and traveled extensively in the USA my advice to you is to visit on vacation and stay put living in the UK; even if it rains alot
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  5. Kiwiology added a post in a topic ECG for discussion   

    Junctional rhythm about 75/min
    Regular
    Axis normal
    No acute ST or T wave changes
    Don't see any pathologic Q waves

    Give her two hardenupacetomol and leave her at home.
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  6. Kiwiology added a post in a topic What I know now that I wish I had known then...   

    I wish I'd known how much sleeping at night was taken for granted.

    ... and that when ERDoc said he'd take me out for dinner and a movie he really meant Dennys on Plainfield and back to his rent-by-the-hour motel on 28th St to watch something from the $1/day bin at Snuff Bunker; the adult subsidiary of Blockbuster.
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  7. Kiwiology added a post in a topic When it sucks to use sux   

    Nah man it's all good.

    If you can use your cellular telephone to video the lecture that'd be pretty badass.
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  8. Kiwiology added a post in a topic When it sucks to use sux   

    Just because Mark Fitzgerald et al say something doesn't make it right or applicable in every situation; personal opinion only but I don't really think IFS is appropriate. RSI or go home.

    We have significantly increased our dosing of fentanyl and midazolam in RSI such that a standard patient gets 150 mcg of fentanyl and 6 mg of midazolam.

    Ketamine (100 mg) is used for patients who have shock.

    I would much prefer ketamine for everybody; midazolam is a poor choice of anaesthetic and no anaesthetist in their daily practice would use it for induction routinely.

    I should be seeing the Medical Director next week so I might ask why they have chosen this.
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  9. Kiwiology added a post in a topic When it sucks to use sux   

    Bah! Flimshaw! Balance of risk vs benefit is in favour of not using suxamethonium.

    I'd use vec or roc, I forget which it is you carry but I'd just use that.

    IFS is IMO bad ju ju so I wouldn't be using that.
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  10. Kiwiology added a post in a topic I'm a nurse, I'm a nurse, I'm here to help   

    Could have been worse, could have been at Billy Bob's place out on County Road 309 down past the Glumpkin residence. That would have meant at least 3 volunteer "First Responders" showed up in their cars/pickup trucks each with 100 lb jump bags, the local volunteer Fire Department would have also come plus an ambulance or two, and because "it looked real bad" somebody would have responded a helicopter ... and all of this is not including the bevy of neighbours who would have come to help out, one of whom would have been a nursing aid and wanted to do an immediate cricothyrotomy.

    Now if you'll excuse me, I have to go ensure that County Road 309 has been closed, I hear the helicopter getting close and they are always so fussy about having a suitable area to land.
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  11. Kiwiology added a post in a topic Medic One in Seattle?   

    I generally call bullshit on Medic One.

    Overall they offer a level of care that is no higher than your average American jurisdiction with a Medical Director who is not a muppet.

    They utilise the local fire department for rapid automated defibrillation - nothing different than is already done with, for example the New Zealand Fire Service or the Metropolitan Fire Brigade and County Fire Authority in VIctoria.

    They go on about survival to discharge for witnessed VF (and I think VT) only - well big shit, that's very selective reporting of the best possible data.

    Forty years ago Dr Leonard Cobb and Gordon Vickery set up what was, at the time, a great system for the best possible chances of surviving a cardiac arrest.

    It's now forty years later and survival from cardiac arrest pales compared to all the other things which have become important yet it's all they seem to focus on.

    If as much effort was put into the 99% of patients who are not in cardiac arrest as to the 1% who are then who knows where things would be, and Medic One probably wouldn't be able to keep up their hot air filled reputation.

    And yes, when I visit Seattle if somebody has a cardiac arrest infront of me I'll probably call Medic One ... maybe, if the Lifepak 10 in my rental car don't fix 'em up
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  12. Kiwiology added a post in a topic From Poland to UK (Paramedic or EMT)   

    Hi mate, you would have to go down the International route with HCPC which shouldn't be too hard plus you have an EU passport so no visa worries, but, do you really want to work in the UK? It rains a lot and they are a tad limited (although small moves are being made to address that) ... I would rather stay on the continent and work in one of the Doctor/Paramedic systems.

    Now, can I have some kielbasa stat!?
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  13. Kiwiology added a post in a topic Good ways to kill patients   

    All I can say is why do you think vecuronium vials have a red cap and ceftriaxone has a green one? .... (noting ceftriaxone in a vial with a red cap can also be bought)
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  14. Kiwiology added a post in a topic Good ways to kill patients   

    Calling ERDoc for medical control

    Getting vecuronium and ceftriaxone confused
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  15. Kiwiology added a post in a topic More on backboards and spinal immobilization   

    Initial consensus statement on immobilisation by the Faculty of Prehospital Care of the Royal College of Surgeons (Ed.)

    http://www.fphc.co.uk/content/Portals/0/Documents/2013-12%20Spinal%20Consensus%20COMPLETE.pdf
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