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bryan20w

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  1. I think that this entire post is trying to compare compantency of the strongest nurses and the weakest paramedics. I have seen paramedics that I would rather have taking care of my emergant need over any doctor, and then I have seen RNs that i would not trust with a pt that actually had a complaint. I think that to compare RNs to Paramedics are like comparing apples and oranges. Paramedics specialize in the ABC's and a few have extended education in critical care to handle the dynamic nature of an ICU patient for a shorter period of time, there job in this setting is not to fix, or improve the outcome of this pt, their job is simply to maintain the patients stability.
  2. Our agency currently uses carries an Iron duck BLS bag which carries all trauma dressings, Basic Airway adjuncts, BVM, NC, NRB's, and Blood pressure cuffs. We also carry a ALS bag that contains our IV needles, syringes, Meds, and Intubation equipment. We are currently at a cross road in trying to decide whether or not to go to a ALS bag that also contains all of the basic airway equipment ie. adjuncts, NC,NRB, and BVM. and a truama bag, or to keep the same configuration we have but switch to back pack style bags. After saying all of that, the purpose of this is to find out what bag configurations the rest of you out there are using either to let me know what is or is not working in other areas of the country/world. Also we staff our ambulance with one EMT and one Paramedic, if you could include in your response how you staff your ambulance that would be helpful. Thank you in advance to all that respond.
  3. Maybe i missed it but i don't think that anyone has brought up that Hypotension that is present although minor is stage 3 shock. This pt needs fluid and of the 1-2 liters that you give only 25% will stay intervascular after 1 hour. Also keep in mind that RBC's are produced based on hypoxia of the renal arteries so no saline does not carry O2 however adiquite pressure throught the renal arteries with Hypoxia present means production of more RBC's.
  4. The Manual available through kendricks states the cross method is the proper placement, however i agree with everyone that EMS is about improvising and do what works!
  5. Make sure you recognize that there is a major difference between bipap and cpap, bipap ventilates a patient where cpap just keep there airway open and will increase FRC.
  6. My personal feeling on this is that we should have P/P rigs. I feel that for vol. departments it is acceptable to have B's and I's but not in paid departments. The reason for this is two fold, first of all during the transport of a patient there are few calls that you can be sure will not turn to ALS, and if it does and the BLS provider is in the back then what, are you going to pull over so that the partners can switch. The second reason that i feel and it is more hypothetical than anything is that it would create a more effective team and due to law of supply and demand would raise the overall pay for paramedics.
  7. Whether it is helpful of not here is one such study, it is a european study however it is also sited in the Emergency medical Journal Nebulized magnesium sulphate versus nebulized salbutamol in acute bronchial asthma: a clinical trial HS Mangat, GA D'Souza, and MS Jacob Intravenous magnesium sulphate (MgSO4) has successfully been used in the treatment of acute asthma. The present study investigated the efficacy of nebulized MgSO4 as a bronchodilator in acute asthma as compared to nebulized salbutamol. This was a randomized, double-blind, controlled clinical trial. Asthmatics aged 12-60 yrs in acute exacerbation, with a peak expiratory flow (PEF) <300 L x min(-1), not having taken bronchodilators and not requiring assisted ventilation were included. Patients were randomized to receive treatment with serial nebulizations of either 3 mL (3.2% solution, 95 mg) MgSO4 solution or 3 mL (2.5 mg) salbutamol solution. All patients were also given 100 mg hydrocortisone i.v., and were monitored continuously for 2 h after which they were given supplemental treatment (if and when needed) and either discharged or admitted. Fischl index, PEF improvements (in % predicted) and admission rates were the outcome variables. Thirty-three patients were studied. Fischl score improvement was comparable and significant in both groups (4.31 to 0.43 in the MgSO4 group and 4.29 to 0.76 in the salbutamol group). The increase in PEF was statistically significant and comparable in both groups (by 35% pred in the MgSO4 and by 42% pred in the salbutamol group). Two patients warranted admission in the salbutamol group and one in the MgSO4 group. Nebulized MgSO4 had a significant bronchodilatory effect in acute asthma. This effect was not significantly different from that of nebulized salbutamol.
  8. I think that it is a good idea, it gets us one step closer to fewer delays in the ED prior to cath lab. Also in my area they are researching bypassing the local hospitals and going directly to a hospital with a PCI.
  9. I think that it is starting out in a 2 to 1 Atrial Flutter then in to a junctional rhythm with ectopy.
  10. What about nebulizing MgSO4 with saline, There has been quite a bit of research in to it and it has had approx. the same success as albuterol, so i might make a good alternative if refractory to albuterol.
  11. I also am a advocate for getting an IV prior to giving nitro, however i also can appreciate the need to not delay transport. In the event that an IV can not be gotten due to bad access i am curious as to everyones opinion on going with the Nitro and having the EZ IO readily available just in case? I know that that is by far not the ideal situation but is an option.
  12. Laura, From the sounds of it you did a great job for what you had to work with. Because you don't have room to tell us about all of your assessment, did you rule out a pneumo or a massive PE? Other than that like everyone else said he just waited too long to get help, like most asthmatics do!!!
  13. Just out of curiosity doesn't milrinone also decrease vascular resistance?
  14. To all that picked my last posting apart i appretiate it because i made me re learn the effects of vasopressin, unfortunately my instructor tried to simplify it and in essence taught it incorrectly. On a different not i wanted to defend my position on the use of epi though. I can appreciate that the primary function is peripheral vaso-constriction, my only argument was that it does have in some cases such as VF unwanted Beta 1 effects, ie automaticity. Last but not least, my only reason for commenting on the cookbook medicine and knowing your drugs is due to the fact that many people tend to look at EMS as if this than do that, because my protocols say so, We all need to be clinicians.
  15. two points that i want to bring up and the first is and it may sound rediculous but if cpap is new to you the most important part is a good mask seal and i know for a fact that if you have any air leak that it will burn through o2, the second thing is that atleast when treating CHF the problem is not the need for o2 it is the need to remove the fluid from the alveoli, you can bring a pt with an spo2 of 70% to an spo2 of 100 using only 30% Fio2 so the units that use high levels of o2 can be excessive for this purpose. using 30% i can usually make a D cylinder last for about 20 to 25 min
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