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About chbare

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  • Occupation Anti-provencial thinkingtologist

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  • Gender Male
  • Location United States

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chbare's Activity

  1. chbare added a post in a topic NS - going the way of MAST pants?   

    I've read a couple of opinions and one can be referenced here: http://www.bmj.com/rapid-response/2011/11/01/hartmann’s-solution-and-09-saline-are-both-unsuitable-severe-dka
    Unfortunately, the author references many sources that do not specifically consider DKA. I will also refrain from a strong ion discussion but I'm not convinced that a SID approach is superior and clinically more useful than standard approaches. 
    Ive seen modest studies that compare NS and LR in DKA patients. One such abstract can be referenced here: http://www.ncbi.nlm.nih.gov/m/pubmed/22109683/
    I would love a reasonable evidence based approach but I'm not really compelled to say NS volume expansion in a prehospital setting involving DKA is harmful. I'm willing to change my mind however. 
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  2. chbare added a post in a topic NS - going the way of MAST pants?   

    Just to clarify, are you saying DKA patients should not routinely receive initial blouses of fluid?
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  3. chbare added a post in a topic Narcan at the EMT level.   

    Again, I think it is important to emphasise a key point. ERdoc is not talking about "awaking" people up. I believe he and others are discussing this in terms of a much more nuanced approach. As already stated, anecdote is of limited value when attempting to generalise. Is there literature that looks at the issue at hand however? 
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  4. chbare added a post in a topic Bad Lungs Bad Transfer   

     Do we have labs, an arterial blood gas and an x-ray? What is her plateau pressure and how has it been trending? How much PEEP is she on? Does the ventilator have a graphics package?
    Let's find her ideal body weight and look at a lung protective ventilator strategy. If need be, we can transition to pressure controlled ventilation or possibly a hybrid that allows us a degree of control over pressures and the inspiratory flow waveform. Is the patient comfortable?
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  5. chbare added a post in a topic Good day everyone, it's been a while   

    Twelve mile, mass start race that begins with a one mile climb on jeep road followed by technical single track. I believe it is followed by a 12 mile "fun" run after all categories have finished. 
    We we are still in the manuscript/peer review process. It's good enough for a poster but official publication is still in the works. 
    That is great to hear! Good luck on the running man! I hear you with the summer issue. Luckily, we've had a wetter than normal summer here in the desert but I've had to ride on a few hot days. 
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  6. chbare added a post in a topic Good day everyone, it's been a while   

    Thanks man! Nope, no new cars. However, I bought a mountain bike and apparently harbour a desire to race as I've been training like an animal for my first race in September. The significant weight loss has been a plus for sure. 
    Otherwise, it's been work as usual, teaching and doing an occasional EMS shift. I've also been preparing to present some research I did in grad school with my adviser at a poster session in October. 
    How is life with you? You still PA'ing it in the ER?
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  7. chbare added a topic in Non-EMS Discussion   

    Good day everyone, it's been a while
    Hello everybody, I hope this finds you well. I've been awol for quite a while. Life has been quite interesting over the past year or so as I completed grad school and apparently dealt with existential angst. Probably a mid life crisis of sorts that resulted in significant life changes much to my poor wife's horror and pleasure. I must confess that I've been less interested in traditional EMS work and have instead focused my efforts on more naturalist and interpersonal pursuits. If I'm to be honest, I find these concepts both refreshing and interesting. Now that I may have a bit more time I may look at engaging in dialogue and being a more productive member. Take care everyone. 
    • 4 replies
  8. chbare added a post in a topic Thoughts on this? Uber style Narcan delivery!   

    First, we need to be able to divorce human hubris and bias from the discussion. For example, I saw earlier comments go on about heroin. What does the data tell us about the types of opioid overdoses that are killing folks? In many cases, the substances involved were not illegally pulled from poppy fields in Afghsnistan, but rather were from prescription opioids. Once we start attaching emotions and using bias to conflate the picture, it is easy to make incorrect conclusions that can further reinforce prior assertions that may not accurately reflect the actual situation.

    With that said, I would ask to look at the evidence. What is the impact when naloxone programmes are used? Do they lead to increased abuse and more problems as some may assert? In general, how does education and risk reduction compare to the use of coercion (making drugs illegal and throwing people in prison) when combating the issue of opioid associated death via overdose? There is a base of literature out there that could allow us to make reasonable conclusions.

    Regarding this particular article and novel approaches it suggests, I'd ask if it was worth considering the author's thesis based on the current literature. I'm not entirely sure, but would it be worthwhile for somebody to develop a protocol, approach an IRB and gather some data?
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  9. chbare added a post in a topic College Degree: Operations mangement/physics?   

    There are folks with undergraduate physics degrees doing amazing things and even doing research or involving themselves with research. A higher degree will likely be needed for academia and writing research proposals/protocols and obtaining good grants, but I would not discount other folks.
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  10. chbare added a post in a topic LGBT in EMS/Fire   

    I have to disagree with "don't ask don't tell." The subjects of kids, home life, life partners, relationships and so on come up naturally as most humans are socially inclined animals. This is particularly true in an intimate setting such as EMS where you may spend 12 or more hours in close contact with another person or a small group of people. I simply cannot see how such subjects would not come up as a natural consequence of normal social activities.

    Unfortunately, in the United States, a whole bunch of people care. Going into elections, this is becoming an issue that potential candidates are already talking about on national and international multimedia. Additionally, the Supreme Court will be making a decision that will (hopefully) address the issue of equal treatment. Regardless of the decision, this country is markedly polarised on certain issues and to think that the issue will not be in the minds of EMS providers is probably rather myopic and naïve.

    Remember, as little as two decades ago, these issues were largely buried and not at all on the forefront of the cultural consciousness of the United States. Things have changed in a big way and the zeitgeist of our nation and perhaps the world may very well be changing and doing so on the scale of human lifetimes.
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  11. chbare added a post in a topic I really appreciate the help   

    That would be great! Thank you so much.
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  12. chbare added a topic in Training - Everything Else   

    I really appreciate the help
    Good day my friends and colleagues. I need to ask for a big favour. Part of my masters project will involve a survey and I have managed to make it relevant to the paramedic profession. If you are a paramedic that has been educated in the United States and is currently working in the field, I would like to invite you to complete the survey. The survey and data collection protocol has been approved by my college's institutional review board (IRB) and involves consent. I have also contacted EMT City admin and have their approval to post the link to the survey. No personal information is shared and all responses are stored on a HIPAA compliant server with robust encryption. Thank you so much in advance. The link to the survey is as follows: https://ufl.qualtrics.com/SE/?SID=SV_9LyAlBh1akJlmy9

    • 7 replies
  13. chbare added a post in a topic Endotracheal Intubation vs. King LT   

    No, a Japanese study showed less favorable results in arrest patients who had advanced airways placed. Unfortunately, I believe some of the issues revolved around the fact that they used a variety of devices including EOA's?

    There was a very small animal study (n=9) that indicates SGA's may decrease CBF in the arresting animals.
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  14. chbare added a post in a topic Combat medics transition to paramedics   

    Hi Ghost. I am saying this as a former 91B who reclassified to the newer MOS designation. I joined the military back in the 1990's and was in until the mid 2000's. I started as an E1 and worked my way into the NCO ranks/grade. While I never deployed OCONUS I did do a contract in Afghanistan a few years after I got out.

    Here's the issue; being a civilian paramedic isn't about providing trauma care in a non-permissive environment. Medical cases abound and the patient populations are incredibly diverse. Additionally, the trauma patterns tend to be more blunt in nature. You are dealing with complex chronic pathology, significant medical issues and a civilian operational environment. This is markedly different than what many 68W series guys get. Certain ASI's such as the M6 have significant civilian crossover however and the newer flight medic programme looks to provide NR-Paramedic credentials. So, as a soldier you potentially have other schools and options that you can choose from with better civilian crossover. However, as a soldier, you are there to serve Uncle Sugar and he's under no obligation to hand you a civilian credential that you may not fully understand but believe you deserve.

    I believe military medics have much to offer, but they will likely need to attend the proper training and education programmes to successfully make the civilian paramedic transition. Luckily, the military is usually pretty good at offering assistance to combat vets as they transition into the civilian workforce.

    Unfortunately, I fear you simply do not know what you do not know. Please attempt to look at the bigger picture and appreciate the fact that you may not have a fully developed appreciation of the role of the civilian paramedic.
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  15. chbare added a post in a topic Pain Management   

    Oh, pain meds were given, but the patient was pretty messed up and giving more than 100 mcg of fentanyl will apparently result in a patient's head spinning around a couple of times, falling off, rolling down the hallway and spontaneously combusting in the Pyxis room.
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