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BlueSkies

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BlueSkies last won the day on October 21 2011

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About BlueSkies

  • Birthday 09/28/1975

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    Chief Flight Paramedic

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    Rapid City, SD
  • Interests
    Flying, Golfing

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  1. Apparently I have been a member since 2011 and it was Dwayne's fault for dragging me here!! I got lucky with the log in info but tonight has been fun and I even replied to a few threads lol Just remember that take offs are optional but landings are mandatory Also its Snoopy side up and sticky side down for bandaid applications!!!
  2. "Take offs are optional...Landings are mandatory"
  3. I know this thread is old but I do love RSI since it is basically our bread and butter in the Aeromedical world so let me throw my two cents in on this one and see what you think!!! First off, I have never seen or heard of anyone using Versed (Midazolam) as an induction agent. It is simply a bad choice. Number one it is a Benzo and it has predictable effects but it's not reliable. While it does provide the amnesic effect it does not effective kill the urge to vomit which is exactly what we are looking for when we use the term RSI. Remember that the "I" in RSI stands for Induction, not intubation as we are inducing a coma. Propofol has a great place but in the rotor wing environment it is hard to keep up with, we have so many tubes and machines in a small space it is not a good situation if someone is snowed with Propofol and your line kinks or you lose your IV and the patient wakes up and starts kicking the pilot in the neck!!! Let's talk about Ketamine for a second, great drug, great profile, easy to dose, good for kiddos and adults but it is not the wonder drug it is made out to be. Look at the side effects, number 1, it causes hyper salivation so if you're using Ketamine without the premeditating of your patient with Atropine then you may want to think about approaching your Medical Director for a change in your RSI protocols. Number 2, Ketamine if give to a sympathetically exhausted patient will cause hypotension, bradycardia and death if your are not careful. Reminder that Ketamine's mechanism of action is to use your catecholamine stores and if they are depleted your patient is screwed! I have seen a lot of the peeps here talking about Suxamethazone which if you're not familiar with it is nothing more than how they package Succinylcholine outside the US. Been there done that when I did medivacs in Mongolia for over 2 years Succs has some lethal and well known side effects such as being a trigger for malignant hyperthermia, increases potassium, can't use it in renal failure patients or patients with increased ICP or Increased intraocular pressures, penetrating eye trauma, blah blah blah Now let's talk about my new favorite drug!!! SUGAMMADEX (Bridrion) it has been available in the US since Dec 2015. This drug has effectively replaced Sux in my RSI and Difficult airway protocol. It's mechanism of action is to encapsulate Rocuronium at the nicotinic and muscarnic receptor sites and make it moot. So, in the near future you will see most of your RSI protocols changing to include Sugammadex as soon as the price goes down lol Basically what your protocol may change to is something like this: Pre Medications such as Atropine, Lidocaine (you can remove your defasciculation doses now since Sux will be gone) Versed, Propofol, Fentanyl, Amidate (My favorite because it is the only one with a linear relationship, 100 secs of induction for every 0.1mg/kg) Rocuronium (your typical dose of 1mg/kg) Intubate Continue in with analgesia and pain control See!! No SUX anywhere!!! What happens if you miss the intubation and you run into a can't ventilate can't oxygenate situation? Of course the answer is Surgical Cryc lol but before you get there you can admin Sugammadex and the effects of Roc will be reversed in typically less than 3 minutes. Great studies have already been released in the US, the UK and Aussie, check it out for yourself if you don't believe me and as I always say, don't take my word for it, go learn it for yourself!!! Look up the new Difficult Airway Algorithms that have been released here in the US, you will see on them that it leads you to the "wake the patient up." option, This is actually referring to using Sugammadex to reverse the neuromuscular blockade! Sugammadex works with Vecuronium also but not nearly as well as it does with Rocuronium. It is still expensive as it is only marketed by MERCK and so far it is $100 for a 200mg vial and the average dose if 4mg/kg which would be 400mg for a 100kg patient at a cost of $200 dollars for your service. The good news is it is not needed for every RSI case if you can pass the tube through the chords Well this has been way more fun for me than it should have but I look forward to the replies on this thread so return fire at will!
  4. Welcome to the City! I have never personally agreed that accelerated classes for this type of certification have ever been a good idea. With this type of class all you really get is the "cookbook" style of medicine which is very simple, when your patient presents this way you do this. It does not give you a root in focused A&P or pathophysiology so therefor there is no way you could be expected to critically think your way out of an emergency that is not listed in your protocols. I look at those types of classes as scams for the most part and in today's world where we are trying to sharpen our image as pre-hospital practitioners and not just ambulance drivers or in my case "self loading baggage", people like yourself are being taken advantage of with high priced classes and promises of jobs and certifications. I feel bad that you had to go through this junk and that you lost a little self confidence by failing your first attempt. So with all that being said, please do not think I am downing you in anyway, merely the methodology behind your so called "Class", I currently teach FP-C, CFRN, CEN, CC-P review courses for my company and I am fairly aware of what is on the NREMT test for Basics so if you would like, we could hook up on skype and I can help you through some of the things you don't understand and I can provide you with some study materials and prep tests to help you gain the confidence that you need to pass. I make no guarantees and I charge no money but as an older Medic, I do believe it is my place to mentor the new generation such as yourself to take my place when I get even older and more broken down So if you are interested please PM me and I will get started with you. I work a salary job so I am basically free most days or I can make time for you when you're available. I am in Mountain time here in South Dakota. Keep your chin up kiddo, we can all get you through this and trust me when I say that if I can pass the NREMT test, anyone can pass it!!!
  5. Geesh...the poor guy left already..we can't have nuffin nice round here Maybe you guys should stop talking when someone new comes over..set the next few plays out!!!
  6. That is what I am guessing too Bieber. Same way over here. We use baby blankets and just as important is the head cover for the baby. Set the temp high in the back of your rig and prepare to sweat!! Infants cannot regulate their bodies temps yet so it's up to us to keep them warm. Warm IV bags I am sure could work but I think that wrapping up the baby, covering its head, turning on the heat and let Mommy hold the baby to her chest is the best course of action. If Mom has planned on breastfeeding I say let her! Skin to skin contact is great for body heat transfer and it will also help with any vaginal bleeding that may still be occuring to Mom. Put the blanket over baby and Mom for a little privact and you have killed several birds with one stone.
  7. A few things come to my mind on this issue. I will be brief and give everyone else a chance to ellaborate. 1. Long hours at work. Before I left the streets back in 08 there had been ongoing talk for some time about the possibility of insurance companies either raising their rates or refusing to insure EMS services that stil rotated on 24 hour shifts. Long hours and no sleep can and has been proven to be deadly to the workers and the public. 2. How many other professions do you know of besides EMS and the fire service where an 18-21 year old (depending on insurance policies) jump into an ambulance or firetruck, flip on the lights and sirens and take off down the road after a 1 or 2 day EVOC class? The inexperience of some of the drivers are to my mind yet another cause. My two biggest recommendations would be to do away with the 24 hours shifts and require someone under tha age of 25 to have not only an EVOC class but several months to a year of documented supervised driving with a senior co worker. Will these happen anytime soon?? Probably not but that's me on my soapbox for a minute.
  8. Dwayne the world may never know!! That pic was actually during a training day with my SAR team. I was making them trust each other and the systems so I was asking them to descend and then let go and invert after they were belayed off. Awesome day!!!
  9. Kiwimedic No way a brand new AAS RN or a BSN will be able to step onto an ambulance and function. By virtue of education only as you say...seriously? Come on now...lay off the sauce
  10. Brother, believe it or not a lot of us have Dx and UnDx PTSD. You are talking to one right now. The support system you have along with the new exercise program will help but you know as well as I do that stress IS A KILLER! Don't use the statement, "I think I may also seek professional help." Just go...bite the bullet like I did a few years ago and go...SOON! You will feel better and please don't ever hesitate to come post here again with anything else. This took massive courage to admit and we are probably all reading this saying to ourselves, "I have been there or I am there now." Stay safe my brother.
  11. Ok from experience with FL and the EMS system there let me give you a little advice. FL is mostly Fire based EMS and if you are applying to a FD they won't even look at your app if you do not have the FL FF Standard Certs. Best avenue for you is possibly consider moving to another part or face a long commute. There are very few county EMS services left. However there is hope for you my friend. Lee Co EMS in Ft Myers Beach is a county EMS, no fire. EVAC in Daytona Beach is EMS and no fire. Rural/Metro in Orlando and West Palm Beach is EMS and no fire. Orange Co FD in Orlando will usually hire for strictly EMS just watch their website. Lake Sumter EMS is not fire based. And of course the largest private service in FL is Sunstar in Pinellas Co which of course is Tampa Bay. They will hire you tomorrow if you just apply. They are always looking for people. There are not many more that I can think of right off hand but what I did was find a county map of Florida and then I searched indivudually on the net for what kind of service they ran. Most of them have decent sized citites in them and you can search for that city and get a lot of info about police, fire and EMS. Also, Okaloosa Co and Escambia Co have straight EMS services but that's way up in the panhandle. Good luck and I hope this helps mate!!! Eric
  12. Dwayne I am proud to say that I know you personally and that we have worked close together on a project. The others on this forum do not realize what a blessing you are to the world. You and your wife are stronger people than I could ever hope to be. God speed your journeys and I look forward to many more years of our friendship!
  13. I know there are some of you here who beleive in different things and I respect that. This isn't meant to start a religious backlash it is simply a joke so have a coke and a smile!!! There was a great flood coming in the mountains. The snow was heavy during the winter and when the spring showers came the flood was on so to speak. It was broadcast all over the radio and TV for residents of a small community near the swollen river to evacuate now! There was one little stubborn lady who insisted that her Lord would save her however. The first day as the streets were begining to flood a rescue truck was dispatched to her house. When the crew arrived at her front door they announced, "Ma'am, we are here to get you out!" To this she replied, "Do not worry about me, my Lord will protect me!" So the rescue crew left. The second day the streets were flooded and the water had begun to rise inside her house so she retreated to the second floor. Soon after a rescue boat noticed her in the window and yelled to her, "Ma'am, we are here to get you out!" To this she replied, "Do not worry about me, my Lord will protect me!" So the rescue crew left. On the third day the waters had rose so high that she had been forced to retreat to her roof. A passing rescue helicopter noticed her and lowered a rescuer and a basket down to her roof. The rescuer shouted, "Ma'am, we are here to get you out!" To this she replied, "Do not worry about me, my Lord will protect me!" So the helicopter left. Soon after the aircraft departed the flood waters completely over took the house and the little old lady was swept away and quickly drowned. The next thing she realized was she was able to open her eyes and standing before her was the Lord. She promptly asked him, " Lord, I have always read that you will protect me from harm, why have you forsaken me by allowing me to die?" To this the Lord replied, "I sent you a rescue truck, a boat and a helicopter! What more do you want?"
  14. I have responded to two of these and was involved in a roll over myself. I never gets easier. Thoughts and prayers for all those involved.
  15. I have always been a proponent of, "If its bad enough to extricate its bad enough to need an XP-1." Which of course isn't always true but it seems that a bunch of advanced providers forget to utilize a great tool. I have talked to several medics who didn't know that it controlled C-Spine once secured into place. Of course I do believe this is lack of education on their respective programs part. Everyone pushes the LSB for complete spinal immobilization when sometimes an XP-1 or KED is a better choice.
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