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  1. Today
  2. Starting EMT school on monday, looking for a study buddy. Preferably one that has discord and/or facebook. thanks~!
  3. Yesterday
  4. Contraindications for morphine use include (among others): head injury, decreased mental status, multiple trauma. Why? I understand why it's respiratory depression effect would make contraindicated for patients with COPD and asthmatic attacks, and why its effect on blood pressure would make it a bad choice for a hypotensive pt. But why would multiple trauma and altered LOC/head injuries make it so? I'd think head injuries would make rise of ICP an issue, one in which morphine would, if anything, help.
  5. Earlier
  6. One more thing, our new ambulance we are getting is gonna cost 235K, if you want to put an X-ray on that new ambulance the cost just went up to maybe 300K, no hospital or ambulance service will justify that cost.
  7. So what are you asking us? is this one of those "Our instructor gave us these two topics and we need to write a paper and I want you guys to write my paper for me" or what are you wanting from us? Yes we have had those people come here with just such a request. give us more info please in what you are asking.
  8. There is no guarantee he will continue on and get his EMT license. Maybe he's just doing this for class time or some other reason. I would take Off Label's advice and complete the course and mind your side of things. These things have a way of working their way out.
  9. Good afternoon EMS people. Please assist me. Is there anyone here who has done the FREC LEVEL 5 DIPLOMA COURSE at RONIN SA? If yes, was your qualification accepted in the UK, seeing that it was obtained outside the UK? Where did you do your practical placements? Thank you in advance for your help. 🙏🙏
  10. Good afternoon EMS people. Is there anyone here who has done the FREC LEVEL 5 DIPLOMA COURSE AT RONIN SA? WAS YOUR QUALIFICATION ACCEPTED IN THE UK, SEEING THAT IT WAS DONE IN A FOREIGN COUNTRY? PLEASE HELP ME BEFORE I COMMIT MYSELF 🙏🙏🙏🙏
  11. Off Label

    CRASH 3; TBI and TXA

    The issues of hyperfibrinolysis and fibrinolysis shutdown are issues that bring to the fore the importance of timing of TXA, TBI aside. Multisystem trauma is pretty likely in patients with TBI, and I think one of the CRASH trials does suggest that if you don't get the timing right, you may do harm.
  12. Kmedic82

    CRASH 3; TBI and TXA

    Let’s talk about TXA and brain injuries. Maybe we can put to rest the suspicion that TXA creates further injury in patient’s with a TBI. TXA is an amazing tool to use for our trauma patients. There has been so much success TXA that there are trials to see how effective it is for GI bleeds. As with most medications new to a service (mine has had standing orders on TXA for about a year), there are always questions and concerns. One that continually comes forward is, “does TXA create further harm in a patient with a brain injury?” Curious and in an effort to self educate, I searched and found an article on my favorite blog, EMcrit. The CRASH studies were used to see the effectiveness of TXA and the trauma patient. The CRASH 3 study was specifically a sub study for the TBI patient. It was ran as a pragmatic study. Meaning, it was a non-controlled atmosphere and based in a real life setting with unpredictable variables. Much like a bad trauma patient. “CRASH-3 was designed to further investigate using tranexamic acid for patients with traumatic brain injury. This study utilized the following inclusion criteria: Enrollment within hours of injury Either Glasgow Coma Scale <13 or intracranial hemorrhage on CT scan No major extracranial bleeding This was a massive, pragmatic, double-blind RCT involving 175 hospitals in 29 countries, with a target enrollment of 10,000 patients. Patients were randomized to receive either saline or tranexamic acid (1 gram loading dose over 10 minutes followed by a second gram infused over the following 8 hours; this is the same regimen used in CRASH-2). The primary endpoint was head injury-related death in the hospital within 28 days of injury.” The utilized saline as the placebo versus TXA. The results showed a reduced mortality rate in patient’s with non-severe TBIs. With an emergency room study such as this, the results were “not statistically significant.” The criteria for a TBI patient is vast. There are too many complications. What proceeded forward was the need to take out the obviously brain dead patients (GCS>9 and fixed pupils). The severe TBI patients would not benefit from TXA just due to the impact of their injury. More severe, the less of a chance of effectiveness. Now, the mildly injured patient’s proved effective. There was a significant increase in the decrease of mortality with in 28 days of the patients who received TXA while suffering from a brain injury. To receive the proper and fair outcome, it was just a matter realizing that some patients were too sick to save. “ Subgroup analysis shows benefit from tranexamic acid among patients with a greater hope of recovery. Specifically, tranexamic acid reduced head injury-related death in the subgroup of patients with GCS>8 and also the subgroup of patients with reactive pupils.” What were the take away and conclusions of the study? “The conclusion of this article sums things up nicely: “tranexamic acid is safe in patients with TBI and treatment within 3 hours of injury reduces head injury-related death. Patients should be treated as soon as possible after injury.” The greatest strength of this study might be an extremely thorough evaluation for possible adverse events among 12,639 patients. Tranexamic acid was found to be safe, without increased rates of any adverse events (including thrombosis, seizure, and stroke). The primary endpoint of this study was technically negative (p-value slightly above 0.05). This likely reflects the inclusion of moribund patients, who diluted out the signal of benefit from tranexamic acid. Numerous subgroup analyses indicate that among patients with a greater hope of recovery, tranexamic acid is beneficial (figure below). As a statistical rebel, I would consider this trial to be positive, despite having a technically negative primary endpoint.” Check out the article at; https://emcrit.org/pulmcrit/crash3/ View the full article
  13. The guy is probably there because of some well intentioned charitable gesture someone is making. Is there really a concern he'll make it to something more than routine IFT's if even that? I'd just consider graciously tolerating him part of my training. Take the high road and just complete the course work and go.
  14. Radiographic interpretation is an advanced practice/physician level skill that requires credentialing and a formal privileging process. Out of scope for pre-hospital use.
  15. j.landrumlp

    Thoughts

    1. alternative funding for fire and EMS organizations. While several options exist, it is important to identify which options are available for non-profit and for-profit organizations. Which alternative funding option do you feel will result in the highest return on investment? Include an option for a non-profit organization and a for-profit organization, and explain. 2. Messages to the community are usually one of two categories: newsworthy or noteworthy. Based on your experiences, share with your class at least one example from each group. Which one had the most reaction in the community?
  16. I have been an army medic for the past couple years. I figured EMT would be a good part time gig since I have the training for field treatment...I gotta say, for my state, my scope of practice as a medic goes sooooo far past what I'm legally able to do as an emt. I think we just got the ability to prick someone for their blood sugar. Awful. Anyway. I am in class/ sidenote this is an extra course im taking on top of my other courses so I can be certified/ and there is this one individual. He has autism....specifically aspergers. Now mind you I have no issue with any persons who has a mental or physical issue. But this is EMS....this is make the choice or the patient dies decisions. This person gets extra time to test while the rest of us have to stick to the strick emt guidelines....I just fail to understand how anyone could have a partner who has this condition. Dont get me wrong I think people with mental conditions can be very intelligent in specific fields...but I feel like ems is a patient field. What I mean is we have to have social skills where we can interact with patients who are going through traumatic experiences....I dont know how I could deal with a partner who couldn't handle patients. I really wanna hear a general consensuses on this because Im not sure if im just a jerk. This guy blurts out random things during class and is just generally a disturbance. Multiple classmates have complained about the fact that he gets extra time during tests and skills. It really just isn't fair. My instructors make us wear our "ems" uniforms to class and treat every scenario as if it was a real patient....I dont see how this guy gets the free pass for extra thinking time.
  17. Thanks rock_shoes. Makes me feel like I am learning something. Although I’m a bit surprised that local protocols don’t reflect evidence based research (which is just common sense here), especially as a “critical fail” point. Well, as I said, I’m new to this.
  18. It's barely possible to justify ultrasound on most units never mind an X-ray generator. Big expense with marginal applicability to practice.
  19. Perhaps try organizing your reporting into a systems based structure. Neuro Cardiovascular Respiratory GI/GU MSK Other (Obs/Endo/immune)
  20. Good luck to you sir. I work flight in British Columbia, Canada and love the job. The US air ambulance safety record scares the living daylights out of me. Enough so I wouldn't be willing to work air ambulance in the US.
  21. Without more information, I'm willing to wager this is likely a matter of local protocol not evidence based practice. Based on the information provided the patient doesn't have an oxygenation problem.
  22. Hi all, I've done a long career in teaching/military, and thinking about what to do with my spare time in 18 months once my kids leave the house. I did a ridealong and volunteering in the local EMS unit seems like it could be really rewarding. I don't want to take the EMT course quite yet - I want to spend the remaining time I can with my kids while they're still around - but I've found a great course offered where I teach that I'll take next year once empty nest arrives, and in the meantime I'd like to poke around and see what those with experience say about the career, especially as a volunteer. I'm a bit concerned that as a 50 yo volunteer I'll never gain the patient volume to have the experience that would make me a great provider, but my local unit has some experienced people to help me along the way.
  23. I'm learning to become an EMT, so be easy on me for asking this newbie question, but it points to something about O2 adminstration that I don't understand. Virginia's health department posts a bunch of scenarios for EMT training like this one: http://www.vdh.virginia.gov/content/uploads/sites/23/2016/05/M003.pdf In it we find a young adult diabetic patient with a Rx for insulin, able to speak but not feeling well, alert and oriented x3 but "sluggish to respond" and a CC of "not feeling right". He has an O2 sat of 95 and respiratory rate of 14, no mention of cyanosis, vitals normal except for low glucose. Why does the grading criteria call it a critical fail to not provide O2? As a not-yet-certified EMT student with no field experience, I'd think this pt doesn't seem to be in any sort of respiratory distress; he just needs some glucose paste and continued monitoring enroute to the ER (and probably doesn't even need the ride, but I understand we are always supposed to transport everyone unless they sign waivers since there are problems that require more skill/equipment than we have to Dx.) Are we supposed to automatically provide O2 for everyone (except those in hypoxic drive), regardless of O2 sat? Just when I think I'm starting to get a handle on this...
  24. has anyone tried transferring their EMT or Paramedic licence to australia? 

  25. hi i'm Jamien i just finished the EMT-B training for New York in september. i am planning to start medic school next fall. my long term goal is to work as a flight medic. anyo advice or tips would be appreciated!! thanks
  26. So I've been out of hands on patient care for bit. Now that I've return to working a rig, I've noticed that my documentation, shall we say is horrible. I'm wondering if there a templates that I can use to help in completing my PCR, until I back in the swing of things. I' created a MS Word document template of sorts with some simple drop downs, but it is not available online nor on my MacBook Pro Circa 2009
  27. Wonder what the charge was? but all things serious - what a evil person.
  28. An Amish woman was injected battery acid by her Amish husband right around the time this person "Timmy" asked about the affects of battery acid. The husband used a syringe and injected it up her rectum several times. She was already being poison by other products and very ill, which is why he was able to keep her still to inject it. She ended up dying from it.
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