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  2. I love it when a plan comes together. The heart of the concept is minimizing cerebral oxygen demand while maintaining a sufficient cerebral perfusion pressure and flow for tissue oxygenation. Assuming an ICP of 20mmHg, it would take a MAP of 80mmHg to maintain a CPP of 60mmHg (I bet MAP guidelines for the management of TBI are suddenly making more sense). Some sedative/analgesic medications balance those considerations better than others. This brings in the concept of flow metabolic coupling (Propofol is particularly good at this as sedative agents go). Agent's with good flow metabolic coupling such as Propofol reduce cerebral oxygen demand in balance with the amount they reduce cerebral blood flow. Agents such as Morphine or Midazolam do a poor job balancing the two considerations and reduce cerebral blood flow relatively more than they reduce cerebral oxygen demand.
  3. Earlier
  4. Hey, good research topic. our service does not do hypothermia because we are so far away from a STEMI/Cardiac center that there is a real possibility that the patient will begin the re-warming process before they get there. The only thing we even remotely do is cold packs to the axilla, groin, small of the back and behind the neck. Any further and we feel that we run the risk of doing more harm than good. Now if we have ROSC and put them in a helicopter from the scene, then we very often put cold packs in those places but thats only if the paramedic thinks of it. So to make a long story short - we do not have a permissive hypothermia protocol/guideline - it's more of a paramedic remember guideline. Does that make sense? By the way, you probably won't get much more of a response out of here, we have a very limited number of people who still post, heck I might be one of the single handful of people who come here and actively review the forum. YOu might have better luck on the facebook sites.
  5. So am writing a research for college about inducing hypothermia after cardiac arrest by paramedics out of the hospital, So am trying to find the safest ways to start targeted temp. management earlier. gonna be thankful if you shared thoughts and experiences.
  6. So question, in your next service, if they practice lax infection control will you quit that service again? Not to be the negative nelly, but did you bring up your concerns to management and if you did where did it go? I have a co-worker at my other service that believes that because he is in great health he won't get Covid regardless of whether he practices infection control or not. I care if he gets it but it's on him and not me. if you practice good Infection control habits you should be ok, honestly, screw your partners, in the end, you have to go home to your family and if they don't then they don't. I would not have quit, I would have brought it to managements attention and let them deal with it, because in the end, you are the one out of a job and they still are working. But honestly, the choice was yours to make and I'm hoping you made the right decision and you have or had a job waiting for you before you quit. I wish you nothing but the best. Sometimes we have to fall on our swords to make a point.
  7. That would fall more under the definition of emotional support animal. You would have to consult your agency's SOP regarding what to do with those. The agency I just left generally won't take them because the hospitals won't. We could only take service animals as defined by the ADA. BTW...a dementia patient should have a caretaker or family member who can answer those questions for you. Just be sure to stick to the same ADA allowable questions you would ask the patient.
  8. Yes, as the others have said, you need to be more specific. Find out what your supervisor means, with examples. I am mainly 911 service but have worked entertainment, mostly concerts and festivals. Without more info it's hard to guess what your boss is talking about.
  9. the agency I just left requires N95's only with suspected or confirmed Covids and just released a memo detailing a plan to sterilize and reuse. Other covid PPE consists of gown, bonnet, eye pro. Face shield for intubation. Surgical mask for all other cases. Surgical mask on patient if they tolerate it. My headache was my fellow providers. I have had partners not want to wear the surgical mask in the day room or in the truck as directed and fire isn't required to wear them at all. I pulled the pin and resigned. Volunteers here don't get the job protections that paid personnel do. If I become sick or die because of this disease, my family will have no recourse. When I resigned, I gave my reasoning and was met with the predictable amount of lousy attitude so I do not regret my decision. They will forget my name in no time. I'm sure I won't be the only one. I have heard this same complaint elsewhere.
  10. I recently quit not out of fear of infection from patients, but out of fear of infection from fellow providers. We have many who seldom practice infection control measures spelled out by the agency such as masks and social distancing, especially indoors. I won't work with people who think so little of their own lives or those of other people's. One must wonder why they work in medicine in the first place with such nihilistic worldviews.
  11. Hello, everyone, Richard B the EMT here on an overdue visit. Hope you and your families have been safe from the CoViD 19, and you have not lost anyone from your teams. As I'm now almost 9 years being medically retired from the FDNY EMS, I'm relatively safe. None of my family, around the country, have been affected, but in the last month, I've lost at least 10 colleagues in the New York City "Tri-state" region, 3 of whom I used to work with, or under their supervision. You know the drill. If dispatch, or you and your partner(s) are the least suspicious of a call, not just the gloves, but the full PPE. Wash your hands, wash your gloves while you're in them, wipe down anything you can think of, including the ambulance door handles, and the keypad that lets you into and out of the Emergency Room. Try NOT to bring the Pandemic home with you to your family. If you're having issues, talk with your Employee Assistance Unit people, by whatever name they go by in your agency. If unavailable, there are several Emergency Psychiatric services available around the country, available 24/7/365. All religions train their men and women "of the cloth" in counciling, which is an available service to be considered. Here in NYC, we just lost an ER doctor and a 3 months on the job rookie EMT to suicide. None of us want that of our coworkers, or they of you. Although it's slow in coming, there will be an end to this Pandemic. Come that time, even with me not being a drinker, I will go to a bar for a beer in salute to my comrades around the world, active and past, and to those no longer with us. Until then, I'm going to continue sounding my car alarm, and ringing my cowbell (been in my family so long, don't remember a time it wasn't in the house) every evening at 7 PM.
  12. Rock_shoes, First, thanks for the response. I appreciate the time people with experience like you take to answer questions from people like me who are in the process of starting out. I have no idea why I find all this so fascinating, but I do. Unfortunately, I'm not sure I understand your point - I'm still just a student without a single ride to my name yet searching for a class that's open during COVID without much success. Can you check my analysis below and tell me if I'm right? The Monro-Kellie Doctrine (which was a new one for me; thanks!) says that if any one of the 3 volumes of brain, blood, or CSF increases then another volume must decrease and ICP will rise. That makes sense intuitively to me, and is why an intracranial bleed 2/2 head trauma would cause an rise in ICP. But why is morphine contraindicated here? I would think morphine would decrease BP, therefore decreasing cranial blood volume proportional to the brain's arterial compliance, therefore decreasing ICP, and therefore improving things. So from that, morphine is good. Cerebral perfusion pressure (yet another thing I hadn't heard of before; thanks!) says the greater the differential between the MAP and ICP, the greater perfusion. Also makes sense intuitively. From that I see that the drop in BP from morphine combined with the increase in ICP if there is a brain bleed or post-traumatic swelling would be bad; it would decrease the pressure gradient and therefore decrease neural cellular respiration. So from that morphine is bad. Combining those two things, the takeaway is that, in practice, the damage that morphine does from decreasing cerebral perfusion is worse than the improvement it does by reducing ICP, so don't use it. Is that right?
  13. Thanks everyone! I appreciate the feedback. It's tough enough to feel comfortable in knowing what to do in a critical emergency, worse to have to juggle conflicting standards of care. But what's really worse is the feeling that it leaves us vulnerable to lawsuits if things go south. I could imagine a lawyer saying, "Mr. EMT, please read here, from the AOSS textbook, the standard in the field, about whether to provide O2 at 95% saturation. And, yet did you provide O2 anyway against this guidance? And let me ask the expert, is it possible unnecessary O2 administration could cause O2 toxicity that could result in death?" Or if the I did the exact opposite thing, the lawyer would say "Mr. EMT, please read here from your own state's scenario on a critical failure point for failure to administer O2 at 95% saturation for a patient with low glucose. And, yet did you withhold O2 anyway against this guidance? And let me ask the expert, is it possible that withholding needed O2 could result in death?" Still, I want to train and get certified. Now, if I can just find an EMT class that's open in my area this summer during COVID lockdown...
  14. This is a dead topic, the original poster never came back and gave us more info. Cell phones on a call are a NO NO. Don't even pull em out unless they are provided by your service. Here are my reasons and I only have a couple 1. They make you look stupid - like you cannot even stay off your phone for the length of a EMS Call. 2. Your EMS Agency should be providing equipment for you to communicate to the hospitals and other agencies, NOT you. Your phone is your property not your companies - unless they want to pay part of your cell phone bill. 3. If you are on any type of crime scene call or call that could be a law enforcement issue call and you pull out your phone - the officers on scene can suspect that you are taking pictures and confiscate your phone to pull evidence even if you are NOT taking photos. The minute they do that you have effectively lost your phone until they determine it has no evidence. 4. it's just bad form to use your phone on a call unless it's for work and the public doesn't have a clue and will think you are making personal phone calls and not concentrating on the patient. JUST DON'T DO IT.
  15. So this scenario just reeks of a national registry scenario from years gone by that hasn't kept up with the times. Evidence based practice dictates that patients with Oxygen saturation of 95% and no significant LOC changes do not require supplemental oxygen therapy but the scenario says the passing criteria is applicaiton of oxygen and in the competency they even suggest Non-rebreather. You are on the right track by not wanting to put oxygen on this guy but again like any other education that we go through these days, we are taught to the test not taught to think independently. So your state examples are still being taught to the National Registry test which is honestly a dinosaur but we all have or have had to take it so until some group gets a backbone and says "NO MORE TO COOKIE CUTTER TEST SCENARIOS" we will still have emt's and medic test takers giving oxygen to patients with O2 sats of 100%. Until you pass the test, my best advice would be to study and practice to the test scenario papers you have and not try to use that beautiful 6 pound piece of gel in your head called your brain, you might just fail if you use your brain. Good luck
  16. My old service upgraded to HP. They were bigger and supposed to be tougher. Yeah. We broke one.
  17. This sounds like a question that needs to be directed to your medical director. As an instructor/preceptor, we taught that if the patient's Spo2 was 94% or greater, you don't really need to apply O2, unless they are having increased difficulty in breathing. Then, you could to supplement and stave off hypoxia. However, based in the scenario you provided, not enough information noted. Remember this though: treat the patient, not the equipment unless you're an equipment technician. But like I stated in the beginning, this sounds like a question for your medical director.
  18. A service I used to work for put phones on the trucks to be able to do much of what you're talking about but not strapped to your forearm. You could carry it in (which I didn't), use it to take pictures of an MVC to send to trauma team (again, I never did), and send up reports while enroute to the ED (which I did do). I think that if you're thinking of using a phone for communication while on scene, that's inappropriate. Especially is in contact with family. I tend to think that sort of activity should be done away for others not connected with the family. These phones could be a good thing for EMS because they can help to record situations or conditions that contribute to the situation, such as ice, snow, etc. You can use them to transmit ECG's and other information to the ED. But in the event of a acute situation where your entire focus needs to be in the patient, drop the damn phone. You have the radio. Use it. We have become so reliant on our telephones and the computers we work with that if your systems dropped for whatever reason, I wonder how many of us could actually write a written report. I could, but I doubt anyone could read it. Trust me. Twenty one years in the Army and seventeen years in health care have destroyed my penmanship!! Before I left, I went back to using the radio to give report because it gave me the connection with the people I was going to hand my patient off to. Oooooor, I could be way off base. Just saying.....
  19. I'm detailed to the ICU right now. When we are in direct contact with patients, minimum of surgical mask. Unless a COVID patient, then the full PPE with PAPR's. Our medics on the units must wear N95's with ALL patient's. ER policy.
  20. It would be nice to get hazard pay, but many services, especially those that are tax based, would lose money and have to cut services. Corporate services could afford it, but would prefer not to pay it and would cut hours first. But, in answer to your question, it truly depends on where the heck you're working. NYC EMS, Chicago, LA, St Louis and other hard hit cities deserve it. Pay them!! Washing your hands would help curb the spread but so does the social distancing and the stay at home orders (which many in my town seem to think does not apply to them!). When I started EMS in 2003, I understood what I was getting myself into. I was raised in a medical family. Mom and Grandma washed their hands incessantly and so did I until I joined the Army. Hard to wash your hands all the time. And hand sanitizer does not travel well in a rucksack. Just saying. As I progressed in this profession, I understood how much could be spread by your hands and that keeping them clean was important. It's a point I stressed to my students when I was precepting them. I made sure they all understood that an epidemic (or pandemic) could easily start. Wash your hands after every patient.
  21. Hello folks! Stay safe!

  22. Hey folks! This is Don. Jess apparently had a brain aneurysm from the past surgeries she had from the complications of our son's birth. Her and I was not together and I have been through my own issues. Last time I saw her and our son was 2011. She passed 3 days after her 31st birthday. I remember on her 2nd surgery the surgeon told her she would not live past 30...…. Anybody want to talk please IM me here or catch me on twitter. https://twitter.com/DonaldJr1977 Thank you all and May God Bless You!
  23. Do you know of anyone that has quit EMS due to COVID-19? Did they give a reason?
  24. Hi @yakc130, Interesting point. I am not sure if new EMTs really understand what they are getting into. With most courses under 200 hours only a small fraction is spend on infectious diseases with emphasis on washing your hands. Could this be another reason why EMS should have a degree requirement so there is a greater understanding of what can happen?
  25. MD2EMS

    MDtoEMS

    Good morning all, I graduated from medical school and entered general surgery residency. Long story short, I became more and more burnt out to the point that I left residency. I saw surgeons spending less and less time with patients (and their own families) and more and more time with administrative BS. anyway, great field but wasn’t for me. I’ve been on a strange path since and currently teaching anatomy and physiology for a nursing program. I miss the thrill of caring for sick and critical patients and am considering becoming an EMT or paramedic. This idea is brand new and I’d love to hear if anyone makes this type of transition. Can I test out of any aspects of certification? Has anyone been in my position? How do you all find the lifestyle and work/life balance? Thanks in advance!
  26. San Mateo seemed to have a comparatively more advanced and exciting system than CoCo or Sonoma, for AMR. And, of course, no system is perfect, it's always a work in progress. But I get excited to hear about systems interested in progress, rather than profits. That's interesting that you wound up out here the way you did. Most tend to deal with what the area has to offer or drive mad commutes. I'm no different. I came out to do an internship at Prevention Point Pittsburgh to finish a bachelor in public health and was just really impressed by all Pittsburgh had to offer, in term of how livable it is and how awesome the harm reduction and healthcare people I met were.
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