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Showing content with the highest reputation on 10/21/2009 in all areas

  1. I can't believe you still have the "be all and end all" instructors in these days. Would you really be thrown off the class for correcting the mistake? I mean seriously, being an instructor I welcome comments and criticism. As a student paying for the course (?) you have the right to getting the (correct) information that you are paying for.
    2 points
  2. Hey man, That is an easy one, Just send me her email, and I will be happy to educate her for you. Sorry, you have to go through this my friend.... Let me know, JW
    2 points
  3. WOW. First, I cannot believe that this instructor is so ignorant to the fact your research into the definitions is wrong. Any instructor that's worth their salt should percieve this as 'feedback'. Question that I have, is the National Registry still going to test this level or drop it before your class is completed? Who knows, as this process has been ongoing for some time now. The main thing that the instructor should be following in the standard curriculum and teaching from that, using the book as a supplement. You, confronting the instructor with supporting evidence should taken as a
    2 points
  4. I wanted to discuss a topic that I am kind of struggling with. Whether sedating a patient to intubate them, or maintaining sedation during a transfer/procedure, the standard round these parts is Fentanyl/Versed. For simplicity I would like to keep the discussion within the limits of a average weight, normotensive, adult patient with no previous medical Hx, that needs sedated deep enough to maintain intubation for whatever reason. So, like I said, most of my education/experience is about 5.0mg Midazolam, Start at (varies) 3mcg/kg Fentanyl then paralytics if needed, or more fentanyl in t
    1 point
  5. EMS workers routinely treat patients that carry infections. There is no way of predicting what germs you may encounter when treating a patient or what illness they will have. What precautions are you taking to protect yourself from the unknowns of your everyday job?
    1 point
  6. Let me give a description of the events then I ask you for your thoughts. I received the call via our Control room asking me to do the inter-hospital transfer of a 2month old, premature (born 2months prem) baby from. We could not get more details as this child was laying at one of the local government hospitals. So off we go, ready to transfer this child to one of the private hospitals. The only thing we know for sure is that the father of the child wants us to transfer him. The current treating doctor sees no reason for the transfer. Normally we will not oblige something like this as it's
    1 point
  7. With all the bashing of the new show Trauma, who remembers in 2006 when TNT came out with a short lived TV shock called Saved starring Tom Everett Scott and Elizabeth Reaser. The show focused on a medical school drop out, paramedic with tons of issues and baggage. In the first episode he is having sex in the back of the rig with his ex who is a resident in the Emergency Department. Now fast forward 3 years and NBC gives us about the same thing with a bigger budget. Some of the medicine in Saved was spot on, some was way out in left field. Trauma has it's problems but we need to remember that t
    1 point
  8. Sounds like instead of Bachelor of Science, it's Bu** Sh** in paramedicine for her. Follow the leads of my and the other posters. You want the best, and it sounds like you are not being provided what you request. Work the chain, but get it done soon or this will fester like a zit on her arse. Make sure that this is not a personality issue, but just the instructional issue you are dealing with. Tread, but don't stomp until the facts are evident. Take care and good luck with the rest of your class.
    1 point
  9. Apparently you still need some more of your legal pain killing stuff (BTW, what labels do you get there?), you're still sharp as ever. I will most certainly be watching this topic.
    1 point
  10. Is the War on Drugs the only War (Police Action) the they believed they could win & well didnt?
    1 point
  11. No problem guys, we will talk about individual concepts, then hopefully put it together into a cohesive format. So Far we know: 1000 mEq = 1 Eq, 1 Eq = Mole/charge, Mole = Avagadro's number or 6.02 * 10 ^23 atoms/molecules Further explanation: 6.02 * 10^23 is what we call scientific notation. When numbers are too small or large for conventional context or understanding, we put them into this format. We essentially make a smaller decimal number and use a factor of 10 to describe how many times we multiply that decimal or whole number by ten to reach the actual number. For example
    1 point
  12. LMAO...Thanks :-) Seriously though, I would be more than happy to send her an email, keeping your name completely anonymous of course, and providing her with correct FACTUAL documentation to support both your premise, and to show her conclusions are erroneous. Just send me a PM... Respectfully, JW
    1 point
  13. Question.....What sort of credentials does this instructor have? What current EMS level are they at? How long have they been teaching this course? Have they ever been a provider at the level you are being taught? Are they a moron or not????? (Oh, I guess we might already know this one)
    1 point
  14. It's in your right as a student to want the correct information. Going about getting the right information that is being presented to you incorrectly should be taken up with the EMS Education Board (the people who gave her the certification/rights to instruct these classes). I would also bring it up to the course adviser, program director and even the dean. This is your education, for treating patients who need your help and may be dying without your help. Having the right information in your head is paramount. Just be more tactful about it. If you DO go and make a big stink about it,
    1 point
  15. True, I did entitle it that way and I did ask for your thoughts. I simply disagree with the postings on deciding when to give the child the benefit of the doubt because of quality of life. We all know babies (especially girls) have more fight in them than adults hence the decision to "terminate" would be easier on adults than infants. My question would be, who teaches you to decide on what acceptable quality of life and what not? There's no universal accepted standard for quality of life? Is it based on your specific area where you live and make a living? The one thing this thread did emph
    1 point
  16. Additionally, I would like to emphasize that yes etomidate is well known to cause transient adrenal suppression after one dose. However, I am unaware of any evidence that definitively says etomidate leads to poor outcomes in patients where this may be a problem. There are studies and allot of talk; however, the fact remains that etomidate is still a viable agent. While some providers has started to stress dose people with steroids, I am unsure if this practice actually improves outcomes. The thought that steroids lead to up regulation to adrenergic receptors in septic patients appears to b
    1 point
  17. While I take all views into consideration and understand the views of everyone here. I do not agree with some of the postings related to this case. The sad reality here is that the government hospitals are severely under resourced as is the government / city run ambulances. Small things such as c-collars, vacuum mattresses, even transport incubators are non existent. If at all possible, I would have taken photo's or a video or something to show you that state of this and other government run hospitals in Africa. I am by no means trying to make excuses for what I have done (whether it be right
    1 point
  18. I love this way of thinking ^..... It never even crossed my mind. Anyone else have any imput on this quote? Did not really think of that either. Ya, one infusion rate may be adequate for a certain hwy, but turn onto the secondary road and the stimulus of a rough ride may be enough to arouse them.... (not that kind of arouse).
    1 point
  19. Saved was a decent summer cable drama, and "trauma" is on the up as a primetime drama. Also, thanks to whoever is turning my reputation points back positive.
    1 point
  20. I suspect you did not read Seb Wongs reply and the advisor Paramedic quit the show and because of the inaccuracies. Must disagree the general public believes what they see on TV is the truth, time for true professionals to stand up and call crap when they see it.
    1 point
  21. Dixie McCall, RN, was never in conversations indicating either if, or who, she was sleeping with, on staff at Ramparts General, or at LACoFD Station 51. "Nancy" on the other hand, doesn't even seem to be upset that her colleagues are making cash bets as to when she'll sleep with the newbie EMT. I emphasize, WHEN, not IF! "Chet" was intended as a part time comic relief, and when called on, always came through in a good "Fire Fighter assisting Paramedics" way. I have not yet decided if he has a counterpart on "Trauma". Chet's only brush with pushing his own fame came when he attempted to phot
    1 point
  22. I treat the patients based on whats going on (s/s's). We have numerous choices so I can choose based on time to definitive care which may not be my hospital, type of injury, illness, etc. I use versed or other for sedation in combination with one of the choices of paralytics, based on patient event, HX, etc. What types of patients? Race plays no part. Their past medical HX does play a part and while I know certain illnesses happen more in certain races I never presume that just because they are a race they have that problem as it could cause me to miss the actual problem. As to dr
    1 point
  23. I rather liked Saved. It died after one season... or a half season.
    1 point
  24. So true. If nothing else, this incident is something to mention to others in all our respective agencies, as something to be attentive to, even if there is no official policy yet. Simple as telling 2 friends, who tell 2 friends, who tell 2 friends, etc. It's a first step, if nothing else.
    1 point
  25. Firstly wherever possible we reverse in so we drive out. This is so there is an extra set of eyes on reversing. We also have reversing cameras in vehicles. Secondly this means that when we get into the drivers seat (remember we drive different vehicles to you, ours are a forward control mercedes van) I can see to the bumper of the van. I also would have noted any people around & made allowances accordingly. No, I am not perfect, but to hide behind 'apparantly was no policy to do such a thing for that service' is a cop out. Do we only do things because there is a policy? If there w
    1 point
  26. Ruff, i respect you & your opinion, however, in this case it is all about vision. What if it was a child sitting there playing? Kids are always in a place they shouldnt have been. The fact this was an adult lying down is not relevant. The relevance is their inability to see that there is a potential risk, expecting that the siren would clear the way & driving off. All for the sake of how many seconds????????? The reality is ALL EMS is risk vs benefit. Doesnt matter if it is drug therapies, high speed driving or leaving the station. They demonstrated a complete lack of understa
    1 point
  27. Ruff, I do not suffer fools well. Their actions show the need for self control & the ability to think, even when the adrenaline is flowing. They have proven they do not have this capability. If they cannot demonstrate it in the most fundamental part of EMS, driving, then how are they with the administration of drug, the prudent use of lights & sirens. This is a poor display of what is needed in emergency services, not just EMS. This profession, yes profession, does not & never will need people like this who are too lazy to check what they should. The reliance on the siren
    1 point
  28. Well said Dust. Thy need to be made an exaple of, stupidity cannot be countered, this was negligent stupidity. Lets get them out of EMS, revoke their licences as well. If they havent got enough brains to operate a vehicle in the safety of themselves & the general community, why the hell should they be trusted to assist the sick & infirmed???????????
    1 point
  29. Hey guys, I also want to emphasize SA is talking about care in an environment so far removed from what we know in the United States, that making a comparison is nearly impossible. If you have never experienced the horrors of some of these places, you really cannot adequately appreciate the profound differences. Therefore, I am not sure I would go so far as to call the doctor in question incompetent as much as simply not having access to resources? Then again, the patient was placed on CPAP, so the hospital in question had access to this resource. I tend to agree with Vent that the progno
    1 point
  30. I have no idea what the doctor told the parents. I arrived at the hospital finding the mother who does not speak, read or write any language myself or my crew understands. In South Africa we have excellent facilities to manage this type of case, sadly in Namibia there's none. I'm awaiting the phone call to tell me to fly this child the 4 hours required to South Africa, which I will most probably refuse to do.
    1 point
  31. Apologies for the delay in my reply, Monday's at the office is at best a day to have rather stayed in bed. Also apologies for not giving more information on this case, I was slightly more than a little pissed at the initial medical treatment and facility. Starting at the beginning (and I wish I could show you this medical facility and it's staff). The only information we had at the time of dispatch was that the child (male) was born 2 months prem and is now 2 months old. The parents were unhappy with the current treatment being given at the Government facility and wished to have the child
    1 point
  32. Actually, you pointed out what I missed. If there was no immediate follow up CXR after intubation at the original hospital, there is little to say but the intubation could have caused the lung collapse. Not knowing the full extent of the baby's medical history and anomalies, this intubation may only prolong the inevitable and/or the baby may have to be trached and pegged. That is not always a good thing especially in remote areas that lack in home care. Quite possibily without knowing the intent of the original hospital/doctor and if they were just waiting for the family to come to g
    1 point
  33. I am going to give SA the benefit of the doubt here. Knowing what I know about some of the government run facilities in South Africa. Take care, chbare.
    1 point
  34. It would depend on the type of PNA as to whether antibiotics would be warranted. When you say collapsed lung, do you mean atelectasis or a pneumothorax? Did you point out absent breath sounds on the collapsed side or what this already know and they were using CPAP to re-exapand the lung? Did you note the PMI which should have been done as part of your assessment? Did you transport the baby on CPAP? If so, what machine did you use? Is it possible that if the collapse was a pneumothorax, could you have caused it in transti? Heart sounds? Did the baby still have a PDA and was yo
    1 point
  35. Government hospitals are completely government owned, run and funded. These hospitals in most cases would be on of those places where I would grab my IV stand and ride it to a PVT facility. Mostly due to slack staff and shortage of equipment. Private hospitals as exactly that. Privately owned and funded by the medical insurance of those that get admitted. The doctor's here are mostly GPs and Specialists (who coincidently does hours at the Govt Hosp) with the nursing staff being old Govt employees wanting a cleaner facility to work in as well as higher salaries. Although, not always the sha
    1 point
  36. I have used the following medications for prehospital sedation: 1. Valium + Morphine (Patient Assisted Intubation), 2. Valium + Nubain, 3. Versed + Morphine, 4. Versed alone.
    1 point
  37. Remote Controlled doors are not the issue. The issue is these guys were just too excited to get a job. Common sense says that you should look at what is happening around you, If they cant see the sidewalk, then what else do they miss on the road? Problem is that you can teach common sense. No matter what you do, they will find a way to get themselves into a position of stupidity (they are firemen after all). The only way to ensure this doesnt happen is proper screening prior to employment, for EMS & Fire. Yes employment, take the whacker out of it & that will resolve pa
    1 point
  38. Actually, it is the other way around in my area of the world. We almost exclusively utilize etomidate for pre-hospital RSI. My choice of diazepam & fentanyl is personal and rather anecdotal. First, I have had sudden hemodynamic changes with conservative doses of midazolam. This is not something a person with a head injury, altered hemodynamic status, or altered cardiac status likes very much. Unfortunately, these three patient compose many of my RSI's. Not that I actually perform RSI that frequently. Therefore, I typically use diazepam and liberal doses of fentanyl. Most of my k
    1 point
  39. Something to ponder within this topic - it's a good read and really breaks down the pain med options and their durations, actions, etc (thanks Dr. Bledsoe) http://www.bryanbledsoe.com/data/pdf/mags/Analgesia.pdf
    1 point
  40. Ditto to the above responses. I too have administered analgesics upon arriving at the ER and have also given them while waiting for a bed while extended at the ER. Most local facilities around here do not complain as they are aware their personal perceptual opinions are irrelevant to our treatment and that we will stand behind our argument that any competent physician can appropriately assess a patient with analgesia on board. Most of the decent agencies around Houston have very liberal (i.e. unlimited) pain protocols. My current guidelines allow for analgesia prn for as long as the patient
    1 point
  41. Etomidate is commonly used in the ER's here, but is not currently on the trucks. It seems that they are not wanting to make additions to the current approved medication list (though if your medical director applies for a waiver for your service you can get additional medications added along with certain procedures). I am aware though several surrounding states have Etomidate within their protocols with Sux and it seems they prefer Versed/Fentanyl with Roc. Using Vec as a paralytic and Ketamine as a sedative are not common within this area. Analgesia again is a pertinent factor as having a
    1 point
  42. Or we could look at agents that are much better for the task of RSI induction agents. Currently, no better agent than etomidate exists. It acts very quickly (one arm brain cycle essentially), has a predictable duration (100 seconds for every 0.1 mg/kg dose), and it has no effect on hemodynamics. The next best would be ketamine IMHO. We must remember that sedatives such as Diprivan and diazepam do not provide analgesia. Sedation and analgesia are different topics. So, I typically use etomidate, then follow up with diazepam and fentanyl. Take care, chbare.
    1 point
  43. try doing divided doses. Yes it takes a bit longer, but giving like 4 at a time and seeing how he responds may have helped. I've seen some patients be able to adjust with smaller divided doses given than with a large bolus and you still get the effect of sedation. You certainly don't want to have a patient tank out because of a large bolus and then have to work to get it back up. Just something to consider Mobey.
    1 point
  44. As far as versed's utilization for RSI I've actually had pretty decent luck with it. It is really patient dependent as you said and obviously if they have any type of benzo tolerance they are going to require higher doses. I have found though in combo with fentanyl that you do well with the sedation. I don't even go with paralytics until I am certain the patient is adequately sedated. I certainly don't want them remembering anything. Everything has to be titrated as you said taking into account their hemodynamic status and adequate maintenance of it. Point well taken though CH - sadly we call
    1 point
  45. We use Ketamine for the intitial sedation of pedi's and bronchspasm patients. 1-2mg/kg IVP. Otherwise its Etomidate 0.3mg/kg and Fentanyl 1-5mcg/kg. Induction is with Sux, Roc, or Vec, Roc being my personal preference. If the transport is greater than 30ish minutes, then I'll start an infusion of either the NMBA or the benzo depending on the patient. If we pick them up on Propofol, then we'll keep them on it blood pressure permitting. Flexibility and individuality is the key.
    1 point
  46. IFT sedation is something the RN or MD would be in control of; our ALS are not used like that for transfers. As far as sedation and analgesia we have ketamine and midazolam. Midazolam was orginally used alone for RSI when we first got it in 2005 at a dose of up to 5mg but we now use ketamine and midazolam combination. Our starting dose of ketamine for analgesia is 20mg (if no morphine has been given) so I would immagine the dose of ketamine for RSI is quite larger but it's not in our guidelines because it is a specialised procedure only taught to select Advanced Paramedics so I do
    1 point
  47. That is actually a very small dose for the purpose of RSI. You may skate by with a minimum of 0.1 mg/kg. However, this will still be ~7mg in the "average" adult. With that, the slow onset and hemodynamic implications of midazolam do not make it a very good candidate for RSI. Take care, chbare.
    1 point
  48. As far as intubation, if you are going to administer paralytics, you must administer sedation along with it. That is without question. Having said that standard "induction" doses to sedate a patient is betwee 4-6 mg versed though I have seen some patients require a bit more and 100mcg fentanyl. Etomidate is also an option with typical dosing being around 20mg (however remember etomidate does not have analgesic qualities). This typically will do well, however you should titrate doses to patient's respone and vital signs. For maintenance infusion of versed which is preferable in the transpo
    1 point
  49. Unfortunately, an initial dose of 5 mg of midazolam for a 70 kg patient is rather suboptimal. A typical recommended dose for midazolam induction is 0.3 mg/kg. How many people do you see giving 21 mg of midazolam IVP? Therefore, many patients are being under-medicated. In addition, 21 mg can effect hemodynamics in the most "stable" patient. Of course, if we are looking at RSI, how "stable" is our patient? One area we often overlook is good ventilator management. We frequently run for the drugs when out patient even twitches. However, we need to ensure we are meeting our patients needs
    1 point
  50. You see, they dont have intelligence tests to be a smokey, just the ability to watch reruns of rescue me.
    1 point
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