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There's a fair amount of back-and-forth recently about the status of supplementary oxygen for a few high-profile conditions, such as stroke and cardiac arrest. It'll be nice to see how that eventually cashes out, but my personal interest is in the less-discussed fronts. A lot of prehospital providers -- particularly the poor BLS buggers who can't do much else -- tend to use O2 as a panacea, on the somewhat religious assumption that it'll help with almost any ailment. But when will it actually help? I'm curious in two things -- 1. For a given condition, in your PERSONAL EXPERIENCE, have you witnessed either ALLEVIATION OF SYMPTOMS or IMPROVED OUTCOMES following the administration of oxygen? This is obviously just anecdotal, but it's the best we're going to do in many cases. 2. For a given condition, have you seen any rigorous research that supports or denies either of the above? I'm interested in this to better inform us all about the true indications for supplementary oxygen. It probably goes without saying that someone with dyspnea and trouble oxygenating will improve with high-concentration O2, but it is far from obvious whether the guy with the broken leg will hurt any less, the guy with appendicitis will live any longer, or the woman with nausea/vomiting will feel any better. "Throw on a cannula" may not be all that harmful but we'd probably all rather avoid unnecessary treatment when possible. So -- any thoughts? I'm interested in everything from AAA to Zebras. I will say for my own small contribution that I've had mixed results giving patients with anxiety and similar psych states low-flow O2 by cannula; sometimes seems to help, sometimes not at all.

http://www.msnbc.msn.com/id/34104180/ns/world_news-weird_news/ MELBOURNE, Australia - An Australian man was in stable condition Monday after being slashed across the abdomen and face by a kangaroo that was holding his dog underwater. Chris Rickard, 49, said he was walking his blue heeler, Rocky, on Sunday morning when they surprised a sleeping kangaroo in Arthur's Creek northeast of Melbourne. The dog chased the animal into a pond but it then turned and pinned the pet underwater. When Rickard tried to pull his dog free, the kangaroo turned on him, attacking with its hind legs and tearing a deep gash into his abdomen and across his face. "I thought I might take a hit or two dragging the dog out from under his grip, but I didn't expect him to actually attack me," Rickard told The Herald Sun newspaper. "It was a shock at the start because it was a kangaroo, about 5 feet high, they don't go around killing people." Kangaroos rarely attack humans but will fight if they feel threatened. Dogs often chase kangaroos, which have been known to lead the pets into water and then pin them underwater as a means of defense. Rickard said he ended the attack by elbowing the kangaroo in the throat, adding Rocky was "half-drowned" when he pulled him from the water.

You're an idiot. Such a broad statement is quite inappropriate and reflects poorly upon you as a provider. If the patient is stable and tolerating the rhythm quite well then why give drugs (atropine/adrenaline or adenosine/amiodarone) at all? Why do ambos have to think because they have a lot of kit in thier bag they have to use it? I agree with you there mate; best plan of action is to treat the underlying problem vs the symptom of a dysrhythmia. In this case a little nebulised salbutamol and a quick trip to the hospital is in order!

To reinforce that a little, I'm sympathetic to the cries of "better education" and "better training," but until those changes run through the system, folks like me are left to learn on their own. So while I think it's great to complain that Basics et al. should already know this stuff, I'd much rather that you just explained as much of it as possible. I don't want to get in the way of whatever other discussions you guys want to have, but if you really believe in creating more educated providers, well -- we're reading, and that's why we're asking questions.

Once again the idea of "we eat our young" has been scattered across these boards... Pfft... Are you even comprehending what you guys are typing or just spewing the same old crap you have been fed over the last few years by our closed-minded veterans here in Ab (no offence tniuqs). So to summarize: New EMT's (not paramedics??) Should spend time in the rural ambulance services as some sort of "right of passage" into the city services??? Where the heck did this come from? How bout we take a look at my current service. We have a small hospital with 1 on-call GP. We have 2 nurses staffing our ER that see a true emergency maybe 5 times a year. We have NO ALS backup. We have NO BLS backup. We have a volly Fire service that may or may not respond. We are 3.5hrs away from the City hospital. We have NO helecopter.... fixed wing is about 1.5hrs out. So, by your guys ideals, THIS is the place for Newbie EMT's?? Why not Calgary again? Because you are within 10min of a major hospital, have an entire Fire Dept available, as much ALS backup as you could ask for, and you need how much experience before you "deserve" to enter this system? Is that idea based on call volume? Why the hell would I get a green EMT fresh out of school,and it is just me and the newbie, when RedDeer responds with up to 6 Paramedics at a "Delta" level call?? I cannot wait for this old "pay your dues" mentality is deleted from our profession.

However, we are still discussing the question about who benefits from oxygen therapy? I think we can say, yes some patients will benefit from supplemental oxygen. However, how much they benefit from the said therapy may be a better concept to discuss. Going back to an anemic patient; There is little doubt that increasing the partial pressure of oxygen will in fact increase the content of arterial oxygen in these patients (assuming no diffusion or oxygen movement problems exist). However, as pointed out earlier the actual impact on content of arterial oxygen is rather small. In addition, we must also appreciate the difference between hypoxemia and hypoxia. There exist very important considerations and implications associated with these two concepts. Take care, chbare.

Ahh Siff, I thought you would never ask..... Judith, these are my personal opinions only, and remember, you get what you pay for.... I work for both a rural service and a city service; I am also an instructor and have supervised EMT practicum placements, and have followed the careers of a number of my students.... and I see a number of fresh EMTs straight out of school who have been hired as casuals for the city service I work for... I see a number of areas where these newbies need a lot of work... (1) on a tough call, they find it far too easy to hand the call completely over to the medic, and not do any thinking or assessing on their own. (2) they find it easy to be "the driver" and not take any responsibilty for how the call went, other than getting the medic to scene, and getting the medic and patient to the hospital (3) they haven't developed patient communication skills - their only patient experience was on their EMT practicum, which really does not give them a well rounded exposure to patients - they don't know how to talk to elderly patients to keep them calm, or an agitated patient to get the information they need. (4) working for an ALS service, they do not spend enough time developing their basic skills (basic assessment, vital signs, history taking) (5) overall, they get used to the security blanket of having ALS always available, and unless they are actively moving towards being a medic, they end up backsliding on the skills they do have. Now... on to rural services. Of course there are drawbacks here.. you may be working with volunteers, who may or may not have their skills up to date either. Yes, it may be inconvenient for you, as you may have to commute, but, on the other hand, some services do provide housing for those staff who come in from out of town, for no cost or a very small cost. You may not get a high call volume. You may be working a BLS service, where ALS may be more than an hour away. However, there are positives to this as well. You will get to attend often, if not most of the time, which will improve your skills, and your confidence. Having to deal with patients for more than 10 minutes will allow you to see if your interventions work or don't work, and force you to review your assessment and interventions to see what you could be doing to better help your patient. It forces you to be a thinker, and not use ALS as your security blanket. Many times, doctors in smaller centres are very happy to answer any questions you may have, and allow you to assist in procedures that you wouldn't have the opportunity to assist with in a larger centre. You will get the opportunity to follow up on patients more, and see long term effects. A word of warning... do not be the EMT who thinks that just because you have that tiny piece of paper that ACP sent you (for all the money you spent, that little card isn't even laminated) you should be able to walk into the job of your dreams instantly. It rarely happens. If you show that you are willing to work, and willing to learn, and are willing to make some sacrifices for your career, doors will open. Some of my students worked 2 and 3 casual positions at a time, at various rural centres, to get the skills and experience they needed before they moved on to larger centres. Some of my students went to larger centres right away, and given the two, I would hire the first ones in a heartbeat, and not the second, as I know the first ones have a wider range of experience and knowledge. The students who show the commitment to getting the experience and working on their skills will do better in the long run. Judith, I am not trying to scare you... I am trying to get you to look at a bigger picture, and the possibility that short term pain (I get the feeling you don't want to be anywhere but Calgary) may lead you to long term gain. Again, best wishes in your endeavors.

Damn you all!!!! You medics just had to keep watching this turd bucket of a show to see how bad it could actually get AND NOW WE CAN`T GET RID OF IT!!!!! Well done.

Ultimately you are going to base your treatment on the clinical picture of the patient, however, you better get all the information needed to make that decision on which treatment modality/pathway you are deciding on. It comes down to fully understanding the pathophysiology of what is going on with the patient. Although fictional, there are many variables that need to be thought of prior to just slamming or bamming (meds/shock). If this was a true situation, your knowledge and experience would hopefully promote a fast clinical decision to the proper treatment regime. One must remember that not all thought out processes will work, and you must always be prepared for the possible unwanted outcome. This could have many factors involved, but my opinion would be in in line with chbare, if the patient was previously in PEA, we need to consider all the H/T's, and could be electrolyte problem. Good scenario.

I have nothing but the utmost respect for the men and women of our armed forces BUT I have nothing but the most intense hatred of Creed, which kind of ruins it for me

I must admit, I'm disappointed. I was accepted as a medical volunteer at the 2010 Olympics. My post is located at the Whistler Sliding Centre. I was quite excited to be a part of the Olympic experience because I will likely never have the opportunity to take part in it again. At the moment, I am drafting my letter to VANOC to withdraw my status as an Olympic volunteer. I doubt that one volunteer from one venue will be all that significant, but I will pass my resignation on to my counterparts and perhaps something will get started.

Why?, go to medic school as soon as you can Freeman.

http://www.nyhealth.gov/nysdoh/ems/certification/reciprocity.htm Click on the information packet for NYS EMT reciprocity. You'll be much better off completing your medic program in NYC or NJ. Ride alongs are on double medic units, who only get ALS call types, a large number of them. Compare this to other areas in the country where the ALS units run everything. Time spent on medic unit ride alongs need not be wasted on calls that aren't challenging your newly learned knowledge and capabilities. Outside of NY/NJ these units only get true ALS calls that are few and far between. Instead, you'll be running a bunch of minor injuries, psych pts, sick calls (may be something more, but not likely - always do a full assessment), drunks and such. Not that these pts aren't important, but you ought to have more of a challenge during medic ride alongs. In NY/NJ a typical 8-12 hour rotation will produce a cardiac arrest or two, a CHF pt, critical asthmatic, maybe an MI or two, unconscious/apneic junkie, multi-trauma, etc. You'll have at least 2-3 good jobs per rotation, maybe more. No exaggeration. Just pull rotations in the rougher parts of B'klyn, uptown in the city, most of the Bronx. The learning curve will go through the roof. Many of these medics aren't degree medics, however. You decide if they're good at what they do or not.

Nothing wrong with the R-22, aside from it being a 2 seater and would offer no where to a patient. Their power plant is also pretty efficient. Being that it is a piston engine, it has power more readily available. Of course, turbines have more power overall, there is nothing wrong with the R-22.