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Posts posted by crazycanuck

  1. If you have a stereo speaker in the truck that has a magnet in it ... but you never heard that from me, no, never, ever .




    If I was getting zapped repeatedly I would not give a crap if you told me I had to ride roof rack because there was a magnet up there. :lol: Then again that's just me.....some people are SO picky.

  2. I do agree with 'zilla in that these magnets probably are used very infrequently in EMS. However, there has been a small increase in the incidence of lead fracture in these devices with a recent recall and discontinuation of the Medtronic Sprint Fidelis lead (the most common ICD lead used).

    Pretty sure a patient would really appreciate someone carrying a magnet vs. them having to 'hurry up and get to the hospital' while they're being zapped! :shock:

    Everyone does programming and setting somewhat different. The device I have is set to pace asynchronously at 85bpm while magnet is in place and then goes back to active V monitor mode once the magnet is removed. I also happen to have one of these recalled leads, which most patients have overinterpreted and been pretty pissed about when in fact the incidence is only about 2% higher of lead fracture and they were pulled preventatively to prevent an upward trend in these stats.

    This also works to inhibit a runaway pacemaker or to determine if a tachy may be pacemaker mediated, though this is probably not really of much use pre-hospital.

    A donut magnet is not required as any magnet of medium strength (i.e. bigger than a fridge magnet) will usually trigger the pacing and inhibit the V sensing. Most devices also emit a continuous beep while the magnet is in place.

    Also, many centers will not readily have a pacer rep in close proximity so while larger centers can call the company and have someone come right away, the poor sucker living in the boonies is SOL.

    Just my 0.02....and really, how much room does a magnet take up?

  3. It's likely her weekly injection is a TNF-alpha med...Humira is one of a few. There are a few other tx approved for severe (usually rheumatoid) arthritis.

    There are some good suggestions posted and sounds like if she's seeing a personal trainer that's a good start in keeping in motion. What about some pain management with physical therapy such as TENS, heat pads, hot tub etc.?

    I wish your friend well!

  4. Though I do not in any way agree with this patient going to the grocery store in hospital attire with an IV and pole, I think there are some other important points to think about here rather than the obvious concerns and media attention to this.

    1) Many people in that grocery store probably pose more infectious and health risk than this lady does and we have no way of knowing it.

    2) What makes this such a problem for people? That she visibly has an 'illness'? That she could be carrying germs?

    3) People go out all kinds of places on home IV therapy for who knows what. Yes, this is a different situation but we have no idea what infectious risk people pose in public places.

    4) As mentioned in the article: many people who work in the health care field wear scrubs out and about before or after medical procedures and this has become so commonplace many of us don't even think twice about it.

    The point is, ok so this wasn't the greatest move for this lady, but big deal....I think there are bigger fish to fry as far as infection concerns in the public. Plus with the UK wait times as here in Canada, the lady probably hadn't eaten in quite some time. I'd damn well go shopping too!

    Hope she got me some food too :D


  5. CMK the "milk of amnesia" is usually Propofol :D

    I have been sedated with various combos including versed, fentanyl, propofol, and brevital and have said a lot of great things along the way no doubt....

    I once after a fairly awake heart procedure looked up at my murse and told him I felt like I had beer goggles on, then proceeded to profess my love :oops:

    Fentanyl makes my nose itch and I would compulsively repeat "Oh my God- HELP! My nose is falling off!!!!"

    And to top it off, not particularly funny but had a laugh with the surgeon after, I was not near sedated enough and while he was cutting I said "OUCH #$%* that hurts, whatever the hell you're doing stop it right now"....freaked him out a bit I guess! :D

    Anything else I may have said under the influence oh well, I know that I have had entire conversations while still semi sedated that I was informed of later, and did not remember a word of what I said ....so anything is possible!

  6. I can only speak for my own opinion here. While others may tell you that it is easier to shut your mouth and turn a blind eye, I do indeed believe this person should be turned in. First of all, most academic facilities have a specific statement on plagirism and academic misconduct.

    Most of these will explicitly tell you that it is your duty to report this type of behavior. Even if you decide not to single this person out for whatever reason, ask your instructor to make a no cell phone policy during tests. This should be standard already that they must be turned off and stowed for tests.

    Good luck.

  7. Well from the perspective of being a consumer of health care in both Canada and the US, I have seen both sides of the tarnished coin. All of us are going to have an opinion on this topic shaped by our own experiences. So that being said, this is my personal 0.02 for whatever it may add to this discussion.

    The biggest question I ask you to think seriously about is this: WHAT DID YOU EVER GET IN LIFE THAT WAS SUPER FANTASTIC GREAT..... FOR FREE?!?!?!?! For most of us, the answer to this once carefully considered is ....absolutely eff all.

    That may seem ultimately pessimistic but coming from the magical land of "free" aka tax-funded health care, I can say I have received better medical care as well as better customer satisfaction for every damn dollar I have paid into US medical insurance and medical bills.

    The system is not perfect either way, and I do believe in order to find a balance it may be a public and private sector joint effort.

    While it is atrocious that people may have limited access to basic medical care in the United States due to lack of financial resources or ineligibility for health insurance, the access problem still exists in a "socialized" medical system. Instead of being limited outwardly by the almighty dollar, it is limited by a lack of access due volume of usage and wait lists.

    In the US, people suffer and perhaps die from lack of medical care because they can't afford it or lack resources.

    In Canada, people die on obscene waiting lists (unless they cash pay and hop the border) or due lack of access because they can't get regular medical attention other than in an ED with an 8+ hour waiting list. This is even worse in rural health care settings where many patients are on ridiculous waiting lists for cardiac care or oncology services.

    So, you can choose to wrap it in the beautiful Christmas wrapping and bows of your choice, but either way you look its still a pile of shit with a fancy wrapping.

    I know this rant is a bit off topic from the original posting, but I suppose I was due to vent some frustration. Both from a medical provider and a patient view, it is not all roses in our "socialized" medical model.

    I do think that with the government paying in socialized medicine that people do abuse the system more often. They figure that if they call 911, they will get seen sooner, even if it is for a stubbed toe. People are known to frequent the ER for splinters, a sore throat, the sniffles, etc....which is true of everywhere I suppose.

    If someone knows you will be the most expensive taxi ride of their life (not the $45 fee that the patient must pay here versus the ~$900 ALS fee in some states of the US) and that they are going to foot the bill, they will be less likely to call for inappropriate reasons (in some cases).

    Anyhow, I have spent a few years researching on this topic with a professor as well as debating both sides of the fence. This discussion is a good one, and needs to be pondered by all health professionals.

    Rant over.

  8. The rate from digoxin toxicity is not necessarily slow though it may be primarily what people see. Dig can make the rate do anything, like magic...bad magic --or good magic depending on how much of it you eat.

    From EMedicine reference link http://www.emedicine.com/emerg/topic137.htm

    * Cardiovascular findings on physical examination relate to the severity of CHF, dysrhythmias, or hemodynamic instability.

    o Digoxin toxicity may cause any dysrhythmia. Classically, dysrhythmias that are associated with increased automaticity and decreased AV conduction occur (ie, paroxysmal atrial tachycardia with 2:1 block, accelerated junctional rhythm, or bidirectional ventricular tachycardia [torsade de pointes]).

    o Premature ventricular contractions (PVCs) are the most common dysrhythmia. Bigeminy or trigeminy occurs frequently.

    o Sinus bradycardia and other bradyarrhythmias are very common. Slow atrial fibrillation with very little variation in the ventricular rate (regularization of the R-R interval) may occur.

    o First- and second-degree AV block, complete AV dissociation, and third-degree heart block are also very common.

    o Rapid atrial fibrillation or atrial flutter is rare.

    o Ventricular tachycardia is an especially serious finding.

    o Cardiac arrest from asystole or ventricular fibrillation is usually fatal.

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