craig

Dude, you slay me!!!

Replying to the OP about grammar, with the poorest written post I have ever seen you type!

Hilarious and genious!

BTW: Is this what U.S. Universities are expecting from students? My short essay's had to be at least 8 pages double spaced and referenced in APA format.

I am in Canada though..... and we are alot smarter.

Didn't say anything about grammer Mobey....

my post was written after being up for 17hrs and being really tired.

however I was expecting more in the essay other that some thing an 11 yo would trun in like a book report, it was very light on information and body...wouyld not pass muster her in Aus for a uni assisgnment (at least 1000 words.......)

what type of school is it, sounds like a grade 5 school repoty of an 11 year old

not that i saying this about you but that is not what i expected

Yeah, I'm not much of a jokester when it comes to reassuring my patient. I take it quite seriously. Here's another peeve I have;

"I'm going to take your vitals." or "I'm going to take your blood pressure."

I prefer to use the word Check rather than Take. If I tell someone that I'm taking something of theirs, the inference is that they will be missing that item and I will possess it when I finish my task. Most would understand what I mean if I were to take their vitals....but some might think I mean their liver or heart.

really??? the doctor probable 'takes' their BP as well. so you are going to 'check' it....compared to what?

how can you check their vitals/ BP if you dont know what is the norm for this person.....

check mine and you might find that it is 160/90...so you 'checked' it...is that normal, cause if you told me you were checking it that is what I would ask....and wuld you know if it was or not....

gee, so you take their vitals......you are not stealing it..........i think that most people would know the difference

Despite the awesome survival to discharge rate here i have yet to have one of mine leave hospital alive, but ive kept a few organ donors going long enough to helpe some other oor begger out

what does that say about CSU trained, vic ambos bushy?................told you to stay in nsw..

it made the news cause a tv crew was at the hospital filming at the time when it just unfortunately happened.

if it wasnt an ambulance and they could also see sensationalistic journalism in it,

it would probably been on funniest home videos

shit happens, wheel nuts get loose,,,,,,wasnt the first and will never be the last

just check your truck at the start of your shift...

says a lot about the american legal system though.......litigate till the cows come home......why work if yuo can get 12 gullible people to rule nothing is your fault...

bit like the lady that won a 900 K payout for getting herpes from a guy that SHE had the one night stand with........surely at the age of 48 she would have know the risk of picking up in a bar and making the beast with two backs......

like i said only in America.........

all i can say is ...only in America.......

gee have a heart attack playing basket ball, what would you do......thats right lets go play basketball..........

so people dont have ANY responsiblity for their OWN actions anymore?

dehydrated? to what extend do you think? with a flushed skin that was MOIST? she has just ran a tri , so I would expect her pulse to be stong and bounding, and flushed in the face and hot to touch, after all she is exercising...It was pretty cool temp to run in, she had had food and fluid prior and during?

give her the oral fluids, cool her and offer reassurance....alll this you did so it was good

why give choccy milk if they feel nauseous? would not aid in guy motility? (spewing)....just a thought.

here is the one we use, we used to have Plano 727 / 747 then we went to soft pack similar to the iron duck and now to these

http://www.emtcity.com/topic/22065-craig/

File Name: Craig

File Submitter: craig

File Submitted: 08 Jun 2012

File Category: Misc Files

Neann ALS kit in ASNSW

Click here to download this file

Hard to find fault With the Fire medics for this one.

the only fault I can see it that FIRE is joined with medics, hose jockeys really dont have a role in emergency prehospital care.....dont the tossers have enough to do dragging the canvas and squirting the liquid?.....

welcome.....stalk away.......and you cannot be anymore difficult to Kiwi and a few others i really shouldn't mention......

cheers

Then take teh basik Engrish compersition class and see if you can find a class that includes biostatistics or scientific research methods, I am not sure what you guys call it but we call it something like Scientific Research Methods.

Rules you out Kiwi with that NZ'er language that you speak................should it not be "thun tek the besuk........"?

i hope he had it with a nice cianti...ffffttttttttttttttttt.......

Youre a first responder, first guy on the scene of a head on crash, one occupant in each car. The ambulance will not be there for 15 minutes.

First PT: Not breathing, no pulse...move to next patient. Basic airway management? still apnoeic DEAD

Second PT: Unconscious, severe bleeding from his arm- control bleeding, assume head stabilization.-maintain airway Maintain basic airway as Pt is unsconsious control heamorrhage wait for ambulance to arrive, extricate via recognised methods

Would you let the ambulance take care of the other PT when they arrive? what other patient? there was only two wern't there? Police to oversee the recovery of the deceased and of course the attending ambulance is to take charge of the unconscious patient....what other patient was there?

the vic wouldn't want to turn the other cheek......be nothing left

My very first job after paramedic school mandated fire training and my job title was "Paramedic/FF". To be fair, and in the effort of full disclosure, it has been many, many moons. Every job since then has been single role paramedic and I've been much happier with that arrangement for a variety of reasons.

cause you are no longer a tosser firey............

probably read his protocol book Dwayne...................

Beibs, you made it difficult as you didnt have enough choices....

Intensive care paramedic, specialist rescue/special operations officer......also instructor

work for state based emergency NON fire tosser ambulance transport service (over 4000 employees), that is the only provider for emergency ems in the state (about the size of texas)

that help beibs?

PHCR is easy just use the KISS system and put in relevant information (not in any order)

* Hx and patients details (Name, DOB, Allergies, Meds etc)

* Mechanism of incident and position of patient in car etc

* Signs, symptoms and injuries

* treatment given, drugs and fluids given and results

* times for all interventions (and if it means syncing watch to dispatch each morning....so be it)

* transport rational (urgent, helo, delayed etc.....)

* extrication time..

all other stuff ie, deptors details etc are good to get but not inportant with the continued treatment of the patient

we also don't need to put in the "Joe said this and I did that" rubbish people write on PHCR's, only write what is relevant. If some thing is said that is relevant tot he treatment and care of the Pateint then put it in the PHCR, otheriwise dont waffle on with crap that is not needed....

Writing PHCR's is a skill that everyone learns as they do them, you are never expected to write the 'perfect' PHCR on your first attempt.

helps if you have a Electronic PHCR as they normally wont let you continue until the required fields are filled out.

I'm referring to clinical scenarios where resuscitation is not best interests of the patient e.g. those who are dying from cancer or with severe end stage chronic medical conditions (e.g. end stage heart failure or end stage COPD) who are bed/house bound or have a such a severely reduced quality of life they are "waiting to die" and may or may not be on palliative care

What about the guy who sits in his recliner all day attached to an oxygen machine and continuous pump driven hospice meds, needs a carer to feed, toilet and shower him and who has not left the house in three years? Where the fuck is the point in coding him?

Look maybe I'm just too out in left field but I find cardiac arrest resuscitation to be incredibly undignified and brutally invasive and in some scenarios it is far more dignified and humane to not work them; sometimes doing what is in the best interest of the patient is to do nothing especially if they have been down any length of time.

The last cardiac arrest I went to was brutal it was horrendous, six people showed up (including myself) and this poor little old lady stayed just as dead as when she got found on the loo.

dont dispute anything you say Kiwi, however it is not up to us to 'play paragod' if the person has not organised an NFR then how can we say that they should not be resusitated at a scene.

how do you know that they do not want all that is possible done to them? whilst I also feel it is cruel to see people in situations like that, WE are not the ones to make the decision that they should be in a better place upon their impending death.

If they do not have an end life plan, then I assume that they do not want to have and end of life (who does) and i am OBLIGATED to assist them to survive (even thought I realise it probably will be a waste of time)...but unfortuntely that is NOT MY CHOICE........

that is why when my father passed away a few weeks ago, he had a end life plan (vebal one in the hospital) they still asked if the family wanted him to have any resusitation attempts when he went unconscious.........we didnt want him to suffer and agreed witht he verbal plan........and as a paramedic whose father was the patient it was a very easy decision for me.

Well said Mike; I wonder who people are really satisfying when they say "but we have to try!" - the patient or themselves without knowing it because somehow making the decision to not resuscitation somebody is unfathomable on some subconscious level to them

Six years ago when my dog was sick and dying she went to the vet and got put to sleep yet declining resuscitation for somebody who is housebound, in constant pain and dying from some end stage disease attached to a bunch of pumps for meds 24/7 and needs help to pee, poo and shower is unfathomable to the human psyche

Same sort of thing really here; you take somebody who is dying and hey they die, yet there is some sort of "thing" which says "we have to try and bring them back!" ... why? where is the logic in that?

could not agree with you more Kiwi, but unfortunately we dont have that option..... yet....what we do have is a legal and ethical responsibility to attempt to preserve life (ie save some one) if there is NO produced NFR or there is no verbal declination of the pateint.

As for the family, we can tell them that if they have been asystolic for some time, that maybe it would not be fesible for any attempt to be made and it would only casue more distress to them....this may suffice....

Our protocols state that we can withhold resusitation if the pateint has an end life plan

Aren't those two statements contradictory?

And this is funny as hell right here...

"...Competent patients have the right to decline ... resuscitation in the event of cardiac arrest..."

I thought that as well dwayne......never met a patient in cardiac arrest that was competent enough to sign or verbalise any type of consent.....but we may do things different down under..........

In general, I think that resuscitation attempts should be made on scene, where the patient is found or nearby if they have to be moved for access, and discontinued if the patient fails to respond to therapy on scene. There's no scene transporting the dead, we're only killing them a little more slowly.

Should a patient who is in asystole when the crew turn up be resuscitated? Without evidence of clinical death? Sure. Will we get them back? Very unlikely. Run them, call them. Not always, why run with an arrest protocol if the patient is asystolic and they have been that way without any resuscitation attempt for greater than 20 minutes before paramedic arrival…..

Should a patient who is housebound and dying from severe end stage systemic disease be resuscitated? Do they want to be resuscitated? If so, then sure, let's try. Ethically it gets tricky when we start to think about what are we really accomplishing here, but at the end of the day I think that if the patient wants us to at least attempt to get them back, we should honor that wish as long as they're viable.Unless they have a DRN that is available, morally and legally we are charged with attempting resuscitation of that patient (.....studying ethics and legal requirement of paramedics at uni atm)

Should somebody in a rest home (nursing home) who has a poor quality of life be resuscitated? Again, same as before. If it's what they want and there's no reason to think that they are non-viable, let's give them the chance they want. See above

Should you cease working on somebody who has been down for a half hour? Absolutely. There's virtually zero chance for a meaningful recovery of any kind. We need to stop thinking in terms of "getting a pulse back is our job" and realize that the ONLY thing that matters is getting a patient discharged neurologically intact; anything less is a failure. No argument on this one

Should you be forced to work somebody because the family wants it? No. We can't bring the dead back to life, and if the family wants us to pound on a corpse's chest the only thing that does is to degraded both the patient and us.

"I'm sorry, they're dead. If there was something I could do something to change that I would, but there isn't and I can't. I'm sorry." Can not agree more, why put the family through it and give them any sliver of false hope that the magical paramedic powers will awaken their family member from the eternal sleep

Alright then...i was interested in your problem solving...ROSC achieved and maintained 50 minutes into code. Good CPR throughout.

50 minutes into the arrest......well not my problem, as there would be no way I would be on scene by then...either he was dead or he is at hospital and its the doctors problem now........

some senarios can be made too difficult....