towheadedmule

yo banana gas, no love for your old partner? how is the fd? R

Considering that I get a complicated call every other day (rough estimate), I don't avoid transfers. I do not go out of my way to get out of them, but I do my share.

Line 6 X

Dust I have an opinion on this. I work in a PUM. But I need time to collect my thoughts and to type in from in front a computer, not my iPhone. So I will get a response up hopefully in the next 24

Dust I have an opinion on this. I work in a PUM. But I need time to collect my thoughts and to type in from in front a computer, not my iPhone. So I will get a response up hopefully in the next 24

it just gets me charged up with no place to ground

it just gets me charged up with no place to ground

I lack the capacity to get electrified over this

what about Ludwig's Angina? Surely the dentist would have seen it, but then again?

Esmolol

non selective beta blockers, i.e. Inderal. Reports from ECHOs show that after betablockade the unopposed alpha stimulation can exacerbate tachycardia leading to precipitous hypotension.

lidocaine lowers the seizure threshold and can potentiate cocaine toxicity. forgot about this till a VERY recent lit review on eMedicine

Nitro? The vasodilation speed the transfer of cocaine? treat with versed to control hypertension and hyperthermia

CBC, CMP (chem 20) TSH, amylase, lipase, cardiac markers, EKG, Head CT to start ETA: Wound and blood cultures, and skin color/condition R

rhabdomyolysis? ABG, CK, UA and outputs lean this way, along with the trauma R

LMAO!!! Aphasic, pressure sky high, blown pupils, diaphorectic, family reports ongoing weakness and dizziness for one week, oh,,,,and unresponsive, good pulse ox and cap, ECG good. ' maybe I should have sat onscene and done the CSS and MSS. Pulled a comprehensive HX from the family? Or Maybe take her the hospital. We find that transfer medics frequently have to be retrained to realize what an emergency is and what to do about it. Is EMSA the best. No. Could things be better. Yes. Our protocols generally work for us. And I have tubed in the bay at St John's and St Francis. If you read the literature beyond JEMS and EMSresponder you'll find that many physicians want to pull RSI from the scope of practice of paramedics due to atrocious intubation rates nationally. Our MD wants us to have rates similar to anesthesiologists in the OR before he will consider RSI. We ask for money because medicare and medicaid do not like to pay. And if you think those extra monies tack onto water bills are going to go away if Fire takes over, how laughable. The EMTs that want to goto paramedic school are screened and are volunteers, unlike many Fire medics that were ''forced'' to goto school. I'll take a volunteer any day over a draftee. Rant off

I have had just over a thousand transports in the last year, and probably only 6 of those were pt who would have benefited from RSI. Three were within 3 minutes of the hospital and ODs. Two were OD with a transport of about 7 minutes. Both were nasally intubated with assistance from Versed. One was an CVA pt who I had in the hospital 18 minutes from the time of the CALL to 911. And just for you Rid, that was with a fullest assessment that needed to be done, 2 IVs and scoop and run. Would I like RSI, yes. We have some areas that have 25-30 minutes transports to the nearest hospital in perfect conditions. I don't know how many intubations we performed last month, but a banner month in transports by setting a record. Over 4000 transports. Successful intubation rate was 91% in the eastern division. Anecdotal evidence though. R

/Rant on We have 16 hours of overtime every pay period. We work on a truck for 12 hours, not all of it is sitting on post. I have run as many as 21 calls in a 13 hour period. No we do not have RSI. With a average 12 minute scene to ED time it is not really needed. Would I like to have it. Sometimes. But it is not needed. We have a complicated system, it takes time to learn. When we placed medics out on the streets without training we had a higher turnover. The academy helps our retention. It also gives us time to bring new paramedics up to speed educationally. It gives us time to get the basic to understand their role in the team. We often end up retraining some the paramedics. Everyone on leaving the academy is set on their refresher at their lever, BLS, ACLS, PEPP, PHTLS, AMLS, EVOC, NIMS 700, Hazmat awareness, and have received classes on Acute reperfusion therapy, capnography and learned that "weighty protocol book''. They are then tested on all of those. The new Medical Director is actually shortening the verbiage in the protocol book. Some have not been updated in quite a while. That is not the fault of EMSA. That is more on the OMD, Office of the Medical Director. It is a busy post. With over 800 EMT-P, EMT-I and EMT-B's working under his license spread out over the 2 largest cities in the state that are 100 miles apart, consists of EMSA east and west, OFD, TFD and numerous other fire departments, writing new protocols has been a challenge. Part of why the Old Medical Director is still on the job. As for the FD's taking over. Who knows. I think both cities would be worse off with uncaring hosemonkeys, looking for a fire fix, whose chiefs want to have a legacy, by getting rid of EMSA. IF the 522 districts are approved, it will be a moot point. Rant off/

Get to do the "fun" stuff with out having to make hard decisions or the responsiblity. Thanks

Get to do the "fun" stuff with out having to make hard decisions or the responsiblity. Thanks

well, just to flame the fire,,,,,maybe he will ''save'' you Dust :headbang:

:happy1: Ahhhh Some Mike Ikes and a large coke please. R

Azcep, sorry for the necropost. I found this book online, cheapest was $160.00 While I am not completely adverse to paying this, given your change in status have you found anything as good or updated? Any other suggestions? Dust, might you have some? As for the Thread. On Killing and On Combat by LTC Grossman. Particularly On Combat. Will give you a good basis for communicating with veterans, both soldiers and public servants. Further the sections on stress innoculations will give you pause for thought, and wonder if training for paramedic should not have more stressful situations during lab time. R

I was wondering what was bothering me about this statement. First was the list, from physician to EMT. Seemed a bit odd (at least in my state). Techs here can be unlicensed and receive OJT, some are EMTs, some are patient care techs (read CNA with foley and pheblotomy skills). My course for Paramedic actually required the same about of didactic and a third more clinical hours as the RNs. But by this list I am under a RN? Wait, when I call for Medical Control, I get a physician, not a nurse. When I give report it is to a person of equal licensure, thus a nurse and myself, per my state, are equals. Then it struck me with what I really had a problem. Tiered? The medical community is tiered? I prefer a TEAM approach. It has fewer egos, and helps more patients. My job is to ensure the safe transport of patients and to deliver them to care in equal or better shape than in which I found. I do this for all my patients; the ankle sprains, headaches, CVA, AMI, the lonely person who just does not feel like living anymore. And has a team player, I have a duty to improve. To take refreshers and new classes, and later to teach those classes so that others may follow. I do not have that duty to my team, but to my end user, My patients. You owe it to your future patients to be the best you can be. R

Sorry Dust. On the other hand I am still a bit irked for paramistress. Knowing her predilection for future of our profession coupled with her choice in handles seems a slap in the face. R