HellsBells

Yes, anyone over 65 does not qualify for the exclusion according to either NEXUS or Canadian C-Spine, I don't recall off the top of my head

Good news Mobey. I'm doing reviews of the revised Alberta EMS protocols coming out in Dec (supposedly). In the draft for the new algorithm concerning C-spine injury they are dropping the over 65 criteria.

In my opinion though, switching to a chev cab is the best thing that has ever happened!

Mobey and I work in the same system, and I agree, the chevy cab is very comfortable.

I'm curious, does your service stock paper cups for this express purpose? I'd be hard pressed to find a paper cup on my ambulance, even if I wanted to make oxygen crafts.

Sounds like miscusi is trolling this post, instead of just stating his meaning clearly, he is leading us down some bizarre passive/aggressive side road.

Nitrous does have a place in some systems but not in ours.

I actually quite like this drug, and yes I have access to fentanyl and morphine in my system.

I find it useful to use on pts in pain from msk injuries while I am preparing the IV, particularly in children, and also with pregnant women in labor.

Is it Weiner?

Very Encouraging, I hope to see the trend continue in this direction.

Thanks CH, I'll try to look into some of the links from that thread. However, its about 4 years old, is there any more recent info/changes regarding employment there?

Bump.

I'm also looking for info on this, anybody?

We trained on the thumper in EMT school.

Thanks a lot Mobey, now I feel like a real dumb paramedic, this scenario already had be brushing up on GBS, and now, bam Cauda Equina Syndrome, which I'm not familiar with at all!

Hmm, I read over the document, but it says nothing of a mandatory attendance to the AGM. It does, however, mention an alternative option to gaining the free credits one could acquire at the AGM.

Arctickat, there is no mention of manatory attendence, I'm stating that it is mandatory attendence by default, becasue as it stands now, it is pretty much impossible to obtain the 120 nessesary credits without attending the AGM. I'm including the 30 credits for the professionalism course offered online for those that can't make it to the AGM.

I don't share in your displeasure HellsBells. This appears to be an earnest effort to ensure practitioners actually engage in continuing education as opposed to just clicking a mouse in CIMS.

I agree the credit allotments are going to need to be tweaked (especially the AGM stuff) but that's doable. I sent Tim an e-mail this morning with a number of questions and look forward to his response. We have an educated paramedic professional at the helm right now. Lets give him a chance here.

I have a lot of respect for Tim; I was very happy when he decided to scrap the CIMS in favour of actual continuing education. This is not what I excepted from him. This new credit system should not have been rolled out half-baked, as it is now. I know that there is more yet to come, in terms of approved courses, but I have no idea what that will be.

So far all of the courses approved (with the execption of the online professionalism course) carry a considerable financial weight. Considering what we already pay for our registration dues, and testing, this added monetary burden is not acceptable in my opinion. If considerable options for credits are added, for free or at low cost, I may change my tune on this matter.

However, I can only comment on what is currently offered. From what I see that offering falls far short of what I expected.

I think I am also disappionted because of the fact that Tim is at the helm, as he is a huge proponent of evidence based medicine in the paramedic profession. Maybe its just me, but consider the following:

Guest Speaker: Darren Sandbeck Future of the Professional in Paramedicine - 10 credits

Neonatal Resuscitation Program (NRP) Provider Course- 10 credits

Where is the evidence that listening to a speech on professionalism holds the same weight as a course on neonatal resuscitation?

he could have GBS.

Gastric Bypass Surgery?

Gay Bowel Syndrome?

I've already sent an email to ACP regarding my displeasure with the new con-ed system.

Last week I wrote them, mentioning how ridiculous it is that in order to complete ones necessary con-ed requirements a practitioner must attend the AGM at least once over 2 years. I personally think that this creates an inequality between employees, depending on where they live in the province. Those around or in Edmonton will have less expense for travel time and accommodation then those of us who have to travel greater distances to attend, not to mention taking time off work.

Furthermore, why should we be forced to the AGM whatsoever? While I think it actually is a worthwhile event, there is no bylaw in the college stating that we must attend. However, now suddenly there is this crass, backdoor scheme to force peoples attendance, as now you can't achieve your registration requirements without making an appearance at this conference.

I find this to be very disgraceful behavior on the college's part, and quite frankly they should be ashamed of themselves. Ironically, I may have to travel to the AGM to properly express my concern about this.

No pill bottles around?

Lets continue suctioning and support resps with 12bpm on the bvm, perpare to intubate.

Probably should be considering pacing her at this point as well.

As to the validity of the dnr in question, the article makes no mention of the cause of cardiac arrest. There could very well be specific circumstances at play here, where, from the physician's perspective resitative attempts would have been futile.

Its fairly silly that this is even "news"

As for the second call saying that the pt was fine, it could be possible that the doctor didn't want the firemonkies coming in an starting CPR on a dead person that has been pronounced(although a situation like that might be rare...oh, wait a minute...)

The fact that the media got hold of this at all is somewhat suspect, what grounds does dispatch, FD have to release this information at all. I am not familiar with privacy laws of this particular jurisdiction, but a would assume there is statute prohibiting this info to be leaked to the media.

Perhaps Mike can in enlighten me on that point, as he is the resident legal expert here.

Look, Id say under the circumstances, good job on the nasal intubation. For the sake of argument, lets say that this is a viable code (clenched jaw not from rigor) and you have to transport asystolic pts, then this is probably the best manner in which to transport him. I would imagine cricking him would lead to significant interruptions in cpr and I would rather transport a pt with a definitive airway rather than BVM.

However, it is pretty dumb to have to transport pts in persistent aystole in the first place.

Well. I think that Mike EMT has officially settled this argument, as he has noted that he spent most of his career in law enforcement, and criminal justice, so... full stop, continue CPR, and ignore the doctor. Clearly, this doctor must be an incompetent fool, as he works for a nursing home facility care must be determined by the highest level of care on scene, which in this case is a basic EMT employed by the local FD.

Seriously though, what was the nurse thinking when she called back stating that the pt was now alive and no longer required EMS?

My training was designed for law enforcement and not EMS. If I were in this situation and had to use the physical, hands on, aspect of my training (going beyond the verbal judo stage) then I would likely be fired from my job after this situation was resolved. I would rather be alive and looking for another job than having my employer make funeral arrangements for me.

Really? If you had to take down an assaliant with a gun to save your own life, your agency would terminate you? On what grounds?

In reference to the LR, are you talking about now, after the damage has been done or initially with the hypoglycemia?

I was refering more to the clinical setting where the pt received the 9L of fluid with his dextrose.

I never palpate the abdomen. no new information will be gained that

would ever change your treatment and the possibility (although remote)

exists that you may exacerbate what is acutely a minor problem and make

it a major problem.

Such As what? thats a particularly vague statement.

Several people have said that palpating the abd can cause a problem.

Can anyone cite any legitimate literature that confirms this?

Particularly the OP's question about palpation of pts with spinal injury. This is a little off topic, but I find the whole idea of spinal immobilization absurd and unproven.

So for this pt, would it be advisable to administer ringers lactate with the dextrose therapy?

Kate's point about the difference between a psych and drugged up pt is a really good distinction. Recently, I had a guy drunk fellow pull out a small pocket knife attached to his key chain on me, however he wasnt particularly threatening, and I just took the keys out of his hand and put them in my pocket. He then proceded to accuse me of taking his keys so that I could steal from his home. I think he overvalued the worth of his threadbare couch and 20 year old television. I have never had a gun pulled on me, nevermind Dirty Harry's peacemaker. I think it would be quite the sobering situation to stare down the barrel of a cannon like that. I have to agree that my first thought would be a fight or flight reaction. The fact that this guy set out to entrap EMS in this manner suggests he is serious and wants to go out in a blaze of glory, I doubt talking him down would have much chance of success.

Both are good schools, if you put in the effort, you should be successful in either. Good luck.