scratrat

As EMS providers, I think we're talking more about the difference between 4-6 lpm on a nasal and 10 to 15 on NRB, not the difference between 10 and 15 lpm. I never go above 10 unless they are draining the resevoir, but still, you can't treat everyone with a nasal @ 4-6 LPM.

HAHA. Great ending. Thank you for the in depth reply. I appreciate. So, judging from your post, it is safe to assume CPAP would have probably caused more harm than good which was why I avoided it. Even if I was questioned, I would still stand by my decision. But thank you, it seems to clear it up for me a little.

Thanks guys/gals. Vent - I did exchange the nasal for a NRB @ 15 lpm, thought I said that. Sorry if I missed that. And we did attempt IV sticks enroute but between the prednisone skin, and veins, they were unsuccessful. I have also had pt's bottom out after CPAP use, so I was leary in this case. We don't have the option of BiPAP so it was CPAP or nothing, I chose the later. Thanks again for your imput.

So without ridiculing, I'm really curious. Case: 90 something from a nursing home. Get limited info from staff for obvious reasons. Pt presents in bed very obviously tachypneic and using accessory muscles. Pt obviously severely dyspneic. Pt CAO x 3. Just states she can't breath. Unknown onset. Pt on O2 @ 5 lpm via NC with SaO2 96%. Normally on 2 lpm per staff. Pt has PMH of HTN, NIDDM, and pulmonary fibrosis. Possibly has part of a lung removed but it is unknown which or how much was removed. BP was around 98/60. Weight 80lbs soaking wet. Lungs were actually clear as est I could hear. And they were present throughout just slightly diminished on the right, so they probably removed the right base. Any other pertinent info that I'm missing here, just ask. Anyway, she's a DNR, definitely no tubes. Pt put on HF O2. Blood sugar 212 mg/dL. ETA of only 2 minutes from local nursing home to hospital, it's right around the corner. Another medic saw me and immediately inquired why I didn't use CPAP. Couple questions here. 1./ What exactly is Pulmonary Fibrosis? I was under the impression it was a disease that basically caused the lungs to harden and have difficulty expanding. 2./ If I used CPAP (not BiPAP), wouldn't that just cause a build up of pressure? This, in my mind, would have led to a probable pneumothorax. I don't think, short of bagging her or intubating her, I could've done much else. But she was a DNR so I couldn't do that. Plus being such a short transport, I opted to just run. But if it was longer, would CPAP have been a good idea to use? Any help is greatly appreciated. I'm still learning, I admit it!! lol

First, it's called SUPRA not super. And carotid massage is a vagal manuvuer kind of. Same thing as telling them to 'bear down' like they are to deficate, which is a Valsalva Maneuver.These maneuvers stimulate the vagus nerve, which can slow conduction of electrical impulses that control your heart rate. Some systems allow for the bearing down but not carotid massage. It's different everywhere you go though. Carotid sinus massage has a lot of contraindications and some badddd juju associated with it.

May I steal a few of these to put on a coffee mug???

Thanks guys.....rub it in just a little more...

Finish your other degree first. If thats what makes you happy. Your mother is paying your tuition, use it while you can. You can go places with that degree. If you go into paramedicine, you're not going much further. Unless you do med school or something. Wait till you're done with EMT school to see if you even like it first.

If someone is stupid enough to follow that protocol and administer a sticky gel to an unconscious person, then shame on them. And shame on that medical director. Someone should be speaking to that medical director to change their protocols. It's all fun and games until someone aspirates on this and it will come back to haunt the EMT. The medical director may have written the protocols, but it still falls back on the person administering the medication. If someone chokes and dies, I GUARENTEE you the lawyers will eat the person alive who gave it. The medical director may get into trouble too, but he/she probably will not stick up for you in that case. You should NEVER give oral glucose to someone who cannot follow your commands to eat it themselves, or you're just asking for trouble.

I just moved to Florida from NJ. I know that as a medic, all I had to do was take Florida's medic exam and once I passed I could practice in FL. I don't know if they would allow the same for a RN or not. If you are interested in a particular state, jus google up State DOH EMS, and you can usually find answers and/or links.

They are already RN's. They must be employed by an MICU project who is willing to allow them to challenge the state paramedic test. They must complete, I believe, 100 hours as a third person on the MICU vehicle as a "student" before they can test. After being certified, they can function as a paramedic while working with another paramedic. HOWEVER, when responding as an MICU vehicle, they can only function as a paramedic, nothing more. When working as an MICN on an SCTU (Specialty Care Transport Unit), they function as a nurse. Since you are in the Atlantic City area, the MICN's you see are from AtlantiCare. They function first as a nurse on the SCTU. They can provide backup paramedic services, last I knew, only in the city of Atlantic City.

AS a brand new EMT I was forced into attending a CISD after a child related date. I was told at the time that this was mandatory. Had I known it wasn't, I never would have attended. The call didn't necessarily bother me to point where I needed to talk about it. But here I was around 15 people, at least 13 of whom I've never met, and I'm supposed to just pour out my feelings. It doesn't work. My advice, seek out a professional counseler. And you're only human for continuing to remember this call. I've got a few I think of periodically.

Nothing a little friendly nasal intubation with a BAM device attached can't solve.

With most employers, I won't pretend to know anything about AMR, if you got an offer letter of employment, that means you are in like Flynn! Congrats!

Don't let it bug you that much. If the doctor didn't catch it at first, then you probably would never have noticed. Stuff happens. Just try to be thourough each time, and if you miss something, as long as its minute, don't fret.

TAKEN FROM PRESS OF ATLANTIC CITY Sadness, frustration at vigil for sisters killed in crash with trooper By MICHAEL MILLER Staff Writer, (609) 463-6712 Published: Friday, January 26, 2007 Staff photo by Edward Lea Family members and friends hold a candlelight vigil Thursday for Christina Becker, 19, and Jacqueline Becker, 17, two sisters from Upper Township, Cape May COunty, who were killed in a crash Sept. 27 with State Police Trooper Robert Higbee. Christina would have been 20 on Thursday. UPPER TOWNSHIP — Neighbors, family and friends gathered Thursday at the Church of the Resurrection to remember two teenage sisters who died last year in a crash with a State Police cruiser. “They were bright lights to us in the all-too-brief time they were with us,” the Rev. Robert Gregorio told the more than 100 people who attended. The sisters' aunt, Laura Caiafa, read from the Bible. “And these three remain: faith, hope and love, but the greatest of these is love,” she said. The Cape May County Prosecutor's Office is still investigating the Sept. 27 crash that killed Jacqueline Becker, 17, and her only sister, Christina, 19. Prosecutor Robert Taylor had no comment on the investigation Thursday. Some of those who attended Thursday's vigil expressed frustration with the duration of the investigation. “I'm upset as a parent,” Tuckahoe resident Ken Thompson said. “I'm not confident at all in the system.” State Trooper Robert Higbee was not using a siren or flashing lights when he ran through a stop sign on Stagecoach Road. Some witnesses have said he was speeding. The prosecutor has said Higbee was pursuing a speeder. Higbee faces traffic citations for careless driving and failure to yield. The Becker sisters' family also filed a citation in Upper Township Municipal Court accusing Higbee of reckless driving. Those tickets are being held in abeyance until the conclusion of the prosecutor's investigation. Higbee faces a fine of $50 to $200 and as many as 15 days in jail for each of the traffic violations. “I think they've been dragging their feet too long,” Dennis Township resident Dan Nees said. “The Attorney General's Office should get involved. It's taken way too long.” The Prosecutor's Office recently obtained data taken from air bags in the police cruiser. Once the memorial service began, people wanted only to remember Christina and Jacqueline. “It's very, very sad for everyone,” said Linda Ellison, who lives near the teenagers' mother, Maria Caiafa. “I saw their grandmother in the store. She was so heartbroken and so sad. I pray for her.” In the months since the accident, those who loved the Becker sisters erected a roadside shrine with a small white garden fence. On Thursday night, it was bathed in alternating pools of flashing red and yellow from the new light signal Cape May County installed after the accident. The Township Committee had asked county freeholders repeatedly to install a flashing signal here as early as 2005. The shrine also had a flier for the Natalie Portman movie “V for Vendetta,” which was one of Jacqueline's favorite movies. A helium birthday balloon floated from a string tied to the shrine, which was covered in flecks of snow. Christina would have been 20 Thursday. This was taken from the Press of NJ where I just left. This illustarates the point I was talking about. Although he didn't have lights on, he is still responsible. If he did have lights on, would he still be charged? I think so. I'm not saying I don't do it, I'm was only pointing out that emergency or not we are still held responsible.

Amen brother!

Tell the newbie he's wrong and right. There is one time you can't do it. When they are awake, alert, and oriented x 4, and they are a compotent adult, with NO alcohol or drugs on board, and they are not considering suicide/homicide, then you can't take them without LEO intervention. Otherwise, if they are drunk (or sorry, intoxicated), under the influence of drugs, suicidal, or otherwise a threat to themselves or others, you can certainly transport without intervention by LEO. But this thread still goes back to scene safety. I still can't fathom the fact that they did that.

All I can say is wow...... They thought this was ok? Why would one partner abandon the other to gather history when the pt already had been violent once? That was a stupid mistake. You should impress on both of them that, that could have ended their lives. In response to whether or not to transport, absolutely. Intoxicated people can't sign a refusal. At least not in the states. I don't know about where you're from. Judging from the limited information (LOL) I would say this person was definitely not capable of making decisions for himself. They should have transported with or without consent. Get the police to go with if need be. I know that here in Florida, they have different Acts that basically state a police officer may, if he feels the person is a danger to himself or others, force him to go to the hospital whether they like it or not. They don't get the choice in that case. This whole call sounds like a SNAFU from the beginning. That crew made several grave mistakes that they need to understand.

And passing through a red light is WITHOUT due regard. I'm not saying you shouldn't do it. We do it all the time. My point was that if you hit someone in the process, you are at fault. Every person I've ever heard of that has done this, has been cited. Didn't matter that it was emergent or that it was an ambulance.

I'll see your post and raise you one. I just got to this state from NJ, and NJ does have that same provision. HOWEVER, if you go thru a light even with lights on, and you hit someone, that still makes it your fault. Thats due regard. If you cross the center line while passing another vehicle, and you hit someone, I guarentee you the officer will cite you for careless driving. Provision or not.

And no, you didn't "fix" my post...

Maybe in CA, from every other state you are by no means exempt. If we run a red light, it's our fault no matter what the circumstances. You are not exempt in any other states that I've ever heard of.

Welcome aboard Jester!! I learned a lot, just not spelling.....

LOL