Code 8 Paramedic

Here is some info on Pulmonary Fibrosis

[web:e4d2a09bf4]http://www.pulmonaryfibrosis.org/ipf.htm[/web:e4d2a09bf4]

As far a using CPAP I dont know

very good replies everyone... just to add my two cents... I typically don't do it... i stick with the bear down method of vagal maneuvers. and just as a piece of trivia... heart transplant patients don't respond to vagal maneuvers, as the vagus nerve doesn't innervate the heart

alot of the time you can see them... but there are some that are hard to find, or not visable... but you should be able to see it with your ECG.. sometimes you have to turn on the interal pacer detector

We Have a few venues in our area that we cover. We do hockey games, basketball, concerts, OzFest was crazy!

Yeah I just want you to know i wasnt trying to start a fight or anything... just had a few points i thought needed to be cleared up

Ok just to clear a few things up

Mastabattas

1st of all.. your Paradoc16 guy is wrong on the fact that yes you do give nitro to dialate coronary blood vessles.. AND do decrease preload.. not the other way around...

2nd im very aware of the physiology of a right sided MI, and lots of things beside muscle movement get the blood back to your heart... id recomend NOT listening to that paradoc guy!

3rd i was refering to the unlike event that a pt with is own nitro takes one while having a right sided MI and dies... not me giving it to him.

4th have you ever started an IV? people have died from IV complications but we still do them, medications work differently on many different people.. sometimes they kill people... but if the benifit out weights the risk... you still do it. If everytime someone died from one treatment or another we wouldnt be treating people at all.

I have a question that I've always wondered but don't think there's much in terms of studies about this.

The patient is having chest pain. They are having a Right sided MI. WE aren't there yet but they've called 911 or a family member has. they just took their 1st nitro and dropped. They are now coding.

How many of our cardiac arrests do you think are caused by this?

If the number is even 1 then maybe giving nitro without a line is counter productive?

Well I really disagree that if the number is even 1... because the benifits of Nitro in general.. far out way the risk of 1 death.

Codeing with a right sided MI because of the Nitro sounds like a reach... Id say the code was more likely due to the right sided MI...

but maybe someone with far more letters after their name could answer that.

We carry LR and NS... but no D5W

People take there own nitro with no ECG or knowing thier BP everyday. So its most likely not gonna kill anyone. If the patients SBP is above 110 i say give them the NTG. My feeling is you could be doing more harm by with holding NTG when the paitent needs it. If the pressure drops, ok you can handle it... drop the head back, elevate the legs. Clearly you need to be aware of whether or not your patient has a right sided infarct, because thats gonna take alot of fluid to counter act the NTG's effect on the BP. But if you dont restore perfusion to heart... larger problems with be down the road.

I look forward to reading the study! I recently had my first ROSC using the new ACLS

Hmmmm TACOS!

Two of the three services I ride with use these systems and they work well. I have no complaints. They are speed and maneuver based. The thing with these systems is that they must be calibrated properly to be accurate. I've worked with them for four years now and have no complaints. If you drive with due regard, they don't go off that often. And once you learn to drive with them, you can still make good time getting anywhere you need to be.

Shane

NREMT-P

yeah we have road saftey... and you get used to it... infact when driving in my POV sometimes i think im gonna hear a tone or clicks!

I had this happen a few weeks ago... patient was waiting for 4 hours at the ER. He was a frequent flyer who comes in for the cold and flu symptoms... but there isnt ever anything wrong with him.. It got the full response to the front of the ER.. fire,police and us. The look on the triage nurses face was priceless! she had no idea we were comming. The patient walked up to us and asked to go to the hospital across town. So he jumped up into the truck and off to the other hospital we went. When we got there and told them the story.. he went straight to the waiting room... where he waited for another 4 hours...

wait you mean to tell me Ive been doing MATH and no one told me! Damnit! i hate it when that happens :shock:

any reason why with an hour transport time... your service doesnt have 12-leads? Maybe im out of line.. but that seems the same as saying.. my service doesnt carry oxygen or EPI.

I did one of my research papers on Idiopathic Thrombocytopenia Purpura... or ITP for short... its pretty simple but it has an impressive name...

Last time I gave a PCT, everybody in the room looked at me like I was a space alien! It took me awhile to figure out why.

Yeah... AHA kinda frowns on the PCT

In the part that I quoted, he said that the patient was oriented to only three parameters, so obviously there was at least one parameter of disorientation in the standard four-parameter assessment of a trauma victim. If the victim is disoriented to any of those parameters, then the possibility must be considered that the patient will not respond appropriately to a history taking and physical assessment either. The result could be a compromised assessment, obscuring an acute injury or condition.

I'm curious as to how well the patient was exposed.

some people dont use person place time and event... some leave out event... thus x3

yeah thats AMR for you... I feel your pain... ive been at AMR for a year and a half

If it wasnt swollen, bruised or deformed.. then you had no reason to think it was fractured, and put on a traction splint. and if his knee was painful then you may have even had a contraindication to using traction... I think (from what you said) you did the right think... you were thinking about.. you checked it out... you splinted... thats why the hospital has x-rays... physical exam cant find everything.

I work for AMR in CT and that offer is the result of your interview and testing... on the letter it should tell you the conditions that you have to meet... like drug test, physical... ect

I would say do it! paramedic class tends take along time... and if your out there working BLS while your in school... that will give you street time for when you are ready to be a medic on the street... plus the things you learn in class will be reinforced by things you will see on the street

Well I think it will be interesting to see how they do it..... and i was bummed that they canceled saved! i thought the show was funny, and even though alot of the real medic stuff was off... or well completely wrong, I liked the characters. I also liked it because they were directly picking on AMR. "NMR" who were they kidding... And PS has anyone ever read "Paramedic" or "Rescue 471" by Peter Canning?

First, Code 8, know who you are dealing with before you start a fight. :roll:

Second, anyone can talk about airway management, very few can do an adequate job of performing it.

Third, vs-eh?, the literature is against you on your stand that PAI is just as effective as full RSI. I'm somewhat surprised that it didn't get your full attention when published.

http://www.google.com/search?sourceid=navc...only+intubation

Just a few for your perusal.

Well id like to say that I don't feel I started the fight... I mentioned three letters R-S-I and this other guy is having a cow! Like how dare I be in a class where we are discussing things like that. I didn't say we were doing it or anything like that... And this guy gets all high and mighty on me! Second it was very offensive to me to insult our medical control doctors.. and my training, when he doesn't know what my level of training is. I wanted to start a disscusion about recent studies wanting to take ALL INTUBATION away from us, and im getting attacked by this guy. It just wasn't very polite way to start off.