Inf

"Vietnam paramedic" doesn't mean anything. If social workers got the judge to get a warrant after seeing a 'huge hematoma and a blown pupil' then the raid was justified, and the media portraing this story as an '11 year old son kidnapped by swat team' is the real problem.

To play devil's advocate, if the patient appears hemodynamically stable and V/S were stable then BGL determination and stroke assessment would take priority over running an EKG strip. If you suspect cardiac condition as a cause of poor perfusion you would see the s/s of poor cardiac output DURING your initial assessment and vital signs. We are talking about EKG/BGL after the BP, RR, Pulse, skin color/temp/condition have been obtained, so to say that EKG is not first priority I would agree. Could be your garden variety dementia or TIA/CVA

inverted T in II, III, aVF :roll: do V7, V8, V9

any redness? cellulitis?

ASHI ACLS and ASHI PALS are excellent accepted alternatives.

Ok Dust, you seem to have gained a momentum with your rambling. I thought of a few angles how to present an argument for Basics, but I think its easier to simply try to explain why there wont be much change. The public in general is not punished for dialing 911 for bullshit. Yes, the fucking welfare recipients who want a refill for their hydrocodone dont call a taxi, they call 911 and complain of abdominal pain, get a free ride to the hospital, get their refill and then one of the privates even transports them back home. Until those pieces of shits who abuse the 911 system are met with a hardcore legislation which would fine and even imprison those who call 911 for nonemergency purposes, there isnt a need for change. The Basics will continue transporting the 85% of patients which are sheer bullshit, and the Medics will wait for their difficulty breathers, their drunks passed out on corners, and their cardiac arrests. So before you blame the Basics, consider yourself being on a 2 medic truck running the bullshit calls - put yourself in the tech's position that transports a "patient" who just wants a refill for his meds and calls you an ambulance driver -- because you can take out the Basics, but you cant take out those who call 911.

Medicine is a dynamic field built up sound scientific principles, and when new treatment modalities come out the physicians are expected to be able to grasp these concepts by relating to previously learned sciences. As the physicians get to play with the new toys and new treatments, they toss the bone to the Paramedics who in turn are expected to learn the new concept and be able to use it. Capnography, 12-Lead EKG, Blood glucometry, SpO2, IV Infusion pumps, Mobile Data Terminals, and a myriad of other biomedical technology is widely used in ground and air ambulance services. By knowing the basic science behind them you are able to learn more advanced equipment- ventilators, IABPs, and maybe someday in a near distant future artificial blood products, etc. Try attending one of those EMS Expos where Zoll, Phillips, Physiocontrol and other leaders of prehospital equipment demonstrate their latest products. To answer your question, it directly relates to my ability to acquire the training and subsequent use of such technology. If I cant use it, then I lose another diagnostic tool, which may be detrimental to the patient (as an example - in NYC only a few hospital-based ambulances even carry glucometers and CPAP).

You have your Lead II on top, Lead I on middle and Lead III on bottom of this strip, if this is so you have Left Axis Deviation. If it was extreme right axis deviation, it would probably be a VTach. This could also be hyperkalemia. Without a 12Lead you really dont know anything about your patient (other than asystole and VF :wink: )

That was a reply to the original post you twerps :roll:

Pedal edema? JVD? Finger clubbing? Birth control use? could be cardiac asthma, PE, APE, STEMI, NSTEMI, unstable angina... have you done a 12 lead?

I like how you mentioned stress on prehospital trauma call. If you get a really bad car wreck your thoughts are on: how difficult that intubation is going to be with jaw thrust, how much does this guy weight for lidocaine, will I be able to get an IV on him? Its unfortunate that in most places IO for adults is not in protocols, and it should really be the first access method used for cardiac arrests and severe trauma, but finding an unbroken bone for a site may be tricky. Blood products for severely hemorrhagic patients is not in protocols either, seems like having a refrigerator on an ambulance is a crazy idea - a few units of type O- blood and lorazepam would've found their place in such a mini refrigerator.