scope2776

Pretty straight forward. Let's hear what you think! Apologize for the image quality.... Bonus for treatment plans....

I've thought about carrying that to test for gag if i want to start thinking about intubation, or a finger splint, or to examine the airway for whatever reason, or other reasons that i can't think about right now. How does that work out for you? Maybe asking this is my inexperience or sparky Paramedic student showing through lol.....

I think to a certain extent we all do have some level of bias when we call in a refusal we do not want to go into the ER. And I think we do have some level of control over people who go vs. people we think will be fine otherwise. The bottom line is people who want to go, go to the hospital, and people who don't have to wait for us to call med. control. I believe giving Paramedics or EMTs here in the US the power to outright refuse transport would be a potentially disastrous. As much as we would like, we are not a hospital. I do support the idea of controlling the billing aspect. Say for instance if there was some way we could document possible abusers or repeat offenders or people who insist on ambulance transport for minor aliments or continued misuse of emergency services. We are not a hospital, but we are clinicians and do have some idea of emergency vs. no emergency; if an ambulance was needed. If for example, the patients insurance would not cover non-emergency transport, or Medicaid would only pay up to a certain amount and the patient would be billed for the remainder, we could have some control over misuse. When an ambulance is used like a taxi the patient should be billed as if they had used one. Just a really expensive taxi....

I agree with most of what has been said here. Plain and simple, there should only be two levels of prehospital providers. EMT-Basic and Paramedic. I think it's best not only from an education and patient advocacy perspective, but from a public perception angle. I already have to correct enough people calling me an "Ambulance Driver", I don't want to have to deal with people mistaking me for an Intermediate or whatever. Hell, not only does the general public have a hard time understanding what we do and the medical interventions we provide, most of our colleagues in the medical services have no idea either. I think it's just ridiculous that there are such things as EMT-Epi and EMT-Defib. I think as members of professional agencies such as the NREMT or NAEMT - or whatever state EMS agencies we belong to - we need to advocate the removal of recognition for these "Intermediate" levels. I've heard the argument that not recognizing Intermediate levels will hurt rural areas. This is simply not true. If you want an expanded scope as an EMT for your special circumstance, then have a conversation with your medical director. And if the state doesn't allow some expanded practices, then have a conversation with your congressman. That's how it's supposed to work. Maybe your medical director could actually train and sign off your EMTs on the special skills. Or hire a Paramedic! As a Paramedic student just finishing up school I feel like I have such a basic and entry-level knowledge of advanced care and cardiology/pharmacology. It's hard to describe, but it's like i'm on the cusp of ALS, and I think any education level below Paramedic, such as Intermediate, that picks and chooses ALS skills - not focusing ALS education or mindset, just skills - is below that entry-level understanding. And this cheats patients. Whereas there is increasing pressure for Paramedics to justify practices such as intubation or the administration of cardiac drugs. And whereas many other ALS providers are continually challenging the Paramedic's ability to provide certain interventions based on lack of education. Then there is little if any justification for Intermediates to provide the same advanced skills. Furthermore, I think it would be a great idea to increase the EMT-Basic curriculum to absorb some of the Intermediate stuff and requiring Paramedics to have degrees. But hey, that's a whole other conversation. whew... my 50 cents.... lol

we use Garcia in class, it's great. The book can really teach you in simple language what's going on. I dunno how your class is set up, if you're learning drug dosages from the local protocols or from your national textbook, but, even if you don't understand or know what they mean - start learning your drug dosages early. It will kill you if you wait until pharmacology to get all those down. Good luck!

I take my first ACLS class in about 3 weeks, at the end of P school. We've been studying the algorithms and scenarios in class for sometime. I cannot comment on the watering down of the ACLS class, but I do think the curriculum has suffered in the last few years and most notably after 2005. It really annoys me that on numerous places on the algorithms the books states, "consult expert opinion". It's almost like a slap in the face. Also in my flip-book there's a whole paragraph about how Amiodarone should only be administered by a doctor experienced in cardiac care. Yea right....

You didn't miss the boat out of ignorance, just a little tunnel vision. Even the best of us still have trouble with that... You have a great attitude! And your participation here shows that you care about gathering more information than can be found in the book or taught to you in class. This will be the mark of a successful career in EMS and quality patient care if you continue this tradition of above and beyond your education from class. A good EMT or medic will never stop learning. The minute you become complacent in this job is the minute you become a dangerous EMT or medic. And there is a difference between complacence and confidence. It's not out of your range, you just haven't been exposed to it yet... lol

I would have to say, "great job." You took the information you had available and come to several different differentials, which you prioritized and treated. Excellent critical thinking. You treated for the most serious differential (stroke), no problem at all. I don't have a CAT scan in my ambulance yet... she prob just got a little extra attention and faster ride to the ER... no harm done, i'm sure next time you'll be thinking Benadryl right away. I was thinking dystonic reaction right off the bat, with the repetitive movements and mainly CNS complaints; along with history. I had a patient with the "deep brain stimulus" electrodes back in EMT school, that's really the only way i can remember. They look just like bilateral pacemakers, or at least on the patient i had. Normally those units are used for advanced Parkinson's disease, which is a deficiency of among other things dopamine. We treat the symptoms with 50mg Diphenhydramine IV or IM. Usually this works great and reduces symptoms immediately. Now what are some other medications patients might be on at home, and overdose on, or be on a dose outside the therapeutic range on, that will also produce a similar dystonic reaction???

Every ambulance here has a scoop here... Great for lifting the back pain, leg pain, etc, pt of the ground with minimal movement.... I was taught in EMT school that it can't be used for immobilization. I would like to know what my med. dir. thinks thou.... The idea of the multicolored lights seems neat, but kinda dangerous. Really an ambulance should only have 2 modes of response. Emergent and non-emergent. Would a red response be driving recklessly without lights+sirens???

I'm surprised nobody caught this yet... but lasix is a sulpha drug! I am all for teaching EMTs and Paramedics above and beyond the standard curriculum, but there has to be a fine line between extracurricular and extravagant. I think the questions may have been to put you in the mindset that many of your patients will have confusing and untreatable complaints with no correlation; but you are still going to have to formulate a treatment plan for when you are caring for them. This becomes a little simpler for EMT students because your scope of practice is limited and the tools you have to play with are fewer. So all of these patients are going to get a through SAMPLE OPQRST history, physical exam and 15 LPM O2 via NRB w/ TKO IV and supportive measures. These are questions that would challenge many first semester Paramedic students... My take on this scenario is: defiantly reeks of CHF. At this point her body is still compensating for the decreased cardiac output. This pt could also have an AMI, and other fairly complicated cardiac complications. What's going to help this pt most is a hospital... I don't really find the glucose to troubling, if your chasing glucose levels as the cause of this pt's troubles you've missed the boat. It's just probably because she didn't eat today and only had liquids. Don't worry about it unless they have altered mental status... FOR YOU MEDICS: just curious - would you treat her pressure with nitro or lasix? Or would you be concerned with disabling her compensatory mechanisms and wait and see about the pressure??? I wouldn't be surprised if this is the guy with 3 previous MIs and a cardiologists number on speed dial. I smell AMI or just an old and busted heart. This is leaning more toward cardiogenic shock i think... check for swelling elsewhere, this guy has either a right sided MI or heart failure... a BP would be nice on this guy lol This fits nicely into the criteria for epiglottis. The pt is a little too old for croup, and the hx of fever is more favorable for epiglottis too. But as always, our patients don't read the textbook. This pt warrants aggressive, aggressive treatment. You don't want to do anything to increase anxiety for fear of completely shutting off the airway, but you do want to be on top of your treatments, very fine line. A helpful hint: if you do end up bagging these pts, try to bag them in the prone position, face down into your bag. This way you are using gravity to your advantage to pull the epiglottis down away from the trachea, and maybe you'll be able to get more O2 in. Maybe it will work, maybe it won't, haven't ever tried it myself. These are also the patients you DO NOT SUCTION!!!!! Don't do anything to aggravate that epiglottis... these are the patients we as medics only get one chance to tube. Scary stuff. Think about it this way, you can either spasm the glottis with a suction catheter or an ET tube, your choice. I choose the ET tube.

I can't think of anything in mg... i think 0.01mg is the smallest dose of epi for pedi I'm sure your system accepts mcg? Cause epi drips start at 1 mcg.... but i guess you use 1 or 2 mg to mix it yourself.... whatever, the point is no i can't think of anything

so i'm a little confused about your patient.... Our protocols focus on ventricular rate control to bring decrease cardiac output and therefore decrease BP. So I know with a-fib w/RVR I would consider a calcium channel blocker, but you described abbarent conduction - so does this mean conductions that did not go through the AV node? If this is the case, as in a Kent or James fiber, I would not consider calcium channel blockers because I would be shutting off the hearts only way to regulate rhythm and possibly send my pt in v-tach. We have no protocols for beta-blocker use in this case. Overall she seems like she has a pretty poopy heart, without a very, and i mean very, through eval. on my part i won't even consider pushing verapamil in the field, even if she is showing some unstable signs. And your darn sure I would call med control. I could be all confused about this....

urgh.... i can almost see it know.... i love how the COPD pt's are always pushing like 2 lpm through about 30-50 feet of after-market nasal cannula tubing and call for "shortness of breath". You did exactly the right thing! Oxygen is what they need most! (15 LPM NRB) If you wanted to be really cool, you could titrate LPM down to a good SpO2. Paramedics in services with ETCO2 "Capnography" can't complain about, (or yell at the EMT's) about hypoxic drive. Just slap the ETCO2 cannula on under the NRB mask and if their carbon-dioxide goes up with continued oxygen administration, titrate the oxygen down to a compromise between SpO2 and ETCO2.

i don't think it's too bad... i think it will be up to the courts to determine what will be use or abuse. I do know that the law should protect people who use their weapons to lawfully protect themselves or their family.

here in my city which is a dual ALS response, fire truck and private ambulance, the fire rigs have a paramedic, 2 EMT's and a lieutenant or capitan. Just make sure to thank everyone before you go, see if you can replace any supplies they might have used from their rig, so they can go right back into service - and since we carry the same stuff, it just makes things easier. Sometimes if it's a good call the medic might ride in, which is great because of all the extra help. Some people in my agency don't get along with the fire service too well, i don't understand why.

nothing big... just sheets and blankets that our service offers at the hospital. I'm sure if i needed something big, i could just ask for it. What do you guys do if you run out of a med half-way through shift? Do you get it from the hospital or does a supervisor bring it to you?

i'm interested as to what you guys think about universal coverage?

i think the main issue here is not whether private EMS or public EMS should get benefits, but that EMS was left out of the question because it was to difficult to appropriate the money and to whom. I agree that a house divided cannot stand. it disappoints me that we cannot offer a solid front on issues such as this, that our national committees and associations cannot use their leverage on this issue. EMS will probably always be the step-child of other agencies until we get our act together... and i don't want to rant to much on that because it's covered ad nauseam in other threads. Call me a commie, but i don't care who provides the benefits, municipal, state of federal and i don't care if private of public employees get the money, there should be something for our families if we die in the line of duty. And it should be equal to the other agencies.

i guess if you had to draw a line in the sand it would be 100 sys. this is of course up to the medics judgment. i would be a little more cautious with lasix than i would with 0.4 mg SL nitro. A single nitro spray i can correct with fluids pretty quickly, lasix will last quite a bit longer.

you'll be fine, I didn't see anything alarming... lots of artifact and baseline drift. A 12-lead would be nice to see. If you feel like you might have a cardiac condition it's probably best to see your doctor thou... I did see some strange settings on the strip thou, i was looking for calibration settings right off the bat because I expected maybe you had some whacky settings on that caused you to get weird tracings. On some of the strips it said 20mV/mm and at other places it said 40mV/mm, i'm not familiar with that brand of monitor so i don't know for sure. do you guys have the super-sweet new Philips monitor?

obviously the answer is to give Paramedics more tools to play with so that we can initiate definitive care at the moment of patient contact, cause if we can't really do anything to help the patient then we are no better than homeboy ambulance company.

my first as an EMT I can't remember, probably something BS my first as a P student was a DOA, nothing to exciting just some lady who died at home... that's the only reason i remember