mrmeaner

3.7 Million? How about 1/1,000 of that cost at the Bunny Ranch for someone who knows what hell they're doing? :twisted:

Right. Guerrilla wordfare.

or textual assault?

His other reviews aren't bad either.

If you cannot "see" the atria repolarize because the QRS buries it

I would say that this assumption is the problem. I've heard the same statement, but as scott said, it doesn't seem realistic to be able to see atrial repolarization.

I agree. Regardless of your level, you need to use all the tools you have available.

As for splinting etc as a method of "pain relief"' date=' while i'll admit that it does reduce pain, actually performing the procedure as a method of obtaining relief without giving meds for the purpose of splinting is just barbaric. Are there any people here who feel it is exceptable to splint / apply traction without meds (if they are available)/quote']

I intended to follow up on my earlier post, but forgot about this thread.

I do use medications for pain management, but I'll start with the basics first. Not because I have a "BLS before ALS!" shirt at home, but I have found plenty of patients who would rather avoid meds. Also, some patients do enjoy somewhat of a medication holiday as they are tired of feeling disconnected from the world, especially the ones who are terminal cancer patients.

If a patient needs chemical pain control, they will receive it. But the patient is commonly involved in thbe decision. Hope his clears up my post a little.

Come on guys and gals. Why is a 22G IVC not ideal in the trauma pt. Remember I'm after the law!!

Dude, the foot in ass thing is a law!!

But seriously, I don't know what law you are referring to.

1) Would you be happy with a 22G IVC in a trauma pt? No.

2) If not why not? Hint - a simple equation or law here will suffice I don't like to have the receiving doctor's foot in any of my orifaces.

3) Alternatives? EJ, Fast1, or EZ IO.

4) Methods of insertion and possible insertion sites? See #3 as applicable.

I would imagine that most places would prefer any form of an IO to be used instead of attempting to access a shunt as it may be permanently damaged and not useful anyway. My guess would that if it were a possibility, you would have to take specific training, have your med control sign off, and have your protocols approved by your state (assuming shunt access is a part of your state's SOP's for the medic level), kind of like mediport access. Again, just my guess.

ACP's can give D50. As a PCP I can't unless my Base Hospital allows for IV therapy, which we're taught in school, but aren't necessairly able to do. My glucagon standing order states that dosage may be repeated if necessary 20 min following the first dose. I've got that and oral glucose in my bag so those are my options as a BLS provider. Afraid I'm not seeing the joke though.

I believe a second dose of glucagon would be an exercise in futility. Just to clarify, this is not a dig in you. You should follow your standing orders.

My point is that if the first dose didn't release enough glycogen stores to make the patient alert enough to be able to control their airway, why would a second dose? With that long of a transport, plus on scene time, plus response time, plus time elapsed before recognition, the patient needs a higher level of care as available.

Okay. If that's her argument, then I'm going to go out on a limb (I promised Spenac I wouldn't hide behind "I'm a student" anymore.) and say she's out to lunch. If the iv is started, give D50 and forget glucagon. If the glucagon's given and no IV, give oral glucose or food. If the first dose of glucagon doesn't work such that food can be given, give another dose 20min later. If the second dose doesn't work and you can't give D50 (which PCP's here can't) then you're SOL and you manage what you can until the hospital.

Don't you have advanced care or any other way to give glucose? Given that you can't give D50, I assume you can't use IO either. You could give more glucagon, but if you were just looking for something to do then you may as well start on paperwork. At least you'll be getting something accomplished.

Not having an IV access is a concern when giving glucagon, but not a contraindication.

As has been stated, it's good to know what to give but it's better to know what it's going to do to your patient and how. If your patient has poor liver function, are you going to get much of a release of glucose? Probably not.

If you are giving glucagon to a patient and have no back up (IO or rectal glucose administration) you should have an ALS intercept en route.

As a medic I use the following for pain management:

Positioning

Splinting

Traction

Morphine

Demerol

Fentanyl

Dilaudid

The first three often work the best.

Well, Oprah got her cut, and that's what's really important. :roll:

Some of the basics where I work hospital based like:

Every

Menial

Task

If you want to reduce the number of BS calls, try charging $100 at the door for transport with the rest of the bill to be sent to their insurance. :twisted:

Any system or procedure can and will be abused.

This is a problem that won't be solved by a name change or a segment on the local news. Any facility or company that has the "You call, we haul" policy will always have this problem. I'm hoping for the scenario that has been discussed here before where the appropriatly trained paramedics are able to expand their treatment on scene and leave the patient with the instructions and the medications or a script to take care of their concern.

Happy Birthday...yesterday. :oops:

May the most that you wish for be the least that you receive.

This store is not a joke

If you can't beat 'em, take their money! :wink:

Having a hott patient is one thing, but I have had a patient that was obviously a good person, funny and cute. Just kind of an "if things were different" scenario.

The 12 lead thing could (should?) get people in a lot of trouble. Ill advised.

First, anyone who believes that their job cannot be cut either works in the upper levels of government or is naive (although both are possible).

As with any type of company, the weak will fall with the declining economy (I don't know enough about AMR to say if they are weak or not). However, I think the rest of your predictions would require a very, very bad 2009 for that to happen. You do have some good points and I hope you are wrong, as I'm sure you do.

Since some seem to be able to find more specific details, had the defendant been charged with battery? Wouldn't that be almost a requirement to base a injury claim from a would be rescuer?

Also, ERDoc, your sarcasm is not lost on all.

Testimonials here.

SureFire Reveals Scope of Multi-Car Accident

While working the night shift on my local volunteer ambulance squad, a call came in for a multi-vehicle accident on a major highway. Our first-line ambulance was already out on a run, and when we arrived on scene, we saw what appeared to be a four-car crash. Unfortunately the generator was acting quirky on the rig, and we couldn't use our powerful flood lights to survey the scene.

While extricating a patient trapped in the vehicle assigned to me by my incident commander, I turned around while the fire department cut through the windshield. Out of the corner of my eye, the E2D Defender clipped to my helmet illuminated the roadside, revealing another two cars we hadn't seen. Thanks to the brightness of the E2D, three passengers received lifesaving emergency medical treatment.

Marc G.

Teaneck, NJ

=D> :laughing3:

Who the hell can support a family of 4 on 8$ an hour? Will YOU? I think the union has many benefits,more so than draw backs. I think you should look at both sides of the picture before you start pointing fingers.

First, who is making $8 and hour? Second, why do you have a family of 4 when you are only making 8$ and hour? Are you looking to the union to solve your problems for you? Do you think that just because you work for an employer as a union member they owe you a living?

Both sides are being looked at, and it looks like only one side is taking responsibility.

Edit: I'm not sticking up for Spenac. He's perfectly capable of digging his own holes. :twisted: I just happen to have a similar view.

Meh, in 5 years it won't even be on their employment histories.

without a union im sure I would be getting paid private, for profit ems wages. Thank god for them. my pension, my wage is due to them. You see what happens when private ems runs things w/o a union? I can't believe people live on those wages

Yep, I have. They make more than the division that is non-union. They are also 911 based where the higher paid division is strictly interfacility transport. Plus, no union dues!

I have always been against unions, and I am still against the traditional union. I argued that they had outlived their usefullness, and had basically priced their employees out of jobs in almost every industry that was heavily unionized (steel, auto, textiles, manufacturing).

Quoted as I am in 100% agreement. Assuming that this really was the reason congress denied the automakers, then I am in total agreement with them and will shed not a tear when General Motors starts their announcements of bankruptsy first thing next year.

But at the same time, when you look at what has happened to the average american worker over the past 20-30 years, you have to wonder if a "new union" would not be a good thing. Think about all the downsizing, mergers, bankruptsies, and buyouts over the past several decades that did nothing but get the CEOs and shareholders rich, while wages for the worker bees had remained relatively stagnant. I have no problem with CEOs making big money, but when they are paid 100's of times what the average employee is making, and they are making it while their company is losing money, that is wrong.

I don't believe unions are going to be able to do a single thing about CEOs' salaries or golden parachutes. I don't think they're going to do a thing about mergers, buyouts, downsizing or bankruptsies, so I still don't see a need for them, new or old.

I think if you want to get a good job, go to school. If you want to protect your future, save money. If you don't want to live paycheck to paycheck, live within your means. Thousands and thousands of grandparents are secretly saying "I told you so!" in thier heads. Why do you think old mantras like "Don't buy it until you have the money in hand." or "Waste not, want not." exist?!? Because these people have lived through or directly after the great depression, they know how easy things you believe are infallable can fail.

It's someone else's turn on the soap box.