entity

I'm not 100% on this, and maybe I'm being a bit picky on semantics.

When you say "each ventricular contraction is not producing enough of a pulsation to reach the peripheral points", I assume you refer to each QRS wave not corresponding to a pulse felt peripherally. My understanding though is that while you may very well see a QRS wave that looks like a normal one, it MAY correspond with zero ventricular contraction. The wave just tells us that there is some conduction through the heart. It tell us nothing about contractility (although it is a safe bet that an asystolic waveform likely points to a heart muscle without contractility). This is similar to pulse deficit where you hear one of the heart sounds but don't feel a pulse because the valve may not open.

"Just because each of those ventricular contractions is not producing enough ejection to produce a palpable pulse, does not mean those beats are putting out nothing."

I think what you said there is a possibility (ie. QRS wave with the heart putting out nothing). PEA's are a good example of this. But yes, it may very well be pushing out SOME blood, but thats hard to confirm. Maybe you would feel those pulses at the carotid but not the radial point?

Not sure about your last question because I'm still learning about that in my rideouts

So from what I got from the article and the proceeding comments, they showed up in case of the need for rescuing anyone trapped in the house, and to protect neighboring properties.

As a discussion point, why are the firefighters obliged to fight the fire if the fee is not paid. If all that is at stake here is the property itself, can't this be viewed similarly to purchasing an insurance policy for your property? As in, by not purchasing insurance, you assume any liability if accidents occur. If they accept fee payments when fires occur, I'm sure people would take advantage of the system.

There probably are better ways to deal with the funding issues though.

I meant would coronary circulation react the same as cerebral in that it would vasoconstrict with inc o2.. Combined with low perfusion to heart b/c of the congenital defect, wont it make it worse?

The normal sat is around 78-80, today he/she is hovering around 70-72%. I do not think that positioning upright in a car seat will hurt, not sure it will help either, but worth a shot.

To whoever said too much O2 is a bad thing in this condition, you are correct. That would be very bad. Physicians try to hold their patient to "their normal" sat, which could be anywhere from 60s-to low 80s depending on the patient and where they are in the process of repair, the good news is the parents are usually educated about O2 sats, and they can tell you where the patient should be.

Now without reading my article, and using only the google articles you found can you tell me why too much O2 is a bad thing for this cyanotic patient ?

haven't read your article yet, only the medscape one partially..

in regards to the too much O2 thing.. i was thinking, for icp, we try to hyperventilate to vasoconstrict centrally/decrease pressure in the brain.. the trouble with hyperventilation is that it can cause ischemia in that case..

going by that, here's my best guess. too much O2 will vasoconstrict systemic circulation.. this cause ischemia since the heart is probably not getting enough blood flow by default given their condition and given high O2 levels, maybe coronary circulation constricts too much (even though the blood is properly oxygenated?)

have a feeling im way off lol

edit: where is your link btw? i dont see anything so far..

edit #2: NVM, found it..

okay, so from what I read, cyanosis peripherally may be normal for them?

and if the case here is that the pipes that would normally allow the infants to temp compensate for not having the LV /aorta functioning is not working, are they now prone to similar symptoms to CHF/pulm edema? could that be why their O2 sat is lower? how are the child's lung sounds?

am I way off?

found some info on http://emedicine.med...treatment#a1127 if anyone wants to read up on it a bit..

edit: this is too complex for my head right now so according to the above, increased O2 for these kids might not be the best thing for them because it will further decrease pulmonary vascular resistance / increase pulmonary blood flow.. so maybe it will be trying to find a balance of the correct O2 levels / not necessarily giving 100% o2?

Few questions just because its the first time I'm doing this. What does the "2/24" refer to in "59yom c/c back/abdo pain 2/24"

It seems from what you said, a trauma cause can be ruled out correct? (ie. patient doesnt talk about any recent trauma history when asked)

Thinking some sort of rupture of something in the abdo area. I was also thinking a ruptured AAA but found it interesting that the abdomen was not firm/rigid, so not sure if there was blood loss in that region? But it is still high on the list for now.

In regards to the blood in urine, and dyuria, not sure if it would be a common sympton for a AAA but I am now also suspicious of the GU organs. I kinda suspect some sort of internal bleeding because that pressure seems pretty darn low for someone who is normally hypertensive. Wonder where it bled off to though -- I am under the impression that if it bled out to the abdo, you would feel the firmness on palpation.. maybe in the pelvic region? Would it be palpable then?

You mentioned that last meal was last night, but we are talking about tonight now (which is ~24 hrs after).. so was he anorexic?

If you were to take away the "patient died" part and the low BP, I would be prone to thinking kidney stones.

Is this meant to be a scenario where we can ask more questions or are we to base our differentials just on the information provided?

If we can ask questions, has the patient ever felt this pain before? Specifically, what portion of the abdo/back is painful? Did he take any meds for the pain?

Sorry, more questions than answers here.. All I know so far is that I need to review a lot of my patho

Just started my rideouts/preceptorship over a month ago and was VERY nervous going into my first day. Thankfully, I got a preceptor that likes to push me to get a better foundational knowledge and build upon it. In the time I spent so far, I've unfortunately not gotten any chest pain, SOB, trauma etc calls that many of my peers have gotten, but I am still content with my rideouts because the time spent on offload delay or just in base waiting for a call meant some quizzing from my preceptor. And luckily I got a ACP/PCP crew of two smart people who are always happy to teach me, regardless of how tired/sleepy they may be. In my region, I don't believe they pay extra to precept a student -- it is strictly voluntary afaik. I only wish that we spent more time in rideouts.

Holy shit...that made my nipples hard. Your attitude shows what the City looks like when it's working right and firing on all cylinders.

Dwayne, please don't scare away the new people with talk of your nipples hardening.

haha.. yep, scary to say the least but appreciate the kind words. Can't say I would have thought about drug interactions without looking it up -- but I'm in what will probably be a looooong learning phase.

Okay, so since drug interactions have been put out in the open already, I also decided to look up Benadryl.. apparently, it may increase the incidence of seizures for people with epilepsy.. but could not find any specific info on why and can't say it is coming from a necessarily credible source. [http://www.epilepsy.com/epilepsy/provoke_otc]

WebMD lists seizures as a rare side-effect to Benadryl, but seizures are probably listed as a side-effect for a heckuva lotta drugs.

[http://www.webmd.com/drugs/drug-5680-Benadryl+Oral.aspx?drugid=5680&drugname=Benadryl+Oral]

So I guess my question to the mom would be, when did he start taking Benadryl and Keflex. Was the Benadryl suggested by a doctor (probably not?). And how much did he/does he take?

Just wanted to bump this topic up to figure out how this scenario proceeded. I'm a student looking to create some scenarios for group discussion and came across this. I was thinking about alternative causes of seizures and did some research (cheated) and found a probable cause. I don't want to just go ahead and blurt it out because I researched (cheated). So I will ask more questions to get a better picture. Was the mom able to elaborate more on the sickness and reason for the "Kef..." medication use? How recently was he put on this medication?

Hi all!

I was going over some scenarios with a fellow student and we came across one that involved a compound femur fracture. We both said we would use some sort of splint (Sam, pillow, or whatever available) because of the fact that it was an open fracture. However the treatment the scenario gave was to apply a traction splint... My teachers have told us time and time again that we CANNOT use saagers or traction splints on open fractures...

SO now I am extremely confused about whether or not a compound fracture is a contraindication or not.

Let me know what you have been taught or if you are positive one way or the other!

Smiles,

Meg

You're not from Centennial College by chance are you?

Our instructor let us know the exact same thing - compound fractures are not to be tractioned.. on the flip side, I can also recall being told that if you have an open fracture but the bone naturally popped back into place, you can use a sager..

I don't have a definitive answer though.. but I found this a bit helpful..

http://www.sagersplints.com/pages/why3.html

Honestly, unless something has drastically changed in the last few years, I don't think you can go wrong with any of the three. All three provide quality education, and I've been impressed with the quality of grads from all three. Mind you, I've never attended any of them personally. But from the feedback I got on the three, I think Centennial probably provides a slight edge over the others in PCP education. I'm just not sure I'd want to go there if I couldn't carry my concealed weapon in that neighbourhood. Next choice would be Humber. Niagara is too close to NY for comfort. There is probably a better job market in the Niagara Region though, so that may be something to consider.

Centennial / Scarborough region isn't THAT bad Did my B.Sc at Univ of Toronto which was just a few mins away.

Regd. Niagara being too close to NY, why would that be an issue? And about the job market being better, why would you say so?? That would definitely be a deciding factor for me.

Thanks for the feedback. Hoping to finish selecting a school by this Friday!

There are a lot of factors that you should take into account when deciding on which programme to take. Personally i'd write a list of pros and cons with all the schools you're interested in, that should help you make the decision.

As for opinions on the programmes, you're going to hear a lot of different ones. Some will be good, some will be bad and all will be biased, so take each one with a grain of salt.

I only know a little bit about each school. When I was applying for programmes several years ago i got accepted to Humber, but didn't apply to either Centennial or Niagara. Several things turned me off of Humber, the first being how the programme was structured. I honestly can't remember the details, I just remember it not appealing to me. Another thing, and the one that was the biggest turn off, was during the Open House, I asked what the first write A-EMCA pass rate was for Humber's last class. She replied "100%". I knew this wasn't true as I known people who had gone to Humber in that year. I felt that if she wasn't willing to give me an honest answer then I didn't want to be there.

As for the calibre of Humber students, I can't really comment on that. I've known people who have graduated from there and they are good medics.

What I know about Centennial is that they have HUGE class sizes. That turns me off right from the get go. But I do know some of the faculty there and I know it's a good program. Niagara, I really can't say much about it as I've only know a few people who've gone there.

What I can say is that i've had students from both Niagara and Centennial rideout with me, and hands down the Centennial students have been better. But again, that may not be a reflection on the school, but rather of the students.

For finding work, it has, for the most part, very little with where you went to school, at least for the larger services in the GTA. Some smaller services tend to prefer to hire on the students who do their consolidation with them, but most of the larger ones will go for anyone as long as they have the requirements and know what they're doing.

As for CMA accreditation, within the next few years just about all the public paramedic programs will be accredited so I wouldn't worry about that.

If you dont mind telling me.. what college did you go to and how would you rate your experience?

I've made a mini pro-con list for the colleges. But I'm not sure how to find out information on things that actually matter, such as student satisfaction, pass rates, quality of instructors and education etc.

My list mainly consists of less important factors (in the grand scheme of things) such as cost, location, campus life and 'reputation'.

I almost feel like I should stop delaying and just randomly pick between Humber, Niagara and Centennial

Hopefully people here can provide me some guidance.

I've applied to Humber, Niagara, Centennial, Durham, and Fanshawe for the Sept 2010 semester and have received offers from all but Fanshawe. I am hoping some of you can give suggestions regarding which college to choose and why. I've ruled out Durham as their cost seems to be almost double of the others. Which leaves Humber, Niagara and Centennial. I've heard good things about these 3 schools from people I've spoken to but people always seem to speak well about the schools they've gone to. And the general reputation of each college seems equal.

The program co-ordinator at Humber said that 75% of their graduates received jobs as paramedics upon graduation, which I was impressed by (but not sure how accurate it is). Anyone know of any numbers on the other colleges?

Does it help/hurt your chances to get a job in a certain location if you goto a specific school? Or is your performance in the testing all that matters? I would preferably like to work somewhere near Toronto or Mississauga as I have family here.

Also, I've noticed that only Durham, Fanshawe and Niagara are CMA accredited. I've heard that going to a CMA accredited school helps you if you plan on switching provinces. I don't necessarily plan on this but its always good to keep options open.

TIA for any advice.

Damn, where is HammerPCP when we need her?

She graduated from both of those college programmes.

Graduated from BOTH programs? or from both colleges but different programs?

I probably should have asked for info a lot earlier

The test for Niagara College is tommorrow and in early March for Humber.

Gotta love Centennial College for accepting me without any admissions tests!

6 more months to go. Can't wait to get back into the academic environment.

I wrote Humber's test three years ago now and was successful (though I ended up going elsewhere). I honestly don't remember much about the bio or chem parts. What i do remember was that they were both pretty straight forward. In the bio section several the questions were based on information they give you (ie: look at this graph and answer questions). It wasn't anything too complex. The chem was basic grade 11 level chemistry, basics like dalton's law of partial pressures and so forth.

With the math, I do remember that the fast majority of the questions were on fractions, and that they didn't want you to use a scientific calculator during the test. I did, and no one said anything lol.

Thanks.

Just did a quick search to find out what Dalton's Law of Partial Pressures was.. knew the theory but didn't know of it by name.. guess there will be quite a bit to review

Hi,

I have some upcoming pre-admissions tests for the Paramedicine programs at Humber and Niagara college. Is there anyone here who has done said tests already and is able to tell me what I can expect? I've been out of HS and Univ for 2 years so I don't necessarily rememeber too much of what I had learned. Humber's website had a sample Math test which I found extremely easy, but there are no practice tests for the biology or chemistry content. I had called Niagara College's admissions number but they essentially told me that there was nothing they could suggest that I prepare for.

Hope someone can guide me in the right direction as to what to study.

Thanks,

Avin