rock_shoes

It's barely possible to justify ultrasound on most units never mind an X-ray generator. Big expense with marginal applicability to practice.

Perhaps try organizing your reporting into a systems based structure. Neuro Cardiovascular Respiratory GI/GU MSK Other (Obs/Endo/immune)

Good luck to you sir. I work flight in British Columbia, Canada and love the job. The US air ambulance safety record scares the living daylights out of me. Enough so I wouldn't be willing to work air ambulance in the US.

Without more information, I'm willing to wager this is likely a matter of local protocol not evidence based practice. Based on the information provided the patient doesn't have an oxygenation problem.

Almost every controlled drug in my daily carry has significant abuse potential in the wrong hands. Why should best practice patient care be compromised because someone might abuse it? What opiate would you suggest a service carry instead when all opiates, benzo's etc. have abuse potential?

Years ago I found this site as a brand new provider. It helped shape where I am now and put me in touch with mentors I am forever indebted to. Site activity has been quite low for some time now so It's difficult to say if it would serve a new provider the same as it did me.

I'm going with a probable welcome back to the field. Sometimes it's nice when what's old is new again. I spend most of my time flying now but still enjoy the occasional shift working a street car. I like the reminder as to where I came from and why I decided to move into my current area of practice.

Wow. 11 year old thread resurrection. Impressive!

Employment status update?

Do you perhaps deal with physicians from outside of North America? Other parts of the world use different descriptors for the same condition ("fitting" is a common descriptor in many places for what we would call a seizure in North America).

I know the feeling. A little more than a decade ago I started here as an EMR (EMT - B equivalent for the US folks). Now I've done an additional 5 years of post secondary along the way and work as a Critical Care Paramedic responding to the sickest folks in the province of BC by air/land/water. Funny how the more you know, the less you feel like you know.

Unfortunately Ruff is right on the mark. If you haven't been assaulted on the job as a paramedic you're probably about 2 days into your career.

The Bledsoe textbook is a decent primer to critical care. I'm not too familiar with the US CCEMT-P education requirements but I know Bledsoe's text is just scratching the surface by the Canadian Critical Care Paramedic standard. I would dive significantly deeper if you want to be good at it. UpToDate is an excellent resource with regular evidence based practice updates. It isn't cheap but worthwhile resources rarely are.

We're essentially walking the Ketamine path right along with you. Big dose IM Ketamine for this indication is starting as a trial in one of our urban zones now and will likely be extended to the rest of the service by the end of the year. We've used Ketamine for all kinds of indications in air-evac for a long time. It's new to street level ALS practice in BC.

1) Ketamine 2) Epinephrine 3) Ancef 4) ASA 5) Benadryl If I only get 5 they better be flexible in their use.