Jump to content


Elite Members
  • Posts

  • Joined

  • Last visited

  • Days Won


Everything posted by rock_shoes

  1. 1) Why is this posted in "Funny Stuff"? 2) Who made any of us judge, jury, and executioner? When someone calls in emergent medical distress, my job is to answer that call not engage in social judgement as to why that person ended up in a particular situation. 3) Previous forms of "3 strike rules" have been complete, epic, failures. Why should this particular line of thinking be allowed to prevail?
  2. Sorry to hear. Rest and healing to his family and loved ones as they work through this.
  3. All of healthcare in British Columbia has mandatory vaccination. At this point anyone who has not received at least dose one has been placed on leave without pay. There are exemptions in place for those not medically able to be vaccinated. Personally I don't have a problem with it. I had to provide proof of the standard schedule of vaccinations just to be allowed into my education programme (never mind to be employed). What reason would I have to expect anything different with respect to vaccination during a pandemic?
  4. Sad news. Rest and healing to his family and loved ones.
  5. I love it when a plan comes together. The heart of the concept is minimizing cerebral oxygen demand while maintaining a sufficient cerebral perfusion pressure and flow for tissue oxygenation. Assuming an ICP of 20mmHg, it would take a MAP of 80mmHg to maintain a CPP of 60mmHg (I bet MAP guidelines for the management of TBI are suddenly making more sense). Some sedative/analgesic medications balance those considerations better than others. This brings in the concept of flow metabolic coupling (Propofol is particularly good at this as sedative agents go). Agent's with good flow metabolic coupling such as Propofol reduce cerebral oxygen demand in balance with the amount they reduce cerebral blood flow. Agents such as Morphine or Midazolam do a poor job balancing the two considerations and reduce cerebral blood flow relatively more than they reduce cerebral oxygen demand.
  6. PHO? I'm guessing that's what your service calls banked time?
  7. All evidence continues to support taking full droplet precautions with suspected COVID patients. This one's the real deal. The numbers out of Italy tell the story as to what will happen if we don't take this seriously soon enough. My service switched our sick leave (75% pay) to general leave with pay (100% pay) to discourage employees from potentially infecting colleagues.
  8. http://www.vch.ca/about-us/news/news-releases/vgh-leads-the-way-in-traumatic-brain-treatment Very long story short, look up the monro-kellie doctrine, and principles of cerebral perfusion pressure.
  9. From what I know of the US system I would suggest getting your RN and doing some form of Paramedic bridging program. Take that with a grain of salt however as I've come up through the Canadian system where working your way to the Critical Care Paramedic (CCP) level is the best way to gain entry to air ambulance work (1 year PCP education, 2 year ACP education, 2 year CCP education). As you can see the path is roughly 5 years of post secondary paramedic education in Canada, which you'll find is markedly different from the US path.
  10. It's barely possible to justify ultrasound on most units never mind an X-ray generator. Big expense with marginal applicability to practice.
  11. Perhaps try organizing your reporting into a systems based structure. Neuro Cardiovascular Respiratory GI/GU MSK Other (Obs/Endo/immune)
  12. 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.
  13. 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.
  14. 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?
  15. 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.
  16. 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.
  17. 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).
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 1) Ketamine 2) Epinephrine 3) Ancef 4) ASA 5) Benadryl If I only get 5 they better be flexible in their use.
  23. Ditto regarding the maintenance of paralysis in our service. We avoid it if at all possible with these patients. I've found Ketamine/Propofol for maintenance of sedation (plus or minus a loading infusion of phenytoin) really give any further seizure activity the old one two punch.
  • Create New...