rock_shoes

From what I've heard the Propaq and the X-series are almost the same monitor. Something about the Propaq having the option for one more invasive monitoring port than the X-series. Sent from my SGH-T989D using Tapatalk 2

Seriously? No one has any experience with this monitor? Sent from my SGH-T989D using Tapatalk 2

No. We were discussing options before it gets to that point. Sent from my SGH-T989D using Tapatalk 2

I know I'm digging up ancient history here but the new Propaq MD is out now and I'm curious if anyone has experience using it. Based on the spec sheet I desperately want to take one out for a test drive. Thoughts? Sent from my A500 using Tapatalk 2

http://www.ncbi.nlm.nih.gov/pubmed/21513584 I really don't like this particular CPAP device for reasons I won't get into here, but the concept is sound. Sent from my A500 using Tapatalk 2

You don't need 12-lead capabilities for a hospital based machine on a code cart. 12-leads are done using dedicated EKG machines in hospital which have markedly better diagnostic quality. Sent from my A500 using Tapatalk 2

I'm going to run down the hyperkalemia route. CaCl, albuterol, fluid challenges, bicarb, serial 12-leads, lasix... Oh and GLH (Go Like Hell) to the big H(Hospital). This patient needs labwork ASAP to direct further patient management. D50W is a good consideration, but I don't know of too many ambulances that also carry insulin to go with it. Interpretation of the ECG much beyond the electrolyte imbalance is interesting but probably not particularly helpful in this case. More of a patient history would be prudent in this case. How about the patient's renal function?

True. It was more an exercise in possible ways to prevent getting to the point of respiratory arrest on my end. If a patient is into respiratory arrest ventilate them as best you can and get invasive with the airway. Ketamine is a great choice for sedation in this case due to its bronchodilatory effects. Paralytics if you have them. Get more aggressive with the PEEP valve, permissive hypercapnea, side-stream or bag in your salbutamol/ipratropium bromide, 1:10000 epi (0.01mg/kg to a max of 0.1mg) IV, magnesium sulfate, corticosteroids. Be acutely aware of potential pneuomothoraces and prepare to decompress if need be. Seriously, throw the kitchen sink at them. For some interesting reading on the topic of permissive hypercapnea: http://www.ubccriticalcaremedicine.ca/academic/jc_article/COCC%202005%20Permissive%20Hypercapnea%20%28May-20-2010%29.pdf

Well it's good to see your post regardless. Back on topic, I've seen all the usual suspects mentioned (epi, salbutamol, Atrovent, corticosteroids, mag, etc.), but I haven't seen any mention of CPAP. CPAP is another option which falls squarely on the, potentially effective but controversial, end of the spectrum. One of our resident RT's can probably explain it better than I, but the general idea involves using pressure levels that exceed the pressure of the tapped air. This allows a kind of waterfall type effect (can't remember the correct term off hand) to take place which essentially "releases" the trapped air from the alveoli. It also "splints" bronchi open from the inside (kind of like using positive pressure ventilation for a patient with a flail segment). The obvious downside is that obtaining these effects involves experimenting with high airway pressures (pneumothorax potential). Sent from my SGH-T989D using Tapatalk 2

If done in partnership with an existing program the actual expense would be quite small. Think of it like what the JI does with alternate program delivery sites. It could be the NAIT or SAIT program delivered at say BCIT. As for what happened with the College of the Rockies program I don't know the details. I do know there is more of a need for qualified staff than the JI might have you believe. My previous station has taken 5 street hires over the last two months. Prior to this the last street hire into that station was 13 years ago. Sent from my SGH-T989D using Tapatalk 2

In my area care of the children would fall to the police until such time as a parent, guardian, or official from the ministry of children and families was able to take over care. Depending on location, in some instances the police might also pick up the care giver (mother in this case) to reduce the time to care. Outside of everything else, why the sedation for a non traumatic pain complaint? Most North American services would have done morphine for pain management and that's about it. Maybe tossed in the ketamine and or midazolam if the pain was refractory to morphine. Sent from my SGH-T989D using Tapatalk 2

Good to know. I wish BC would do the same. Only 20 years behind with certain things. Guess my BC is showing. Everyone in BC working on an emergency ambulance is a BCAS employee. BCAS is responsible for providing any training necessary for license maintenance by contract.

There is a fine line between spurring useful discussion and being a smartass. If I expect my comments to promote intelligent discussion I make them at the time. If I expect a negative, non-productive response I save it for later when I can pursue things intelligently. I like it. It demonstrates an open willingness to learn. Sometimes all that’s needed is an attitude adjustment.

Most places in BC have PCPs with ACPs in larger centres. I imagine Saskatchewan is much the same. A little clarification for our american colleagues, Canada essentially has intermediate level coverage for the majority of the population with ALS in larger centres and BLS (think EMT - in rural/remote areas. Arctickat Wouldn't the additional training you require to "un-lock" yourself typically be provided by your employer? Doesn't really help if you also happen to be the employer of course.

I'm going to have to disagree to some extent. There exists both a time to speak and a time to listen. While the majority of your educational time should be spent with ears open and mouth closed, there are times when it's appropriate to speak. Speak with respect, do not be dismissive, and always follow the appropriate chain of discourse. Other individual, instructor, academic chair, finally dean; in that order. Always remember; while you do have the right to hold an opinion, you also have the responsibility to back that opinion with sound and evidence based research. If you are going to disagree with an instructor show them the respect they're due. Do it in private and back your position with well researched articles. Any instructor worth their salt will welcome the challenge and appreciate the respect you show. Sent from my SGH-T989D using Tapatalk 2

Tintinalli and Bates are my two go to reference texts. I don't have much experience with Mosby outside of the Paramedic text which I found marginally useful. It was bare bones with less than adequate elaboration on the various pathologies. Sent from my SGH-T989D using Tapatalk 2

Who still uses a 15gtt set? Sent from my SGH-T989D using Tapatalk 2

That's probably about the best way I've heard someone put the ketamine/benzo relationship. Sent from my SGH-T989D using Tapatalk 2

Try picking up Albertans after they crack it up on the Coquihalla. After they pass you driving Mommy and Daddy's Tahoe at 140 km/hour. Sent from my A500 using Tapatalk 2

New Jersey's Volleywhacker system has me baffled. It's like a separate universe void of all common sense. How has this continued? Sent from my A500 using Tapatalk 2

That entirely depends on location of practice. In BC for example I'm expected to act within the scope of my license, and within the confines of what I have available for resources. If I have more advanced resources available to me and the treatment is appropriate I'm expected to use those resources. I can't speak for New Jersey. Just worth bearing in mind that those restraints are jurisdiction specific. Sent from my SGH-T989D using Tapatalk 2

While I agree such a process would be unlikely to reduce the incidence of intentional gun violence, I'm willing to postulate that it would reduce the number of unintentional gun related incidents. Enforcing a reasonable amount of gun safety training through a licensing process is far from unreasonable and certainly wouldn't violate the right to bear arms. I think of it as the right to bear arms responsibly. Gun storage requirements are also something to consider. Little Johnny can't access daddy's gun if it's locked away in a gun safe. Sent from my A500 using Tapatalk 2

Holy whacker Batman! This guy is completely out of control. For starters he was probably removed from his volly squad for good reason. It's volly for crying out loud. Unless this squad is drastically different than most you pretty much have to kill someone to get the boot. As for his "education," the equivalent of a 3 week first aid course doesn't qualify you to make any medical decisions beyond the provision of basic first aid. For all this guy knows the state trooper and firefighters could be EMT or even Paramedic qualified making him the jackass. What is out with New Jersey? I've never been there and this kind of thing makes me leery about ever going. Sent from my SGH-T989D using Tapatalk 2

Convert pounds to kilograms. Simple as that. Sent from my A500 using Tapatalk 2

I just use the KED with kids. It does a great job and tends to be more comfortable than a board in my experience. The way it wraps actually seems to help calm them. Sent from my SGH-T989D using Tapatalk 2