rock_shoes

While technically that does fall in the allowable scope for an Alberta EMT-P there isn't a medical director I know of who would let one of us do it. The growing push toward pre-hospital ultrasound might change that. Sent from my SGH-T989D using Tapatalk 2

Pericardial effusion with a non-traumatic cause? Any cancer history with this patient? Recent illness? Sent from my SGH-T989D using Tapatalk 2

Most of us only went as far east as Alberta, but you certainly raise a valid point. Why doesn't BC have enough ACP seats available to at least keep up with the attrition rate of current providers? Never mind enough to expand ALS service coverage. Beyond that I have to wonder if the JI is in need of some competition. I see no reason SAIT, NAIT, or SIAST couldn't field a sister program in partnership with BCIT. Monopoly in education isn't necessarily a good thing. Sent from my A500 using Tapatalk 2

Boulder gave you a great overview of the questions you need answered. Before moving forward you need to establish that their exists an actual need for the type of service you're proposing. Does the area you're looking to serve lack available ALS staffed ambulances? If their is already a service in place for the area the reality is they'll squash you rather quickly. Beyond that I don't really know what to tell you. Sent from my SGH-T989D using Tapatalk 2

Mike, I think your a few decades too late. The time for mom & pop with big hearts is drawing to a close. Sent from my SGH-T989D using Tapatalk 2

Beyond any of the rest of this I have to ask, why didn't the patient get more albuterol/atrovent than "a couple puffs" of their own inhaler? In a serious bronchospastic event 180-200mcg of albuterol is pretty negligible. 10 puffs of albuterol with a spacer or albuterol/atrovent 5mg/500mcg by neb is more realistic for a first dose. If an asthmatic patient is calling for EMS their own rescue inhaler probably isn't cutting it for them during this event. Without knowing more about the incident, it would seem you both dropped the ball on this one. Sent from my A500 using Tapatalk 2

You can also use a scoop to begin with, which is both spinal rated and dramatically more comfortable than a LSB. Granted, I do come from an area where LSB's are considered to be extrication devices and unfit for patients for any more than the time it takes to scoop them off of it. Sent from my SGH-T989D using Tapatalk 2 Even better of course would be a correctly fitted vacuum mattress. Sent from my SGH-T989D using Tapatalk 2

So no titration of O2 to maintain something resembling physiologic norms for a patient's pathology? Just 6 LPM or nothing? I know educational practices are due for some serious revamping but we need to stop doing things that harm patients the instant we find out the practice is harmful. Sent from my A500 using Tapatalk 2

I see no reason it shouldn't have been set up. As a climber myself I treasure every opportunity I have to share that passion with other people. If anything the presence of something geared toward developing interest in a passion of your fallen member should be seen as a fitting tribute. Just my opinion of course. Sent from my SGH-T989D using Tapatalk 2

The most recent thing I remember along these lines was when BCAS participated in the ROC trials. Selected units carried hypertonic saline with or without Dextran. It was double blinded with three different solutions in play. Normal saline for a control and the two study fluids. Sent from my SGH-T989D using Tapatalk 2

Sounds like a fun project. The 7.3 is a good engine. It gets pretty costly to push it much past 500 ponies though because of the HEUI injection system. Sent from my SGH-T989D using Tapatalk 2

Propane as an additive. Most people just do propane injection. Water/methanol injection is also an option of you're looking to hot rod a diesel. Sent from my SGH-T989D using Tapatalk 2

I'm going to be blunt because I think you can take it. Your class was wrong in that respect. Oxygen must be treated like any other drug. Only use it when indicated, and titrate it to effect. Sent from my A500 using Tapatalk 2

I would imagine you have someone able to translate available in the clinic. Does that make the suggestion more viable? Sent from my SGH-T989D using Tapatalk 2

For British Columbia it's the Emergency Medical Assistant Licensing Board. http://www.health.gov.bc.ca/ema/ Sent from my A500 using Tapatalk 2

I love the sensible direction you've chosen to take this doc. Long overdue. Kiwi, I didn't see anything in the New Zealand guidelines about assessing for midline pain/tenderness while putting then through a range of motion exam. Sent from my A500 using Tapatalk 2

Precisely why I'm not really a fan of O2 driven CPAP systems like the boussignac. A patient benefiting from positive pressure doesn't mean they also need to be hyperoxygenated. Sent from my A500 using Tapatalk 2

I'm with kiwi on this one. We titrate to 95% (92% for COPD patients). Anyone 95% or greater on room air doesn't need supplemental oxygen. The only real caveat is with suspected carbon monoxide poisoning. Sent from my SGH-T989D using Tapatalk 2

How did she respond to a small fluid challenge? Sent from my SGH-T989D using Tapatalk 2

BP on the other arm? 12-lead? Sent from my SGH-T989D using Tapatalk 2

Wikipedia does a reasonable job of explaining the concept. Of course, as with anything Wiki, source verification is required. http://en.wikipedia.org/wiki/Glycated_hemoglobin For a more practical analysis of the relevance of hemoglobin A1C, from a reputable source, try this article. http://jama.jamanetwork.com/article.aspx?articleid=202649

What if you had the ability to essentially "self dispatch"? Ie. the security staff call you any time they're even remotely concerned and you decide whether or not you should attend based on their answers to your questions. The biggest downfall would of course relate to potential language barriers. Do you think the guards understand enough English for "self dispatch" to work? Sent from my A500 using Tapatalk 2

A hgbA1C of 6.2% would indicate that a patient should undergo further screening for diabetes. A hgbA1C of 6.2% roughly correlates to having had an average BGL of 143 mg/dL (7.9 mmol/L for the non US types). My own treatment plan would start with 3 months of diet and exercise modification followed by a repeat hgbA1C. 6.2% certainly isn't high enough I would want to run straight to pharmacotherapy. Start simple when you can and ramp up from there.

Are you currently attending Paramedic school or are you studying up prior to entry? With regard to attending Paramedic school as an ADHD adult I've certainly been there done that. It does present certain difficulties, but they are far from insurmountable. If you haven't yet started I have two suggestions that really helped me prepare for Paramedic school. Firstly, learn your drugs through history taking. Every time you see a patient medication you're unfamiliar with look it up (indications, contraindications, drug intereactions, mechanism of action, the works). Eventually you will be able to direct a lot of your history questions based on the patients medication list (provided it's available of course). Secondly, every time you interact with a patient who has a presentation or diagnosis you're unfamiliar with look it up (pathophysiology, presentation, treatments, everything). If you work even a moderately busy unit for awhile before starting and actually do these two things, you'll fly through Paramedic school like it's nothing. The method works so well for ADHD individuals for two reasons. One, they're short bursts of information. Two, it gives you the ability to relate what you've learned to actual case presentations you've witnessed. Good luck to you. The learning never stops. If it does it's time to take your leave of the profession.

It isn't a terrible idea to do a 12 lead on patients who have prolonged periods of N/V/D. They could easily end up with an electrolyte imbalance that will show up on ECG. Sent from my SGH-T989D using Tapatalk 2