backinboston

Your placement was probably fine... What you need to do is hook up a compression bag around your fluid bag, or if you dont have one, grab a BP cuff and inflate it until the IV runs -boston

Ive been using the IO pre hospital for about three years now, with great success when it is needed First, your checking your patency when you push your prefilled NS flush, and it should go in pritty easy Second, if your gona hang a bag , and i reccomend it, you need to put a compression bag (if you dont have one pump up a BP cuff) around the NS bag. Third, why would you remove the IO? Keep it in and leave it set up for the hospital to use when you get there. They are great tools and if your using the IO, you should not be able to obtain IV access. Finally, the patient isnt really gona feel pain from the drill. Its when you go to push anything through it that they will be in pain. Its becuase the receptors in this area of the bone respond to pressure not pain stimulous. On an adult you can take your prefilled Lido (that you use in codes) and push 20-40mg. This will relieve the pain caused by pushing fluids into the marrow. I have never had problems with the IO except on large patients that have a lot of tissue (FAT) between the skin and bone. Use at your own caution in these. But like I said before if im going to the IO, it means i cant get an IV. Usually on the fat ones Ill just do an EJ. However, these are great tools and give you a patent IV in less than 30 seconds. -boston

Taking away pediatric intrubations would be a really poor move. There is really no true justification to do it. Anyone that has access to a tube should know when and where to intubate. I agree that intubating a pedi should be a last resort but at just that, without that last resort we may see an increse in motality. Anyone that says we need to take away ETT due to lack of tubes is looking as lazy people. If you dont tube atleast 10 people a year, you should be talking to your medical director about getting into the OR to re-up your skills. We need to take it upon ourselves to keep up our skills, as this is a very important one. Many people have been saved by this procedure.

"or some random computer skills class probably does not make you a better paramedic," Sorry you did not say in the long run, however... I think even in the short scheme of things it really does make you a better medic Like I said before a good medic brings strong knowledge and transfers it to their actions. I think if you wanted to go get a bachelor in business, it would create higher thinking and thus a better medic as opposed to just the minimum certificate program. Coupled with experience, if its for you... you will succeed

I feel like there are a lot of different ways it will work... At my 911 medic job.... We work two 24hr shifts 1als truck 1 bls truck in each city. Personally I work Sun/Wed and it works out great At my 911 fire/medic job... We work 10hr days 14hr nights 4 days a week on a rotating schedual. Each of them really work well.

I have to disagree with the last poster. Taking the degree program absolutly makes you a better medic. Higher education is something we can all benefit from. That random "computer class" will only benefit you in the coming years as PCR's move to computers and 12leads/EKG are sent to computers to increase our ability to recognize dysrythmias. I am so sick of new medics that just do the minimum and think they are strong medics because they can establish Iv's and sink tubes. People, these are Monkey skills that even bucketheads can do. These do not make you a good medic. A good medic knows their meds and when to use them, can recognize EKG dysrthmias and not just the basic ones, dont just look for tombstones to know when a stemi is occuring. I am so sick of these medics that just do the minimum in school and then get their medic just to get on a fire dept and suck. We are never going to move forward as a profession with just a certificate program to establish you position in our field. I hope the degree program becomes the standard. So many of us are not great in school but you need to be able to read, have advanced math skills etc. Higher learning creates higher thinking, instead of cookbook medicine. Anyone can learn an algorithm or run a "code". Codes can be the easiest calls you ever do, but when you get that sick medical emergency are you going to shit your pants and rely on your partner or step up and know what you are doing. We as a profession need to take all the courses we can, get all the certifications we can and constantly relearn and upgrade our knowledge. If you think that taking your National is only useful if your are going to move, then you are lazy. Having your state and national shows you actually care about your professional and realize that just the minimum isnt enough. The national can actually be quite useful, expecally if you have been a medic 1+ year. It causes you to go back and study, relearn and bring out knowledge that you may have put in the back of your head. We are never going to move up as a profession and progress unless we all take it upon ourselves to bring up the standard and make a cutoff line for these lazy, incompetant medics. The EMT to Medics that had to right taking the EMT course in the first place. I am an FTO at my job and I see it time and time again lately, these kids who are great in school, can regurgitate knowledge with the best of them, but when it comes to applying it, see ya later... just another transfer medic in the making. If the schools are going to continue just passing these kids through over and over again, then we as a profesion need to step up the standard and create some sort of filter. I can tell you one thing, I wouldnt want many of these people taking care of my sick family memeber. Would you? -Boston disclaimer: this is my opinion and hope that other agree. Dont take these views too personally and if you do, it may be a wake up call to go and bring your self up to a new standard.

I couldnt agree more, EZ IO is the forefront but the BIG would be great as a backup that is rarely used. I have had my share of IO's that did not make it deep enough in the bone, however, never had the second shot not make it. If i have to go for a second shot ud better be damn sure im gona make it work. Has anyone ever tried it into the humerous? I have been toying with the idea in my head lately but havnt met anyone that has also tried it. Im curious, but at the same time kinda hesitant....

It doesnt matter if your state is NR or not. Its great to keep your options open. It will make it a lot easier if you in the future decide to move because even if the state your going to doesnt accept the NR, they may allow you to transfer your licence in easier by skipping their practical if you have it. This is all from experience, I never thought id need it eaither, but it really came in handy

If you take a look at most patients meds now days you will find it is quite common to have Calcium Channel blockers and Beta blockers combind. You treat this patient with cardizem although she is not showing the cookbook style S/S because your lucky she is in a compensating state. You TREAT this afib, slow down the rate and monitor there reaction. your job is to know these things and take care of the best interests of the patient. If you want to just know they have an IRR HR that is fast and want to just drive to the hospital with O2 on then pick up a BLS shift. Personally, I have Cardizem on standing order and when called upon in the clinical setting I have no fear in using it. I have had great results and a Hx of Afib does not mean you withold cardizem by any means. Yes maybe on a daily basis there HR is mildly Irr in the 80-110 range. There is NO WAY that this patient on a daily basis is in the 160-210 range. There is no way to sustain their cardiac output with there ventricals getting such a minimal output. If anything you would withhold the albuterol due to the cardiac issues, because they are breathing and within the Er they will get the needed antibiotics. PNE is something they can live with for some time and will make it to the hospital, an unstable HR (Not unstable pt) will not last long in this condition.

we have terbutaline as a med control option but I have found it takes 10-15mins usually to start to work on that locked up tight patient. I have Mag in our standing orders and will usually go with 2grams in a 250cc bag wide open and have had excellent results. Usually throw on a combineb while its going in. Ive had impressive turn around prior to arrivial at the hospital.

doin the old stare of life.... it will go away with continued experience... but like stated eairlyer... if it continues to happen after a few interventive efforts... maybe its time for the im not sure if this is right for you talk.

To the original poster.... If you are going to be a new medic and want to work for Boston EMS... although much less appealing, I highly recommend you find a Private that has some good 911 shifts in the area (there are ample options) to work for on the side. Boston EMS will not be promoting any new medics to their ranks without putting in your time. Working there BLS trucks will get you great experience and allow you to prove yourself to others but without developing and keeping your skills up it will be an unattainable goal. From what Ive heard, there are a lot of BLS Boston EMS personal that hold an EMT-P but are just waiting for a spot to appear, then get chosen and finish the required time. Its a great goal but something way down the street. Good luck, and if you have any questions this is a great place to ask. I am sure there are a lot of us from boston somewhere around here

To use amiodarone you are supposed to have two lines going and one dediacted for amiodarone because it can crystalize up. Last time I checked crystals going into the blood stream are frowned upon.

10 year smoker here.... I "want" to quit, but what would I do while I write up my PCR? I think it has to be overcome mentally to move on to other avenues. However, I have heard rave reviews about chantex, but maybe someone could write about how long it lasts and if anyones had any relapse with it. It sounds great, but sometimes it just sounds too good, and we all know where that old saying takes us.

Congrats! I think if you were able to pass all the stations without a retest then the actual written shouldn't be a problem for you. I take my tests in about a month or two and am more worried about the skills test. Something about having boston EMS testers watching my every move that makes my hands shake a little. The written is nothing but a pick the worst of all the evils and go with your first intuition. You can do it, and good luck!

They are quick and easy. The name says it all.

Honestly, when it comes to pain like I stated earlier if they need pain meds from me, its going to be obvious. Often the natural "pain" meds will kick in or id rather talk them through it. I am usually against unnecessary med application unless its truly appropriate. Another part of this ideal is the receiving MD/RN is unable to truly see the pt for who they are when you bring them in and any other injuries that may have occurred are undetectable once they have those meds onboard. If they break their elbow and its the obvious pain for the pt, whos to say that once they are able to control/deal with the pain that they may begin to realize they have pain in that quad of the abd because the elbow actually slammed into the rib and may have caused internal injury. Pain is for a reason

I received my cert from MassBay's day program. Similar to Northeastern they are going through a transition period. However, they require A+P and all the gen ed prior to starting the program. They also have a 1 1/2 year part time night program. I highly reccomend Safety which is through PRO ambulance now or North Shore Community College's 2 year program I have seen the medics coming out and they have been top notch. Exspecally the North Shore program because with that two years they are better able to absorb the info, get the extra time in the lab and the instructors are able to spend more time on subjects instead of just bombing through them like some one year programs tend to do. Northeastern is a great program but for around $20,000 it just didn't seem worth it to me.

sorry, this was poorly worded and not completely explained. I was not implying to look at this from a finanical cost vs benefit. More I was looking at it as, how much morphine is it going to take to make this pt with possible pain (pain is often exaggerated) to get them comfortable down the "bumpy road" the ambulance is going to go down. I was talking about cost vs benefit of giving a med with obvious resp depressant effects, reduced preload/afterload effects etc... When if they can just deal with the pain for just a little longer than they already have can get those "good" pain meds when they reach the ER from an MD that will look at the whole picture that the pt brings into the situation (PMH) and then choose from a wide array of drugs to give the pt relief. ps: I could care less how much something costs if I really feel it will help the pt I would use the most expensive anything and I just had someone do my taxes because "I have people" (aka i know nothing)

On a side note, if the pt didn't have fibro, just the pain, you dont have to give every pt with pain, pain meds. Its cost vs benefit not treat the pt not the monitor in this situation. When a pt really needs pain meds, you will know... but often I just think... Pain lets you know you are still alive.... and we cant be doping up every pt with some kind of pain we encounter

I work in a tierd system in the urban environment that allows BLS to use glucometers. We often have 911 coverage for the duration of time that ALS is out on a call. Many of our cities use BLS more than ALS due to sheer call volume. Glucometers are an important tool that doesnt always mean that the BLS can make a difference with medication but it is a tool for assessment. Everytime we go to a syncope, low sugar, high sugar, general weakness, seizures, possible stroke... etc... When we go to meet up with ALS or when we BLS the pt to the hospital it is one of the first things asked because both will be moving on to get a sugar quite eairly in their assessment. It is something that the regular lay person can do on their own, so why not get it out of the way en route to ALS or the hospital. It is not a difficult skill nor does it require vast knowledge. Something to think about that was mentioned by Dust eairlyer. Giving EMT-B's a glucometer is not going to propetuate giving them more tools , expecally 12leads. However, even if they did it would be the same as when the pt hits the hospital since... Many RN's cant read a 12lead... let alone the monitor. They often dont even take the 12lead the tech does (lower than EMT- and... when they hit the hospital, they can just pass it off to the MD just like the RN will do about 20 minutes after they have bumbled around to take a report. just food for thought tho

Came on scene to a code a few weeks back... Fire was already on scene and they are pretty good about attaching the AED, bvm and giving us an update. We came in and to my astonishment found the crew doing compressions 2:1 bagging. Greatest part was they were using a NRB as a BVM and had no idea they were doing anything wrong. however, I always feel that they make an effort and its better than walking in and nobody is doing anything.

.5 if there alive, 1 if there done (mg of atropine that is)

Something I was taught in addition to the adage of "bring home the one, you brought to the dance" is the possible result of "torsade de pointes" as a result of mixing lido and amiodarone to treat a dysrhythmia. However, if you reach a max on either, you can always call med control and see if there licence will hold up the risk/benefit

I agree with the eairlyer post... not wearing a helmet is a classic example of social darwinism at its best... if your not bright enough to realize what a helmet can do when you dump your bike... then crackin your mellon open is what your asking for...