Kaisu

LMAO you guys kill me... here's me trying to make a point... and even funnier.... running to stick up for Dust.. now that there's funny - I don't care who you are....

Suze you are articulate, intelligent and passionate. If you've been around the site for a while, you will see that this basic/paramedic argument has been rehashed infinitum... Girl it's not personal. No one is attacking you for being an EMT - we all started that way. The problem is the EMS system in general. In mosts part of the country, the system is a mess. People are being hurt and are dying because of the way it is organized and like it or not - basic, volunteer and fire based EMS are a big part of this problem. The fact that you (and NOT you personally but YOU as in anyone with 120 hours of training and a license) can jump into an ambulance and do stuff to sick and dying people is wrong wrong wrong wrong. I'm glad that you find it fulfilling - I wonder if the patients that die because the system does not get the resources to them in a timely fashion find it the same... hang around girl - it is refreshing to hear articulate and reasoned discourse BUT try and understand why we feel the way we do - and if you can't, maybe you need some more education.. that's all we're saying. and PS... poor form is low on the list of bad things when people are dying that don't have to.

what is it about him that you object to? His knowledge? his experience? his willingness to teach? his character? what exactly do you mean?

What's ET short for? he's only got little legs

what has four legs, lives in the desert, howls at the moon, and has a bag of cement? a coyote - I threw in the cement to make it harder

We did ACLS megacode individual testing style. No one was allowed to help you. The wrong drug, dosage, use of electricity and doseage were all critical fails, as were doing anything that could potentially harm the patient, yourself or your team. It was a must pass for our paramedic course too. Anyone that failed was out. It was an intense week and I can't believe that others have watered it down. I was very proud of myself when I passed. PS.. the testing took a week. Our cardiology stuff was about 9 weeks and ACLS specific was 50 hours.

I totally agree... this would have been the major point of the aforementioned ass kicking.. If I didn't think that my point was made and the behaviour would NEVER be repeated, then I would take it up the chain...

Im sorry Dwayne - but it is his fault - if he asked any questions whatsoever (with an open mind) he would have learned how much he didn't know. The fact that he has worked for 2 years without pulling his head out of his ass is his problem. You asked him to hang a bag and he didn't do it - the next time you ask for help with a critical intervention will he do it? or will he think he knows better? How can any human being smart enough to brush his teeth in the morning listen to a couple of medics discuss a patient, condition, call and not understand that they are talking a language he/she doesn't understand. My first 4 hour ride time shift as a basic showed me that there was a ton of stuff I didnt have a clue about. If you look over my last post, you will see that I clearly stated that I love working with the basics I work with. It doesn't change the fact that the specific person you describe is an asshole... Just my humble opinion.... PS - did you ever ever ever in your career as a basic talk to a paramedic the way he did to you? Did you EVER not understand that they knew more than you? Did you ever not hang a bag when asked?

When I was about 2/3rds of the way through Basic class, my instructor said that he would be comfortable with any of us (students) taking care of him or his loved ones in an emergency. My first and only thought was - You have got to be kidding. There was NO way that anyone with the amount of education (almost nil) or training (a wee bit above nil) that we get as basics should be in charge on anyone that is sick. If you think that that class prepares you, then you are fooling yourself. When I started anatomy and physiology, I was stunned that there was this whole world of stuff out there that I had been totally ignorant about. We would learn about cell chemistry and I would be amazed - and guess what? The RNs and the paramedics all knew it. Then I started paramedic class. I learned that not every medical patient needs hurricane force oxygen, even though 15 LPM NRB had been burned into my brain in basic class. As basics, we are taught to put occlusive dressings on open chest wounds. In paramedic class I learned that this actually causes pnuemothoraxes. Then I began clinicals.... thank God there were educated (note educated NOT trained) people to learn from and to make sure that I didn't hurt anyone. The more I learn, the more I learn that I don't know - I cannot imagine the gall of people with limited education thinking they can instruct people who know more... If you think as an EMT that you can tell a paramedic how to do stuff than you are self delusional and dangerous to your patients. I hope you work in a cook book protocol system where you have very short transport times and lots of people to cover your ass. I love working with the basics in my system. They are eager, motivated and a tremendous help on scene and with patients. If any one of them talked to me the way they did to Dwayne I would kick their ass - Dwayne - you are a patient man.

ROTFLMAO

cheeze... what a softy.....

Absolutely - a gesture made to service personnel - not to professionals.

OMG - do you tip your doctor? your lawyer? your RN? I don't - I tip waitresses, bag handlers, room cleaners, other service providers. I am a health care professional. Just cause the money in EMS sucks doesn't mean I'm not going to act and expect to be treated as a professional.

gosh.. i am so flattered that you all care... I had a bucket handle tear of the lateral meniscus - It was scoped on Wednesday, I was in class on Friday and will be going to clinicals tomorrow. I spent the weekend exercising and icing and things are going really well. I hope to be back to ride time on Saturday. I looked over the surgery notes after I came out of anasthesia. I brady'd down on them - HR below 40 - I must have been hypotensive too.. because they gave me 675ml of fluid and 15 mg of ephidrine. - Pilots say that any landing you walk away from is a good one. I guess the same can be said of anaesthesia. Compared to ACL reconstruction I had a couple of years ago, the meniscus is a walk in the park. Once again.. thanks for asking

. :twisted:

I run in a hospital based two paramedic system. We do long transports and with a very interesting continuity of care paradigm where often we intercept with a BLS unit, care for the patient in the ED, and then do the interfacility transport as well. We run with a senior paramedic for two years before we are let lose on calls with junior people. It is a terrific way to do it. We have on occasion hired people from other services who have been running in 1 medic - 1 emt systems. They need the two years too...

I am now ACLS certified. This is probably no big deal for those of you who have been paramedics for a while but I am very proud of myself. They ran 4 different arrhythmias on me, beginning with an MI and going through stable and unstable Vtach, Vfib, Asystole and finally symptomatic bradycardia. I took my time, kept my cool and did very well. I passed the written test too. I don't know how other programs are, but it is a must pass for mine. Anyone who fails this is out of the paramedic program. It's under 3 months to graduation so that would have been a major blow. Now that this is over, I have meniscus surgery tomorrow. Wish me luck.

Shelby 500 GT KR drool - lust

Do you think that you would be able to provide professional, competent care to someone that close to you?

I thought I'd bump this again.. my spidy sense tells me that this amazing young lady could use some encouragement at this time... www.caringbridge.org/visit/alyssageske Thanks all you guys

From ACP Medicine Online, Dale DC; Federman DD, Eds. Acute noncardiogenic pulmonary edema can occur after administration of a number of drugs. Acute pulmonary edema can occur after intravenous injection of heroin or other narcotics. Because the edema fluid has a high protein concentration, it has been suggested that a permeability defect could be a pathogenetic factor, but this finding could result from a transient, extreme increase in capillary pressure produced by a so-called neurogenic mechanism. Onset usually occurs within a few hours after narcotic use, but occasionally, it may be delayed for as long as 24 hours. In addition to the clinical and radiographic features of pulmonary edema, typical signs of narcotic intoxication are present, such as pupillary constriction, decreased respiration, and altered mentation. Fever and leukocytosis do not necessarily indicate the presence of infection. As with neurogenic pulmonary edema, the primary differential diagnostic consideration is aspiration, because of the altered level of consciousness. The OP patient had no signs of altered level of consciousness. She was alert, orientated and insistant that she needed something for the pain. Management is supportive and should generally include intubation with mechanical ventilation, both to guarantee adequate ventilatory support and to provide airway protection against aspiration. The role of naloxone is uncertain. Certainly, a patient who has overdosed on narcotics and is experiencing life-threatening hypotension or bradycardia should be given naloxone. Likewise, if naloxone is given to an unresponsive and hypopneic patient who does not necessarily require mechanical ventilation for pulmonary edema, the patient may be spared intubation. In contrast, for a patient who is intubated on an emergency basis because of acute pulmonary edema and who becomes clinically stable without hemodynamic compromise, better management may be to allow the narcotic intoxication to reverse gradually rather than precipitously. There is no evidence that naloxone helps speed resolution of narcotic-induced pulmonary edema. In fact, naloxone has been reported to cause pulmonary edema.32 Furthermore, acute reversal of narcotic intoxication in a long-term addict could result in agitation, with marked sympathetic activation and a less stable clinical course. This was exactly her treatment when she presented 5 weeks ago in severe respiratory distress. She was not given naloxon and her pulmonary edema resolved swiftly (first 12 hours). During her 3 - 4 day stay, she was scoped and investigated extensively, and given a lot of narcotics. Cocaine causes acute pulmonary edema, usually when used as free-base cocaine. The pathophysiology is uncertain. Like heroin, cocaine leads to a high-protein pulmonary edema that suggests endothelial cell injury and increased capillary permeability. However, as has been suggested with heroin, cocaine could lead to extreme sympathetic activation with a steep, extreme increase in capillary pressure that could produce a transient increase in protein leakage across the capillary membrane. Cocaine also causes coronary vasoconstriction, with acute myocardial ischemia or infarction, resulting in pulmonary edema. I will get the specifics on the patient in the OP after clinicals next week. I stand by my initial impression. She had mild respiratory distress, some pulmonary edema and it was brought on by her narcotic abuse. She came to the hospital hoping for more drugs.

I googled this and found http://www.chestjournal.org/cgi/reprint/72/2/230.pdf pretty cool. I know that this patient's diagnosis will likely be pulmonary edema caused by narcotic overdose because that was the diagnoses 4-5 weeks ago when she was admitted and intubated. The resolution was- as this article asserts - very fast and complete. She is under care of a pulmonary specialist who refuses to admit her to hospital unless/until she agrees to treatment by a pain management specialist - in our area, a euphemism for the guy that gets you off the narcs. While there is no doubt that the lady's issue is real, she also learned that breathing difficulty is good for 2 - 3 days worth of the really good drugs. She was playing up the problem. I'll get the data from this visit to demonstrate it to you but I know this is what was happening. Once again - thank you so much for your interest and input. I'm tickled because I thought it was pretty interesting and its nice to know you all think so too.

Dwayne.. you most totally and completely rock man... I too am a dumb medic student and the reason this case interested me is the lady sounded exactly like a guy I had picked up a couple of weeks earlier who was too obtunded for CPAP - and the discrepancy between the way she sounded and the way she looked I could not explain. It's a sad case in that the woman is definately a drug seeker, but her abuse of narcotics has now given her a very real problem.. I was in basic class with her husband, who is a very cool guy but when I started to talk to him about her drug issues, it was like mental blinders came down over his eyes and a very smart, articulate and funny man all of a sudden became purposely obtuse. I can't answer the specific questions about her because she was not my patient and I notified the appropriate people and left it at that. (I had alligators snapping at my ankles that I had to attend to). Next clinical shift, I will try and find out more and I will post it here because you say you are interested. Please wait for it and I will get it for you.

yep.. pretty well