Kaisu

Dfib - it's not so much the terrible danger of free radicals that concerns me... it's the treatment before assessment. How are you going to get any kind of baseline on anything until you do the 5 second or so assessment that we all do on the scene? The problem with scenarios is that there is a lot of information that we get on scene that we have to ask for in scenarios. I was trying to prevent the cookbook approach and more importantly, delineate the steps of a good, thorough scene size up and immediate impressions.

regarding the O2 - premature.. until we get answers to the preceding (excellent) questions. We don't have an initial impression yet.. so no treatment yet

PS.. Brotherhood is insulting.....

Thank you for the prayers, good wishes and solid advice. I always appreciate the good comments. Captain Kick, Arctik and others that suggested I talk to the employer - great advice. I did, telling them what I had told you. The response was amazing. They told me that they admired my strength and respected my priorities and to let them know when I was ready. The opportunity would be there for me. I was so humbled and grateful. It was a validation of the effort I had put into my job, driving myself to be the best I could. For those of you concerned that I am in fact "enabling". I totally hear you. I think when I was younger and stronger, that would have been an easier trap to fall into. Now that I am in my 50s, I can't afford to not take care of myself. I do appreciate your cautionary notes. This environment is toxic. It almost destroyed me. The bottom line is I got out and healed. I became a productive and vital member of the human race and I am so grateful for that. I know what it takes to change a life and I also know that my kids and grandkid have something I did not - they have me. I don't think I am a superwoman and I know that it is their lives and their decisions and their ultimate responsibility. What I do have is the roadmap and the t-shirt and can often prevent the wrong turns. Dwayne - sometimes I think you know me better than I know myself. I love you big guy - always have, always will. Happiness - you are my girl. I know you always have my back. Mobey - I respect you so much. It means a lot to me that you would help me get a job. I do have a timeline. When this house is done, I am out of here and after my own dreams. Thank you again for your help and advice. I don't know what I would do without you people. I am just kicking myself that I carried this so long by myself instead of coming to you all sooner. Keep those prayers coming. Love Kaisu

Here I am struggling with a personal decision (again) and this is the one true place where I can just let it all hang out. I have been working towards a flight medic position since I started EMS. The job became open a few days ago. I am honored to count the base manager and the most influential member of the selection team as a friend. (He was a newbie about 6 months after I started at an eat-your-young type service and we became friends). His number 2 man is my best friend's husband. The manager told me that although they had 1000+ applications, I am at the top of the list if I want it. I go into all this detail so that you know that this job is as much in the bag as anything can be. I would be thrilled to be doing it. The problem - my family is in big trouble. Since I arrived here in Canada, I have supported and assisted my youngest child's (21 yom) decision to become sober after 3 years of daily pot smoking. He has been clean for 2 1/2 weeks and has a job interview tomorrow. My granddaughter completed a treatment program 3 days ago and I am home schooling her to get 2 credits so that she can go to a regular high school in the fall. My eldest daughter faced financial difficulties because of poor relationship decisions and cannot get her mortgage renewed. She is paying interest only at 12% for a year. I have several months work on her home to get it into condition to sell so she can get out from under and get her equity out for a fresh start. My mother and father are both very ill. I have been supervising their medical treatment and making sure they are compliant and as well as can be expected. My husband is alone in Arizona currently. He also has health issues. I am flying back to AZ at the end of the month and bringing him to our home in WI for the summer. He resents the time and energy I am spending on my family and attacks my efforts to help as "enabling". Most of you know that my brother committed suicide last August. I cannot live with myself if I abandon the people I love when I am truly being helpful and something awful happens. I have pretty well decided that I will tell the flight company that I would love the job but would not be available until September. I'm pretty sure that means I am kissing the job off.... I would appreciate any comments you may have. Thank you so much for listening. I love you all.

That hyperthermia is a killer. I took in a patient with once with an internal rectal (taken at the hospital) of 107F. I had cardioverted twice en-route (he was in the middle of the desert with no first response and I was alone in the back of the truck.) He went from a perfusing tachycardia to a non-perfusing one, but unlike your ecstasy guy I was able to cardiovert successfully with a pretty small dose of electricity. (I think 50 joules). Be that as it may, the ER doc made fun of my cold packs in his axillary, his groin, abdomen, etc. In this man's case, drugs were not involved. He just got too hot, didn't get cool, and died. Other than the cooling methods mentioned above, anything else we could do for these patients?

I knew it... thank you smart person

I have to totally agree with mobey and am just sorry I didn't think of it first. MAP is something I learned to use when I ran CCT. That is something that is not obtainable with a manual BP (as far as I know, and may be corrected once again - thank you smart people,) It should be taught as part of the vital signs. It's easy and furthers the concept much more effectively than the stroke scale IMHO, PS.. I'm not sure I agree that the magic number is 60. Like everything else in medicine, it is highly individualistic. I have seen patients with MAP of 50 doing just fine. edited to add ps

awwww.. you silver tongued devil. I can't understand why you have trouble getting laid.... .

Oh girl.. If only you had been around when I started at my first paramedic job. They did everything in their power to drive me out. My co-workers had a pool going for how long I was going to last. The highest estimate was 2 months. I stayed for 2 1/2 years and by the time I moved, they loved me. More crazy, I loved them. As a new paramedic, I was pretty sensitive. Now, the crap they dished out would make me laugh and I would dismiss it. I realized that if I focused on the pettiness and the BS, I wouldn't last a month. I ignored it. I concentrated on patient care. It's what I loved anyway. I critiqued myself after every call, researched any questions I had, and spent a lot of time on this site. There were no medical mentors available for me in that BS service but I found the best mentors in the world on this site. I would get on here daily and cry about how unfair it all was. The people here would bind my wounds and kick me in the ass when warranted. Many told me to leave. (I am pretty stubborn. I will run but I will be damned if I will be run off.) They were a reality check. That service made me. I am proud of who I am now. I can't tell you to leave or stay. I stayed because of the huge call volumes, the acute medical calls, the fact that I was often the only medic on that scene and I felt my patients needed me. Chin up. Hang out. Learn and grow. All the best to you

In the minimal hours required for EMT-B certification? Hardly likely my friend. There isn't even time in that curriculum to explain what BP is.

Thanks for the update. Always good to know how things are going.

It is a very difficult thing to go through. You are doing very well. Take care of yourself. It is important because I know your family needs you. I will be praying for you.

Yes he sure was. I feel very privileged. He is an amazing man - an EMS visionary.

Welcome. I got my training up in Wisconsin. I am a Jeff Clark paramedic. (he's since retired). I did my ride time up in Northeast Wisconsin/Michigan border and it sounds a lot like the area you are describing. It's nice to see someone from "home".

I renovate houses. I've flipped 3 of them. I do some landscaping. I built a 5000 gallon pond and waterfall in my backyard in Wisconsin. I sew - made an authentic Victorian era receiving gown with over 300 yards of silk ribbon embroidery on it... I read a ton - always have a novel on the go and sometimes even read things of redeeming intellectual value. I used to do dressage, but when I moved from Canada I had to sell my horse. I am currently retired from the martial arts, however, it is my intention to get back at it. I love to paint and draw. I would like to get a degree in fine arts. I don't cook, clean or do laundry.

good for you Toni! I wish you every success and happiness.

yeah.. I mis-spoke. I use it as one tool.. sometimes a sternal rub is necessary, but not nearly as often as people do it. I can't tell you how many drunks come up swinging from a provider's sternal rub when one really isn't needed

I treated a guy who shot at an ambulance. I had about 10 seconds of internal struggle and went into the rig to get my supplies with a less than gracious attitude. It was tough.

I keep waiting for the decade when the stupid arm drop test is relegated to whackerdom. Providers still bring it up, usually with a stupid grin cause they are oh so smart. I touch the eyelashes. The corresponding reflex movement of the eyelid is enough to reassure me that my patient is protecting their airway.

The first intubation attempts I made in the OR were comical (now). My hands shook, flop sweat ran down my face and body and a dropped instrument made me startle out of my mask. I kept at it. It was tough. It was difficult to stick with it but I made it. Had 18 tubes in the 48 hour OR rotation and double that many LMAs. The time to get over your nerves is now, in school because it doesnt get any easier in the field. Good luck edited because I said ED, meant to say OR.

Amazing film. I am reminded of the biblical passage that states (paraphrased) that the sins of the fathers are upon 7 generations. History of apartheid and government sanctioned oppression = violence, upheaval and even more suffering. Every situation in the world that is dealing with unequal opportunity and distribution of wealth can be traced to oppression. In North America and Australia we have the problem of Aboriginal destruction of family structure, apartheid (reservations) and racism; slavery in North America and other parts of the world ; the separation of Palestinian and the Israeli. It is a sad and fallen world.

neurological symptoms.. I would guess heavy metal poisoning...

I carried it on CCT. I found it very useful. Interesting learned from experience bit - We often had renal/hepatic failure patients that were extremely restless, combative, etc.. probably because of elevated ammonia levels among other things. Taking them on 3 - 4 hour transports was a daunting prospect when they were fighting restraints. I found that 1 mg of ativan followed by 1 mg of dilaudid put them into peaceful sleep. Don't know why that combination but I used it a lot.

I would stay rural and get my education. A positive work place and professionals you can respect will teach you a lot more than the turn and burn environment where you don't get a chance to learn from those calls. Believe me, high call volume and lots of grinders gets old real fast. Do you plan to work while in school? even part-time? If you need to combine work and school, the low volume shop is a no brainer, leaving you the time and energy to pursue your studies. Good luck to you.