BAYAMedic

Upon looking at the website the X1 was generation one and they have been replaced. I think due to the limited sizes they are clearing shelf space for new model inventory. BAYAMedic

I have no evidence based research to back this up but rather my twisted thought pattern. We have a didactic measure with the CBT. It quantifies the fund of knowledge and adds a scenerio based logic test based on the variables programmed through school. In a field as hands-on as ours can be, doesn't it make since to have an evaluation by a non biased, third party, to verify ability of intubation, cannulation, medicine administration, ECG interpretation, and two medical and trauma skills station? In nursing typically there is another nurse there to assist in the event of failed IVs, a anaesthesiologist for a doc who can't get the tube. Where ALS providers are often running solo, although far from an enforced national FTEP program, I feel it does better than a written only test to verify entry level abilities. BAYAMedic formerly known as Fireman1037

Wendy. I plead/drink the fifth. My weekend a year ago was one of the best I have had in my career. I raise a glass to the City, 'zilla, and most of all to Rob. BAYAMedic formerly Fireman1037

Ok I have a few questions, that sugar seems a bit high post seizure, as well as a relatively high heart rate for a pt. on a beta blocker. 12 lead? Could you describe the seizure activity for me? What's her mentation now and what's her baseline post stroke. How is her medication compliance? And is she having parkinsonian symptoms or restless leg at baseline? BAYAMedic And what was on TV at time of seizure?

1274 mg/dl on a CCT from a rural hospital

Very true, I heard the same thing last year at CAP lab from that MD that miss Eyedawn took such a fancy too *wink* infact, he said that he has successfully used Adenosine through an IO placed in the humeral head. BAYAMedic

For what were you allowed to use propofol?

Ok guys, lets start with pre-intubation meds. My protocols give me the option for Etomidate 0.3mg/kg, or Ketamine 2mg/kg (if etomidate not available) Anectine 2mg/kg for Induction, with Vecuronium (very rarly used) at 0.05mg/kg (Continued, detrimental agitation in the intubated patient that does not respond to midazolam and analgesia.) Versed for post intubation sedation. 2-4mg every 5 minutes. How many of you have rocuronium or other non-depolarizing paralytic for initial intubation? LIke wise does anyone have Propofol or other seditive in the field? Please post if your protocol varies from mine BAYAMedic

Ey, With known HX of Haldol, that presentation lead to extra pyramidal unless I see something else jumping out at me. Giving the Diphenhydramine first you have a (semi) conclusive R/O of the Dystonia. With a complex focal Seizure, the Benzos will break the Seizure, but what caused it in the first place? Any time I can treat something that treats a causative issue or gives a diagnosis versus treating a symptom, I would prefer to go down that track. BAYAMedic Secondary thought and answer. Harm in going with the dyphenhydramine before Benzos? Its a stretch but I would say the potentiation between the two would cause increased somnolence and possible respiratory depression. BAYAMedic

If it is hardware you need, I recommend Home Depot. If it is Groceries, Safeway isn't bad. If it is Ambulances, I am a fan of the North Star line by Braun Northwest. If it is Uniforms, LA Police Gear has a fine site. If it is Toilet paper, Costco is hard to beat on price and quality. Need I continue on indefinitely until I guess what your needs are, or will you humor me and narrow the spectrum a bit. BAYAMedic

We all know that paramedic intubation is a point of contention globally. The fact it is a diminishing skill, and OR's are hard to get time in, and historically a bad percentage of recognized gut tubes are all valid points. However, I live in an area that it is common to get one to two tubes (or more) per medic per month so proficiency here, is better than some areas. I want to open the floor to discussion on airway management and the protocols you have for RSI, Etomidate only intubation, and code only intubation. I hope we can, in this discussion, discuss drugs and sedation and doses thereof, Tools utilized: conventional, archaic and cutting edge. I would even like to discuss the supraglottic options. I know many, if not all has been discussed in the past, but this forum hasn't had the activity as of late, so I would like to have a good old fashioned debate about this stuff. Any takers? BAYAMedic *edit* Typo, no content changes

I have to agree with Mike on this one. If this is, in fact a research question, then you should be using good peer reviewed sources rather than a Semi moderated forum, such as this. What makes you go towards tardive dyskinesia over a dystonic reaction? What other pathologies could cause a presentation for this? Yes, most if not all ALS providers carry something for appropriate treatment of this condition, however Medical control may need to be contacted due to higher than normal dosages required. BAYAMedic

I, the EMS provider formally known as Fireman1037, have completed Paramedic school. As of 0630 this morning I am a NREMT-P. I felt since I was now a Paramedic and I am haven't been on a structure since 2005, a name change was in order. Folks you can now call me BAYAMedic. Joshua aka BAYAMedic

Well folks, I did it. As of this morning I have successfully completed Paramedic school. I will be testing in the next couple weeks andthen begins my state cert waiting game. I want to thank the site for all the support the last few years. A special thanks to some Awsome friends who encouraged me along the way. Kiwi. Thanks for being yourself. Helpful and fun. Eydawn. So supportive a great friend. Doczilla. Your CAP lab took me to the next level on all things airway. Admin. Thanks for the site to allow a meeting of the minds. CAPT. Ruffles thanks for the flight to CAP. Dwayne. You drunken SOB. I love you brother. Thanks for all the support and conversations and making me choose the hard road. Last of all Rob "dustdevil" Davis. You mentored me through hard times as you were having your own. Thanks for you insight in professional EMS. Fireman1037 Josh And soon to be known as BAYAMedic.

I spent 20k US to get my Paramedic. Out of my pocket. Out of my class of 24 students only 3 were sponsored by agencies. Very similar ratios exist in the 3 other programs I am familiar with. It doesn't come down to the training budgets, It comes down to people driven to the industry. Does every hospital babysit their nurses and make sure they attend all required CME's and bolt on certs and give them time off to ensure they do them? Or do they expect them to be adults and maintain their licensure? Its been said before and I will say it again. Every county/city has a garbage man and every hospital has an RN, both of which get paid better than the average street medic. I feel like we need to be doing more public education of what we do before it comes to levy year for EMS. then they know what that % of assessed values goes to rather then another tax added. FIreman1037

I sincerely hope I am misreading this. Let's talk about survivability in Vtach/Fib arrest. Have you seen the survivability curve? That" 5 minutes " of bringing them to the rig is far from acceptable. And why put a body in your rig if not ROSC. Bring all resuscitation gear in. Work the code. Then move post ROSC. Fireman1037

All calls get the airway bag that contains: BP cuff/steth D cylinder Nrb, cannulas, Neb mask, T-Neb, BVM adult and peds. Airway roll: ETT 6.0-10.0, styletts, bougie, 10ml syringe, colormetric, tube holder, handle and mac 3-4 and miller 4. Jet insuffalation kit Surgical cricothyrotomy kit. Thoracocentisis kit Trauma modules with 4x4, vaseline gauze, coban, kling, abd, etc. Procedure masks, emisis bags, red bags extra bsi stuff. Loved the idea of the symptom med bag on the monitor. I intend to steal that and implement that here. Fireman1037 *edit to add a few items*

In regards to the snake and staff, it is as likely to be the snake and rod referenced in Numbers 21:6-9. "And the Lord sent among the people deadly serpents, and they bit the people, and much people of the children of Israel died. And the people came to Moses and said, We have sinned, for we have spoken against the Lord, and against thee: pray therefore to the Lord, and let him take away the serpent from us. And Moses prayed to the Lord for the people; and the Lord said to Moses, Make thee a serpent, and put it on a signal-staff; and it shall come to pass that whenever a serpent shall bite a man, every one so bitten that looks upon it shall live. And Moses made a serpent of brass, and put it upon a signal-staff: and it came to pass that whenever a serpent bit a man, and he looked on the brazen serpent, he lived."

Ahh Semantics Mike, It would be a false positive if we call the test, a pregnancy test. However, if we call it an Urine HCG detection device then the results coming back would be a legitimate positive. Dwayne, The reason a male would take one, as it was explained to me, was a quick down dirty cheap test for testicular cancer. Not sure why this would be used solely as I would think additional markers through blood work and histology would be used, But something that came up in pathophysiology back in school. Fireman1037

Currently Certified as a Basic, and have about 4 weeks until program completion of Paramedic school. I work for a small Private, for profit, 911 and IFT Agency. We also run a Cabulance/ wheelchair van service. We are unique in the aspect we also have a few contracts with other agencies to provide atypical EMS services.We hold a contract with the Forest Service to do Forest Fire Medical standbys, A contract with a COncert venue to do Concert standbys, and other event standbys. We have been known to respond to nursing homes to start IV's of do lab draws for the staff, Do legal blood draws for the Washington State Patrol, and we do Removals of bodies and transport to the funeral homes during nights and weekends. I also am a Volunteer Fireman that works on a non transporting aid car. Fireman1037

We just got it, and I have heard of several other places getting it, in the wake of Etomidate being unavailable. P.S Kiwi, you gave me some great info about 2 months ago about the Kittymeenz.... on a thread right here on the City.... Damn silly Flightless birds.... Fireman1037

One such case of false positives is a male with testicular cancer will come back positive. Fireman1037

how about you draw a wicked cool new logo for the city here?

Damn you Richard. Between your suggestion and my total lack of self control when it comes to freebies with purchase... the free Stainless steel 5.11 water bottle and a clearance fleece blanket are on order... Fireman1037

Good question! I currently carry Zofran and it does moderatly well with nausea, but as soon as they have tossed their cookies it seems to be shooting a BB gun at a battleship. I have been far more impressed with Phenergan as a anti emetic. And as a new medic but in conversation with the old guys, Inapsine seems to have taken the cake, before that annoying, overreactive, blackbox from the FDA. Fireman1037