Siffaliss

Actually that would be interesting to know. An EMR (and we've all been one) certainly doesn't have the background knowledge to understand the information presented in ACLS. It would be like sending a kitten to "puppy school 301" and expecting it to be able to bark ... or something ...

Yup. The school you've chosen has its own booklist, and it's best to abide by that for the abundance of your studying as they will be testing you on that information. Experience as a BLS provider prior to obtaining ALS education is also key, and will likely help you more than pre-reading a bunch of books that you'll have to trade in for required reading. Where I'm from medic school is a 2 year program, not including the year or two of EMR and EMT prerequisites. or the couple years of BLS experience that makes the coursework easier, and improves your chances of getting into a GOOD school.

Chocolate puffed wheat squares ...

Fortunately suturing is in the scope of practice for paramedics here. Medical director in larger centers won't allow us to do it on car, likely do to a very short transport time to hospital and of course, plastics. As for remote northern locations, it gets done all the time. Glue, thread, whatever is best for that situation. Some suturing taught to us is to stop bleeding (usually arterial) for the time being and transfer to a more appropriate facility, it's not all just fixing a cut. Judgement call as always.

Gotta say I pretty much agree with everything Dwayne said. When you're new somewhere, spend your free time ensuring you know where shit is in the truck. Study. Explore the truck some more. Ask questions. Repeat. And yes, slow down. If you get flustered and your heart rate gets up there too much, you'll end up with tunnel vision and can't focus on the entire picture. You'll learn that well as you go along. The only stupid questions are the ones you DON'T ask. Very few things are unacceptable in this industry. You'll need to quickly develop a very thick skin to deal with the BS from patients, co-workers, shift work etc. Pick your battles very carefully (especially when brand new), and always think things over thoroughly before to take them to a higher authority.

I had a similar call 2 years ago, questioned myself for a year following the call on my treatment decisions and speed of. Bottom line was, this guy had no chance even if a surgeon was right beside his crushed body. I also recall a question I asked of one of my EMR instructors 6 years ago when I was green and shiny ... "So what happens if you've done everything you can do and the pt still has no heartbeat, even after all that work? Can we do more?" He replied, "Then they die". This seemingly basic Q&A stuck with me through early schooling, my 5 years working in the field and now medic school. I think you already know that nobody is perfect and the good ones learn from their mistakes. You were probably running through that day over and over again, questioning yourself and the judgements you made. We all have those. Shit just went seven ways from Sunday for you that day. Don't beat yourself up over it, sounds like you did everything you could.

So the initial 12 lead showed NSR, what about serial 12 leads or any evidence of prolonged QT in serial 12's? Chance he got into someone else's meds, perhaps TCA's?

Unfortunately I don't recall word for word what my formularies say, so here are a few of the basic actions and contraindications for each drug. Other precautions are considered, however I have laundry to do and am running out of time for play stuff. Perhaps this will help ... Amiodarone pharmacodynamics - prolongs the action potential and refractory period (repolarization inhibition) - with prolonged therapy, the effective refractory period increases in atria, ventricles, AV node, His-Perkinje system, and by pass tracts and conduction slows in the atria, AV node, His-Perkinje system, and ventricles; as well SA node automaticity decreases - inhibits adrenergic stimulation and decreases peripheral vascular resistance (PVR) - some vasodilation Amiodarone contraindications - AV block, pre-existing 2nd or 3rd degree block (without artificial pacemaker) - bradycardia resulting is syncope – amiodarone reduces sinus node automaticity and may cause atropine resistant sinus bradycardia - sinus node impairment - sensitivity to amiodarone or iodine (contains iodine) - cardiogenic shock - thyroid disease Lidocaine pharmacodynamics - one of the oldest antiarrhythmics - suppresses automaticity and shortens the effective refractory period and action potential of the His-Purkinje fibers and suppresses spontaneous ventricular depolarization during diastole - unlike quinidine and procainamide, lidocaine doesn’t significantly alter hemodynamics when given in usual doses - seems to act preferentially on diseased or ischemic myocardial tissue; exerting its effects on the conduction system, it inhibits reentry mechanisms and halts ventricular arrhythmias Lidocaine contraindications - ventricular escape rhythms, idioventricular rhythms - severe degrees of SA, AV, or intraventricular block - hypersensitivity to amide-type local anesthetics - Stokes-adams syndrome (resultant cerebral ischemia from infranodal block due to disease in the bundle of His, causes dizziness and fainting) Current ACLS guidelines still state that either Lidocaine or Amiodarone can be used in a VF or pulseless VT code. I dunno what the new ones will look like when they're squeaked out later this year for drugs specifically in algorithms. Considering some of the contraindications for each drug and that you've of course gotten a full history (or as much of one as you can from frantic families and other sorts), AND are thinking about H's and T's, you might lean specifically towards one drug or the other. Remember that if you end up needing an infusion of an anti-arrhythmic to sustain ROSC, you would need to infuse Lidocaine if you pushed it, so on and so forth ... This is basic pharmacology knowledge we'd learned by the second year of my program, so ACLS was a breeze. Each code is different in one way or another, so I wouldn't say that it's always better to use one over the other. Getting ROSC is not really a save if they can't walk out of the hospital being able to lead a relatively normal life afterwards, it's just prolonging the inevitable. I've been in the field for 5 years now so I'm still green on a crapload of stuff of course. Of the several dozen codes I've been on during my EMS time so far, I've had 2 actual saves. LOTS of ROSC but nothing viable after transfer of care at hospital. One save was due to good family CPR and a shockable rhythm when we got there. We only had the tourniquet on for the IV, intubation kit was being set up and pt was being bagged with an OPA at that time. No drugs given here. The second was because we were right beside our pt when she collapsed. Ripped off the shirt, slappedy slap the pads on, oh look, v-fib ... she went from a GCS=3 to a GCS=15 within minutes, and is still around today. We had Lidocaine removed from our drug kits and replaced with Amiodarone, however it's not to be used for codes. Only as an infusion for those appropriate wide/regular/stable problems people have sometimes ...

As long as a pair of shears will cut a penny in half, they will go on my belt

Most schools here won't accept a potential paramedic student who doesn't have at least a year or two of experience on the road (transfers and industrial do NOT count). The occasional applicant may make it through perhaps based on good interview skills and who knows what else, I obviously don't do the interviews. On day 1 of medic classes at the school I attend, we were all told those with limited experience or no ALS experience would likely have a much harder time. The instructor was correct; those people did have a more difficult time especially on practicum #1. A practitioner should be 150% competent with their BLS skills and able to effectively run a BLS call from beginning to end before advancing to the next level. This of course only comes with experience. Learn to walk before you learn to run.

I was thinking something more along the lines of being related to phallic ...

Any comments on what the new logo looks like?

Suspected barotrauma is also a contraindication in AB.

Perhaps ... I think employers chance rolling with dice with anyone. They could hire a newbie with no experience in the field who will lose it on their first code or juicy trauma. They could also hire someone in the field for several years who's already burned out and won't last long. There are useless tards at every level. Some are just "made" for the field. I didn't have any previous post-secondary before entering the field a little over 5 years ago. Where I lacked in road experience entering the field at the ripe old age of 28 I made up for in life experience, and don't have a problem talking to any demographic. Talking is most of our job, and I don't picture myself doing anything else but this. What my longevity is due to physical requirements of humping stretchers, well, that remains to be seen. Perhaps looking at someone with a little more of the latter could benefit the employer, employee and of course the patient. This, instead of hiring 18 year old kids right out of high school who decided taking their EMT would be "cool".

On our PCR's it's not a mandatory field, so if left empty it doesn't ask for a reason why at the end when we attempt to finalize. Which kinda makes me wonder why it's there in the first place ...

I used to do it when I first started using E-PCR's when I started at my current job over 3 years ago. This was only because it was a field that was there, so I thought I should put something in. Stopped doing it a long time ago because I really don't feel it has any relevance to patient care. Race doesn't affect what I need or need not to do for any patient in particular.

Yes thanks, I have seen the poster and am well aware of what it says. I made my point however, and made it out of disgust for the verbal diarrhea I saw coming from that person.

Support and stand behind your troops, asshole ... or feel free to enlist and stand in front of them. You're obviously of no decent character, so in no position to be judging others as you just have.

I'd say I'm with Herbie and Lone on this one. I don't see the school showing scene pictures in an attempt to make you senile. First really good accident picture I saw in EMT school nearly 5 years ago now was of a man (still alive), who had been run over by a train and had his legs severed just above the knees. He was apparently drunk and passed out, woke up when he was being dismembered. Whatever. Ok, so it's just a picture. I've yet in my career after 5 years to have a pediatric code or pediatric trauma code, however have been so several adult cases of each. It will come, I will deal with it. It will probably be hard, but I'll quite likely find a way to get over it. Now I'm sure everyone here could revel in their stories as those of us on the road for a bit of time certainly have a few, but that's not the point. Pictures are one thing. Being on scene with the sights, sounds and smells of accidents, blood and body parts is different and most everyone finds a way to be the rock we're expected to be. It's what we do. To sit there and get MAD because the school that's trying to teach you several skills you'll be using in the field when you go onto those juicy scenes shows you a few pictures? That's just silly. Do your textbooks not have pictures of anything similar? Have you done any on-car stuff like ridealongs or worked in the field at all? Because (and I'm going to be blunt here) if you get that uptight over a picture, what do you think the real world will be like when you get out there? Yeah it can be a shock seeing and doing this stuff for the first time especially if you've been somewhat sheltered to that sort of thing. Something will get to everyone at some point, we deal with it and usually move on. If you end up finishing school and working on car, you'll probably know after your first really messy one if you're meant to work in EMS. Good luck to you.

The paramedic (EMT-P) program in Alberta is 2 years, not including the prerequisites as an EMR or EMT, or previous experience required and recommended. During the two years at the school I'm currently attending there is an approximate total of 16 months didactic and another 1400+ hours of clinical including an intermediate ambulance practicum, hospital practicum and advanced ALS practicum (over approximately 7-8 months). Our scope of practice can be found here: http://www.collegeofparamedics.org/Content_Files/Files/aocp_emtP.pdf There is too much to list ...

Paul, we'll all have a drink in the Bitch next week. Me, you, emtannie and whomever. Until then, my thoughts are with you and take care, Siff

Try a different service ... The bullshit calls are annoying and get on everyone's nerves. I got out of rural to get away from transfers, however with the amount of nursing homes and other such places in the city, they are unfortunately inevitable. I plan on moving out of Alberta (maybe even Canada) once done with medic school, as I'll only have more doors open to be after the further education ...

Ok so the RSI question has been answered. As for the other one, unless I've had too much wine I didn't see the answer was provided in detail ... Etomidate is classified as an anesthetic or sedative hypnotic (non-benzo/non-barbiturate). It's indicated for general anesthesia or short procedures that don't need skeletal muscle relaxation. It kicks in quick (15 to 30 seconds) but doesn't last long either (3 to 5 minutes), so if you perhaps want to continue sedation after intubating then a longer acting sedative is preferred (such as Versed). It has minimal cardiovascular and respiratory effects, and doesn't promote histamine release when you give it. ... as with any drug out there ...