ccmedoc

:scratch: I'd love to post an answer, but my eyes crossed half way through the first paragraph..I'm not sure what the question was?? :shock: :shock:

I say lock everything. If you then need to initiate a drip, use a clip or luer extension, whichever is appropriate. Without the administration set in the way, well, thats just one less line in the way. In the ED, the patients are most often changed to the institutions locks anyhow, right?

This is all that needs to be said at this point.. This is a highly emotionally and politically (are they different?) charged argument. As it should be. This is serious, not some 'do you use paddles or pads' argument..This has real repercussions, and goes further than someones pocketbook. An individual with a position on either side will most likely not, nor should not, be easily swayed away from their beliefs. Do not chastise Ruff for this. We disagree on this topic fundamentally, among other things I'm sure, but I have a HUGE amount of respect for him and the way he handled his argument for his beliefs. Some good questions have been asked, and many excellent answers have been given. This will most likely be a black and white issue, so leave the small fry attacks home. It has to be understood that, not believing individuals with these diseases should work in EMS or other health fields, this does not put individuals with these beliefs in the dark ages, this is real world thinking, and they have a good reason most likely. It's not the 9 post that make this comment worthless or lack credibility, it is the tone, and lack of substantial argument to back it up. Although it conveys a similar message, I don't consider this comment to bolster my position in the least. Like I said, its a heated argument, and is probably going to stay black and white...Just a good topic for good discussion, and maybe a huge learning experience, both philosophically and scientifically if you let it be.. I have not changed my stance on the subject, Only tired of the same old attacks on one person from the smallfrys of the world..... By the way..good topic, but the OP has 2 posts in this fray..How distressed about the subject was he really?? edited for a "d" and format

No problem..I must have read the posts a dozen times trying to find the problem with them...8-[ Thanks for making me think I was (am) crazy...Jeesh!

Fair enough.. I am not sure where I was going with the last bit I wrote, to be honest. I don't think I have any Prejudices or fears concerning this subject, either. I do, however, think that anyone with a disease such as hepatitis or HIV, given they take proper precautions, should not be prevented from practicing medicine..EMT, Paramedic, Nurse, Physician, etc.., if they don't mind putting themselves at risk. I believe the risk is greater to them than their patients. Where TB is concerned, I believe that with the proper treatment, and being away from patients until cleared with the three clear sputum cultures, a previously infected person should be allowed to practice. I think what I was saying was that a person most likely would not be held responsible for transmitting the flu or common cold to an immunocompromised patient prehospital, and it would be far easier to do this than transmit Hep or HIV. I just worded it a bit retarded..I read Ventmedic's posts and agree with most of those also.. And to answer the second question...I most likely have gone insane..It comes and goes, I'm just ridin the manic wave at the moment.. :wink: If we still disagree I'm sorry, but I think people can work with these illnesses when proper precautions are taken..thats all..

Prednisone is a steroid very similar to cortisol. In the body cortisol stimulates gluconeogenisis by the liver, often 6 to 10 fold increase from what would be considered normal. The cortisol may reduce the amount of glucose used by the tissues, and make them a bit resistant to the insulin, further raising BGL. Lipolsys is also stimulated increasing glucose levels, as well as acid levels. This is a potentially complicated subject, but this is a basic description of the mechanism you are looking for. Cortisol can be stimulated by stress, whether it be trauma, psychological, surgery, illness, etc. Prednisone being similar to cortisol..well you see how the blood sugars could be elevated? You should do some research online..I will see if I can find some journal articles in PDF format..

=D> =D> =D> =D> =D> =D>

I wholeheartedly recommend this option. The group CISD is, more often than not, a farce. In a professional, one on one setting, you will be able to open up more and learn more. Getting it out is only a part of the process. You must learn what you are feeling, why you are feeling it, and how to deal effectively with it. PTSD is a serious problem that may never go away. Dealing may be a lifelong process and starting early is the key, in my opinion. I have used both, the CISD at the request of my employer. Long term counseling is most likely your best option. Just asking for help, or seeking psychiatric counseling does not make you "crazy"....Not doing so may... There are many comments on here, I have made some myself, that make light of some of these feelings. Knee jerk reactions, if you will. I believe that some of us have heard so many times of people having a hard time, simply for attention. The genuine ones stick out, the truly hard situations that we also have been put in. Children being one of the worst. Try to put things in perspective and don't hold yourself too responsible. Try to realize that not too often are we going to "save a life"..our most important service is to influence patient outcomes in the most positive way possible, and bear witness to some wonderful happenings, and also some of the worst things imaginable..often so others don't have to... Try to take comfort in that you are not alone..Best of luck to you.... edited for wording

You don't by chance work there, do you?...thinking of moving down there shortly...

Going with this though; if you are sick with strep or another virus, or the common cold, do you think these could lead to complications quickly leading to death....certainly. There is probably a greater risk of these, droplet and airborne viruses and bacteria, infecting your patient than hepatitis or HIV.. Would you be held in the same irresponsible light?

TB being a reportable disease, any health care worker with an infection would probably not be working. As for the other diseases, HIV, Hepatitis; if you or the health care worker with them take precautions, I doubt any sharing of body fluids would be at issue. If the person in question were to stick someone after sticking themselves, well... Keep wounds covered and wear gloves and a mask when warranted to prevent body fluid mixing, thats all. The stigma is probably worse than the health risk.. My opinion, nothing more...

Negative skin tests are suggestive of no infection or exposure, and in the absence of signs and symptoms are taken as that. Anyone infected, or that has had a BCG in the last 10 years may test positive with the mantoux test. Any exposure will also probably test positive. Diagnosis is by sputum culture, not xray. You can be skin positive and TB negative.. To be cleared as non-infectious after having TB, you must have three clear sputum cultures. These cultures should be taken every 2-4 weeks during drug therapy which lasts from 6-12 months. Skin tests are not used to clear someone as non-infectious at this point. (BCG=bacillus Calmette-Guerin vaccine[sp?]...used in some european and eastern countries)

A lot of places used to allow IJ cannulation as well as subclavian..maybe this is what you were thinking of, Just a thought??

you'd have to be very comfortable with the patient's stability..I've seen pressures go from 110s over 60s to 70 over 40, in seconds..not great for the patient. In the field this makes for a VERY bad presentation to the ED.... :wink:..IV or not.

Thats a shame..You should lobby for on scene pronouncement after ACLS has been done for 20 min. Dead is dead, ya know. Whether at the scene or at the hospital...

I don't understand this comment or any reason for it. We do E.J. cannulation quite a bit on conscious individuals. If you need an IV, it is a sure bet in most cases..not too traumatic in my experience. As for nitro in inferior/right sided MI, An IV is a must for all the reasons previously mentioned. Not the best drug for the situation for sure. PCI is the intervention that is needed in this case.

Could it be Patent ductus arteriosis. This has been connected to ASA administration in third trimester pregnancy. The closing of the ductus arteriosis within a few days of birth. With PDA, the connection does not close. In utero, ASA has been associated with constriction of the Ductus Arteriosis, but only with high doses and late in pregnancy. Usually those doses taken for RA are quite high and ASA or other NSAIDs have been associated with the DA constriction, primary pulmonary hypertension in neonates, or oligohydramnios. Low dose ASA , to my knowledge, has not been specifically shown damaging in late pregnancy but more research is necessary. Risk/benefit is important to analyze here. This should be specifically discussed with med control and providers in the area as to what treatment would be acceptable. I don't think 324mg of ASA would be seen as high dose. My opinion.. edit:..It was brought to me that one baby aspirin a day could be helpful in preventing pre-ecclampsia or HELLP syndrome..just another thought..

The best way I can think of to help with the critical thinking is scenarios. He must have a good grasp of the basic knowledge though. Maybe have some quick question and answer sessions to realize the parts of the education he is lacking before trying scenarios. Knowledge is only a part of the equation though. Make sure he knows that it doesn't matter what he knows, if he can't apply it, it is wasted knowledge. Some people do not want to learn, and this is not possible to overcome other than asking for another partner. Maybe the lack of motivation has come from others belittling him for not being able to apply his knowledge to the job. If you show him you are willing to work with him on this, maybe he will come around. I think a straight forward approach is best with this and he should be made aware of the situation. Learn or go home...end of story. Mentoring has its rewards, but they are hard won sometimes. Some people just do not want to learn, and this is the hard reality. If he has trouble with a certain kind of learning, try to accommodate this, if he doesn't want to be taught, you will lose.... Good Luck with this.... All three levels of what? :?

GCS= "3"

Absolutely the best answer for your question. Short and to the point. They would be beneficial in the rural setting for first response only. to be used as an adjunct to paid, full time ALS..not a replacement. No BLS transporting volunteers, just as first responders. Opinion

That is one of the funniest things I have ever read...thank you for the laugh...

I would suppose that the child suffered from cerebral hypoxia, judging from how he was found. The posturing and moaning would not necessarily make him responsive to me. I don't think conscious would be an appropriate assessment of this child. Did the child respond to any noxious stimuli, or any stimuli. Did he withdraw from the IV sticks?? I still think the child was most likely unconscious. To answer your question, unconscious patients can cry, moan, and grimace from pain...if the brain senses it. Sedated patients in the ICU will respond to pain with an alteration in their vitals and, at times, facial changes.

I'm not trying to argue here but, can you call the hospital or medical control hospital and get permission to go further if the patient desires? I'll leave it alone now..I was just curious how you guys worked..sounds messed up!

I think the IO is the least of the kids problems.. If they needed the line..perfectly acceptable. My opinion

This is so very true..They tout it as so efficient. How efficient, or responsible even, is it with the petrol prices so high??. Just another area it falls short. IMHO