ccmedoc

"Primum non nocere"........or is it ...Do the least harm possible? I would think that a civilized society would respect the beliefs of different cultures and religions. How is it civilized to impose ones will on others. In some instances this is seen as tyranny, but here it is seen as a civilized societies mandate???... I believe that it is morally reprehensible to demand that a person or persons relinquish their beliefs when the only harm done is to themselves or someone in their family. It is only when the act begins to affect society as a whole, most often negative effects, that preparations must be made to take action.IMHO.. Is it worse to let the family unit survive with their beliefs intact, or save the child with taboo procedures, and have the child, and most likely the family as a whole, looked poorly upon in their circle, or ostracized all together? To be shunned by the faith is not unheard of. It simply is not our choice to make for the most part. We are to provide the best care possible as a medical professional; medical, emotional, and to their beliefs. This regardless of our own beliefs. I have also been in a situation where a court order was had to administer blood to two children of this faith against parent consent. As it would happen, one survived, the other didn't. The parents did not return for 2 weeks. This child was not looked on with the previous reverence, and I doubt life was the same for the family, irregardless of the other loss. They were prepared to lose two children, and indeed they did. The additional hardship forced upon this family, and their community as a whole was something to behold. I am not sure how to describe how strongly the satff still believes, myself included, that the wrong decision was made by the physicians in this instance. We have been referred to webpages such as this in our parctice..there are more current hanges in the blood policy, but is is on a community by community basis http://www.ajwrb.org/basics/change.shtml

I would say if no one had responded yet, possibly fresh MVC..stop and be sure that the potential patients are alert, breathing, maintain calm, and are not dragged out unnecessarily and injured by other bystanders. As soon as the professionals on duty arrive, it is most often wise to back off as they have their own way of doing things....most often. Above all, don't get in the way. Being new, this can be very easy to do and can only end bad in most cases. If they don't mind you watching, stand back and learn!!! Keep yourself safe........

Good question, short answer is Yes it can, pregnancy is very stressful. Another issue is DKA can be observed at lower glucose levels than in non-pregnant mothers that are diabetics. This would possibly delay the diagnosis and put the mother and fetus at high risk. In a woman with diabetes, pregnancy has the potential for increased complications due to drastic changes in the mother's carbohydrate metabolism. A growing fetus is dependent on the mother's nutrient supply of glucose, amino acids, and lipids. This supply mostly is regulated by insulin. In the early stages of pregnancy, insulin sensitivity is normal or increased. However, in later pregnancy, the hormonal changes associated with fetal growth such as the rise in estrogen, progesterone, HPL (a hormone similar to growth hormone), prolactin, and cortisol, are all associated with insulin resistance. The biggest contributor to this resistance is most likely the HPL as it is a known insulin antagonist. This resistance is maximized in the third trimester as maternal insulin levels reach a bit of a plateau , leading to an increase in free fatty acids, which further aggravates insulin resistance. All of these changes in insulin sensitivity and in glucose and lipid levels have the potential for adverse complications for the diabetic mother, and contribute to the aforementioned DKA potentially occurring at lower levels than in non-pregnant mothers.

My account was used by my partner while I slept and now I must apologize :oops: . I would like to apologize for his sophomoric attempt at humor..He's young and thought this was funny, not realizing that this forum is VERY serious for the most part. ..That rocks.. :headbang:

Augmentin=Amoxicillin and clavulanate potassium

:binky: OMG :shock: condone....NO.. Think its funny that someone is actually stupid enough to do that....YES

she taking any cholinergics, by chance 8) .....I doubt it is cardiac, but I could be wrong...happens all the time..Absolutely NO thyroid Hx??..I guess GERD would be possible??

I still cant find meds?? :oops: ...only antibiotics??

during transport did you get her meds and allergies?

MI, costochondritis or pericarditis for a starting differential..I'd like to see an ekg tho... :wink:

does the pain quality change with position change????

does the pain change in quality or intensity on moving to different positions?..if so, does leaning forward decrease or increase pain..Laying down increase decrease pain.. How long ago were the stents and how long has the abcess been there?? Need a guess?? I'll wait for more assessment...

Most likely vomiting, resp. distress, and we have had patients with blisters on their face from the transporting unit putting them in NRB or under the line of a nasal cannula bilaterally...not pretty :shock: I like this one.. ..That rocks.. :headbang:

I think UVC is quicker and more effective, if your protocols allow for it. NRP calls for UVC and does not teach IO as "...there are limited data evaluating the use of intraosseous lines in newborns...". Although they do say it may be acceptable in the out of hospital environment with the previous limitation. This from the Neonatal Resuscitation Textbook, 5th ed, AHA. 2006.

I posted this in another topic of discussion...kinda applies here. I don't think necessarily do away with it, for transfers and such..just not in EMS proper. Emergency ambulances should have paramedics. This was the formality I was talking about. Unless you WANT to deliver advanced first aid for a living, not many people get into EMS to be a basic EMT. Aside from the aforementioned FF and lifeguard..I don't think there is any valid argument as to the necessity of basic before medic, and against incorporating the basic curriculum into paramedic degree..notice the DEGREE part...

good post...I need to clarify the ceu requirements as I have always had well above 72 in the two years and never been audited. I will also agree that the FP-C is the most difficult cert test I have taken, and there is no good way to prepare other than experience and exposure to the CCT process....maybe luck. :wink: I think we agree that the test should be an available way to recertify, although should not be the only way to recertify...Just another option.

Maybe normal for the patient, but the correct terminology should be addressed. A normal sinus rhythm is just that, normal rate, rhythm, and all intervals within normal ranges. If there are deviations, PVCs, then not NSR, but sinus with the PVC. like was said, semantics..but correctly labeling the rhythm will help convey findings to other caregivers. I agree that no treatment is necessary for this patient save oxygen and monitoring. After history and transport, if it stays benign, then possibly normal for patient. If the NREMT need pharmacy, then the 1-1.5 mg/kg with repeat of 0.5-0.75 mg/kg is correct to my knowledge. It would appear that semantics play an important role to this proctor?

I was under the impression that 72 ceu were needed for paramedic recert. In some areas, it is difficult to get these and, to be honest, the test is not that hard. I'm still not sure why the failure rate. It sure seems to be a bit easier than the written one, if the questions for the recertification test and certification test are indeed from the same bank. I agree that seminars, lectures, and recertifications have their value, and updating your education or information base regularly should be a professional decision not solely based on recertification or relicensure. To recertify for the NREMT...a test is a good way to be sure you have maintained some sort of minimum competency, at least on information recall or application. It wasn't until recent that FP-C could be recertified by ceu, and it is a bit tougher to get them approved as they have a 100% audit policy for the classes and credits claimed.(edit )I bring this in because I believe that this certification holds more creedence than NREMT...My opinion I think the test is good and should be available, with additional clinical or practical ceu or documentation necessary also..If you take the test and fail, you simply need to satisfy the 72 ceu requirement and the necessary signatures..

I disagree, in fact. Unless an RN is specifically working prehospital, whether medic or PHRN, the scene control is never in their hands to begin with. It is often a detriment to have them onscene unless they have this particular training. I believe that most don't want to be put in that position, as they know the limits to their training and licensure demands. Simple and concise..unless an RN is working as an RN..they are simply joe samaritan and can be expected to be treated as such, worse if the trap opens up and arrogance ensues. :shock: If you need ALS in an area, put ALS in an area..there are a few posts that show it is feasible, both fiscally and logistically..It all comes down to how bad it is wanted or needed. Do away with the volunteers and amazing things happen :twisted: Another humble opinion...

I took the test in Nov. for recertification...what a joke!!..sure beats trying to gather all those credits in two years. I'd do it again, sixty questions and out...(LUV the C.B.T. from Pearson Vue.) I think they will stick to the recert every two years, I think they should add practical competency proof though, we have to in Michigan to keep our license every three years. 10 practical credits minimum. It would be a good start..

Some of the best medics I have had the privilege to work with or teach NEVER worked as a basic. It is not much more than a formality in most cases, to have to be licensed as a basic first. With the scope of practice at this level, I don't much see the use in EMS as much as transport work and maybe first response. I'm not trying to be a sh!t, but it is what it is..all the basic education can and should be incorporated into one program and leave the basic classes for lifeguards and FF first response...probably not a popular stance, just an honest opinion. :wink:

Stop volunteering and its amazing how fast the finances are found..Someone has to start it though...someone with a plan..

perfect!! :salute: :thumbright:

Agreed..Can they be taught to aquire a 12 lead accurately? Anyone can..techs do it in the ED with essentially no previous medical training. The facts are that it serves no beneficial purpose. A 12 lead can be aquired by a paramedic in less than two minutes if need be and interpreted as fast. For the cost of outfitting basic ambulances with a lifepack 12 in every ambulance, employ and deploy a few additional medics and more benefit will be realized..IMHO No rhythm analysis needed for AED. This "No medical training" comment does not hold water with the machine and subsequent algorithm analyzing the rhythm for the provider. When the box says shock...shock. I dont, in recent recollection, know of any advanced provider needing to call ahead for defibrillation instructions. Johnny and Roy do not count.. :roll: Saying a lifepack has an AED function will not fly either as the expense far outweighs the benefit of EMT generated 12 leads..

Jackson MI. has them I believe they call them PSO..Public Safety Officers..all crosstrained and rotate shifts. I'm not sure I like the idea though. Staying certified and lisenced may be a bit rough, it would seem, along with keeping up on current modalities of care and performance of each profession. I believe it is Jackson...somewhere down state anyhow.. :roll: