ccmedoc

Yyyyyyyyyyep....

They are kind of crud anyhow (my opinion). The drop(drip) factor was at issue last I heard; not exactly consistent. At any rate, on an ambulance it doesn't really matter, short of a pump you will not get any consistency. The only study on these 'dial a flo' I was aware of was done on HEMS.

You wont get very precise in the back of an ambulance, it is near impossible in the controlled settings of hospital. Any variance.. vibrations, bending of the arm or wrist, movement of the patient, raising or lowering the infusion; affects the drip rate. I feel the "titrate to effect" is most often practiced here, and put to a pump as soon as possible; dubious practice at best.. All of the drips used in the prehospital seem to be very tight tolerance; as far as dose/effect. Gravity drips manually set are very labor intensive and impractical for everyday use. Necessity is the only reason I can see these used. It is (has been) routine in one of our hospitals to infuse ABX and less touchy infusions by this method. This has since been stopped. There are no real tricks to setting one up, it is just foolish to expect to "set it and forget it"...it wont happen that way.. Vasoactive drugs are labor intensive on a pump, let alone on a gravity drip..

I wouldn't think physics is particularly relevant, unless you like physics . I like chbare's list, don't underestimate the importance of the computer literacy, composition, and mathematics courses. With all the electronic charting and PCR coming to the forefront, you may be glad for them; and it bumps the progression possibility. If you don't want to be a nurse, don't. You will be miserable and your patients will suffer. You can set yourself up for degrees in other specialties with a good base of pre-requisites as chbare mentioned. Err on the side of sciences if you need additional credits. Ethics and psychology would be a great benefit to you; most certainly in EMS. I would stress that you should not rely on the training you get in your paramedic course alone to totally prepare you for the job.

And the wheels keep turning...These threads should not be allowed to propagate.. But on an intelligent note = This is it...

I agree with NG/OG in the field, Foley is marginal (sterile). I think maybe we have differing opinions on what constitutes a central line, but where in any national curriculum is a central line advocated for a field paramedic??? And yes, we have seen a shift from the diuretics and towards NTG and ACEIs in a few areas..CPAP or BiPAP is very nice, but how many areas have a true CPAP or BiPAP or vent setup in their ambulances??

I get from the thread that everyone assumes that after inspection of the abdomen, the very next step would be palpation or percussion..general assessment procedure would follow the pattern: Inspection, palpation, percussion, auscultation..generally this is correct. Where an abdominal assessment differs is the ordering of the vary same tools. For the abdomen it should be: Inspection, auscultation, palpation, then percussion. There are a number of reasons for this change, mainly to attain an accurate assessment. If there will be pain associated with palpation (and there usually is), then you would want to inspect the abdomen and auscultate it before you interrupt bowel sounds or other abdominal signs by causing said pain and guarding. Even if the palpation is not necessarily painful, the agitation will alter peristalsis and bowl sounds..You may ask what do bowel sounds have to do with anything??? You should read up on abdominal assessment...(i.e. hyperactive bowel sounds with intense pain = ?). You may never see this sign if you are pushing and thumping right away.. My point is that in the OP asking about an abdominal assessment, the auscultation should have been performed after the inspection; certainly after seeing the protrusion in the lower abdomen.This would lead the astute clinician (I know.. ) to adjust palpation accordingly or even postpone it until later after USS, CT, or MRI..or until the physician took patient care. Adequate abdominal assessment could, and should, be done without undue pain. Following correct sequence of assessment can clue the clinician into the next appropriate procedure. With the proper assessment training, that is...But maybe I expect too much.. My opinion: IPPA = upper chest A/P, flank, and select epigastric assessment IAPP = Abdominal assessment (ALWAYS) Always attempt to minimize pain..... (EDIT:grammar)

I dont recall this protocol, it must be a regional thing..Basics can, indeed, honor the DNR if it is present and valid. Contact of MC may be prudent though.. Some examples.. Kent.. Another..Here LCA and Genesee County is attached as PDF..they all say that the protocol applies to all EMS providers..The Basic EMT not honoring the DNR is an exception rather than the rule, I believe.. If any family wants the resuscitation started, I believe the DNR is revoked..as far as I know. The papers must be filled out, signed, and presented to the EMS personnel.. GCDNR.pdf

Nope. They usually have them for a reason. I more often wonder why we are resuscitating them and why they don't have one..

@Medicone: Actually that is known as funnel chest...or pectus excavatum Pigeon chest is the protrusion of the breast plate...or Pectus carinatum As far as the reason for the A/P paddles or pads in the pectus excavatum, it may be because the corrective surgery involves placing a curved bar across the chest for some time..This may impede the current from directing towards the other paddle..A/P placement may avoid the bar. The bars are not permanent, so after a couple years of surgery and recovery, the point is moot. Recurrence is unusual after correction, but I would be curious if the procedure would make the chest wall stiffer. the chest is also wired, so this is a concern?

Yep..Most ED docs pucker up when they have to keep an ICU player for more than a couple hours..Usually when they meet criteria, they are headed for a big bed. Not to be confrontational, but me thinks Bryan20w needs to reread the last part of the thread..To compare the strongest medics with the strongest (read ICU) nurses is not a fair comparison, simply due to the added educational availabilities for nurses as compared to most medics. You are right though, it is apples and oranges..

I would imagine the answer to the lying question would depend entirely on the ethical construct you associate with. Virtue ethics, deontological ethics,utilitarianism,ethical relativism, etc.....to each his own. It would appear that the Medical control director was advocating a very paternalistic approach...saving people from themselves, as it were... were there any examples of this misplaced advocacy (lies to get them to the hospital)????

Looks like broken teeth to me..from the demonstrations anyway... I think this is gonna prove useless. Any more reasons to take EMS from the FD???... /jk

@jwade I, too, love working as a paramedic; and I still do. I do not, however, have any illusions as to the extent of the differences between the educational requisites of either profession; EMS or Nursing. I find those courses to be a bit excessive, and I would love to see the program, if the anomaly still exists.. You must agree that is no where close to the norm. That is on par with average entry requisites for a BSN program, an AAS most likely does not require all the science, particularly chemistry. I am not arguing this, simply stating it is borderline inconceivable. EDIT: Vent, it is because MI is becoming a cesspool..Not much is going well in this fine state..

I have read this last part of the thread, and I really don’t know what can come from this discussion. The education of a nurse and a paramedic are different. Maybe in the community college the pre-requisites are the same or similar, but the core classes are different. As far as I know, ADN nurses do not need chemistry courses, but require a biology/microbiology course. I think this is not required for AAS paramedic yet is it, it wasn’t for mine. I think these go a long way to understanding the base of disease and treatments, certainly from an outcome standpoint. Most nursing pharmacology courses are much more in depth than the paramedic curriculum, if you attended the same course as nursing, count yourself lucky and in the majority. Paramedic training, education if you are lucky, focused on emergent, short term care and taught in a very medical model. Find the problem, focus on the problem, and fix the problem. Nursing is a more holistic assessment and treatment process, and brings into this process a lot of psychosocial and less tangible factors than medicine. I think you can assume, and you would be correct, that the nursing model incorporates many aspects of the medical model; plus the additional factors of home situations, recent lifestyle changes, ability to care for oneself, support systems, etc. None of which would be taught in any paramedic program I have been associated with, although they are all proven to affect the healing process significantly. The additional education in psychiatric nursing is far beyond anything you will see in paramedic school; community health is non-existent in any programs I have seen; geriatric medicine is a specialty barely touched upon in paramedic education, but what percentage are the elderly in your patient logs? Pediatric education is severely lacking in the paramedic education, but is a primary course in nursing; how many pediatric clinical rotations were in paramedic school? There is a depth and breadth of education issue, I believe, at the heart of the question at hand. Nursing education is much deeper in detail and wider in breadth than that of a paramedic. Simply a difference in curriculums and focus; the intent was never to have a paramedic perform long-term care, as far as I know. As far as skills; monkeys can learn skills and perform repetitive tasks, but thinking through the technology and how it is going to affect the patient is certainly dynamic and an exercise in critical thinking. During all the “clinical” in the ICU, CCU, Stepdowns, med/surg, etc; how much time did you spend actually caring for a patient, talking to the patient and their family, assessing the treatment plans, adjusting the plans accordingly, conversing with the physicians and students and interns….. I still believe that there is a big difference between the “education” a paramedic attains and that of a nurse. Most paramedic programs are based on training that, like it or not, is based on cookbook type medicine. The average paramedic school graduate doesn’t not have the education that an average nurse has, and I can also pretty much guarantee you than a well educated paramedic would not have anywhere near the education or training that a well educated and trained ICU, CCU, or other intensive care based nurse would have, unless they were also the latter. This, of course, would start the micturation competition you were not looking for. As both a very educated paramedic and a fairly educated nurse, I can assure you there are differences between nursing and paramedic. Both have their place in the health machine, and are two totally different animals. Although I don’t think nurses should insult a profession they possibly know little about, if the nurse worked in the ED for any length of time, the insult was likely warranted. You say you are educated to a much higher level than most paramedics (medically I assume); she sees most paramedics. Most medics are the same way towards nurses and they are both way off base. I still think that comparing a paramedic education to a nursing education is ludicrous, and I also know this discussion will be going on long after this thread is closed, regrettably… If you don't want to be a nurse, don't. There are already too many disgruntled practitioners out there that are only in it for a paycheck. This can make for very poor patient care and you will be very miserable....I guarantee it.

I see no need to pause for intubation, at least not for very long. If you are placing an alternative blind airway, you wouldn't need to stop either. If the medic is prepared, the laryngoscope can be placed and visualization can be done with little cessation of compressions..I guess this is where preparation and a little foresight come in.. Poorly run arrest. You would think that an arrest is the least stressful part of being a paramedic. It should be down cold, with little apprehension.

National curriculum or not, this is unacceptable. 30 Seconds is a long time, and I think that the medic should know in a few seconds if the airway will be difficult or not. A rudimentary assessment could possibly clue him in to that before he even gets into the hypopharynx, and maybe allow him into being a bit more prepared. I would also say that maybe just an OPA and bagging could benefit this patient more, in refractory VF as you state, as well as potentially allowing a more beneficial treatment..ETT is certainly in the plan, but if the airway is open and patent with a more basic airway, then other interventions take priority; i.e. compressions, defib, and meds... I stand by my assertion that a cursory assessment could predict the airway troubles and dictate perhaps different prep, more assistance, or postponing the ETT for a bit....Simply some armchair quarterback, but this is how I try to approach a situation such as this.. I think that a longer period of compression/oxygenation should be allowed before a second attempt..Was any monitoring of the SaO2 possible while doing this?? Just curious and I am still not sure how accurate this would be...

True, true, true...It seems that nursing is pushing through to get the DNP as a preferred track, while at the same time not having the resources to adequately educate at the BS or even ADN level. I have even heard talk about the CC level colleges offering a BSN. 1/3 of the students from the last BSN class in the University I am affiliated with are not even planning on staying in nursing or nursing education. They seem to prefer the BSN as a launch pad to anesthesia. This contributes the educator shortage for sure; but comparing salaries, who can blame them. I think it is prudent to get our own house in order before putting these statements forth. If I gave this impression, I apologize. As easy as it is to pick the shortcomings of EMS education, Nursing is far from being a model of efficiency..

I think this is the most important issue..if you want to be a Paramedic, and concentrate on flight..then you should. You need to have your full energy into whatever you choose, and make it yours..I love working as a Paramedic, and do it quite often in the cities around here. To do nursing because other people think you should or for a paycheck will make you miserable.. JakeEMTP has the attitude of a lot of ground medics that have never been on a flight. I would not discourage you from vacating MI, I will be leaving in the next couple of years myself. It is a mess up here and I don't see it getting better any time soon.. Good Luck and enjoy whatever you do..If you choose an accelerated BSN program, they are not difficult, but very busy..expect a significant time investment.

Hmmmmmmm Anyhow, the NREMTP test is very simple. There are no tricks to passing it other than knowing entry level paramedic information. If you have to take the test more than once, I would look to the instructors, or maybe EMS is just not your bag. I re-certify every two years by the test, even though I have enough CEUs, just to keep tabs on the testing. I think the CBT is much easier than the old written, and I am sick of hearing how the man has put it to the "would be paramedics" taking the test..Conspiracy theory 101 is in session....

There have been reports and studies showing a direct correlation to reduced mortality and morbidity with higher educated nurses (ADN vs BSN. Something from the ACCN: I am curious where you get the information about the basic education classes included in the BSN programs, if you have not gone through one yourself. Your "BSN MGT 101" reference seems to be a sticking point for you. If you believe the only difference between associates and bachelors degree is this, you are sorely mistaken.. There have been many reports issued that also state that a major determinate in good patient outcomes is education of the caregiver, not experience. We could debate this all day, and the evidence to the benefit of BSN can be presented as well, I seriously doubt you will be swayed so the point is moot... Source: http://www.aacn.nche.edu/Media/FactSheets/ImpactEdNp.htm

Noted...

IMO the ADN to BSN is quite a bit different than the basic BSN program. with online classes and the limited interaction of the transition, I think you (the students) get more out of a traditional program and that is specifically what I was speaking to.. Online matriculation is adequate at best. The clinical rotations and focus are different between a ADN program and a BSN program..(transitions not withstanding..Medic to ADN is another area fraught with inadequacies... I think BSN nurses that started a bachelors program think different than ADN nurses that transitioned..this is simply my experience, and certainly a generalization.

I think I can let this post speak for itself...A look into the curriculum would prove this wrong... I believe there are seven or so flight programs in Michigan, Kzoo switched to RN/RN some time ago, and the couple in Mid Mich are making motions that way..That is not a debate here though..Maybe I should have said most instead of a lot in my post...... Probably N-Flight and the St. Joes will be the last two.. At any rate, there is more to a BSN education that stats and management, and I cant remember finance being part of it....pre-requisites are more science oriented with additional emphasis on evidence based medicine, pharmacology, chemistry, etc...I think the programs make you a better thinking and more well rounded Nurse. Understanding the process a little better. But I am biased for sure..I guess if increased knowledge and education about interventions, outcomes, and critical thinking doesnt provide better patient care, then I am way off base to prefer the BSN model.. Go for the BSN then the medic.. It will make you more marketable at least...

Something else to think about is that if you are serious about the flight nursing, most will require a BSN any more. I know a lot of HEMS in Michigan have phased out the Medic/Nurse and are going to Nurse/Nurse. One, that I know of, is RN/MD..An ADN is not going to cut it in a very competitive market in the near future; certainly not a matriculation from medic to RN... Just some food for thought.....