ccmedoc

I 100% agree with your opinion. I do not think that providers medicated for depression compromise care..quite the contrary..I believe that not providing the appropriate medications and counseling does just that, compromises patient care and caregiver health.. I was curious, since it seemed popular opinion that providers being medicated with antidepressants were a liability, if the opinion changed when the providers in question were physicians.. I think this is the common misconception, and the articles kind of point this out.. This is where the last discussion went south, in my opinion..more education on antidepressants and how they work would help the stigma you speak of.. perhaps I could have worded the first part of my post differently, I was more referring to the previous question than advocating for it...

I don't know why this surprised me so.....I guess I just didn't think it was this big of a problem...It begs the question asked elsewhere, if it was acceptable to have medical professionals medicated for depression...... Just over one suicide a day........... :shock: [web:e024a5677a]http://www.familydocs.org/files/physiciansuicidefactsheet.pdf[/web:e024a5677a] Some more on the PBS special and the information available.... http://www.newsweek.com/id/132887 http://www.associatedcontent.com/article/7...de_rate_of.html http://www.doctorswithdepression.org/

Perhaps more than a little :wink: ..I have a couple of friends in Iraq as civilian medics (or so they say)..I wish I could swing it, but I have too many responsibilities here. Good luck, have fun, and be safe..

did she wear a corset?? Maybe she 'caught the vapors'..... -just sayin'

Diuresis will be necessary for maintaining kidney function..dialysis for the toxins..rapid transport to a facility with dialysis on site would be advantageous....I disagree with the tourniquet..I don't like it.. Attention must also be given to assess for compartment syndrome and fasciotomy performed as necessary..these are not as 'in vogue' as they once were, but when necessary, they can save the limb.. cardiac monitoring is paramount, along with urine output and urine color...both can indicate impending problems..In my experience, Bicarb and calcium chloride are not usually administered without labs...if the patient is suspected hyperkalemic..fluids, insulin, and glucose may be given emperically, along with high dose albuterol..blindly giving bicarb could be considered malpractice, and has not been shown to improve outcomes without high CK levels...as far as I know.. In the absence of dialysis, a foley with fluids and diuretics (loop diuretics preferred) may be indicated after consult with medical direction depending on length of transport and the length of time the patient was trapped...again, not as much for electrolyte control but to keep the kidneys functioning in regards to the rhabdo that is undoubtedly present..... The rhabdomyolysis is the killer here..

8-[ Grammar cannot be understated....is this intentional?? Maybe I put too much emphasis on literacy, but...... :dontknow: :banghead:

The minimum requirement in Michigan is one MFR and one EMT-B..no such thing as an ambulance driver anymore, although the MFR is as close as you can get in any state..not worth the paper the cert is printed on..medically wise anyhow (opinion).. If a medic is on board with an MFR..the ambulance is basic..not ALS..I think this is a bit crazy, but that is the law..

It actually does minimize the sting that some feel with administration of the morphine, and some other narcotics..some individuals (pts.) dislike the fact that the narcs are reduced because it minimizes the 'rush' the patient may feel..patient comfort is one reason, but I feel that ease of administration is the primary reason it is done..

#-o What did he say??? :dontknow: About those English/grammar classes

I'm curious as to what my working as a basic has to do with anything.. I still have not heard many intelligent arguments being made for the benefit of working as a basic before a paramedic. Certainly none compelling enough to justify it being mandatory... Rest assured it has been discussed here ad nauseum....I suggest a search on the subject.. Most of the AAS paramedic programs around here..that I am aware of..produce a graduate paramedic without very much time as a licensed basic..should they be mandated to work six months as an EMT? What would this accomplish? what is the benefit? This is not to belittle basics..just tell be why working as a basic, or having to be a basic first is a benefit...... :wink:

Whats to hate...JPINFV has it correct... I still have not heard a valid argument for working as a basic EMT first...Straight to medic is the way to go...

Just a heads up.......wikipedia is NOT a reference.. 8) --just sayin'

If you want to succeed and be respected by your peers, be given more responsibility and the "skills" everyone seems to base EMS on...you have to prove you have what it takes to thoroughly understand and use them.. --just sayin'

Would you be willing to correlate the studies for nursing and additional education to that of EMS. I seriously doubt that any studies for EMS and the advantage of increasing education are available, since advancing the educational standards is a relatively new concept for EMS. Although I firmly believe that Nursing and EMS are very different, I think a bit of insight can be gleaned from articles such as this.. http://jama.ama-assn.org/cgi/content/full/290/12/1617 If increasing the education for nurses decreases patient mortality, I have to believe that it is a small reach to apply this to EMS.

Professional adj. 1. Of, relating to, engaged in, or suitable for a profession: 2. Conforming to the standards of a profession: professional behavior. 2. Engaging in a given activity as a source of livelihood or as a career: 3. Performed by persons receiving pay: 4. Having or showing great skill; expert: amateur n. 1. A person who engages in an art, science, study, or athletic activity as a pastime rather than as a profession. 2. Sports. An athlete who has never accepted money, or who accepts money under restrictions specified by a regulatory body, for participating in a competition. 3. One lacking the skill of a professional, as in an art. I think the paid professionals have it... I don't want the amateurs at my, or my families, house if the need arises...Passion aside :wink: --just sayin'

I just caught this....all I can say is.....WTF :shock: This is embarrassing, to say the least... -just sayin'

I believe that the reference to dry drowning is incorrect. I was under the assumption that dry drowning was in fact asphyxiation secondary to laryngospasm after sudden submersion in cold water...the person drowns with no water entering the lungs... This case explained, what I have been taught as, secondary drowning..occurring after a near drowning episode. The small amount of water entering the lungs causes irritation and, subsequently, fluid production. The resultant fluid accumulation and fluid shifts produce a pulmonary edema and the individual drowns in this fluid. This can occur many hours after the near drowning.. Some say that a small child can drown in a tablespoon of water due to this condition. Another reason not to leave small children alone around water....

This is very probably one of the most ignorant statements I have read on this site..I am at a loss for words.. :oops:

I don't think you are talking out of your butt, this can be a very heated issue and argument, as well as somewhat vague. Some people, professionals and otherwise, still believe that PTSD is bunk.. although the terms in these articles are not official diagnoses, most psychological professionals recognize them. They are variants of PTSD without a name, as of yet. Cumulative PTSD is very real and is coming to the forefront of public safety, emergency services, and military psychology. Here are a few excerpts with the pages for reference. I have not done an exhaustive literature search, just a few minutes.. First: While it seems as though the final trauma is the one that affected you, it isn’t. Your PTSD would then be the combination of all the traumas you have experienced. This would take more time, because you would need to digest and master all the traumas you have experienced. http://www.mental-health-today.com/ptsd/ptsdther/3.htm Second: The focus of PTSD is a single life-threatening event or threat to integrity. However, the symptoms of traumatic stress also arise from an accumulation of small incidents rather than one major incident. Examples include: • repeated exposure to horrific scenes at accidents or fires, such as those endured by members of the emergency services (eg bodies mutilated in car crashes, or horribly burnt or disfigured by fire, or dismembered or disembowelled in aeroplane disasters, etc) • repeated involvement in dealing with serious crime, eg where violence has been used and especially where children are hurt • breaking news of bereavement caused by accident or violence, especially if children are involved • repeated violations such as in verbal abuse, physical abuse and sexual abuse • regular intrusion and violation, both physical and psychological, as in bullying, stalking, harassment, domestic violence, etc Where the symptoms are the result of a series of events, the term Prolonged Duress Stress Disorder (PDSD) may be more appropriate. Whilst PDSD is not yet an official diagnosis in DSM-IV or ICD-10, it is often used in preference to other terms such as "rolling PTSD" and "cumulative stress". http://www.a2zgorge.info/prevention/PTSD.htm Third article: http://www.emich.edu/cerns/downloads/paper...e%20Officer.pdf Although local to me and Police based, this research project illustrates the effects of multiple exposures resulting in cumulative PTSD. I do not advocate the CISD, based on my own research and experience, but to each his/her own, right? Fourth: Abstract: Two and one-half years after the September 11, 2001 World Trade Center attack, 204 middle school students in an immigrant community located near Ground Zero were assessed for posttraumatic stress disorder (PTSD) symptoms as influenced by "dose" of exposure to the attack and accumulated lifetime traumas. Ninety percent of students reported at least one traumatic event other than 9/11 (e.g., community violence) with an average of 4 lifetime events reported. An interaction was obtained such that the dose-response effect depended on presence of other traumas. Among students with the lowest number of additional traumas, the usual dose-response pattern of increasing PTSD symptoms with increasing 9/11 exposure was observed; among those with medium to high cumulative life trauma, PTSD symptoms were substantially higher and uniformly so regardless of 9/11 exposure dose. Results suggest that traumas that precede or follow mass violence often have as much as if not greater impact on long-term symptom severity than high-dose exposure to the event. Implications regarding the presence of continuing or previous trauma exposure for post disaster and early intervention policies are discussed. (Cumulative trauma and posttraumatic stress disorder among children exposed to the 9/11 World Trade Center attack. Mullett-Hume, Elizabeth; Anshel, Daphne; Guevara, Vivianne; Cloitre, Marylene American Journal of Orthopsychiatry. 2008 Jan Vol 78(1) 103-108) Variants to the ‘standard’ PTSD are inevitable. Everyone is affected differently depending on coping mechanisms, or lack thereof. More and more of what is being learned about these disorders is being refined into new diagnoses. Whether you choose to agree with the legitimacy of them is largely an individual preference..As with most psychiatric dilemmas. :wink:

I think the 'intense' part of the description you offer is correct, it is also very subjective. One person's intense is another's mundane.. If she had a rough career, or last couple of calls, this could have been enough. I often think that the more experience a medic (or others exposed to human tragedy) has, the greater the possibility that they will develop a PTSD. By repressing, or avoiding, these unpleasant or traumatic memories..they build up. It only takes one more event for the memories and emotions to come rushing back..a flashback of sorts. This can be very debilitating and difficult to deal with. It was obviously very hard on this person to be available and to not be allowed in to help. I would imagine that if she were allowed to treat this patient, and he died, she would have put the experience with all the others and continued the build up. Maybe the increased media attention was the trigger for the pent up remorse from the previous incidents..the final straw.. I agree with the irritation of the over dramatic individuals, when everything is too much to bear, but how do we identify these people..largely on history. This is, of course, my opinion and I respect and appreciate yours also..PTSD is difficult to find in any scenerio, this I am still very cautious with CISD..Patients who don't know better ways of coping with their conflicts might actually get worse when those conflicts are rubbed in their faces if further steps are not taken to teach alternative coping methods...This needs to be done through professional means.... Hopefully a little different view, hopefully

I was just trying to understand the conversation..I probably could have worded it differently, but the discussion seemed to be getting more and more clouded. I guess I thought there was a point I was missing.. Oh well, live and learn.. 8)

I agree with AZCEP, you should do only what the patients needs. For this reason only, not 'because you can'. Aggressive treatment is a noble thought, but you tread a fine line between helpful and harmful. Aggressive is not always what the patient needs, especially kids. I think as a rule, least invasive interventions first are best. You should be bagging while preparing your intubation equipment anyway, how can that be the wrong answer? Priorities brother.. --Just sayin'

OK..... Fluid for the distributive shock and possibly the cause of the PEA (relative hypovolemia ?) Epi for the alpha and beta effects I think since excessive vagal tone may be the source of the bradycardia, Atropine would be indicated as a vagolytic. This has nothing to do with the SCI, only control of the vagal response. I guess I fail to see what the muscarinic, nicotinic, postsynaptic, presynaptic, etc talk has to do with anything. Other than direct damage to the vagus nerve, why should a SCI have any impact on the effect of atropine in this 'application'? Last I knew, Atropine had little effect on the CNS at these doses you speak of.. 1.Atropine is absolutely indicated for rate control. 2.Fluid for the obvious effects of the SCI, and probable cause of PEA. 3.Epinepherine or Neosynepherine to increase SVR 4.Dopamine as necessary.... Either I am oversimplifying this, we are talking about different things, or you like to argue over moot points... Just because the brain no longer controls the nerves doesn't mean they can't be stimulated by other means.. Lots of big fancy words..doesn't read especially well..kind of a circular argument What are you trying to validate? :shock: With all due respect, I don't see it. :?

Now that is comical..they 'recommend' actual patients and qualified faculty.. I shall stay away from California..

From what I have been hearing, California may be one of the few places that an excelsior grad.(?), may get a quick job. I had a gentleman tell me today that you don't even need a license to work there..just graduate an 'accredited' program..Some kind of provisional certification..I can't find it anywhere. I don't know if it is true, but it sounds kinda hinkey to me..