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triemal04

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triemal04 last won the day on February 2 2016

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  1. Yep. In all honesty, I think it would be in a departments best interests if they were ALL on the fence about this until they took a good, hard look at their particular area and capabilities. Giving it to cops is one thing; they have zero ability to ventilate a person and may be on scene for several minutes before anyone who can shows up. Better withdrawal (if it was packaged in a 2mg dose) than an anoxic injury or death. For EMT's...depends. How well can they use a BVM? How long would they be with the person before a paramedic arrived? How often would this actually be needed? Worth think
  2. Sarcastic? Absolutely. Sadly though, there was more truth in it than there should be. Get to that in a minute. For you, I'd suggest that you actually learn a bit about pharmacology and the in's and out's of narcotics, narcotic withdrawal, and narcotic antagonists instead of just parroting a textbook. Because as I said, giving someone 0.4mg of narcan, or even 0.8mg if it's needed is not going do all those nasty, dirty things you mentioned. And even the lowest common denominator can be taught how to dry up 1cc of liquid and inject it into the deltoid or thigh. Now, given that the sarcastic
  3. What effects are you talking about? The ones that won't exist if this is done using more than 2 brain cells? Just because an EMT can administer narcan does not mean they need to be giving a large dose; 0.4 or 0.8mg is all that is needed in probably 95% all all narcotic OD's, especially if paramedics are also responding. I know there is talk of developing an auto-injector ala the epipen, but a much easier thing to do would be to give EMT's a 3cc syringe, 18g needle, alcohol wipe, and a 0.4mg vial of narcan. Just like they give to junkies is some places. Of course, this being EMS I do unders
  4. http://jama.jamanetwork.com/article.aspx?articleid=1778673 I'm sure you already saw this. Retrospective analysis vs randomized trial...132 patients vs 1359... Therapeutic hypothermia isn't necessarily dead, but I think (based on other info) that just keeping them from getting hyperthermic or even slightly cool is plenty.
  5. I got sent this recently so I can't take any credit for writing it. And while I have some minor quibbles with some of them, all in all I think it's a pretty decent list. Observations of and old paramedic 1) When you sew on a new patch, you’re not an expert. It just means that some governing body has authorized you to learn your job. 2) Never, ever, ever fight with someone for the opportunity to help them feel better. 3) We don’t save lives, we postpone death. 4) Documentation serves 3 purposes: it informs the ER what you saw and what you did about it, it gives the business office the opport
  6. Junkies don't call 911 as often as they should, or stick around to help the patient (CPR in someone in respiratory arrest or severe respiratory depression works people) as often as they should...but a lot of times they do. The cops...unless someone there is being a douchebag or something blatantly bad is going on (the 16 year old girl laid out in a roomful of dirtbags...not that that EVER happens... ) or you work in some small place where a heroin OD is such a big bad thing...most cops are not going to waste their time busting someone for a couple bags of heroin. It's a pain and waste of tim
  7. I think it was Boston EMS that did something like this years ago...and then scrapped it because it wasn't making a difference. Really, given the increasing controversy over when tPA should be given, or even if it should be given for most eligible strokes, this really just shows how out of touch EMS is with both current trends in medicine, and where medicine is going. Maybe someday people will actually realize that there is a point where trying to do more and more and more passes the point of diminishing returns, and that, even in targeted systems, a lot of the patients that get treat
  8. Yes. A degree in buisness admin' (or a MBA if you actually went that far) would be very beneficial in both the fire and EMS worlds. Not at the base level though. Having a bachelors might help you get a job, but as a line paramedic or firefighter you won't use it much. However...if you ever decide to promote or move into the administration side of things, then it will be very helpful, especially the higher up you go.
  9. And you know that you are not afraid of blood and guts...how? Even disregarding the fact that "blood and guts" is a very, very small part of being a paramedic and is one of the less disturbing things that you will see, your implication that you can handle the unpleasant parts of the job is true because...why? I'm sorry, but being able to make decisions while playing a very simple game with very set rules and expectations does not mean that you will be able to think quickly, accurately, and objectively under duress in the real world, especially in the medical field. There. Now that
  10. What about it? There's really nothing to say other than to dispel some myths; no, you won't lose your certification, no, you won't be held responsible for not performing a paramedic-level intervention if your job description is that of an EMT, no, it is not illegal in ANY state (I dare anyone to try and prove me wrong on that one ), yes, there are places that require this for various reasons, yes, a company can hire someone with a paramedic cert to work as an EMT. Depending on why a particular department does this and how it is set up it can certainly be a good thing, a bad thing, or an
  11. Yes. And it's very easy to understand why people will market shit like this, AND why people will buy/use it. One, because it's always such an ego boost to be able to tell people you are using all these fancy toys that nobody else is...because, you know...you CARE about people and are such a GOOD department. Two, because to actually change things to make a difference in cardiac arrest requires some effort. And fuck effort, ain't nobody got time for that! King County used to stand out with very high resuscitation rates (using Utstein criteria); for the last few years more depart
  12. Aaaaaaand? Come on, this was actually an interesting situation...
  13. Well he's certainly having a bad day. I'd still like to know what your total door to door time will be. What resources does the hospital have immedietly available? ie is anesthesia and ENT in house and available? Start by moving the BP cuff and pulse ox to the left arm and recheck the values. If the sat is still only 95% it's very likely that you are either missing a pneumo/hemo or blood flow to the lungs has been compromised. I would still be very concerned for additional injuries, or damage to major vessels that has been missed due to the other internal bleeding; unfor
  14. What actually happened to the patient? When did it happen? Other than a CT what other interventions and tests, if any, have been done? What has been the trend in his vitals? What size plane do you have? What will your door to door travel time be? Start with your own exam; any other injuries or abnormalities to the entire body? Chest injuries? Lung sounds (and review the x-ray if it was done; 95% on a NRB isn't right)? If you are good at ultrasound pulling that out might be nice, but really that can wait until you are airborne. What is the injury to his hand
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