Kiwiology

I did read one or two articles about it a while ago randomly on the interweb one Saturday at 1 or 2am (yeah, my life is boring) and all said significantly improved outcomes for patients who has prehospital steriods or corticosteriods. One small service here currently has hydrocortisone the rest of us have ventolin and adrenaline only. I'd love to see us get some steriods in our tool box!

Patient is unconscious w GCS 4 (1/1/2) Nuero will localize painful stimuli No track marks BGL is 6 mmol or 108ml/dl Temp is 37°C or 98°F Pupils dialated Negative meningitis New vitals PR 50 RR 24 BP 170/100

Cool potatoes .... with no prev sz hx any guess at what might have caused it?

You know this very was just in an episode of Emergency! I saw the other week and no no I would not attempt it beyond the reduction we apply with the traction splints (Hare or Seger). I don't want to go playing with moving broken bones and risking lacerating an artery or nerves; those x ray glasses that came with my Marvel Man comic suck balls. I'm not an orthopedist.

Patient is still seizing; 5mg of midazolam settles it down nicely. You get the following from da ho's: S: N&V, lethargy, headache, unable to pass urine, generalised cramps x 2 days A: NKA M: NA P: NA L: Unknown E: Was hanging out with the other frat sisters BP is 160/100 PR is 84 reguar RR is 20 NL ECG shows inverted T waves in Lead II

So I posted this earlier and it vanished .... You are called to a local frat house for a seizing female about 20. Her frat sisters report she was feeling unwell/N&V the last few days, uanble to pee and had been having cramps. Tonight she was partying when she began to complain of a headache and started to seize shortly thereafter. The college med school lab is at your disposal should you request it.

You don't get "hired" as a First Respoder from my experience. First Responders are usually cops, boondock volunteer fire/rescue squad or people who need some form of medical training but not enough to be an EMT, AEMT or Paramedic - like people who work at Disneyworld (as an example, but they have EMTs) First responders typically do not drive, render any patient care beyond oxygen/AED and are used as a stop gap measure in very, very isolated and rural areas where the response time for even a BLS unit would be long enough to compromise outcomes. With that in mind, did I mention Flordia does not have them? (from the FL DOH EMS site) Take a chill pill dude and wait. If you are so uber keen go down and see if you can volunteer at the local ER or something or go out with Fire Rescue on some ridealongs.

The answer is NO, simple. It does not matter how badly you want it, think you should get it or need it, the answer is NO. I realise that you are young, sparky and ambitious but the National Registry of EMTs (which is the certification body used by most states) has a requirement of 18 years of age or older (click for more info). With that in mind; I must ask WHY you want to be an EMT; is this a career move? do you need it to be a firefighter? do you want to become a doctor and it would "look good"? .... or, are you a nutjob who is into red lights and sirens?

I would ballpark a liver problem simply because of the size of the liver in relation to the RUQ; but it could very well be something else. How large is this mass? Like are we talking a pimple or golf ball sized? It could be a herniated liver.

Lets see .... RUQ contains gallblader, duodenum, right kidney, part of the liver, pancreas and colon (go Marieb's A&P) ... could be anything from a big ass hernia to a ruptured liver or something in between If it were altitude sickness or elevational hypoxia he sure isint showing it What did hsi brother have? What is the enlarged area like; does it pulse, change colour, move etc, what does palpating it produce; tendernedd, rigidity, pain etc?

- How is his physical condition; does he "look sick", yellow eyes, mottled skin, hair falling out etc - Has he been sick like this before? - If he has, is it better/worse than last time? What caused it last time, does he know? What made it go away? - What was he doing 3 mo. ago when he started to feel sick? Has he changed jobs i.e. could something there have made him sick etc? - Does anything make him feel better or worse? - Has he been toileting, eating, drinking the same as usual? Is he eating/drinking the same [food and water] as everybody else? - Is there anybody else sick? I'd like to check his bowel sounds, blood sugar, XII lead, pedal pulses and sensation and palpate abdo

Dude, first of all I wouldn't be in Afgoatastan I'd be on the job in that ad I saw online for medics in Ziare making the mint cash ... anyway - Where are we? i.e. out in the desert, down on the bayou, remote wilderness etc - What type of camp is this? - i.e. camping ground, vocational base site e.g where forrest workers or fishermen live - What sort of facilities do they have? e.g. water, food, toilet/cooking facilities; is the water clean, food can be cooked to adequate temp, store properly ... - Who lives there? what do they do for work, kind of like #2 above; i.e. could something on the job make them sick that they can bring back? - How do the people here live? do they all live in one big tent or something, you know, thinking infection control/isolation I'd rock on down with the usual (first in bag, monitor, O2) and for some reason something tells me taking the N95 would be wise I would speak to somebody first before seeing the patient to ascertain if he was vomiting or coughing up anything nasty; bleeding from the eyes etc; this is obviously a remote facility with what I'd take to be limited outside assistance and supplies; I don't want to contaminate myself in case this guy got ebola from some monkey out in the forrest or something. Usual crap, SAMPLE, vitals, ECG, primary and secondary survey, pertinent negatives ....

It varies here depending on if you are a volunteer, paid, already certified or not and which area you are in (remember for the volunteers and new hires in Auckland, training/certification is on the job rather than done pre-employment) If you are a volunteer you do the following (generally, not always) - 1 day induction "welcome to us" touchy/feely session - 1 day bridge program to bring you up to first responder level (O2, AED, BVM) - 2 day driver course (at the end of which you are able to drive L&S if the tutor feels you can) After which you are able to be in the truck responding to whatever the dispatcher puts you to. You will be paired (unless at an all volunteer station) with usually an ALS or ILS provider as paid BLS is rare but not unheard of. You will need to complete 10 calls as the driver including P1 (L&S) then you get signed off as being able to drive on your own. If you are doing the internal education track you need to do 3 online modules (about 12 weeks), 6 days in class and document 20 calls explaining your treatment, rationale, self reflection etc and have 3 of those reviewed by a mentor. If you are successful in that (which can take anywhere from 4 months to a year depending on your station workload and how fast you complete the modules) you become a qualified Ambulance Officer (BLS) where you can give NTG, ASA, O2, use the AED, and insert an LMA/NPA. However if you are a new graduate of the Bachelor of Health Science (Paramedic) degree (having just completed 3 years of study at ALS level, having to have gotten so many intubations, so many IVs (I think it's 100), so many drugs etc) you must go through an "intern" program where you get screwed over by being "demoted" back to Ambulance Officer (BLS) level where you are "gatekept" to progress through the levels (Ambulance Officer, Paramedic (intermediate) and Advanced Paramedic (ALS)) as the service sees fit; which can take 18 months or longer; one of the Intermediates I know said she took five years post graduation to become an ALS provider.

Highly interesting, looks like I have to join you in some reading Mobey

My bad, Mobitz II

Strip looks like 3rd degree heart block and possibly a bundle branch blocks (rabbits ears QRS) His sats are good, BP is a wee bit low but I wouldn't be concerned about that, at the most I might put this pt. on O2 depending on how bad his shortness of breath/sats were/got (mainly for psychosematic effect).

people should need some sort of license or permit before procreating

If I had to list the things I am most vocal about in prehospital care I suppose the top one would be spinal immobilization. Our clinical procedures leave a lot to be desired when it comes to this (well, our medical director in himself leaves a lot to be desired period). I (and another ambulance officer) I know have had more than one argument and head-butting session with the education people about this issue. There really are two schools of thought; the American "strap everybody to a longboard" way and the "don't do it because it's uncomfortable, if the patient is not comfortable they will move which may cause further injury" way of thinking. I have seen people put a collar on, take it off for whatever reason I don't know, then put it back on! I was told one of our wooden long board was "for show only" (although the Paramedic was joking it lets you see into his mindset I suppose). Never ever have I seen a patient put on a longboard, we always use the scoop stretcher. I'd be interested to see what creates less movement, somebody strapped down to a longboard or somebody strapped to a scoop.

Greyhound sucks. But hey, at least I didn't get decapitated on 'em, only delayed a couple hours

He's right ... surgeons here generally have the title of Mister or Professor, although not always. Mwahahaha

ERAU is highly respected as is UND - both where I have friends doing the pilot/ATCS degrees. They are a little bit spoiled but they pay hideous amounts of money for it like $20 grand a year although I hear in the US that is not uncommon (my entire Bachelors degree cost me about $12,000)

No, no, and hmm oh yeah .... no! It seems to me EMS always caters for the lowest common denominator. All these upskilling packages, advanced classes, accelerated programs and minimal education are simply holding us back. EMS will never advance as a health care profession until we do away with these skill hungry, title seeking piecemail type dealies where you can get certs for this and that and that too without any real education. I can see it now .... oh guess what y'all says so and so I am a Basic but I have these add on certs so I can do glucose (I have no idea about glycogenogenesis and the Krebs cycle), I can give you GTN (but I don't understand much beyond "it makes pain go away") and if I do a 16 hour course I can start IVs just don't ask me about osmosis, tonicity, diffusion and filtration because I'm not required to know it! And .... if I go to 624 hour Houston Fire Department cookbook firemedic tech school I can get a bright red patch and begin shocking people in five months! Strikes me that many in EMS are about minimal education to get out onto the street and start using thier skills. Seems too much emphasis is placed upon "skills" and not enough emphasis on a robust education focusing around A&P, pharmacology and pathophysiology because thats too hard and/or boring.

Yup same problem; I spent 4 years in the airline world and it's the same thing .... FAA only requires a minimum number of hours to gain a CPL/ATPL. The little regional airlines pay shit and hire shit pilots; I'm still in contact with many of my friends in the airline industry and this thing is the exception rather than the rule.

Looking around the 21st of June give or take a day for a couple days .... either gon' be in Brooklyn or Manhattan either way no biggie two bit on the train up to GCT or somethin'

Yo I'll be in NYC for a bit in a couple weeks; if yooz guys can get your ass into Manhattan or something food and booze are on me. Ben