Kiwiology

Whatsay we get an old sixties ford wagon with those ridicilously oversided red lights, a great big four foot tall radio aerial and a mechanical siren? Hot diggity now we talkin y'all!

I know a guy with the SPVM in Montreal Ill ask maybe he knows something.

Try here (French) http://www.urgences-sante.qc.ca/indexx.asp?page=22

Congrats to the three of you; I think kids are the most awesome thing out there!!!

We use AMPDS in BC and speaking from my own experience it is a complete failure. The number of unneccesary "hot" runs to scene has increased dramatically with no relatable increase to positive patient care outcomes.

I would have to agree. Another problem we have here from what I've seen is the call detriments (A/B/C/D/E) are also tied into our KPIs of response times and Government funding; high levels of over-proritization is just not a good thing.

I don't know what it is but a lot of our people have an attitute problem; they are just arseholes with bad attidues towards patients, subordinates and peers.

Are you kidding, that would make me look bad!

We report it to our medical director but we also have "clinical standards" people who are a waste of time that take Paramedics off the road and shove them behind a desk, could go see them.

I am not even going to dignify this with a response I am sickened.

No I do not have a problem with "young" Paramedics provided they have the knowledge and competence to accept such responsibility.

"EMS Education"

"My Assessment" by tech school fire medics.

no no that's 624 hour class cookbook firemedics

Wouldn't the world be much easier growing up if we had these instead of the three bears or whatshisface, the tiger with OCD and that manic depressive donkey?

You Are Different and That's Bad

The Boy Who Died From Eating All His Vegetables

Dad's New Wife Robert

Fun four-letter Words to Know and Share

Hammers, Screwdrivers and Scissors: An I-Can-Do-It Book

The Kids' Guide to Hitchhiking

Kathy Was So Bad Her Mom Stopped Loving Her

Curious George and the High-Voltage Fence

All Cats Go to Hell

The Little Sissy Who Snitched

Some Kittens Can Fly

That's it, I'm Putting You Up for Adoption

Grandpa Gets a Casket

The Magic World Inside the Abandoned Refrigerator

Garfield Gets Feline Leukemia

The Pop-Up Book of Human Anatomy

Strangers Have the Best Candy

Whining, Kicking and Crying to Get Your Way

You Were an Accident

Things Rich Kids Have, But You Never Will

Pop! Goes The Hamster...And Other Great Microwave Games

The Man in the Moon Is Actually Satan

Your Nightmares Are Real

Where Would You Like to Be Buried?

Eggs, Toilet Paper, and Your School

Why Can't Mr. Fork and Ms. Electrical Outlet Be Friends?

Places Where Mommy and Daddy Hide Neat Things

Daddy Drinks Because You Cry

I do not see a problem with SAMPLE, DCAPBTLS or whatever other fancy wanker acronyms you want but you can't teach "look for A, B, C, D etc" and blindly follow it -- that's as bad as being a cookbook skill monkey.

If you have the knowledge of normal physiology and anatomy then you should know what would be abnormal anyway and if you know that and simply use some acronym to make sure you cover your bases that is fine.

Example: I love cardiology, I absolutely love it to bits and know how all the systems tie up into the cardiovascular function and what normal and abormal function is and how it affects the body. I know Nana who is having an acute infarct should be hypoperfused so diaphoretic, dizzy, ALOC, maybe SOB if a CPE is involved etc, might have some localized edema due to > ISF .... I don't need a fancy acronym to remember what to look for.

If you blindly follow an acronym because that's all you know THEN YOU FAIL AS A MEDICAL PROVIDER and FORESHAME on the education system and the regulators for ALLOWING it.

If you take an 18 day course because you want to go from zero to hero with zero previous knowledge THEN YOU FAIL and get the hell away from me. If you have a background of A&P, pharm, med term etc or if you're an RN (etc) who needs the cert then I don't see a problem with it; I mean after all, it's not rocket science, it's a bunch of skills you could teach a fencepost to carry out.

Well I agree; if you have no medical background and auctually want to be a decent provider stay the hell away from these courses; if you have medical background and just need the cert then maybe it's just what you are after.

I agree with Rob. Maybe you can find the local community college program (they are usually 1-2 nights a week and a Saturday of rotations thrown in every month) for a semester, quite cheap, couple hundred bucks probably.

Let me make a comparison- I am a certified computer techie, it was two or three days a week for six months; we got time to do stuff, to pull bits apart and rewire them, to break it, remake it and learn from it. We could have done it eight hours a day for a couple weeks and gotten the same cert but we'd never have learnt anything.

We're not talking about computers here, we are talking about human lives. Do you have any prior medical background? Do you understand that people's lives will be in your hands potentially after you finish this course? I am not saying don't do it but I am not saying do it either.

We can train you to pass a test; but that's rather superficial and very poor. If you're trained to pass a test and follow a set of guidelines you are simply a what we term a "cook book" provider (not to say I am better than you or that I know everything, because I do not nor am I better than you).

It's enough to pass the test knowing "do A if B and if not, do C" but it's far better if you can say "do A because of B, B won't work if C, if C is present, do D instead" -- let me give you an example of just what I am talking about.

When I very first started out in EMS we had an anaphylaxis patient who crashed and the medic drew up some epinephrine and administered it; it was like this guy's lightblub got switched back on the effect was (for a newcomer) just what was desired but I thought this medic was the greatest thing in the world.

I then promptly memorized 0.5mg epi IM ("A") or if that didn't work 1mg:1000cc NS TKO ("B") or 0.01mg IVP PRN ("C") so; see what I mean, I had the "recipe" for treating anaphylaxis - do A, if no result, do B, instead of B can do C.

Then I wondered "hey, why do we do that?" and it really wasn't until I began my college A&P that I figured out ...

- the body has things called vessels that carry blood, these can dialate (vasodialation)

- when that happens there is more suface area for the blood to fill, so blood pressure drops

- if blood pressure drops too much the body won't get enough oxygen and nutrients, things start dying and you pass out

- the body (the very small airways of the lungs in particular) have smooth muscle which can constract

- when that happens its called bronchoconstriction and it's very hard to breathe

- breathing is important

- the body has things called mast cells which release histamine and these are triggered by an allergy (bee, nuts etc)

- histamine triggers histamine (H1) receptors which are found on the smooth muscle of the lungs and resp tract

- when that happens your blood vessels dialate, your throat and lungs close up, you pass out and stop breathing which can lead to brain death and cardiac arrest

- we give epinephrine because it is a vasoconstrictor (A1 receptor), bronchodailator and antihistamine (B2 receptor) so it 1) increaes blood pressure 2) stops histamine being produced and 3) makes it easier for you to breathe

- hey, because epineprhine acts on the A1 receptor that's also responsible for increasing the heart rate and stroke volume, if this guy just had major bypass surgery we might need to reduce the dose a bit!

See what I mean, I'm not trying to be a know-all smart bastard but you see the difference? I'm not saying you won't learn that on an 18 day course (but ten bucks says you wont!) and if you do, will you remember it??

It's one thing to know TO do something, its another entirely to know WHY to do it, why and when NOT to do it and WHAT will happen if you do it.

Best of luck mate.

Ben

Our lp12 has paddles. We still use a lp10 as a backup. We even had a 12 lead adapter for the lp10.

Ah hah! I KNEW the Lifepak 10 could do a 12 lead, and people said I was crazy!

LP12 is too heavy, too weird to store and it's queer looking, and it has pads (ewwwww pads)

Bring back the Lifepack 10!

Go down to the Krogers, Safeway, Voldermart, Food Lion, A&P etc etc, get a loaf of bread, couple tomatoes, some ham and cheese, maybe a lettuce if thats what you're into and viola, lunch, and what's more, depending on how much you get, you might even get two lunches out of it! Maybe even more

This looks like electrical alternans that can be noted in all leads except lead III. Whilst not pathognomonic for pericardial tamponade, in the setting of PEA it would certainly have to be at the top of my list of causative factors. Or at least top of the list of causes that are easily reversible any way!!

You would be correct, go directly past GO, collect as much money as the patients' HMO will cough and wash and re stock the truck

Are both strips from the same patient?

Yup

Agreed. Looks like a third degree AV block to me. Could try dopamine and epi, but I'd prolly pace em.

It's not 3rd degree block because of the absence of any P waves. 3rd degree block will still produce P waves but they will be disassociated. Here is another strip (tip: look in the chest leads, note how the QRS complex goes in different directions in the same lead)

"Treat the patient, not the machinery" is a mantra I learned when NY State, and the NYC Health and Hospitals Corporation EMS, first went with the EMT-Defibrillation program. A good thing for all levels of responders to go by.

Thats very true.

Got to be the beta blocker.

Nope -- look at the ECG again

Go to PEA protocol. CPR. Start your drugs. Get him intubated. Work him there as current guidelines say no rolling codes.

You are correct - it's PEA. Want to guess at what caused it?

No pulse but an orginized rhythm on the monitor.

You got two IVs

This is what your ECG shows

You put gramps on some O2 and find temp 36.5°C and BGL of 4mmol/L (or whatever normal is how you measure)

Having done that, the old boy promptly falls out the chair and collapses to the ground unconscious.

Get well soon mate

You are dispatched to the home of a 60 yom who is looking after his 9yo grandson for the day. The grandson can't get grandpa up out of the recliner to play monopoly (my favorite game when I babysit my sister )

Grandpa is seated in his recliner in the lounge and complains of being "real tired"; he says that he does not want to cause any trouble and just needs to lay down for a bit

BP 97/72

RR 22 shallow with equal rise and rales upon auscultation

Pulse 110 and irregular

GCS 12

SpO2 of 92% on RA

(S) He is pale, cool, diaphoretic, confused and has that nasty grey sheen of death

(A) None

(M) Coumadin, nitro and a beta blocker

(P) Had an MI about three years ago

(L) Ate some eggs and toast for breakfast about three hours ago

(E) Sat down to read the paper before playing with his grandson

Now, the grandson really wants bust out the monoploy set and have you pack up and leave so .... whatcha gon' do?