Kiwiology

Would you think any less of me if I told you I have a scanner app on my iPhone and listen to the freqs from NY? Sometimes when the tones drop for my old VAC, I pretend to use the siren but I follow all traffic laws.

I now think less of you because you have an iPhone, android is where it's at

Rx valium (diazepam) 10 mg x 1 cap prn nmt qid 30 cap unlimited refills /S/ Emergentologist, FACEM (NZ Hons.)

Thanks Emergentologist, perfect for Christmas, note that I am still expecting those chemistry tutorials from a hot single pickup truck, gun and country music loving chemistry tutor.

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Not as easily as you just giving me some

I thought giving you some was what your husband was for?

Oh you mean valiumz, silly me .... I will have to ask our Consultant Emergentologist for a refill of my Rx then you can have some but he is probably in his room playing with his toy ambulance or decking out his car with lights and shit seeing and how he is a buff wannabee Paramedic ...

Met a kiwi yesterday at the liquor store and it made me think of you! P.S. Can I have som valium too?!?

I met a Kiwi at the store in Indianapolis, he was fairly badass.

You can probably get your own valiumz ....

Yay insomnia...

Oh what the hell, its Christmas, have some of my valiumz ....

Santa is a fraud, the FAA would have totally revoked his airman medical certificate by now, fat old bastard bound to have ischaemic heart disease, diabetes, hypertension, dyslipidaemia, gout, arthritis, slipped disc from carrying that sack round, probably already 90% occluded in one of his coronary arteries and needs major stenting ....

We should not be treating patients with chest pain with aspirin and nitro; rather, we need to get it into our heads that that is the treatment for patients complaining of ACS.

Not all chest pain is ACS, and not all ACS includes chest pain.

Please tell me that y'all do look for some objective evidence of myocardial ischaemia before treating patients for it? If not then teach time you do, one of my brain cells, some starving beafran child and a cute small animal dies a violent, gut wrenching, gutteral death because of the intense stupidity and massively extreme fail involved.

Merry Christmas Jeedadeech from the World Vision ads of the 90s, better hope Nana don't get no chest pain tonight!

Bloody hell I am fresh out of ideas then, ring up ICP and let them figure it out ...

ECG looks like SVT with rate about 160 and some non-specific ST depression

His pain makes me wonder if he has an aortic anyersim

With his physiological signs he is just enough this side of status 2 for me to call him that (unstable)

For now, simple ABCs and take him to the hospital

What was Tony Smith thinking?!

Thanks guys. I notice that some people include an introduction of how their service/country operates EMS but I'm sure you've heard about it from NZ ... members on here

Yeah I pretty much told them how badass we are - when I was active, before the mental breakdowns

Bought a patient into resus and was met by the Consultant Emergency Physician as part of the resus team. At this particular hospital all the staff wore different coloured scrubs so you could tell everybody by everybody else.

"So, are you the nurse?"

That did not go down well

These patients you speak of sound icky. I think I might need some of those valiumzzz if I have to deal with them.

No, valiumz mine! I have had 3 mental breakdowns in the space of 18 months so I think I've earned my valiumz ....

"Likely to be well" my ass, thanks a lot Kessler psychological distress scale!

What's a patient?

They would be the great unwashed your Registrar deals with because the House Surgeon died from fatigue and has not been replaced due to budget cuts.

I have been busy having another severe mental breakdown and have recovered slightly enough to lurk and post severe verbal outbursts that offer little productive content, repeat what we already know and generally reinforce the fact I represent a severe departure from mental homeostasis.

Mmmm num nums, bedtime valiumz ...

Glad to see you gave that corporate life the flick, I hear people on the train talking about it and it makes me want to vomit blood; I would rather be raped up the ass with a white hot poker than do some corporate BS job, fuck that

I will hopefully (hopefully) be starting the degree next year as well.

Now, should I show up when you ring up for R50, be afraid, be very, very afraid, mwahahahaha!

We had to go through 2 separate radios to get to medical control, now it's a simple phone call away.

*puts up hand, excuse me sir, what is this medical control you speak of?

Easy Kiwi, he's new here and he may be from NY or NJ. He can only do what is system allows him. Give him a chance.

You didn't give me a chance, you called security on me after I got into a fight with the Surgical Registrar because he was turfing the patient back to Medical because "he didn't need an operation".

I wouldn't want any of my family with chest pain to get high flow oxygen, even if it was in a protocol, not sure about this bloke

So 30 yrs in ems and vol fire...16 yrs as a paramedic....found that a good assessment...and ACS and chest pains...considering your BLS and ALS protocols.....keep it simple....baseline v/s telemetry.12 lead high flow oxygen. Aspirin nitro titrate to blood pressure and morphine ....rapid transport if necessary....confidence in your ability and calming bedside smile......thinking ......what would i do for my own family member...thanks

um ... telemetery? high flow oxygen? rapid transport? supreme fail much?

I wonder if this bloke works in Western Australia? There are no other Australian states that use volunteers to my knowledge and here in New Zed an Emergency Medical Technician can give both aspirin and GTN whereas an Ambulance Assistant (First Responder) can give neither so that counts him being a Kiwi out.

I am just about the dumbest motherfucker out there, I mean seriously I had to be shown how to turn on the oxygen and reminded that while ceftriaxone and vecuronium are both powder for resonstitution that you cannot get the two mixed up cos if you do that the bloke with an infection will stop talking and turn awful blue and you will get a finger wagging form the boss ... anyway, if me, the stupidest bastard to ever set foot on the big white van, can figure out the GTN is for myocardial ischaemia (angina) and the primary treatment in AF is rate control doesn't that mean that the rest of you blokes should be able to figure it out?

GTN is a good idea in patients with exertional angina or cardiogenic pulmonary edema. I am not so sure GTN has a role in STEMI or acute myocardial infarction but this remains to be borne out by any evidence; right now it is just a feeling ....

Carry on.

In New Zed we used to have the old school Cooks screw in needle - that thing was freaking traumatic enough just to watch it going in, then it was decided to change to the BIG but this was withdrawn due to a very high failure rate so back to the manual screw in needles it was until about 3 years ago when the budget allowed introduction of the EZ IO

Intraosseuous access can be utilised by Intensive Care Paramedics in all age groupsidi when there is a time critical need to for medicines and or fluids and there is no IV access obtainable. Insertion sites are humerus or fibula only.

You are not alone, New Zed has a significant challenge with the recruitment (and to a lesser degree, retention) of Volunteer Ambulance Officers. Being a VAO is at the more extreme end of the scale; it takes almost a year to do the Diploma and then there are bi-weekly CCE sessions and mandatory minimum of 2 shifts per month (12 hours) which is a bit different than doling out soup for the Salvos for a couple hours a week or whatever.

A significant part of the recruitment campaign here is showing prospective volunteers what the benefits are for them including the non tangible (helping the community, good feeling, touchy wanky shit like that) and the tangible including the National Diploma in Ambulance Practice (the Technician qualification), free uniform, reasonable expenses reimbursed etc

We are adding Ketamine this year to the regional protocol for agitated delirium/combative patient. 100mg IV/IN or 500mg IM.

We are also allowing its use in the RSI and sedate to intubate protocols. 100mg IV/IN

A couple of local services (mine) will be using it for pain control in trauma, 0.5mg/kg IV.

'zilla

The win in this cannot be overstated for realz ...

Why fixed bolus dosages for combative pt/RSI rather than a weight based dosing as you have done in trauma?

In saying that, New Zed is using fixed bolus dosages for pain (10-40 mg IV as required) and weight based dosing for combative patients and anaesthesia for RSI (1 mg and 1.5 mg/kg respectively)

Like all our analgesia, the aetiology of the pain is not important, so ketamine can be used in a patient who has physiologic pain say from gallstones or a headache (if cranial haemmorhage can be confidently excluded)

In Europe 112 ambulance comes to you

Our Community First Responders still have to pass the ambulance driving course, and even if they did not, they still have to drive their own car there so yeah.

Newsbot knows you have no life Trev so he keeps slinging stuff at you so you won't sit there bored and with a sore hand

Good ole' Newsbot

As long as he is still OK to lift and drive and crawl into wrecked cars and whatnot then go for it I reckon

This is a common situation here in New Zed; a small station will have one (or two or three) paid Officers and an ensemble of volunteers who roster on as they are able (minimum of 2x month) so if there is no volly the ambulance is half crewed and responds as such. A one person paid roster (96 hours/pw) is still out there, but it doesn't happen nearly as often as it used to, most rural stations have two or three or four paid Officers to ensure coverage 24/7 (even if it is a half-crewed response) and I know many have been actively upgraded in the past few years to reduce the incidence of 96 hour work rosters (which is basically 4x4 with on call 100% nights) as this is technically illegal with our legislated driving hours and it is very unacceptable industrially.

With $160k we could employ about 2.7 Paramedics on a salary of $55k!