Kiwiology

This is actually a very complex question.

The short answer, as said above, is that a patient having difficulty breathing needs the underlying problem fixed.

Oxygenation is more the key problem, sub optimal ventilation can, in the short term, be tolerated as long as oxygenation is adequate. \

Do not confuse oxygenation and ventilation; one is a physiologic process and the other is mechanical; they are separate yet intimately connected.

Somebody who is ventilating poorly but oxygenating adequately is less of a concern than somebody who is adequately ventilated but poorly oxygenated.

I hear that from the next CPG update (middle of the year) Intensive Care Paramedics who have RSI will be getting transport ventilators to better combat bad dyscarboxaemic juj ju as well as all Intensive Care Paramedics getting thrombolysis.

I am sure we will be getting something else that is cool and new and flash; there is nothing else I can think of that is appropriate to be re-classified from ICP to Paramedic or from Paramedic to Technician so whatever updates to the scope of practice take places will be something new, I have absolutely no idea what it might be; last time it was oral loratadine (new medicine) and that was just totally unexpected; I believe New Zed be the only ambulance service in the world that has it.

I think I saw this guy on late night TV

Unfortunately, despite being hilariously funny they are sadly true ...

See even I don't self diagnose myself, that is what people who went to medical school are for

They're also excellent for prescribing valiumz ... and fucking up 11 hours of peoples hard work!

But hey, my Chinese is improving

QAS are using it in Australia and there is talk of it being bought in here

Attention non-treating locum House Surgeon who has not even laid eyes upon my patient

A patient who fell 5 days ago, had a single seizure, has no acute intracranial pathology on CT and has just had an MRI scan also reveal same, who is physiologically stable and has no had no more seizures, who is under the care of a Consultant Neurosurgeon and who has no other complaints is not "too unstable" for a two hour trip to a neurological centre of excellence with a Doctor medevac.

Thank's for fucking up 11 hours of my work, has it never occurred to you to pick up the damn phone and talk to the Consultant Neurosurgeon who is looking after him?

Damn it Emergentologist, you are lucky I still got the love for you man, Doctors are not in my good books for tonight thats for damn sure!

Oh don't spit your tea out just yet eh bro

I shall eagerly await the next JRCALC update then ....

I eagerly await the new JRCALC guidelines, maybe they'll look a little less like what we had 20 years ago this time

I've got no problems with it. Spit swapping might go a little beyond my comfort level, but have you seen some of the tranny porn? There are some pretty hot ones...er...so I hear.

Still going to the adult store with the tinted windows across the strip mall from the Hooters on Fulton are we Emergentologist?

Didn't notice that blacked out van taking up three disability parks in the Dominos lot across the street did you?

Kiwi, PI is where its at

Erectile dysfunction pills are not a contraindication to GTN here, just a warning that it is prudent to give a reduced dose i.e. 0.4 mg SL instead of the usual 0.8 mg

If there was no very strong evidence as to an alternate, non cardiac cause I would give him aspirin.

Entonox +/- morphine as required for analgesia.

Serial 12 leads

Transport to the hospital

Has he ever had pain like this before?

Does the pain go anywhere apart from in his chest?

What type of pain is it? sharp? stabbing? cramping?

How bad is the pain?

Does anything make the pain better or worse?

What is his past medical history like?

Does he have any family history of heart disease?

When did he last eat?

Ix - obs and 12 lead ECG including V4R, right sided or posterior leads as appropriate?

Does physical exam reveal anything? lung sounds? heart sounds? JVP?

PDx - myocardial ischaemia until proven otherwise

DDx - MSK pain, spontaneous pneumothorax, trauma, PE, chest infection, pneumomediastinum, AAA, acute ventricular aneurysm, acute valve rupture, pericarditis/myocarditis, epigastric pain, GERD

Dude I messaged you on Facebook but you didn't respond

Wait at least I think it was you

And I'm not on LinkedIn ... wait, yes I am

I am just here for the free coffee and donuts and to go on long, deconstructive rants about various topics.

If I ever overcome my aversion to chemistry I might become docktorb ... but I dno, I hear medical school is pretty relenting, they even want you to know iz proton!

Not all of us can graduate Cums A Lot with a BSc in Biochemistry from Stoners of Brooklyn University

Yes Emergentologist I have been LinkedIn stalking you

Yep, wouldn't be a problem

I am sure the one of the ACO's on the City LSU used to be a man ...

Some old guy I had the other day, his medical problem list was twenty one items long including such things as severe ischaemic heart disease, a bunch of stents, couple forms of cancer, HTN, hyper cholesterol, AF, I can't remember what else ...

How are people like this even able to stay alive?

The mind boggles!

If you move to a different state you must apply for reciprocity with the new state.

Each state has different rules regarding this; for example New York State has a bunch of batshit crazy levels (e.g. EMT-CC) that do not exist in other states nor require National Registry certification therefore may not be recognised in the new state.

I forget whatever number it is but basically the Constitution provides for whatever is not explicitly the responsibility of the Federal Government is divested to each individual state. It's basically like swapping your drivers license over to the new state with one or two small hoops.

Also note that New York is not a state; it is a confusing place where nobody can be understood and those who live there think it is the centre of the universe

Sounds like a good idea

New Zed has AVL and MDT although they have very limited functionality compared to the North American systems, ironic considering we spent millions and millions of dollars on them and they took nearly a decade to be rolled out.

Job details, ability to mark responding, at scene, transporting, at hospital, clear and in theory you can tap a button to request notification to hospital (R40) or Intensive Care Paramedic (R50) but I've never seen them used.

No maps, no vehicle to vehicle chat, no grid or system view, no ePCR etc

Welcome, remember to pay no attention to me whatsoever or anything I say

Hands and feet inside the forum at all times, listen to the driver, no flash photography and you must exit through the gift shop.

and hit the ground running singing "Hallelujah"........."Hallelujah"

Um, yeah, not so much ...

I feel empathetic toward the people affected when somebody else dies but I don't sit up at night worrying about it.

One of the main reasons I dislike cardiac arrest resuscitation is many people begin resuscitation that is either clinically futile or not in the best interest of the patient and I find it quite undignified, particularly for the family.

In NZ a Doctor must sign the death certificate stating cause of death however Ambulance Officers (at all practice levels) may pronounce life extinct and an Intensive Care Paramedic may complete a Deceased Person Certificate for the Police or Coroner. Once there is national agreement between the various Coroners it is expected that this ability will be extended to Paramedic and ICP.

Death is just a fact of life I guess.

Damn, I missed the civilized world. I need a bagel and a pepperoni pie.

Lets take the A Train uptown to 51st St, I know a good pizza place, hopefully we get on the train where one of the homeless crazies has taken over the PA system and makes the announcements. Those are always funny.

"This is a Bronx bound A train running express between 50th St and 52nd St, next stop 51st St, praise Jesus!"

I would encourage you look up and learn the correct spelling as well to read up more about cellular respiration and the exchange of O2/CO2 at the cellular level including the electron transport chain.

ERDoc can probably help us out seeing as how graduated Cums A Lot from Brooklyn Stoners University with a BSc in Biochemistry

May be useful to note the aortic and pulmonary valve are also known as the aortic and pulmonary semilunar valves.

Its not a tumor meningococcial septicaemia

Airway and ventilation are the second-lowest priorities in primary cardiac arrest in the 2013 CPG; the lowest is IV drugs so we are already as close to compression only CPR as we can get. Intubation is no longer recommended and in fact it is discouraged over preference to a well fitted LMA while ventilation is now taught to be 8-10 breaths per minute and not more.

Intubation is still practiced in cardiac arrest however it is more the engrainings of the individual ICP than the formal view of the Clinical Working Group; clearly old habits die hard and something you have done for 10 or 20 years is hard to break. CWG acknowledge this and are working hard on it.

When more evidence comes out then I believe we will move to compression only CPR without ventilations and that we are already as close to this as the current evidence base will allow. It has also been stated that IV drugs are going to be removed but there is not enough evidence for that either at the moment.

Welcome, remember to ignore everything I say and pay no attention to me whatsoever.

Keep your hands and feet inside the forum at all times, no flash photography.