Kiwiology

I told you, give me a PCP slave and I can be ACP ...

Call back and overtime is voluntary so I wouldn't worry about it; here you work your 4 days on, then you get 4 days off without interruption or exception unless you volunteer to do call back. Overtime e.g. finishing beyond the end of your shift does vary, most crews are very good at showing up 15 minutes early for changeover so the off-going crew can finish on time and not get stuck on a job for 2 hours after their shift Overtime is a great way to earn extra money. As for the emotional side of things, it might sound callous but its not your problem so you can deal with it more objectively than if it was you it was happening to. Yes, I have seen plenty of fucked up shit and sad things happen to people but you sit there when all is said and done and go "oh shit you know I kind of feel sorry for that bloke" but thats it, if you sit there and dwell on it or whatever you will simply stop functioning, you have no real emotional attachment so its not that hard; if you look at me when my life fell apart and I stopped functioning for a year and tried to commit suicide it was because I was emotionally attached to what had happened and it was personal as opposed to professional. I do not know of any AO/Paramedics who says that the emotional side of things are a problem.

Heeheeheehee .... oral

I am seriously perturbed at the notion that UK Paramedic will not get pacing, cardioversion and may not be getting combination analgesia (I mean real combination analgesia, a bit of entonox before IV morphine is not combination analgesia mmkay) I mean WTF, I looked it up, our Intermediate Care Officers could cardiovert people in 1977! Although ICO no longer exists (it was turned into the "Paramedic" level which now requires a Bachelors Degree) cardioversion remains in their scope of practice, pacing would be there too if it was feasible but it's an Intensive Care Paramedic thing because they have the options of midaz and ketamine for sedation plus IV adrenaline infusion should the patient not respond to pacing which Paramedic does not. Oh and that reminds me, as far as I know, UK Paramedics have midazolam for seizures only, they do not have the options to sedate people like we do here (and is common in Australia and sometimes in US) Do you know why this is such? And let's not even get onto to that whole everywhere-else-in-the-world-is-strengthening-their-base-level-but-heck-in-UK-we-will-just-remove-it-all-together-and-replace-it-with-a-glorified-driver-who-is-not-allowed-to-touch-patients thing that happened with Ambulance Technician.

Any talk of pacing, cardioversion, morphine plus midazolam, ketamine or any of the other things which are used elsewhere in the world? Jeez, our old Coronary Care or Intermediate Care Officers could cardiovert people 30 years ago ....

To have a myocardium that ischaemic/irritable as to have a VF cardiac arrest surprised me as he did not show the classic signs of significant occlusion i.e. ST elevation. Interesting!

What constitutes mental illness is a very interesting question and one I have often pondered. I think there are different kinds of mental illness; there are those who are a bit depressed or whatever right through to those who require to be held securely in an inpatient psychiatric facility because the voices are telling them to kill people. Now me, I am fucked in the head there is no denying it but I am psychologically fucked up, I don't have a structural or organic psychiatric condition where voices that come out the bathroom tap are telling me to go kill people nor am I having hallucinations that I am playing with the Rolling Stones or something like that, fuck that, I'd rather have some sort of delusions that I was doing a duo of "Piano Man" with Billy Joel or playing with Sugarland or something, you know, fuck the Rolling Stones ... anyway. Should I be not allowed to have guns because of a "mental illness" ... well no.

JRCALC are the UK's clinical practice guidelines yes, I do believe they are due for a full update this year.

I think this bloke might be having NSTEMI If the GTN is not making his pain significantly better or resolving the ST depression then I reckon he probably has some sort of non occlusive thrombus. I would be interested to see what his enzymes e.g. Trop-T / CKmb and angipgraphy have to say for themselves

What about if we change trom an NC to an acute (ordinary) oxygen mask does his SpO2 increase? Whatever the lowest possible flow we can use to achieve an SpO2 > 96% then lets do that. If his discomfort and ECG remain unchanged then no further GTN In the first instance I would offer him some entonox, if he doesn't want it (or any other pain relief) then that is fine, don't give it to him

Yeah well my Doctor says I have PTSD, and I already knew I was significantly fucked in the head; so um yeah, you ain't the only one

Respectfully, wrong. Fluid is not always good, intravascular volume expansion has a specific purpose with specific indications which are specific to that patient, if they are not met then do not give it. Get him off the non rebreather mask; put him on a nasal cannula. Like fluid, oxygen is not always "good to have" and appears to make mortality in patients with acute coronary syndrome / myocardial infarction worse. Does his chest pain get significantly better / go away and/or does his ST depression resolve with GTN administration? If either of these are the case, and then they come back, I would give him more GTN but if neither of these are the case then I would not give any further GTN. The ECG looks like some ST depression in the inferior leads with reciprocal ST elevation in V4 and V5? The rhythm strip shows quadrageminal PVC. No further treatment apart from GTN if appropriate and some analgesia as required. If his chest pain significantly improved with GTN then he has no immediate life threat and is not time critical (status 3) however if not then he is time sensitive (but not time critical) and has a possible threat to his life (status 2). Normal transport.

My diagnosis is now exertional angina until proven to be otherwise His ECG possibly shows some inferior ST depression however eh, its so-so I'd like to give him some GTN and see what that does to the ECG as well as his pain; if he feels significantly better with the GTN and/or his ? ST depression completely resolves but then comes back or post-GTN he feels the same pain then I'd repeat it; but if after 2 sprays of 0.8 mg GTN it has little or no effect I would not give any more. What is his take on being transported to the hospital, still doesn't want to go?

On the internet, content is king. If you write dribbling non-sensical garbage nobody will care or read it (like most of my posts!) but if you write something well thought out people might be like oh thats interesting and stop off on their journey on this here information superhighway as they as passing through on the way to teh Facebookz or to watch porn.

I thought you got banned from the school for stealing that kids sloppy joe?

I am not sure if UK services carry the KED; truth be told I do not remember ever seeing them in anything to do with the UK, but I would be quite surprised if they actually did not carry them but it is entirely plausible! Remember too that while UK Paramedic is different than in US in quite a few areas, in others it is still a bit conservative and that each of the NHS Ambulance Trusts do some things slightly differently; e.g. some use a scoop or combi-carrier while others still use a long rigid board and head blocks. JRCALC have a spinal clearance / non immobilisation thing but it hasn't been updated since 2006.

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 If he doesn't want to go nowhere then that's fine by me, a competent patient has the right to refuse treatment, including life saving treatment, put big green pack and monitor back in ambulance, get in ambulance, drive home, done.

Craig, you hater ... when I am in Sydney for the SMACC Conference no beer for you!

It's almost midnight and I am up wandering the house as I try to desperately and with every fiber of my being to escape the mental demons both pre-existing and the new ones that cropped up after I fell down rather spectacularly from the top of the world; and I sort of look up out of this black hole and go "wow, life was totally badass two years ago, I want to go back!" I guess at the end of the day when all is said and done I've only got myself to blame, so I'll keep holding on tight with knees buckled and white knuckled (for now), for such is the punishment for travelling at twice the speed of life. Whatever Chris is getting sedated on I'll take some of.

Welcome, hands and feet inside the forum at all times, no flash photography and please ignore the Kiwi, most of the time he is destroyed on valiumz, various dopanergic, noradrenaline reuptake antagonists and tricyclic drugs ...

Here is what Advanced First Aid covers in NZ • Managing simple hazards at a scene. • Managing and assisting at a cardiac arrest using a OPA, BVM and AED • Understanding how infection spreads and how to minimise it spreading. • Assessing, cleaning and dressing wounds including wounds with embedded objects • Using direct pressure to stop major bleeding. • Dealing with jelly fish stings, spider, human and animal bites. • Understanding what shock is, how its caused and the signs of it. • SAMPLE and PQRST questioning and basic secondary survey • Assessment of pulse, breathing, and skin. • How to manage burns using cold water and cling film. • How to manage isolated limb injuries using a sling, pillow and cardboard splint. • Understanding common medical conditions that may lead to an acute emergency • Understanding common causes a loss of unconsciousness, SOB and chest pain. • How to make a basic assessment of a patients respiratory status • How to handover to someone using the MIST method. • Recognising a spinal injury and immobilising the patient using blankets in a “nose to toes” position without cervical collars

Sorry mate I got really destroyed on valiumz and blacked out for a couple of days ... I think she has some sort of dysfunction of vascular permeability related to the release of inflammatory factors secondary to SIRS / acute infection most likely of respiratory origin but could also be urosepsis. My treatment plan of put on stretcher and take to hospital remains unchanged.

We have drugs that will take care of that

The notion that Physicians would oppose such a model because they might loose some money on it is quite, ok lets be honest, extremely extremely aquared by elventygadzilliotybillion, perturbing

In Canada things are similar to other countries such as Australia, NZ and UK where Paramedic is an educated, well paid professional position. I know the pay in BC, Alberta and Ontario is very good (PCP is about $25 an hour and ACP more) while I think the pay in NS is a bit less but still quite good, other provinces not so much from what I hear. The whole internal labour thing means that scope of practice will soon become standardised and national registration will be achieved from what I understand. There are many Canadian Paramedics here and I don't know any of them who bitch and moan about being overworked, burnt out, underpaid etc or who upgrade to being a Nurse to get paid more, or who moan about being stuck 20 years behind the rest of the world in some respects of practice because their medical director is a douchebag. I'd say go for it mate