PRPGfirerescuetech

Have you, or would you use the term, "ambulance driver?" I would think we would be past this mother juggs and speed term, but am I wrong? edited 11/03 prpg 0545

Interesting dichotomy in this thread. amazing how people can say that it's poor for a BLS provider to utilize one, but acceptable for a ALS provider to use one. y? Because your busier? Ok, ill accept that. Makes me wonder, if thats the case...why isnt it acceptable for BLS usage? Because we arent as busy? Seems to me these are responses from medic who are ok with cutting corners on necessary skills. If you feel EMT's should go manual pressures on every call, so should you. Unless you have a clinical reason for not using manual pressures. Which their isn't one. If the tool is unacceptable for one type of provider, it has to be unacceptable for all. Now that is out of the way, I will say this. Technology is a wonderful thing in this business, but I have to wonder, have we gotten too reliant on technology? When will we realize that we are losing the basic skills of assessments, that sixth sense. At least, till they design a machine for that... *Steps off soapbox* PRPG

=D>

ER job a few years back, automated cuff got a BP of 102/70ish (if i remember the numbers right) on an iv pole. That killed autocuffs as a primary use for me

Im curious, how many of you all use the automated BP cuffs... If you do...is it your primary, or secondary BP. Do you check it against a manual reading? If not, why not?

...plus PHRN (pre hospital registered nurse), and PHPA (pre-hospital physician assistant)...

"PRPG", Duely noted, I agree and I missed the ' "could be considered to be" ' part of the post..I apologize, and agree with you in all of your above points.. As for your sidenote, I guess one can consider that in some ways where an airway is concerned you could use the philsophy that "bigger is better" within the realm that it will actually fit where it is "being placed".....Umm.... on second though perhaps that will take us to a place we don't need to go and be grossly misunderstood......!?!?!? Lastly, you wrote;

"Ace" First, I appreciate the compliment. Second, you bring up some great points. I have always enjoyed the intellectual and well contructed posts youve brought... Now to the task at hand... I agree with all of your statements. If you refer to my posts careful wording, it states "could be considered to be" Referring to #1 - As much as your correct with your statements regarding unlikely anatomy penetration through NPA usage in basal skull fractures, basal skull fractures are still taught as a contra indictation for NPA usage. Until the standard changes, a basal skull fx is still considered as such. As we all know, to vary from the standard of care is a huge liability. To change a standard, we have appropriate channels, and we need to adhere to that. So is it a contra indictation, yes. Should it be, no. Which was the reasoning for my careful wording. Referring to #2 and #3 - Your right again. When it comes down to it, Airway is first. But...(yes, their is always a but) You still have to take bleeding into consideration with airway in these circumstances that if bleeding does occur, specifically the originally cited examples. This person was correct, although im fairly sure he didnt realize it. If an NPA is placed, and a laceration occurs in the aforementioned cirtcumstances, the subsequent blood in the airway is less a bleeding problem (the "b" in ABC) and more a airway problem (the "A" in ABC) acting similarly to an airway obstruction... So, to close...my mistake was not the reading, but instead my wording. The bleeding that can occur is less a contra-indication and more a consideration prior to placement. and as a side note, is it me, or do you have to have severely misjudged the NPA size prior to placement to cause the kind of damage that poster seems to reference? This was my biggest question... That is all.....PRPG

All three are not relative, the discussion previously quoted NPS contra-indications, which all of these could be considered to be. PRPG

i know..apologies if i came off with any sort of attitude

Likely why its considered an adjunct...

Actually, according to our good friends at google, who showed me several airway articles... Combi-tubes are listed in just about every article as an "airway adjunct" similar to OPA, NPA, and LMA. Establishes pathway, yes. Has the same connotion of skill level associated with intubation, no. Lets remember, the word "intubation" refers to the actually skill.

I used to ride at a squad that required all junior officer positions to be applied for within the organization. Lieutenant, Captain. Open exams were held for the available positions. Highest score of the exam got the position...senior officers needed to hold junior officers positions first. Not bad for a volunteer house. Seemed to work well... PRPG

My OPA / NPA theory IF you use an OPA, it has to be remove when ALS attempts the oral intubation. IF you use an NPA, it can, in theory, remain in place during an oral intubation. Saves time form a BLS airway to have to be re-placed if the oral intubation attempt is unsuccessful. I tend to only gravitate to OPA use when NPA use is contra-indicated Just my thing... PRPG

Not armed.

Dust...regional thing... Most Tactical entry medics up here are not sworn officers, nor on payroll as officers. Holy Liability insurance! Yes I know...

Ok kewl, now were on the same page. Regarding pain management perspectives...my personal opinion is this, anyone with some sort of experience in this business can get an idea of how bad a patient's pain truely is. They look at a grimace scale, pain rate scale, noted diaphoresis, or even heart rate. But, any vaguely intelligent frequent flyer can pick up on these signs and know when to display them. Especially the "opoid seeking" individuals who are painfully aware of the system. Should their be more options for pain mgt? Absolutely. Do you really need to hit granny with 2.5 of MSO4 before moving her with her bad hip, or could Nitrous do the trick? Maybe 600 of motrin for that 4/10 knee pain? Just me spouting off here, any other opinions on this?

By what basis are you "discretionary"? You can doubt their pain, but can you prove they arent having said pain?? No, you can't. My question was purely hypothetical by the way, just to get folks kicking ideas around... PRPG

Absolutely is what I meant. My apologies for the miscommunication. Pain is incredibly subjective, as well as intangible. You cant look at someone and know how much pain their in, what their pain tolerances are, and if they truely "need" something from the "Pain management family". Something to think about...

Just a thought, Pain is a complete intangible. We have no "pain-o-meter". That being said, can you really deny a patient pain meds, if their is no contra-indications, IE: Social hx, allergies, mental status, etc...etc.... Just my 2 cents. PRPG

Wow...havent heard THAT acronym in awhile... SLUDGE is an acronym for the classic symptoms OPP. As follows... S- salivation, L- lacrimation, U- urination, D-diarrhea G- gastric distress, E- emesis Props for dragging this one out...not many teach this anymore...

To all, please bluecard above post. Thank you. PRPG

I have to ask. So what is underdog anyway?

How many calls do you do that are truely ALS calls? Its certainly not 50 / 50, but its darn surn not 100% ALS. According to my #'s most recently, i've doc'd 47% of 632 ALS calls between all services. So does EMT-D (or B in this era) actually mean driver? Maybe not?

Rid for president