celticcare

Just more field time, I am lucky I have a nursing degree and A&P knowledge to boot, just wish more field time and followed up on more patients as in what the outcome was, did my field diagnosis *yes I know we arent supposed to do it, but we are human we have knowledge for a reason* was correct. You will succeed because it is evident you wish to learn and know more, study when you can, don't be knocked back by the old medics who still think that a bandage and some rectal diazapam solves everything. Good luck

Probably Typos more than anything, I love the brady books, but they have typos all the way through them, like the pictures of the manual defib sequence, it is all out of sync, you see a picture of them charging the paddles with the phrase "apply adhesive pads to the patients bare chest". White to right, red far from the head, black is smoke above fire and green is the grass below the clouds.

It all depends on the way the monitor has been calibrated and whether the amplitude has been set to allow the limb leads to be placed on the torso. There are settings you can adjust on your monitors to allow this so you can have a patient conected to a 12 lead for conitnual analysis and have the limbs free for IV's etc. Yes the limb leads should ideally be placed on the limbs, however practicality can make this a different reality. Check the monitor guidebook for further information on this.

Amen to that brother and terri, in many contexts, in scene safety, lifting stretchers and trusting others.

To watch your back

I am looking at a transfer to Canada, primarily the Yukon to undertake a contract there nursing and EMT. I am mainly writing in response to Aarons pathetic miniscule comments. You have come back to this site and already have caused nothing but disharmony. Wouldn't it be best to actually complete your NR and EMT-P before actually ripping into individuals and people from other countries who actually have qualifications, certification and oh surprise surprise, are actually working as paramedics. You have insulted others from another country which is bluntly, pathetic and again, I reiterate my point, when you actually pass EMT P and actually register, then talk, otherwise keep your mouth shut and its people like you that make me very happy I am bypassing America and going to Canada!

I will choose to ignore that seperate fire and ems comment. Be aware that is treading on some toes on here. Welcome anyway, you'll hear about me no doubt.

Granted but hey life aint free and so have to accept it as the rest of us have too. I wish for a bottle of nice cold vanilla coke

Granted, but you end up with a lame and crippled crew on a leaky boat with only a parrot with turrets as your only friend. I wish I won the international poker champs

Star wars fan would have been more appropriate mike! And I want one

Crotchity, I will try and find the stats for you but in our last revalidation day, the statistics are showing about 25% survival to discharge from out of hospital cardiac arrest with about 20% with no or extremely little neuro impairment. Maybe we are a smaller country and able to spread the message about CPR easier and its taught as part of your cirriculum in school and nationally funded cpr courses are held annually for the public. Defib is a standard part of your first aid course now, its not a seperate course, you learn CPR and AED.

Ok I'll write my current CCU nurse routine and then ems one ok, and remember other country, other drugs, other protocols we have the New Zealand Resus Council guidelines not the AHA so no post pissing as we are governed by a different set of rules and regs here not the same as america. Just writing that before I start as I have read some of the posts and it is like a pissing match at times. VF/VT/ on the monitor *patients are wired to telemetry* Assess patient Precordial thump CPR In the last 30 seconds, charge the defib and assess rhythm, 200 Joules biaphasic shock 2 mins cpr 200 joules shock 2 mins cpr with 1mg adrenaline pushed in this time 200 joule shock. If, at any stage, we see an output capable rhythm, for one to two minutes we do CPR to give the heart time to recover. However, if they sit up and are trying to punch me off, then I stop CPR. Asystole, similar however No shocks unless you are thinking potentially fine VF, then follow that protocol. If we respond as a code team to somewhere in the hospital, hopefully the other nurses have put at least one shock through and we then take over with the above algorhythm. EMS Arrive - Assess. 2 mins CPR, in this time, the four chest leads are applied and the defib pads *ugh pads* in the last thirty seconds charge defib to maximum output. shock resume CPR Adrenaline Charge again and if needed, shock again or dump charge. This is the general run of arrest alogorhythm here. Now in terms of pulse checking, me personally, I do check for a pulse as last I checked, that is part of DRABC. I see the monitors flash enough saying VF and VT when its artifact. I do personally check for a pulse during compression rounds if I am not doing compressions, as I do want to gauge the effectiveness of compressions and also gauge skin warmth if we are getting perfusion occuring. Its what I do personally, and I base it on science on the fact air goes in and out, blood goes round and round. The comment of "how can we move forward as a profession" that is bullshit. how does checking or not checking a pulse hold back an entire profession. You will have MD's RN's technicians, Paramedics, first aiders, will still feel for a pulse, because we want something to either A) keep our hands busy, reasure we are doing the right things and c) because it can be a sign of adequate compressions. So answer the question, we feel for a pulse during compressions, at assessment and if we see a rhythm that is perfusing with life. Scotty

Thank you Ruff, I will send you a beer for that

Here Here Rid

I'd be happy to upload papers etc I have written on the condition they arent plagerised plain and simple.

Ok, I'll throw in my little bit as an RN working in CCU. We have standard protocols that we use, we can intubate, medicate, defibrillate and cannulate without a doctor being present. We have protocols that we can chart meds if we have patients that fit the criteria which we don't need a doctor there to do. Those are great for us.... but I still am not impressed about them at my hospital, dumbing down our ACLS. Yes we cover alot of things in our time through in house training and every single RN is trained to insert an LMA, use an AED and the cardiac arrest drugs in the hospital, the front line stuff before we respond. The hospital got tired of too many nurses and doctors and support staff and paramedics, failing ACLS, that they took out chunks of it and called it ECLS *extended cardiac life support* and then a year later, ACRC - Advanced Cardiac Resuscitaton Care*. in ECLS you only have to identify Vfib, Vtach, PEA, Asystole and NSR. those were your only rhythms, know the meds and how to manually defib. There is also an option for nurses to only do an AED module. Impressed HELL NO. The ACRC course covers intubation, TCP, more meds and advanced protocols. ACLS is dumbed down too damn much. Yes I have a bachelors degree in science majoring in nursing but come on, we do the courses for a reason, to enhance the underlying knowledge in an applicable manner and expertise. I don't take kindly to some RN bashing in this thread, we are health professionals too and some of us give the rest a bad name as do some EMS personel give the rest a bad name. It's down to showing ability. I think ACLS is something that should be reviewed and brought to a 21st century standard, its too damn PC everyone can pass if they sing kumbiyah and hold hands. Oh and our ECLS and ACRC does'nt cover paeds or trauma as we apparently have no need to learn that. Pity the poor family member who has a baby code in the waiting room or we come across a trauma patient. No second guesses, no lets just give a cert, its you learn, you do, you show and you apply, not we need the numbers to make the books look good. Scotty

Including an area for powerpoints we have made ourselves be it for presentations or teaching could be a good thing and make sure that the authors are credited and an ability to message that user or notify them that their powerpoint etc has been downloaded to ensure proper credit is given. I am giving a presentation via Powerpoint in just over a week on Congestive Heart failure which I will be happy to share on here to give a nursing/health care perspective and also insight into New Zealand services etc. Maybe an ability if we include articles we have written or papers etc, that they can be water marked so they cant be printed and submitted. Great idea though Admin

I was here but now I'm gone, I've left my smell to turn you on. Oh sweet jesus thank god I don't live in the USA, I'd be locked away for days with having Hurchsprungs disease and well flatus is a great by product.

I was one of the 12 who posted Dust, please read my post on the first page and please remember that in 7 weeks I will be an EMD using ProQa and so will be reporting back to you all.

Eyedawn take a damn chill pill. You should know me I have humour, develop a sense of one and use it! Personally am only for circumcision if it is medically necessary. If it became necessary for you to have the hood of your clitoris removed for same reasons, then would you want to? A heap of guys I know who had to be circumsized in their teens hated it because they lost sensation and sensitivity. People go on about female circumcision in the aspect that women had their clitorisis mutilated to not enjoy sexual intercourse, and yet you think its ok for a guy to be and lose or risk losing that potential too. And there are many botched up ones, some horrific messes doctors have made. It was not a personal attack at Mr eyedawn, it was a JOKE!!!! Follow safe sex procedures and ECP is emergency Contreceptive Pill. I thought maybe an educated woman who has been educated about contraception would know about that. and the would you want fries with that, relates to portion and proporton (a dig a supersize me where America seems to always want to upsize and gives fries with that) Jeeez it was a joke and trying to lighten the mood, give me a break! End rant!

Taking the law and lives into their own hands literally eh

*cough* ECP *Cough* Prodisentasm *cough* Eye dawn got ripped off by Mr Eyedawn *cough* It's my preeeeescious *cough* would you like fries with that Scotty

Darnit I come on threads too late again

We have a priority staging system built into our emergency dispatch system here. If a call percieves as being non life threatening or emergent, then the call is catagorised as a priority three and four and the caller is told it can take up to an hour (so they are forewarned, most of the time an ambulance is there before that time, but it is a statement that has to be said) and if anything changes, they are to ring again and let us know. This seems to work from what I can ascertain. There is the divert system in place so if responding to a call and a higher ranking one of a priority one or two status comes through, then the nearest unit is dispatched, which can be an ambulance on the way to a priority three or four job. Hard call on the patient with demanding to go to hospital in regards to medicolegal issues, I don't know how to answer that one. We have a different legal system here and if the patient is explained that they do not need to attend hospital or if we can take them to a doctors surgery, often it suffices. I have a had various calls like that too and it frustrates you. But again, as afore mentioned in previous posts, if a patient is calling with something that they deem an emergency, then we have to act as emergency medical personell. Its like a pain score, we cannot percieve an individuals pain or their tolerance, so it is individual to each circumstance. and yes there will be some who will always abuse it and their numbers are logged in the system and also there are those who will not want to bother the poor ambulance officers time or those busy nurses and doctors at the ER and they are the ones we will end up responding to in Cardiac arrest. Education yes is the key, but it seems to be aimed primarilly at children how to call for help and when not to help, but maybe some public education campaigns need to be put out. TV perhaps? I mean how many people do we hear that say "well I saw this once on TV...." Scotty

We use it here, when a call comes in from the operator, the call taker then uses a system known as ProQA. A series of questions are asked and if certain answers come up then the call is deemed as being priority one, two, three or four (one being Lights and Sirens). With this system, alot of calls are catagorised into mainly a priority two and three area and it works cutting down on the number of unnecessary p1 jobs. However the ultimate decision can lay with the dispatcher who can take the information from the call taker and think that just doesnt suond like a priority two response. I'm still nervously waiting to hear back from Comms to see if I got the job in there, so I've just spent the last few days immersed in the computers and equipment. Hope this helps. I personally cant see any cons with it but no doubt some people will in their posts, look forward to seeing them. Scotty