celticcare

*looks for the strip show*

Firstly Dust, I have to hand it to you mate, I had an inkling you were going to actually go down the path of **** young paramedics blah blah, but you came in batting for the younger ones of us out there. Education of young in general today, is ten times different to education of our same age group set 10/20 years ago. What was classed as higher education then, is high school education now *DNA, biology to a cellular level, digital technology etc*. Advanced skills are now intermediate or basic now *LMA, defibrillation, ecg interpretation, 12 lead acquisition* In an age we are in now, technology and science are around us, now there will be 1 good paramedic *and I say paramedic as any knuckle dragger can be an EMT plain and simple* and 1 bad one in amongst that young lot graduating... and there will be one who will have a moment when they are at a trauma, that is WHY it is important for double crewing and support and mentoring. Krumel, if you have that article, I would love to read it as I believe the stepping ladder program was just set up to protect the old timers who still sit on the top of their mountains. We have the paramedic degree programs here, where students need hundreds and hundreds of hours of road time including shifts with very very experienced advanced paramedics and also hospital rotations etc. Now the service doesn't feel these people should be allowed to practice when they graduate at the skill level they have been trained for. They do a degree and do all the skills of an advanced paramedic (EMT-P) during that time, have to perform hundreds of IV's, drop so many tubes, defibrilate many others and still be able to recite their medications, science and anatomy and rationales for everything. They have an indepth knowledge of anatomy, skills to do the tasks and the ambulance services will only give them EMT-B to practice at. To me that is an insult, some young excellent paramedics, and they have to go to the bottom of the pile, why because some paramedics have this mental attitude, that working for a few years as a basic makes you a better paramedic. No it doesnt, as was pointed out previously, it teaches you shortcuts, how to tie someone to a board and get some vitals, it does not teach you how to be a paramedic and use paramedic skills. I feel sorry for the paramedic graduates to be honest, hard work, thousands of dollars and passing the same skill stations etc as their "in house" trained collegues, for what, to be told "oh sorry you are only able to work as a basic, we taught you all these things now you wont get to use them, get rusty at them and then when it comes to reval for them and apply to other positions, you wont meet the grade". Face it, younger people are getting into industries, purely because the general information and knowledge is out there, yes there are some idiots out there, but I'll show you just as many useless and idiot 50 year olds as there are 19 year olds. Bball........ if you're a newbie, I do suggest you dont argue with the big boys, take it as a friendly hint Stay safe Scotty

As a coronary care unit nurse, I have to totally disagree with you and having those bits of information from EMS, even if it is at least an educated guess, is a gauge to understanding if a potential condition has gotten worse or even rectified to an extent. There is more to a patient than a STEMI and a developing LBBB or RBBB is just as important for me to know as a STEMI and how am I going to see that.... via lead 1 mainly. How am I going to clearly get an image of axis? via 12 lead. How am I going to locate ST depression and T wave inversion, which I think at times are just as if not more important than a STEMI due to the fact this is ischemia, this is myocardium we can save. STEMI is infarct, that is dead tissue we have already lost, if a patient is showing t wave inversion or segment depression, I would want them hauled ass for potential revascularisation or reperfusion therapy. Just my two cents, but I notice a big continium of care when a pre-hospital 12 lead is done and its a guiding baseline. So even if you don't fully know how to read them *heck I don't know all the facts either, it takes time*, just print one for us, please, it does actually make treatment options more clear and that baseline vital trend, 12 lead the other vital sign. Scotty

Why AFIB, is that a cheque from Physio Control I see coming out of your pocket there?

Hey all, I subscribed to the e-newsletter about updates of the Lifepak 15. Not sure if any of you are familiar with the site launching the new unit so here is the link with some info and videos. Basically a lighter and brighter Lifepak12. Designed mainly for EMS in mind. Dust no bad comments lol, just posting this for information rather than product placement (*cough MRX beats Lifepak*) Scotty Lifepak 15 page

We have the ability to disable interpretation on our machines if we wish, we leave it on though as its fun to compare the human eye to the machine

I am torn on this one too, part of me wants to go down the lets give Cardizem path, but the other is treat the underlying issue, the initial complaint was SOB with Pneumonia compounding everything. Then the Afib showing a fluctuating rate on the screen as 170 +bpm and an associated palpable pulse of 88. She is normotensive in a textbook sense *or could be her response to beta blocker bp*. Part of me wants to go down the path of lets cardiovert her "either chemically or electrically" but she is "stable" in the essense of GCS 15/15 and holding her bp. Without knowing if she had taken her BB, when she took it, what the afib itself looked like on the monitor and potential to deteroirate is like. Also what her body mass and general apperance was like would be a factor for me on giving the medication. Co morbidities also, had she had any anti hyperglycemic medications? Its a tough call, an hour out from hospital, yeah probably would have seriously considered cardizem for the issues of cardiac intergrity etc, but close to hospital, unless she was looking like she was going to code or crash on me, i would withhold the cardizem. Some excellent points raised here, some egotistical issues raised and some definate "my wangers bigger than yours" posts, but I wonder whether as much debate would have arisen if the other information on pulse rate, temp etc were included in the initial post?

When we were learning drug calcs before I transfered to RN, we used basic nursing medication guidebooks, there are a wide variety available on Ebay and amazon and can be transfered to the EMS field as they relate to over time, weight, conversions *SLED - Smaller to Larger Equals Divide* etc. Might help might not, worth a shot and consult your pharmaco section of your brady book *hint hint* there is a maths section in there. Scotty

Even with our static monitors here in CCU we get similar messages and as many of the fine posters before me have said, its down to your individual reading of the patient, the signs and symptoms and then the monitor to make a diagnosis of ACS. The amount of patients we have been having lately showing collateral ST elevation on the monitors and associated chest pain and are actually in coronary artery spasm is amazing. Hence I dont call them as an MI until I get a trop back, I just use the Term ACS instead.

Good ol NHS skate, cycle or run, we'll beat that damn truck to the call

Because the fire service here in New Zealand is a national service, there is a national regulation of uniform. You get issued basically (regardless of volunteer or paid) 1 Turn out coat / 1 pair of turn out pants (Both are lion apparell and the Fire Service has them on a rotational hire service that they get sent to Lion to be repaired and cleaned and a replacement pair sent in their place) 1 pair of level one overalls 1 pair of gumboots for the turn out level 2s 1 pair of level one boots *current brand is paraflex* One Helmet which again is issued on a rotational repair service *I forgot to mention this prior hence the edit* 1 Level one shirt (Dark Blue with Fire rescue patch on shoulders) 1 Level one pair of pants (Dark Blue again) 2 tee shirts with fire and rescue crest on the left breast Some areas issue personal Hi Viz vests however there are at least three to four on each truck. One to two Dress uniform shirts Dress uniform pants Shoes Dress uniform jacket Hat Tie And for the ladies, an option of a skirt for dress uniform so they wish Most trucks will carry a level three splash suit and the urban trucks often carry a level four and five hazchem suit on their appliances. You get paged, turn up to the station, get into your gear and respond on the truck, no responding straight to the scene in POV's. EMS - 2-4 White uniform shirts 2-4 Pairs of Black pants (However the services are looking at going to two piece overall material pants and shirts) Hi Viz Jerkin *Vest* Jersey Lined Fleece jacket with detachable sleeves Rain jacket Belt Some areas and individual stations, issue a holster with shears and a penlight. Procedures manual. Boots you need to provide yourself and any other gear. Some rural areas issue members with personal kits especially if they do first response or PRIME response. You can put together your own kit if you so wish. Scotty

London Beat them to it

Of course Terri can't be there to be Phill's personal nurse....... CAUSE I AM MUWAHAAHAHAHAHAHAHAHA size 12 Foley anyone Get well soon ya sheep shagger

17 but didnt get it for another two years. How old were you when you stopped chasing the ice cream man's van?

22. I miss that car. How old were you when you first stayed up without your parents knowing?

13 at high school, not part of the in crowd, you are no body. How old were you when you had your first ride in the back of a cop car?

Hey good work on following your gut, there are some things the paramedic classes or even RN classes teach you and only by taking in all of your senses and the environment around you, will you know more and more to follow your gut. The medic wasn't happy? well Boo Hoo its his job plain and simple, he is for responding for ALS backup as part of his job description. What if the patient needed an IV, or further meds, or those PAC's deteriorated to a Junctional rhythm, a sign of a heart in trouble etc. You did the right thing, at the end of the day, its about the patient and not individuals egos Scotty

I would offer advice but I am on the verge of being neutered in another thread so me will remain :-#

Be careful who you share your ideas with, look at Microsoft, have one good idea, tell one person and BOOM its stolen from under you. Hope you get success mate Scotty

People please, the topic of the thread is the administration of IM glucagon without an IV in situ. Some interesting facts have come through in the thread of including push the dextrose, yes some areas can do it, others cant, the administation of glucose rectally *which I had heard of fluids rectally and meds but not glucose, but a good point none the less* This is turning into another EMT City brawl, please please I am sure the original author of this thread did not intend it to get to this level. I am not wanting to name individuals as I don't personally want to end up on a hate list, but please can we get to the topic at hand, if you want to discuss transport or not to transport with substantiating evidence, then please do so in a new topic. Thank you Scotty

We have the same issues here with the electrodes not sticking with diaphoresis and its frustrating being a coronary care unit and the electrodes not adhering. We have different brands for these patients and properlly shaving and drying the patients skin helps. The sweating as we all know seems to be from the underlying problem *circulatory strain* so fix the strain fixes the problem most of the time, but hey thats in an ideal world. Tape works well, skin prep and alcohol wipes are other good sources. Its trial and error, some patients it works, sometimes it doesnt and others it takes a whole process of them trying over and over to get to work. Scotty

Ok people, we know sometimes I am a :joker: sometimes I should keep my mouth :-# but if you neuter me, the Scotty Dog, then you'll be hurting the future of EMS and that would be just a sad sad tune. :-({|= So out of the kindness of your hearts, spare me my nuts, and can't we all just get along? :3some:

Do you still need some strips, we have folders here in CCU of interesting 12 leads and also rhythm strips, I can scan some if you want.