celticcare

Thank you Dwayne, you hit it on the head. The situation that presented itself, was that a patient was bucked from their horse, now the MOI of the patient landing DID NOT indicate a C-collar and the patient met the in field requirements for spinal clearance and the ED physician also concured with this. The nurse questioned the Paramedic in front of the family and I felt this was wrong. When I spoke to her afterwards about it, she didn't know that in the field clearance of C-Spine can take place. This isn't the first instance that it has occured where Nurses have questioned paramedics abilities or knowledge in the field and time and time again I have had to explain things to them about what can and can't be done out in the field. Another aspect is we upgraded and built a brand new Emergency Department and upgraded all of our patient monitors which utilise the same ecg dots as the ambulance, I had one ambulance crew remove their twelve lead dots as they didn't think that we had monitors to interconnect *which we didn't in the last ER but we do now* and so what I want to learn about, develop and hopefully implement, is a nurse who, along with a med director or other advanced paramedics, give education sessions to RN's about advancements in the field, technology that is being used in the ambulance, organise regular ride alongs and the same for us for paramedics, to come and spend a day in resus/crash rooms with us or continue more assessment, IV or 12 lead assessments with us. I want to see intergration/support for both sides. I am not out to piss anyone off, or say "you are a paramedic you can't do this or shouldn't do this". I am lucky in the essence I am the only RN in there with an EMS background and credentials *just have had to put EMS riding on hold for a bit balancing the last of a masters degree, getting married, working full time and being a dad, had to put something on hold for a short while*. I don't want to see situations like what occured occur again, hence I am asking if there was an ER liason nurse role, what would you see he/she doing in this role? Organising training together? Organising shifts together? Being a go to with questions about the ER or any problems that may have arisen in the shift? Thanks Dwayne though, and your feedback has been appreciated, as has the rest of the comments on this thread. Hope this post has clarified it up a bit more. Scotty

Woah, back the horse. I am an ER RN as well as certified EMT-I. I am more meaning on the aspect that this other nurse I work with didn't know what EMS staff could do in the field, as in lack of knowledge of the scope of practice and procedures available etc. I am not saying the RN makes the decisions about paramedic skills etc, far from it. I am asking is there an RN at your local hospitals that acts like an EMS liason or support person between RN's and EMT's? Like if an RN pisses you off, do you have a nurse there that you can talk to about it or find passages to rectify situations, or an RN that is involved with your service also that educates staff back at the ER about new equipment or procedures in the field to ensure continium of care is processed etc. Remember I am in New Zealand, we generally have a good rapport between EMS and Emergency Nursing here, but just curious if there is anything like I have asked in any of your hospitals. And I personally think its good for ER RN's to know what Paramedics/EMT's here can do and what sort of skills are in the tool box. It is not a pissing post for anyone, merely a support network for each other and also a chance for each speciality to see into the world of each other. Scotty

Happiness, its actually a snorkel for the management officials who suffer rectal cranial inversion. They have to breath some how apparently Scotty

Thank you Ugly *feel so bad writing that lol * for just thinking of us even for that moment, we do our best but it is hard especially with short staffing and overfilling departments. Scotty ER RN

Interesting read, considering most arrests get two trucks arriving, each with a manual defibrillator on board, so there is two defibs on scene, might have a chat to the cardiologists and EP docs about what do they think about it. Especially if one set is A/P placement and the others are sterum/apex placement. Scotty

Bushy.... I'M BATMAN :dribble: :dribble:

Due to the time of my registration and training skill levels, its only ever been Amioderone that I have used, but then bear in mind, that it has only recently been incorporated into the resuscitation guidelines for the event of ROSC. Some doctors I have worked with have still asked for Lignocaine as that is what they know and have had successes with. I can only comment on giving Amioderone as a standard. All medications have factors which enhance or limit their success. How long the patient has been down, the time of admin, state of the myocardium, hypoxia, sensitivities to the medication, precipitating factors to the arrest *H's and T's etc* and the outcomes with studies have shown favor to amioderone hence the current recomendations for it. Are meds of little benefit in Cardiac arrest? Who knows, are all cardiac arrests the same? No. So perhaps the statement of that "all meds in cardiac arrest management have little or no effect" is contradicted. But then the date of that statement is also the time we did alright chest compressions and three stacked shocks and only had monophasic defibrillators and intracardiac medications lol. Times change, meds change and so do protocols. Be interested to see other replies on this thread. Scotty

Hi all. Have a question for you lovely people out there. I had a situation recently in the er I work in in where a fellow collegue was unsure of certain things the EMS providers here can provide and do such as in field spinal clearance or tourniquet application. So am just curious does your ER have a nurse assigned as an EMS liason to assist with education or staff issues? If so, how does this system work? I would like to create this role within our ER and would love some input including what would you envision the nurse in this role to have and what would you expect them to do for your voice in the ER? Thanks in advance guys Scotty

Ok so have an answer to one part of the process, the machines are designed to return to asynchro mode post sync shock. There is only one unit in the hospital that doesn't and that is the one in the theatre that does the cardioversions on an elective level. The operators there are reminded via large prompts that it will remain in sync mode when the sync button is pushed *or until it is powered down*. In regards to the defibrillator reverting to paddles lead from lead 2 after the sync shock? I am still stumped.

Thank you Ben oh great master of Youtube.

Lets try this again grrrrrr

I used to work comms and this is some of the attitudes we would get from staff on the road, however not on the airwaves but on landline to comms. The attitude is out there true and hard, but don't rain on the poor guys parade guys, he was trying to share a joke with us all that is online, and its his first posts, ever been to party and made a joke to try fit in that didn't actually turn out funny? Scotty

It wont work, alot of series that have been created by the Brits have been attempted by the Americans and it doesn't work or come across as it was intended. As said on the article quoted, its based on the book written by British Paramedics and the systems are different, the politics are different and frankly, British humour outshines alot of American stuff. Hope these link but here are a couple of trailers of the British version. Seen it on UKTV here on Digital and its hilarious. And plus the Brits can take the mickey out of themselves without getting political or their knickers in a twist like Americans can. Scotty <iframe width="560" height="349" src="http://www.youtube.com/embed/4OSgwlby_uw" frameborder="0" allowfullscreen></iframe> <iframe width="640" height="390" src="http://www.youtube.com/embed/pVxByQjUzk8" frameborder="0" allowfullscreen></iframe> *edited to try and get these damn youtube videos to embed grrrrrr*

I like this, downloaded the powerpoint presentation to take to our next resus committee meeting and see if maybe might be something we could trial, especially for cpap see if it assists. Thanks mr secret paraninja man

Here in NZ, with one of the services I was with, anyone EMT-B upwards was refered to as Paramedic and then there was Intensive Care Paramedic above that. So hence was refered to as medic, but luckily there is a strong community push here where people are educated in that there are different levels of ambulance staff. Most first aid courses here have at least a slide talking about the different ambulance provider levels and so people understood the tiered response system and there are tv shows here following the ambulance crews around and explain the scope and skill levels. If people asked what I did, I would say I'm an Ambo as it let people know that I worked on the trucks but then often a converstion would ensue about what the work entails and would be up front saying that there are levels and that some skills are reserved for certain levels and that I could do such and such for my work. I currently work full time as an RN within a busy metropolitan Emergency Department. We have different scopes of Nurse there, I am happily a run of the mill RN, we don't have LPN's or CNA's here. There are Enrolled nurses coming back, but our uniforms all say nurse, the only difference being that we have some more advanced scopes than the EN's. I do get pissy at some of the Clinical Nurse Specialists that flaunt their title around, at the end of the day, they are still RN's just with some extra skills under their belt but get shitty if you refer to them as "nurse". And CHBARE, I had a nursing lecturer who had her PhD and it was all about nursing education and how we had come along, no actual clinical focus in it, and she would tear you a new one if you didn't refer to her as Dr. I'm sorry but if you want to be called Dr, do something actually clinical and get an MD or a focus on something other than how touchy feely we have become in our Nursing journeys. Used to make me mad as it seemed a throw in the face of what the true paths of nursing had become. Titles, yes at the end of the day, are just titles, how we portray ourselves with honesty and intergrity are different things and it takes a stronger individual to actually correct someone and educate those who otherwise wouldn't know. Dwayne thanks for the input and perhaps putting a leg out there for the rest of us in this field/profession.

No perception of racism here, it is literally a lost in translation element. It happens in french, german, Maori and of course any asian language, if Asians were really worried about it, they would have made new signs or changed things, but these signs still exist, so musn't seem to bother them. These have been around for years, thanks for posting again though Happiness love it Scotty

12 Lead was done showing a regular rhythm of over 220 beats per minute, once rosc was achieved patient was in Sinus rhythm with occasional pvc's.

Hi guys and gals, ok so this is a spin of the thread that I started in the Equipment section in regards to synchronised cardioversion and defibrillation settings. Patient presents with SVT, textbook narrow regular complex rate of 210-223. Pt GCS 15/15, BP holding in a normotensive state and complaining of Chest pain secondary to the Tachycardia. The patient is a 43 year old male, normally fit and well, has a history of Parasoximal AF which has needed cardioverting 5 times within the last 5 years. Decision made by Attending to take patient into the resuscitation area and give an adenosine push to hopefully chemically cardiovert the patient. 6mg of Adenosine was given first and there was a slowing of the rate with what looked like a flutter pattern on the screen when the patient then went into Ventricular Tachycardia. 150 mg of Amioderone IV push was given with no success. Decision made for patient to be sedated and 100 joule sync shock given. As soon as the shock was given, patient went into Vfib and 360 joule defib given *first defib I'd done in a while so put the full joules through * Patient reverted to sinus rhythm post shock and remained in it and no return of SVT or VT *or thankfully as well VF*. My question, is that has anyone had similar episodes after giving adenosine with the rhythm changing to a VT post push. Its surprised me as I have never seen it. I will update tomorrow on any further details on any outcome from further investigation. Scotty

Hi guys and gals. Got a question here especially for the techno kids amongst the teams. Had a patient yesterday that had svt, gave adenosine and no reversion but bounced into conscious vt with symptomatic complaints. Sedated and cardioverted at 100 joules, the patient then went into vf and then defibrillated at 360 joules. For the cardioversion the lead input was lead 2 but after the shock the input converted to paddles lead. The senior nurses said that the units at our hospital were apparently calibrated that after a sync shock that they remained in sync mode. Thankfully this one didn't but the question I have is: has your defib done that post sync shock and are any of you aware of machines being calibrated to do remain in sync mode post shock? I think it's dangerous and in this case pleased it went to async mode. Thanks in advance guys Scotty

You aren't alone my friend, there are friends here who you can PM and even vent at if anything, random words or anything just come to mind. I know about the rutt feeling, that you try to get back into it and feel useless. You can do it mate, just breathe and message if you need to Scotty

I have to say thank you for introducing me to a new route for glucagon, haven't encountered it I/N yet, yet with the nasal mucosa and linings it makes sense. In hospital, I haven't personally had trouble with patients who have come in with glucagon administered. If they have come in with hypoglycemia with fragile insulin regiemes, often a GIK infusion is started to balance out the solutions in the body, often with just the dextrose prior to initiating the GIK infusion. We have a frequent flier who overdoses on her husbands metformin and it is a bitch to get IV starts on her, mind you am getting better at my foot cannulations now with her I will look at Glucagon I/N at work and speak to some docs about it, and from a Prehospital perspective, we only have it IM here. Scotty

Suit Hired - Check Reception Paid for - Check Venue paid for - Check Dress ordered - Check Flowers organised - Check Invites ordered - Check Parties organised - Check Rings ordered - Check Photographer sorted - Check Celebrant organised - Check I'M GETTING MARRIED IN 6 MONTHS OH MY GOD!!!!!

You see alot of schlong in British films and series, but then alot of British stuff isn't as censored as the American or even Canadian stuff primarily for the fact that its a different type of culture, what was once seen as the prudish nation, now has penis's on display. For those of us who are happy with our package and also have in the past shown an interest to them *cough cough*, I am neither bothered nor concerned about more men or women on tv. Seen one naked..... you wanna see 'em all naked ;-) *thank you Ron "tater salad" white".

Hey if it's not too late, e-mail me on here or my email addy - celticcare@gmail.com if you want an international perspective.

Dust, we have been through rough points together, butted heads on many issues, my personal life became a topic of fights, but my friend, I wouldn't be half the man I am today, the husband that I am to be in October and the father I am to my beautiful little girl, had you not been the blunt and abrupt and actually open hearted man that you are. I have grown in so many ways, as an RN, as an EMT and soon to be NP and Emergency Care Practitioner, combining RN/NP and EMS workforces together out on the road and into the wider communities. Your passion for making us find the answer, find the knowledge and skills, pushed me to strive to the best of my abilities. Whilst I haven't the pleasure of meeting you face to face yet, I would love to sometime soon, and for my daughter to met someone who follows their heart and strives onwards. You have the ablity to fight, now do it. Strive on and you will continue on. If I had the ability I would come there and be your RN, it would be the least I can do to support you. Strive towards the future, you have a neice here in little New Zealand who will be proud to know her Uncle Rob has fought for her liberty and success in this world, my fiance' is a Texan and so we are practically family now Rob . I am sorry, I am actually choked up reading that you've endured this, makes my current busted wrist worthless whilst you are going through this. I owe alot to you, even in the times of our fights, I owe alot to you and as well as doing it for me, I am doing my masters in thought of you, because New Zealand needs your representitive here, and I'll carry that for you. Pro Utilitate Hominum - For the service of mankind. Pro drinkus de beerus - To the good times of life Kissies non homius - Brotherly love. Take care my friend, mentor and guide in emergency medicine. Scotty, Laura, Nicole and Oscar (the dog bark bark)