celticcare

All the best advise has been laid, also having your monitor in a position that means your leads wont be drooping all over the place and causing gross artifact. Also knowing your monitor, how its calibrated in regards to the limb leads being on the torso or on the actual extremities.

Not settling for second best and looking for quick fixes will lead to disaster in the long run. Misplaced leads could lead to misplaced treatment. Take the time, take the care, maintain dignity, but at the end of the day, in regards to female patient, a moment that they may be disrobed to provide an adequate diagnosis, could mean the difference between life and death and life over property.

Scotty

Because it takes 5 seconds to look and see if I am dealing with a severe brady, a tachy (SVT, VT)or something else and make the decision if I'm going to go out to the ambulance, or stop in the front living room and try to get a head of the game there. Also because by the time you yank this poor son of a bitch even into the living room, you now have blown 5 minutes in many cases ... 5 minutes where your partner can be setting up something for you, like meds, or pacing pads, or anything...

Its just different styles, but I cringe when I hear people make up excuses why they didn't get vital information because they were doing something else...

There are times when I would do a snatch and grab, as you mentioned, but haveing a basic idea what is (or more importantly ...isnt) going on in the first 2-3 minutes is helpful. And as for getting tangled up in the EKG, thats why the leads are detachable from the monitor.

Thank you, exactly right. If you know you can do a bit of stabilising in an emergent sense in the lounge and then get them out to the truck then go for it. Rather know that if I had an SVT that I got them out of the cramp spot, into the lounge, do some stabilising, stretch them out, put them on stair chair properly and then get them to the truck. Its case by case but would rather know I had a bit of an Idea what I am dealing with and could have complications wise before going to the unit. And in reality, someone reading that might think "oh hell thats taking ten minutes" when in reality, the process would be a minute, takes longer to explain something than do it.

And Ben, implying my new job,

I am curious also, notice no further word from the infamous O/P? I am with Mobey on the replies too

Whilst not the same, we had our limb leads set up in a diagnostic mode in CCU in the days after infarct to continually give the six lead views without the patient being permanantly attached to precordial leads.

I am going to check this out with the LP 12 at work, I like the idea that if you have suspicion, you can get a look in, and remember you only need 2,3 and AVR to diagonose inferior MI.

I am just worried if anything might void the warrenties on products pressing the button when its not supposed to be used that way, we know how some medical companies get with products.

Good thread idea though, just curious are some people reading this as that you are attaching 6 leads *wires and electrodes* to the chest or gaining 6 views of the heart?

Scotty

Not very much information about the product on the site, bar the PDF file and couple of videos. Seems if this is the revolutionary method of airway care, there would be more out there about it.

Oh well, something else that will be purchased as a fad perhaps. Put it in the trunk with the LUCAS?

Stick to the AUT program, don't go to the other.

The process and transition to the ALS/ILS and BLS process is going ahead strongly from initial information recieved.

The BLS skill set, despite prior comment, is actually more than the "average" basic level that has perhaps been portrayed by other posters. BLS skill level is essential and with the higher level of skills coming out, BLS skills are not what is perhaps percieved as being a basic grunt.

And for someone who actually has done the RN degree here in New Zealand, yes some idiots apply, they soon leave in the first couple of months, and a nurse is more than a nurse, there are critical care nursing avenues, medical, surgical, primary care, nurse practitioners, nurse lecturers. A nurse is more than a nurse as a nurse has a chance to cross across to different facets of care and focus areas. A PHEC provider has a scope that is prehospital in a general scope.

Please also remember, we don't have the money like alot of other countries, so we have to have the BLS/ILS and ALS skill level to provide care in general. And there is encouragement for all to be higher than BLS, but please don't paint BLS as being a bunch of Morons with a bandage and some panadol.

Scotty

EMD/EMT/RN

I haven't actually gotten that far on it. I do know that we're going to look into atropine and lidocaine. Anyone have suggestions on resources I could look into? I've been looking at drug books so far, and have designs on interviewing an MD and/or a medic.

Could look at how dosages have changed and the pharmacokinetics of each and how both are used to get the heart in a regular form of rhythm *yes basic slang there, its early morning on my fourth night so shuddup lol* and maintain it.

Or the use of Atropine in arrythmias as opposed to Cardiac Arrest and the medics use of each. Who knows its wide and complex.... just like a tachy cardia *ka boom boom dush*

Sing out if you want articles and resources, CCU RN here.

Scotty

Ask for free samples and dont accept anything less than 5k street value

Sing out if you want any help, there are some good pharmacology for paramedic books out there and even general nursing pharmacology books will be a help. Think of what your patients have been on in the past, common trends like beta blockers, Ace inhibitors, diuretics, anti psychotics, ntirates, opiates and also street drugs of abuse etc.

You will do well

Scottster

How did the article/report turn out? Hope it went well and Cardiology is a good area to explore in regards to alot of meds, treatments etc. Hope it went well mate

Scotty - RN/EMD

My reputation for rehashing old topics should preceed me and here I am proving it lol.

First aid courses I have been involved in teaching are often industry specific (line haul drivers, volunteer firefighteres, ERT memebers, forestry workers, children groups etc) and so each course is tailored to suit the individual needs.

If I am dealing with responder teams like ERT that need a two day basic course with CPR, WPFA, AED and some extra skills like C-Collars and O2, I do find introductions are important as I don't work with the people, helps me identify the leaders and the shy ones that I will need to assist through the course and in some courses, you may have members from three or four different ERT teams, so its a chance to mingle with the team memebers themselves.

Humour is a brilliant instructional tool, if you can laugh at yourself and with the students, personally, I've found the courses to run alot smoother.

I use visual aids such as Powerpoint, video and big clear charts. The books and charts are scattered around the desks for group work of taking a medical condition each and presenting the basic - what it is, how it presents and what treatment is used and whether its time critical or not. I am not a fan of written exams, I am a person who would rather see someone succeed with the practical and verbally give the answers in a relaxed essence.

Every instructors style is different and also every countries style is different, New Zealand is a very much, sweet as mate attitude whilst maintaining professionalism.

Scotty

What is the MRX and QCPR? I'm not familiar with those terms.

MRX is the philips heartstart manual defibrillator which when combined with the QCPR sensor, gives feedback on compression effectiveness. This pad sits in the middle of the chest where you perform compressions and gives feedback in real time to the Monitor to advise CPR changes *push harder, faster, slower...... wait sounds like a night out with the wife.... anyway back to the topic*

Only downside to QCPR, not compatable with the MRX units with Paddles as it requires the pads to collaborate the resus information as the pads sense the recoil etc.

More information can be found on the philips health care site.

Scotty

As Scotty said; New Zealand has two not for profits (hell they run defecits exceeding ten million pa no chance of a profit there!) and two hospital based systems that provide emergency 111 ambulance (EMS).

St John is the main provider operating a loose national structure across five regions with service level agreements between the national office and each region - don't get that? hell me neither. This leads to some variance in how the services are operated across each region although in the last little while there has been a hard push by management to create a single, national way of operating.

Our scopes of practice and clinical procedures are (within St John) nationally consistent and come from a panel of our 5 medical advisors (1 of which is the national medical director) and 5 ALS Paramedics. Before '99/2000 we did have nationally consistent procedures and practice levels for all of New Zealand but the group responsible for this was disbanded. Having said that there is now a new system being built where all providers will have consistent levels and education across the four providers and the defence force. Our scopes of practice across the four providers are almost consistent but there are some minor variances (e.g. thrombolysis and corticoteriods) but again, we are working on a national scope of practice.

The New Zealand Fire Service is a totally seperate entity and does not get involved in medical calls except for rural first responders and on-scene medical care say at an MVA before the ambulance turns up. The highest level of care for the Fire Service is basic first responder and AED; we don't have Firefighter/EMTs or Firefighter/Paramedics - although when I was running with the Fire Service they liked me for my medical skills; does that make me the only Firefighter/EMT in the country? *tongue firmly in cheek

As far as our funding we are funded partly by the Ministry of Health for medical calls and ACC for trauma. ACC is our national accident insurer so does not "bulk fund" like the MoH but rather pays use per-patient; I know the amount ACC pays is set per call and whether the ambulance has one crewmember or two. This creates a bit of an incentive to transport people who don't really need it to earn as much money as possible.

AHEM BEN!!! We do have medical co-responder units here in Northern region in which firefighters are turned out to medical calls and its NOT just in the rural areas! Wellington Firefighters are turned out to medical calls also. Alot of fire brigades around NZ do have staff on the appliance that are also either volunteer or full time ambulance staff and individual agreements with the brigade officials will give them leeway in response to their skills if agreed between the ambulance service there and the fire officals. *gives an angry glare*

My apologies to the OP but had to nib that in the butt.

In the prehospital field, I've seen and personally felt for a femoral pulse during compressions and also looked on the monitor in lead 2 primarily and looked for continious wide complexes in sync with the compressions. Complying with the standards of hard and fast and allowing adequate recoil of the chest between compressions was the standards taught and the evidence presented in the AHA guidelines as well as the training given. We dont have the Autopulse devices etc HOWEVER..... most of the ambulances in NZ are now going MRX with QCPR so be interesting to see what that does to perhaps the CPR we have done for ages thinking was adequate. ETCO2 is also used if the patient is LMA'd or intubated.

In Hospital as a CCU RN, the monitors, femoral pulse, ETCO2 and maybe them fighting us off of them is signs we are getting good compressions/resus in. I do think though that CCU is one of the harder areas to assess as we get a defib in within about 10 seconds roughly or at least a Pthump and all of the staff are trained in manual defib with paddles to get the shock in faster.

It is interesting though reading the femoral pulse debate. Through any of my training it was standardly taught to feel the groin..... wait that sounds wrong....

Here in NZ the Paramedics run the PRIME courses (PHTLS, ACLS, PALS and Scene management) for doctors and RN's....

I rest my case I think someone was just trying to go har har har, I am in charge now.

Welcome back btw SA

Recent discussions about standards of care got me thinking... are their any other countries' EMS systems that are as inexorably linked with another service (i.e. Fire/Police...sometimes)? Or are they stand alone entities, judged and evaluated based on their own performance/need?

I've read many threads about treatment protocols and education, but I can't remember if we ever discussed this aspect. I think that it could serve as a valuable distinction between the level o' standards, and possibly explain some of the fundamental differences between the U.S. and others.

Hi there, I am sure this has been written before on another thread, but here in New Zealand, the EMS agencies are independent agencies. Four main services exist with St John being the main provider covering approx 80% of the country. There are five regions spread out each with its own medical director however a national standard of protocols exist for the minimums and some areas have more procedures they perform due to locality or distance from hospital. There is co-operation between NZ fire and Rescue and ambulance but no merger exists. Funding comes from ACC *accident compensation corporation* in relation to trauma calls, and the Ministry of Health provides funding for patient transfer services through the hospital boards, and some funding to fund emergency medical calls, however the rest of the funding comes from bills for medical calls, public donations, bequeths and general do gooders. Two hospital run services are run in the lower parts of the north island and are Hospital board funded and also with ACC for trauma. Wellington Free ambulance is what the name suggests, free ambulance care to the people in the wellington area at the bottom of the north island. however they run in a deficit and rely on public donations as well. Funding comes from ACC and Ministry of Health Contracts.

I do hope one day the services will merge as it will mean that more funding can come available and a more unification of the services can occur. This is my own personal opinion, any one replying dont rip a new backside for it because I will show you respect for yours also.

Scotty

*sets out a pill bottle of Ativan and a few bottles of water*

take the hint

*Gives Arron the whole bottle and one bottle of water* now you and your best buddy dust can decide how to take these, either orally in one go or a suppository. Or better yet, take the lot as a suppository up dust's ass and that way you get it orally as your often so far up it its not even funny.

Dust, I don't know why I even bother now. You're a burnt out washed out has been wanna cry for me medic, all you thrive on, is a reputation for bringing people, beliefs and thoughts down when they dont match your own. But ya know what, its all good, because when your sitting alone thinking oh woe is me, I'm gonna be out on the streets doing the real job and doing it in the advanced world, with my cookbook knowledge because I chose to learn it. Yes completely off topic, but throughout this thread and others, you just dig yourself into the hole that is arriving faster and faster and you just prove that you are an asshole and have your little minnions of assholes who follow suit so well also.

I'll just stick up for Happiness and Annie on the way you've acted, and spell check might have been applicable in your original title of this thread,

Looks like Afib with slight st depression starting, could be secondary to the opiate use, with occasional runs of Sinus in also.

WTF is personal about that? Did I ever say anything about you personally? Did I say anything about BC medics in general? Did I say anything to disparage BCAS? No. It was a statement of fact. You have been on strike for two months, and the public doesn't even realise it yet. That is the very definition of fail. Personal? Is your entire personal identity tied up in your union leadership? Are you the one who ordered the strike? How would this be personal for you? If my organisation fails, I don't take it personal when someone points it out.

I thought I did. But both of you have gone off the deep end on this one, attacking me for something I never did. When you whine that I was attacking BCAS medics, when I was not -- and you're smart enough to know I was not -- then that is playing the victim. I was not the aggressor here. And to claim I was is a lie.

Why don't you? When was the last time you posted anything like that? I didn't post this thread to make anyone think. I posted it because it was EMS related news. Period. But I disagree that it doesn't make anyone think. Everyone in EMS should read that news article and give serious thought to what they would do in a similar situation.

Nonsense. I have always posted news articles like this. Most of them never get past a couple of replies. I never heard you complain about any of them. Maybe this one just struck a nerve because it revealed the failure of your union. That's what this is all about, isn't it? You're embarrassed, and you're taking it out on me. How lame.

What shyte was I trying to stir?

Ummm... I said it was what I knew best. I didn't say it was the only thing I've ever done in my life. Now who is stirring shyte?

Post proof or STFU. You won't find it, because I have NEVER posted any such thing. Pretty much anytime I even mention Canadian EMS here it is to proclaim it's superiority over American EMS. You're lying, cock breath.

*Licks LIps and smiles* Oh sorry were you talking to me?

hahahahahaaha still have your 3.5 gpa ok I will grant that and yes school is over but now you have to get a job and the new standard for your field is 4.0 (Remember im canadian i hope 4.0 is higher)

I wish Jeep finds a job

Granted but it is working with me as my personal sex kitten.

I wish more women would job share with Jeep

Where does it say they aren't American citizens? I just skimmed it but didn't see that anywhere.

Pleased someone posted that fact too, just because they have Arab names, doesn't mean they aren't American born and raised even. Don't jump the gun Aaron

EXCUSE ME.... I AM THE HOUND OF EMTCITY!!!!!

And Dust, it was evident it was a shit stir thread. Too bad that the Canadian medics have morals that they wont comprimise their patients, it was the same as us as RN's striking for equal pay, a street cleaner was on more than an RN here and we couldnt abandon our patients or their families to strike, it took years to get anywhere and now we finally have a level of pay that is satisfactory *not great but satisfactory*

Keep the sob story out of the thread Dust, you've had that many jobs that its not actually proof of creditbility, its a sign of not sticking in, yes the general field has been medicine, but its been through many sometimes versitility is not better than secure grounding.

There have been plenty of threads where you have bashed Canada and other nations. again another sign of the "Gi Joe the great american Hero" mentality possessed by ex military.

I've not been in the military nor have any desire to be in it, I serve my country and my commonwealth through science and looking after my own people. Each day I wonder how much further you can slip with posts dust, and another -10 from me today.

Scotty

Guilty

Have you forgetten a birthday?

Guilty, my sons. (Long story there about me and his mother)

Have you ever wanted to change something so bad in this world it hurts?

Very good indeed, just wondering how long till something stupid gets done by another amateur that just doesnt work as well.

Not Guilty.

Have you ever wanted to go jello wrestling?

Guilty *in thought and action*

Have you Streaked *Be it drunk or sober*?

Def CHB, and its a LBBB for the reason listed prior, negative in lead v1 and wide QRS complex. Looks like ST depression in Lead 2 also.