medic001918

For the best advice, visit an accountant. They can guide you as to what kinds of things can be written off and what can't.

I write off any uniform supplies (boots, equipment, etc).

I write off a portion of my cell phone bill.

I write off a portion of my internet provider (used for required CME's, email)

I write off a portion of any new computer I buy (used for CME's, internet, company email).

Those are a few that come to mind quickly, but check with your accountant first.

Shane

NREMT-P

But, you are measuring two totally different aspects of Respiration: Ventilation and Oxygenation with each device.

I don't disagree with you. It's been my experience that capnography will give you a better indicator since the two often times (not always) go hand in hand. You always have to look at the total picture being presented by your patient though.

Shane

NREMT-P

The presence of CO does make the pulse oximetry inaccurate. The CO binds to the hemoglobin the same way oxygen does. The oximeter can't differentiate between the two, and sees the hemoglobin molecule as "fully saturated." Really, the pulse oximeter is only measuring a saturation of how full the molecule is.

End tidal capnography tends to be a far better diagnostic tool for respiratory cases as changes are witnessed in real time. Pulse oximetry is about 3-5 minutes behind the patient in most cases.

Shane

NREMT-P

So based on this topic about ink I have concluded ink = scum. You either harass or cheat.

Been in EMS long time. Met some great looking females. Never cheated with any of them. I have not harassed any of them. I have no ink. No ink = professional.

Just my view based on the facts I have before me.

I have tattoo's that are all covered while I'm at work. I don't consider myself unfaithful or scum. I have a wife that I would never cheat on.

So I guess since I have tattoo's...I'm scum.

Shane

NREMT-P

Should have reported it immediately and had him fired. Or to push the issue, requested a police officer and reported it that way.

Shane

NREMT-P

I'm going with rapid a-fib, with the possibility of WPW. I wouldn't jump to cardizem to treat this one though, with the chance of that WPW being a problem. I'm going to go with Amiodarone or Procainamide. If you're really not sure, you could always start with the electricity. But if he's mentating well and has IV access, I wouldn't want to go that route to start.

I would want to know more about his dig. How long has he been on it? Any recent changes to the dosing? When was the last time he saw his doctor for a follow up?

Shane

NREMT-P

Don't really see a choice here. The guy has a pulse. It would be different if he was still in PEA. Technically he is no longer dead and therefore should be cared for. The outcome is going to suck, but what can you do.

+1. There really isn't a question here. This is what has to be done for this patient.

Shane

NREMT-P

Yeah, thanks for the heads up. I used spellcheck I might have missed a few things.

Spellcheck checks spelling. It's not a grammar check. Do a little proofreading before posting. If you struggle to read your own post, you might want to retype it to make it easier for everyone else. I know this has been brought up to you in the past, as I'm one of the people who raised the point. You had a good couple of posts after that. But it seems we've slipped right back to where we started. And there were certainly plenty of errors in one of your posts that spellcheck would have caught had it been used. Please represent us as a professional, educated group.

Surely I miss understand. There can not be any idiots out there planning on using kids to fill shortages. Up your pay grade, that will attract people to work. Crap surly I miss read that some idiot plans on this route for coverage. Please someone tell me I have misread that someone would be idiotic enough to start a program for kids to staff their ambulances. I am in complete shock. Does no one care about this profession?

You didn't misread. Someone actually thinks this is a good idea to get more people in their service riding. I guess when it's not someone's profession that they depend on to provide for their families, it's easier for them to look at the easy answer instead of the right one.

Shane

NREMT-P

There's actually a large difference between epi and vasopressin. Vasopressin works only on alpha receptors and has no electrical impact on the heart. Epi has alpha and beta effects, so you'll see an increased electrical activity with it's use. While protocol says they're interchangable, if you give some thought to the patient's problem (electrical, fluid or pump) you can figure out which might lend itself to your given situation. I tend to use vasopressin in VF/VT arrests (since there's an already irritable focus), and I'll use epi in the case of asystole or slow PEA's.

Just my two cents.

Shane

NREMT-P

I work in CT (not Darien though, that's in the southwest "rich" area of our state), and I have to say I am ashamed that something like this happens this close to me. I agree with all who have said that this is a horrible idea, and a disgrace to our profession. It makes me sick to know that people believe this job can be handled properly by people barely old enough to get a driver's license. It is a reflection on how EMS is generally viewed by the public, and I think a very poignant example of how low the EMT curriculum standards truly are. Let's raise the freaking bar, already.

Actually, we have two towns that do this. Ellington is primarily staffed by their high school explorer program as well, at least during the day. That's even closer to us.

Shane

NREMT-P

Kyle, don't automatically assume that the next time you go pick up this same "little old lady" when she calls 911 because she's been stung by a bee, that it's BS. It might be anaphylactic shock. Her body's been exposed to the venom before, and now it's reacting violently. Would you know the difference? How would you treat it? What happens in the body with someone who's experiencing anaphylactic shock??

You think a 16 y/o EMT who works the trucks in Darien, CT would know how to treat it? Would he/she know the difference between anaphylactic shock and a minor allergic reaction?? Would ALS get there in time if it was genuine anaphylactic shock???

I say they're too young....

I think a 16 year old EMT in Darien has as good of chance of recognizing anaphylaxis as any other EMT with the same training. The larger questions remains of if a 16 year old EMT has the maturity to handle the things they see and to deal with the public in a time of crisis.

Shane

NREMT-P

I post from work all the time. We either have staff computers, or wireless for those with our own laptops.

Shane

NREMT-P

The off-duty medic was attempting to establish IV access...

Wonder what their medical control thinks of that? Where I live we can't practice as a medic when we're not off duty. I know in this case it was a family member, but I'm sure this type of things happens more than anyone would admit.

Shane

NREMT-P

Part of being a paramedic is knowing where to research answers to your questions. Use the search feature and you'll find this topic discussed at great length.

Shane

NREMT-P

I dont think you did anything wrong, and i dont know that an ALS crew would have had a lot more to offer..

An ALS crew may not have been able to do any more for this patient, but in the presence of a head injury an ALS provider can manage potential side effects of a head injury. Significant head injuries can come with respiratory compromise and seizures to name two big issues. That being said, I don't know enough about this call to make a good decision as to if ALS would have been warranted for this call. It sounds like it could go either way.

I might have been inclined to work this patient up simply based on there being people there who know the patient and say that he's not acting right. That indicates a potential injury to me. Head injuries can go either way with signs and symptoms. Sometimes the signs and symptoms will progressively improve with time, and other times they become more pronounced. You don't know which way they will go without waiting.

As far as c-spine, we can't spinally exclude someone if they have altered mental status per our protocol. But the whole spinal immobilization issue is a whole other topic that's been discussed. EMS as a whole tends to do it poorly, and more often than is really needed.

Without knowing more about the call, where ALS was coming from and your proximity to a hospital it's difficult to say if you were right or wrong. The bottom line is that the patient was transported to a hospital and then transferred to an appropriate facility based on their findings.

Shane

NREMT-P

What kind of help are you looking for? You need to have specific questions in order for anyone to help you. General help with paramedic school is a rather broad topic that would be never ending.

Also, you said that you've posted a bunch of stuff but you only have two posts to your credit? I'm a little confused.

And remember, spell check is your friend. Use it and take pride in your posts here, as well as your chosen profession.

Good luck,

Shane

NREMT-P

There are countless threads about RSI here at EMT City. Search them, read them and then feel free to ask more questions.

But, it should not be a standard. It does have it's place and application in prehospital care...but that application is limited.

Shane

NREMT-P

Stabilize, O2, Monitor, IV, MS or Demerol for pain, castrate and lobotomize pt for the good of society.

Peace,

Marty

Guess you've never been hurt while participating in a sport. I used to race motorcycles, and injuries just went with it. It doesn't mean I was a poor reflection on society, or that I was not intelligent. I'd rather see him doing something like that then out dealing drugs to little kids.

As far as treatment, stabilize as best as possible in position of comfort, routine ALS and morphine for pain control.

Shane

NREMT-P

I agree, we should not check and there's no need. Checking for crowning in an active labor patient is significantly different from checking dilation as there's no need to insert fingers inside the patient. Inserting fingers is a last ditch effort for the presence of a prolapsed cord.

My wife is an OB nurse and she agreed with me that it's not needed for us to check for dilation.

I'd like to hear the protocol for those that say they do check, along with the educational background provided.

Shane

NREMT-P

Spelling, grammar and punctuation will work wonders for conveying your point.

Call the manufacturer and see what they can do to help you set your truck up the way you want. They'll be able to help you far more than anyone here I would think. And they should be able to do it in a way that doesn't void any warranty's since they should be "authorized" repair and service centers.

Shane

Poorly controlled blood glucose levels tend to increase the onset and effects of neuropathy. The neuropathy and poor circulation to the extremities can cause ischemic events and tissue damage or death. Ischemia in itself is enough to cause pain.

As far as treatment prehospitally, you could consider pain management but I think the most common modality is just a saline bolus. Use starling's law to try to increase peripheral circulation by increasing cardiac output.

In hospital treatment would consist of pain management and constant management and monitoring of blood glucose level. To begin to correct the effects of the problem, you have to correct the underlying cause. Start with the diabetes and move on from there.

Shane

NREMT-P

If your service isn't licensed as an ALS service, you cannot perform any ALS intervention. Otherwise, you're operating without authorization. I wouldn't work for a service that's willing to put you out like that. If things go well, great. But if thing's don't go well, I'm going to guess they'd leave you hanging out to dry.

Shane

NREMT-P

Sorry, I missed your post until your last one. So I just read it. There is plenty of justification for having a partner, I agree with you about that. And partner's are supposed to catch each other. But then where does the saying come into play with regard to EMT's saving medics? That's a separate issue. How does an EMT save a medic? And where are these stories to get an idea of where the saying comes from? So opening the whole saying back up to interpretation, just how does an EMT save a paramedic? Partner's saving partner's I can understand. But still, I don't see the EMT's saving medics.

Shane

NREMT-P

I'd be curious about his blood glucose level and how well controlled his sugar has been. It could be some neuropathy setting in.

Shane

NREMT-P

I live in Connecticut, where we can perform them as well. Does our system suck too for allowing them? One service I work for uses the surgical procedure, while another uses the Melker airway kit. Both are effective when needed to be used.

I like how quickly you changed from no state allows it to be done, to it's not smart to do them. That's an interesting dodge to avoid admitting you're wrong. The procedure is not benign, but it's also a "last resort" procedure. At that point, the risk of aspiration outweighs the consequence of having no airway. It's not like you go into a call and start with the surgical airway.

They can, and do have their application in perhospital care.

Shane

NREMT-P