crotchitymedic1986

This took about 5 minutes, I am sure if I spent the night googling I would find more ACLS: http://en.wikipedia....ac_life_support shows the major changes 1980, 86,92, 2000, 2005, 2010. http://circ.ahajourn...ppl_1/I-86.full discusses 2000 http://circ.ahajourn...12/24_suppl.toc 2007 http://media.america...r-updates.shtml 2010 BLS: http://www.amazon.co...13960767&sr=1-1 iscusses 2000 and 2005 changes http://www.msnbc.msn...-new-cpr-rules/ 2008 http://www.heart.org.../ucm_317350.pdf 2010

I disagree dwayne, respectfully. I did not get a degree, and I have found it has shut me out of some management positions where an Associates or Bachelors was a minimum requirement. The poster may not be interested in management now, but 10 years from now, things may be different. Also I forecast that AMR and Rural Metro will gobble up a significant amount of private and municipal providers as they did in the 90s, as the economy worsens (it is about to get a lot worse in my opinion thanks to the lack of leadership in DC -- both parties). I agree with Dwayne that in most municipal departments a degree is useless, but in the corporate world it will make a difference. I would suggest a Bachelor's in Health Care/Management/Sciences (whatever they call it in your area), which opens door to other medical industries outside of EMS (Hospital managers change jobs about every 2-4 years). Good luck!

It really does not matter, every 2-4 years AHA changes the algorythm to sell more books and keep themselves relative, but the truth is despite all those changes, out of hospital survivability has not significantly improved. So go through the motions to put on a good show for the family, then transport the body to the ER to be pronounced.

In other words, "Thanks crotchity you were right, I was tunnelvisioned by my glucometer and searched for every other disease process including malaria, instead of what is the most likely cause, statistically speaking, while my patient's blood sugar continued to drop. I would have started an IV, O2, maybe backboarded them . I would have then transported to the nearest emergency room, emergency, because they continued to deteriorate as my malaria treatment did not correct their condition, and they arrested 15 minutes into my care plan. After reading what I wrote, I realized that I should consider D50 in my treatment plan much earlier than I originally planned, but I could never admit you were right, so I will say that I will now consider it." You're welcome, and ten years from now when this scenario really happens, I want you to come back and teach the new rookies in the room how to handle this patient. I am not claiming to be smarter than you, I have just seen a lot more patients and situations than you have. You know everything that is in the textbook, I know everything that is NOT in the textbook.

http://www.infoplease.com/ipa/A0001454.html My list shows it's been pretty much a Muslim thing, I can only hope that our wonderful military is killing ten times as many of them as they have to us, but we never know since those numbers are no longer released.

If the playing field were completely level, I would be against discrimination against anyone for any reason, but discrimination against whites happens so rarely, I would not shed many tears if it happened. As far as asking about how tests can be discriminatory, we argued that to death in previous posts. But I have a solution, but I doubt white folks would be brave enough to make it the rule: 1. Interviews for hiring and promotion are done by the neighboring jurisdictions personnel, no one from that department can be in the process, except maybe one member from the HR Department (this gets rid of the buddy-buddy system, or bribes or brown-nosing the chiefs (decision makers). 2. All interviews are blinded, the applicant sits in another room and can not be seen, and uses one of those voice changing devices that changes their spoken word into the same monotone computer voice (cant tell male/female, ethnicity or nationality). The applicants are then given a "score" for interviewing. 3. The applicants are given one written test, written by a test-writing company or university, and are scored with no curves or weird formulas. Again, the test is taken in private, applicants are not seen. 4. Once the applicants have both scores, background check, drugscreen, and physical done, the outside interviewers hold a one day skills observation test (or physical agility test) where the applicants are viewed for the first time by the outside panel, and they score using the same score sheet for all. If it is a physical agility test then everyone is graded by the amount of time it took to complete the test. To establish a minimum cut off that is fair, I would mandate that everyone that is a current employee from chief on down to rookie has to take that same physical agility (or skills / if skills it has to be national registry format) test annually; they would then average everyone's time/grade to create a "department average". Applicants must surpass the department average to be considered for the position. It is not fair to disqualify a female for not being able to pass the test, when half of your department is so overweight that they can not pass the same test; Skills Score should be weighted to = 50% of your total score Interview and Written are weighted to = 25% each of the total score for a total of 50% Tell me why that isn't fair ? And if you site extra costs, there shouldn't be any. When it is the other department's turn to do the same procedure, you will do it for them to pay them back (no extra payroll). To protect employers I would be fine with a 90 day orientation period where the applicant is only awarded temporary employment and can be terminated if the candidate is somehow unacceptable, but the employer will have to show clear proof of why the applicant is unacceptable and document the steps they took to try to bring the applicant up to standard.

wow, very mature. Since I frequently get admonished by admin, can I ask for a little two-way street here. Posters should not be allowed to curse or call people names like this when unprovoked.

You are right, the court found that there was discrimination here, but you only seem to get upset when white people dont get hired. Go figure ?

No when a freak occurrence occurs 3 times in 30 years, it is still a freak occurrence, even if all 3 occur in the same year. Actually we may even be able to go back over 40 years, I do not remember what the first outdoor concert was, but Woodstock comes to mind as one of the biggest in my era. Nevermind, I just found the answer : http://en.wikipedia.org/wiki/Monterey_Pop_Festival so we have had 44 years of outdoor concerts and a handful of stage collapses.

You are welcome again Doc.

Well lets let the members decide. How would the rest of the room treat this patient ?

Yes I am aware of past terrorists, but today it is pretty much a muslim activity statistically speaking. Obviously the recent island attack and the high school attack that was thwarted was not muslim, but if you take the number of deaths over the past 10 years, most have occurred at the hands of Muslims (and the US Military).

Well since the court decided discrimination occurred, I doubt there would be any difference if the racist are allowed to choose again. I know you white people hate to hear when you have been caught again, but justice might actually be served here.

I agree rock, you have to think about what is best for the patient long term, and not what is most convenient for you. I also agree that foot and leg veins are way underused, when I worked for a pediatric facility we started IVs in the foot all the time. There is a myth about increased infection, sort of like taking a B/P on the same side of a mastectomy will certainly lead to death. Some rumors dont like to die.

ff ? dont get it ! Oh, "F Off", hope you dont kiss your kids with that mouth. I hate to see anyone die, but we all have to do it, all I am saying is that accidents happen, and we should not overreact everytime some dies from a freak occurrence. If you felt compelled to send money, light a candle, say a prayer, or write a song, there is nothing wrong with that.

Of course I want your opinion, that is how we learn from each other

I apologize, you did ask 2 questions, but I am not sure I understand them. #1. I am not advocating not using your technology, but I submit that your generation is too reliant on technology and often lack some basic assessment skills, much like we no longer use as much of our memory, as there is no need to, since you can quickly look up anything on the internet. I did not have a pulse oximeter, so I had to know breath sounds and severity of event without looking at a digital readout. This leads to undertreatment in my opinion, as I often encountered patients in the ER that EMS did not treat appropriately, because the pulse ox was good in a sitting position, if they had made the patient walk 10 steps (or lay them flat)they would have seen that the patient was in far more distress than they recognized. #2 In cardioversion, I hope you are not just treating the machine. Just because a patient has a rhythm that is too wide, too narrow, or too fast does not necessarily mean cardioversion is necessary. And the choice to not treat the patient in my scenario would have lead to that patients death. I have had four patients in my career who were severely hypoglycemic with a normal glucometer reading. Yes you should try to rule out all the conditions you listed, but how could you in the field ? The better answer is to look at the patient. The patient is normotensive (I stated all v/s were normal which was intended to include every test you have at your disposal). So you are left with diaphoretic and unconscious, with a known diabetic history. Seizures, head injury, and ETOH rarely produce diaphoresis (yes possible). A cardiac event could produce diaphoresis, but usually does not produce unconsciousness with normal vital signs. CVA or an aneurysm could produce unconsciousness and diaphoresis, but again you would probably see a shift in V/S. So hypoglycemia is the most likely cause. So you push half an amp of D50, and see if the patient responds, if they do, you push the other half (draw blood first if you can so you will know if your machine was faulty). Worst case scenario, you have raised that blood glucose reading from 120 to something in the 200's, which is nothing for a diabetic. If the D50 fails to work, then you can pretty much rule that out and move on to your other possibilities that you can not rule out in the field.

Point well taken tnuigs, new is not always bad. But let me give you this presentation: Known diabetic, unconscious and diaphoretic, all V/S normal, including your glucometer reading which states 120 (you are in a public setting, not near the patient's family, so all you have to go on is the med-alert bracelet that says IDDM. So what do you do ? I am starting an IV and pushing 1/2 amp of D50, and saving the patient's life (old school style), how many of you would not because your machine told you not to ?

What say you ?

http://www.cato.org/...ny/ct-wc67.html I hope the CATO institute qualifies: Welfare contributes to crime in several ways. First, children from single-parent families are more likely to become involved in criminal activity. According to one study, children raised in single-parent families are one-third more likely to exhibit anti-social behavior.(3) Moreover, O'Neill found that, holding other variables constant, black children from single- parent households are twice as likely to commit crimes as black children from a family where the father is present. Nearly 70 percent of juveniles in state reform institutions come from fatherless homes, as do 43 percent of prison inmates.(4) Research indicates a direct correlation between crime rates and the number of single-parent families in a neighborhood.(5) http://boysraisedbys...nsible-for.html http://www.fatherhoo...ence-statistics And yes I am aware that not all single moms are bad, and yes, there are kids raised in 2 parent homes that turn out bad as well, but the statistics do not lie on this one. Its kind of like saying not all Muslims are terrorist, but 98% of terrorists are muslims. I am sorry, I just realized that we have hijacked this thread by carrying on about ADD, we should move that subject elsewhere, and leave PTSD to itself. I apologize.

You also need to be suspect of any blood glucose reading in the field, for a variety of reasons in any patient: 1. The glucometers are slung around, dropped, and are exposed to heat/cold extremes that the manufacturer does not approve of. 2. Read number one above but exchange glucometer with glucometer strips. 3. Many EMS agencies do not run "controls" as often as recommended. Most hospital glucometers have controls ran at least once per 24 hours. 4. You are measuring surface capillary blood, there are a variety of illnesses and conditions that can cause an inaccurate reading. Some simple examples, an obese patient, or a patient who knew their sugar was dropping so they put some sugary food in their mouth with the same finger you tested, and you failed to clean it properly. Hopefully, your teacher will tell you on day one to "TREAT THE PATIENT, NOT THE EQUIPMENT", but if not, you have just received your first EMS lesson. Study hard grasshopper ! P.S. In the old days an amp of D50 and 1-2 amps of bicarb was standard treatment for all out of hospital arrests (including trauma). Not saying that was good or bad, just throwing in some history for perspective.

I would expect as much. I have a relative who works in a large family practice. Funny thing, they never have to worry about lunch, it is catered every day. She has a drawer full of pens and pads and all kind of other gifts she has collected over the years. The Doctors don't have to pay for their vacations, briefcases, laptops, as they were all gifts too. Was it their generous and thankful patients who provided the gifts ? No they were all provided by the Pharmacy Reps who come in every day (except saturdays when they are open half a day). Of course this practice in no way influences the Doctors as to which prescription they give to the patient. And of course the fact that Pharmacy Rep's commission is based on the number of prescriptions written in their assigned zip codes has nothing to do with the prescriptions offered to the patients, IT IS JUST A BIG COINCIDENCE.

http://www.mymultipl...-aboutalib.html here is another one, http://bodyodd.msnbc.msn.com/_news/2009/03/04/4380061-the-curious-case-of-the-stone-baby more details: http://en.wikipedia.org/wiki/Lithopedion

It really doesn't matter what you were "told", the only thing that matters is what is in writing. I am betting some eager salespeople told you whatever you needed to hear to sell you the system.

http://www.nbcchicago.com/news/local/firefighter-lawsuit-127968493.html