Arctickat

A & P has got to be the most difficult class to get a handle on it's just hard core memorization of the body systems and how they work. I can't offer you any real memory tips and tricks but I can provide this bit of advice. When you're learning about each system, think about how the body systems respond and are affected by variations down the line. Here's an example. Hypernatremia. How does the body respond? What the receptors detect is too much salt, so, to fix it, the brain tells the digestive system to drink more water. Does this decrease the salt content? No, but it dilutes it to the point of reduced risk to the body. In truth, hypernatremia is typically caused by dehydration. The salt content in the body is usually normal, but it's the water content that is reduced, resulting in higher serum levels.

Hyper and Hypoglycemia are similar, Hyperglycemics have a loss of appetite, nausea, vomitting, frequent urination and excessive thirst. Why? The body is trying to prevent food (sugar) intake by getting the digestive tract to remove as much as possible, urinate as much as it can to remove the glucose from the body, and thirst to get fluid into the body that would dilute the glucose as well as feed the kidneys.

Hypoglycemics are the opposite, they get hungry, wanna eat, not urinate, and try to get those glucose levels back up.

A&P is likely the most important class you will take because you will learn to think about how things work in the body and more importantly, how they affect other parts of the body when they don't work properly. Once you get the hang of it, the rest of class will be a breeze because you'll be able to look at a patient's condition and with a reasonably high index of suspicion be able to identify the root cause of the problem.

On another note, if I may ask; why is your user name the symbol for commerce and banking?

Greetings

My understanding is that the pain is not associated with the injection site but more that the high pressures required for infusion result in discomfort  beyond the site. Think of it like this, when we give an IM injection the patient is left with discomfort for some time afterwards. This is because we've created an artificial hematoma with that 1 cc of fluid and it is putting pressure on the surrounding tissue. The situation is similar in IO. the tissues are being forced to deal with increased pressures that they are unaccustomed to. So it hurts.

You realise that you have all the room you could ever need....yer just lazy.

Never left Mike, just keep my mouth shut when I have nothing intelligent to say.

There's not a lot of medicolegal stuff in the EMT course Ruff, and if I recall correctly, there wasn't any mention of incompetent adults. It was just assumed that an incompetent adult would fall under the same criteria as a child. In essence, any treatments that would immediately reverse a life threatening condition are okay, but beyond that we need the permission of a guardian.

Our vehicles have a swivel airway seat. I'd flip it all the way around so it faces forward and have the kid ride there. He may turn his head around to see what's going on with dad and that's fine. Face it, if dad is really in that bad shape that the child may be traumatised, the damage is already done. He was with dad, alone, waiting for you to arrive. If he's going to be, the child has already been damaged by what he witnessed. I would think it might be therapeutic for him in the long run to be able to witness dad's demise rather than be sheltered from it.

Here's a story, like you asked for in your intro thread.

I got called to a scene by a husband whose wife has been suffering from depression and is threatening suicide. As we pulled up and my partner walked to the house and the husband answered the door. He told my partner what's going on and so on and so forth. Partner walked in and as I entered the room the husband lost his mind. He started screaming at me and yelling to "GET THE F___ OUT!!!" , "I HATE YOU!!! GET OUT!!!!" He's perfectly fine with my partner, it's me he's enraged with and I couldn't fathom why. My partner and I both left to discuss what's going on when the husband came outside. He's incredibly distraught and very remorseful for his conduct, and that's when I recognised him.

Two years earlier I responded to a different house for what was eventually diagnosed as a SIDS baby. THEIR baby. My partner went in to talk to mom and I talked to dad. This was the first time I had seen him since they lost their daughter, and as we sat on the front step of their house, he shared what happened over the past couple years. When his wife couldn't wake their daughter he called for an ambulance. When we arrived I swooped in, grabbed his lifeless daughter away from his wife, and rushed out the door. The next time he saw his little girl she was dead. (Remember, it doesn't matter how dead someone is, when we leave the house actively working on a body, the family holds out some hope for survival.) I took away his chance for reconciliation. For years he harboured the envy that I got to spend his daughter's last moments with her and he did not, and he was jealous that I had taken that away from him. Even though she was long dead. His wife got depressed from the loss of their only child, their marriage began to suffer, their love life was non-existent, they became withdrawn, had to move in hopes of burying the memories and continued to spiral. Eventually she became suicidal and when I was called in, it was her third attempt.

I was stunned, I didn't know what I should do. Here I was, a young EMT with only a few years under my belt and this guy is pouring his most private and intimate life details out for me. I hadn't learned the coping mechanisms that I have now. I had no advice I could give him. He was older and wiser than I, what could I do that could console him and start their healing. I tried to apologise, I tried to explain my point of view when we were called to his daughter. I didn't have the experience to be able to empathise with his pain. 6 months later they both committed suicide.

30 years ago there was a mantra, work every dead body, even if it's useless, it gives the family hope and time to prepare to grieve. After this call I changed my entire outlook when it comes to dealing properly with loved ones. I am entirely open, honest, and forthright regarding the care they are receiving. I would take a free moment during a cardiac arrest while my partners continued CPR and speak with the family about what we are doing and what to expect. I also invite family to come with us if we are transporting, regardless of how gruesome the call is. They don't see the blood and gore...they see their little girl or little boy. Just as your scenario, the child sees daddy, not daddy's intestines on the floor or blood squirting from an arterial bleed.

Regardless the choice you make, the child will likely need some form of therapy, but the current thinking in many sectors is that being shut away from a family member in this way usually does more harm than good.

Welcome, you must be from Alberta. (edit, Oh yeah, I see that in your location now)

Ahh the exuberance of the NFG paramedic. I remember 30 years ago when I reveled in sharing war stories, competing with my co-workers to win the most bloody/smelly/disgusting/grossest, call competition.

Then I got old, and remembered that that bloody mess was once a child before he ran in front of a speeding train, or that smelly corpse was a rape and murder victim, or that disgusting oozing body was an abused elder, the memories from those stories have become the nightmares that wake me from my sleep.

When blood sugar levels are low there is a potential for spontaneous glycogen release from the liver in diabetic patients. It's similar to what happens when glucagon IM is administered. Basically, what happens is that the patient is hypoglycemic and loses consciousness. Someone calls 911 and before the ambulance arrives, the liver releases the stored glycogen which converts to glucose. When the ambulance arrives the patient is alert and oriented, seems completely normal, and has a normal or near normal glucose reading. However, the glycogen is still a short tern solution and gets used up pretty quickly, so the patient bottoms out again.

I've simplified it tremendously here, but here are some links:

https://en.wikipedia.org/wiki/Glycogen

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442155/

http://www.diabetes.co.uk/body/glycogen.html

Thanks Rock, that's kinda what I had in mind. We only have the one school here, so it'll be an easy discussion. CAMATA isn't a part of our ACP training here.

Thanks Rock, my staff has all been trained in CAMATA and it's a requirement for employment. I'm thinking of targeting the student paramedics. More or less an aviation primer so they have a chance to actually witness how physiology is affected by flight as well as the safety and patient handling aspects that many of them may only see infrequently from a ground perspective.

So, I've recently started a new business partnership with a health facility and an airline for the provision of aeromedical services to remote health clinics. Airline provides the aircraft and flight crew, I provide the medics, Health facility is the funding partner.

Our educational institutions do not provide for any aeromedical practicum training, so I'm thinking I may offer up an opportunity.

For any of you who have been involved in the aeromedical training, what pitfalls can I avoid.

For any of you who might be interested in such training, what specifically would you like to see?

Just remember, this isn't any sort of critical care transport, it's simply a ground ambulance that has to fly because there are no roads.

I had seen this about a year or so ago. It seemed like a neat idea, however the doc doing the interview made some odd assumptions. We have a stroke policy here that dictates if someone fits the criteria we transport direct to the nearest CT location, which is 175km away. We don't stop at the local hospital, we don't stop in Emerg at the CT site. We call the CT site when we're 20 minutes out and they clear the room for our arrival. Then our patient goes straight in for a scan, then he goes to emerg.

If they were to spend that money streamlining the access to CT in the facility, they would likely be able to save more brains.

What do they do when the mobile stroke unit is across town on another call?

What do the medics on scene do when they suspect a stroke? Call the stroke unit and wait for them to come?

Just seems inefficient to me.

Jenny McCarthy screwed somebody!!!!..................GASP!!!!!!!!!!!!!

Whew

Umm...does it count if my wife and I are working together and we have a transfer going out at 0600, but a call comes in at midnite that only takes an hour, so we take the ambulance home instead of take it back to the base for 4 hours?

So I've been doing a little self reflection and inventory and I've reached the conclusion that I think I may be a whacker.

I don't have the POV with all the flashy lights.

I refuse to wear a duty belt for fear that stuff might be attracted to it.

I would rather turn my emergency lights to their dimmest setting at night rather than blind oncoming traffic on a mostly deserted highway.

Truly the antithesis of a whacker.

However, over the last 10 years I have acquired:

1. FLIR technology, for the purpose of seeing large wildlife and searching for motionless bodies...or other uses that have come to pass.
2. My Ford E450 AM/FM radios got tossed for a JVC Navigation, Satellite Radio, with Bluetooth, USB and SD card inputs..oh, and DVD too.
3. Speaking of DVD, a patient compartment DVD player for those 2 hour stable patient transports.
4. Point of care blood tests for elevated Troponin I and Myoglobin.
5. Point of care test device for Hemoglobin
6. An electric impact wrench and a 2 X 6 board...so if we ever blow an outside dual, (has happened several times) we can change the tire in less than 5 minutes and the other tires in 15. (when the nearest ambulance is 30 to 45 min away, it makes a difference)
7. A tire pressure monitoring system...because we kept blowing so many tires due to the valve extensions failing.
8. Backup camera...yeah, I know, everyone has them now...but not when I put them in 10 years ago.
9. Blind spot cameras that come on when the signal light is activated and override the FLIR
10. Patient compartment camera so the driver can watch what is happening in the back. (must be manually selected to override the FLIR with 1 button press)
11. Dash cam...because I don't really have enough cameras already
12. Transport ventilator with CPAP/BiPaP
13. Thermal Angel for hypothermic patients
14. Stryker Power Cots
15. Video Laryngoscope
16. Veinlite
17. And, most recently discussed in another thread..a portable U/S machine.
18. Next will be an infrascanner..probably.

Now, 10 years later I am looking to upgrade the fleet. Remounting two of my three ambulances onto a Dodge Super Duty 4X4 chassis that will include an 18 inch cargo area between the cab and module for our underwater rescue/recovery equipment. (SCUBA Gear) They'll be 5 feet longer than my current ambulances, abd I went through the options list and checked off everything. Heated/Ventilated seats, heated steering wheel, 8.4 Nav/Sat/CD/BT. Liquid Suspension, Stryker Power Load, Bumper winch, and an ASAP all terrain remote rescue vehicle.

Ya know, I'm sure there is more, and I really try to justify all of this by saying it's improving our ability to provide patient care....and it really has. Some might think that all the gadgets might result in a waste of time...or looking at a herd of horses and seeing zebras, but I think they really do help.

I can be confident that no other ambulance within 1000 miles carries all that I do, some might have 1 or 2 things, but not everything. Problem is...I think they're really cool beans too, and I can't decide...have I been buying all these things to improve patient care....or just for the whacker factor so I can do things that no one else can?

I'm with ERDoc on this...and it's my new toy. It's a simple case of treat the patient, not the machine. Just because I might see a Pneumo doesn't mean it'll get a dart. The patient's current presentation is the defining factor in my treatment decisions. I have two reasons for buying the U/S:

1. Bypass the Doc in the Box direct to a trauma centre (Edit) In situations that warrant such measures, and the criteria are specific.
2. monitor changes and let the trauma centre see any changes that may have occurred over the two hour transport time.

Can I use my infrascanner?

Donations...yeah...that's it. lol. The only person donating to my service is me.

Welcome to the club. We're all a bit green around here...some with decay.

he means that he already has all the other bells and whistles and has a surplus budget to spend before his fiscal year is over. ha ha just kidding

You forget Ruff, I'm a privateer. Any money I have left over is supposed to go into my pocket, and the more I can gouge out of patient care, the more I get to keep.

They are great for getting peripheral IVs.

I already have a veinlite.

Here's the true life scenario...

16 year old male kicked in the LUQ and complaining of ABD pain. Skin is pale and diaphoretic. Heart rate 95, BP 104/70, RR 20, SPo2 is 93%. Nearest trauma centre is a 2 hour drive, air transport is unavailable, doc in the box is the nearest option 15 minutes away, however all he has is Lab, (no ABGs) X-ray, and colloids. Current practise dictates we stop at the doc in a box, waste 2 hours while he does labs, gets x-rays, and sets up the referral to the trauma centre, then continue transport.

If our u/s gives us the ability to identify free fluid in the abd from a splenec rupture, I would opt to bypass the doc in a box and head direct to the trauma centre.