Arctickat

So: Questions

1: In with LBBB and RBBB are ECGs giving you the entire picture, could one observe ST elevation without infarct?

Yes, there are several other conditions which could result in elevated S-T segments, pericarditis being one of them. S-T elevation is not the sole indication of STEMI on an ECG, there also has to be reciprocal changes in other leads. ie, S-T elevation in 2 contiguous leads as well as S-T depression in others.

2: Can Sask EMT/PCP draw a blood sample from IV start line ?

In a word, No, if only because the PCP can't start a line in Sask in the first place. The ICP and ACP can though. Having said that, I have used those blood tests from TnT Diagnostics. There is sufficient blood in the flash chamber to conduct the test and there is no reason I can't pass my sharp to the PCP to express the blood from the chamber and run the test. As far as being beyond the scope of practice, it's not an invasive procedure, therefore it is not addressed in our protocols. The nearest comparison would be a blood glucose test.

All good points Vent, we've always used a filter for intubated patients but have ordered in some new ones to follow with the Health Canada guidelines.

"If high concentration oxygen and/or positive pressure ventilation are required, appropriate oxygen delivery system should be filtered with an antimicrobial, hydrophobic filter."

No oxygen mask will protect against any aerosolized particles.

Sorry, I wasn't clear, I didn't mean the oxygen mask but a typical surgical mask...I'll edit my post accordingly.

Quakefire, you're gonna have to get Wally to give you guys up there some CME on H1N1. These questions of yours should have been answered back in June. Also, some of the well intentioned individuals here are giving you region specific, ie bad, information.

Take mhull's response for question regarding the requirement for innoculation. Sask Health has mandated that all employees of health services, including us, are not required to take the H1N1 innoculation, but, if an outbreak occurs, all employees who refused the innoculation will be prohibited from working because they pose a risk to patients.

Sask Health no longer tests for H1N1 because it is a community acquired illness. In essence, it is treated like any other influenza case. If symptoms are severe enough to require hospitalization the patient will be given antivirals, otherwise they are told to stay at home. I've been called to several Influenza Like Illness(ILI) cases and have transported very few because they didn't require hospitalization and were simply in panic mode. People are of the assumption that H1N1 is a death sentence and that every cough, sniffle, and fever requires a trip to the ED.

Even the use of an N95 is not required unless an activity is being conducted that will result in aerosolized vapours, such as a neb treatment. Otherwise a simple surgical mask on the patient or you will suffice. Proper hand washing techniques is most important. The virus can only survive on a hard surface for 2 - 8 hours, even less on a soft surface like a blanket or clothing.

You would be best served in going here for information rather than asking for help from individuals who have no idea what your specific local and provincial policies are.

Blades with a right handed flange are available for the left handed practitioner as are Miller blades with bulbs on the right or left side. My thoughts though are thus:

It requires greater dexterity to manipulate the tube into position than is required to hold the laryngoscope in place. Therefore, the most dominant hand would likely be the best option for placing the endotracheal tube. For the right handed person, the hand with the greatest dexterity would be right hand.

Attempting to place a tube left handed using a Mac blade with a left side flange would be difficult at best and a risk to patient care at worst. As mentioned, if one is left handed and incapable of functioning with a blade designed for those with right hand dominance, there are blades available.

That aint write are it?

ROFL

I have a spelling checker It came with my PC. It plane lee marks four my revue Miss steaks aye can knot see.

Eye ran this poem threw it. Your sure real glad two no. Its very polished in its weigh, My checker tolled me sew.

A checker is a blessing. It freeze yew lodes of thyme. It helps me right awl stiles two reed, And aides me when aye rime.

Each frays comes posed up on my screen Eye trussed too bee a joule. The checker pours o'er every word To cheque sum spelling rule.

Bee fore a veiling checkers Hour spelling mite decline, And if we're laks oar have a laps, We wood bee maid too wine.

Butt now bee cause my spelling Is checked with such grate flare, There are know faults with in my cite, Of nun eye am a wear.

Now spelling does not phase me, It does knot bring a tier. My pay purrs awl due glad den With wrapped words fare as hear.

To rite with care is quite a feet Of witch won should be proud, And wee mussed dew the best wee can, Sew flaws are knot aloud.

Sow ewe can sea why aye dew prays Such soft wear four pea seas, And why eye brake in two averse Buy righting want too please.

Edit: Author Unknown....to me at least

I cant spell sphygonomometer

Can't spell can't either.

I have to disagree doc...to an extent.

I'm with you all the way when it comes to those who speak the English language as their native tongue, but, for those who are trying to communicate with their counterparts and don't have the English skills we were raised with, I have to cut them some slack. Over the years I've chatted with many who have a poorly constructed post only because they are not all that familiar with the language written in these forums because these are not just American forums, but world wide. Isn't that the whole purpose of websites like this? To be able to simplify communication with our counterparts across the globe? To dismiss these people out of hand as being idiots is nearsighted at best.

Just last summer I gave a tour of my EMS service to a medic from Hungary who didn't speak a word of English, but when the translator with us was unable to interpret the phrase "subarachnoid Hemorrhage" the medic knew exactly what I meant. From that point on I continued to use as much Latin as I could so I wouldn't have to dumb it down into words our interpreter could translate.

Yet another context to consider is those who have a different regional dialect or regional spelling differences than some others. For example, Those from the U.S.A. put "ize" at the ends of words such as victimize or realize. Those in the British commonwealth use 'ise" as in realise and victimise. I've even had people call me an idiot for that very reason because in their arrogance they assume that everyone should communicate just like them.

Edit: Nice post SA-Medic, guess I'm a slower typer than you.

For registration with our professional college, fluency in English is a requirement for licencure. If you can't speak the language, you can't be a paramedic at any level.

Drum Roll Please xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

NBC cancels 'Trauma'

Next Stop? Ash Heap of History

Sorry, just saw Dust beat me to the news by three minutes . . .

Like we where on death watch or something.

Actually, I beat you both be 24 hours. But who cares, just so long as it's gone.

Seriously? Someone is dinging our reputation points for this thread? I figured it wouldn't take long for some ass to start abusing this system. It would be nice to know why.

Both are guys I know! I haven't read Kelly's book because I just don't read books anymore.

Is it because of a time issue that you don't read? If so, I like the way Kelly wrote his book, each chapter is only 2 or 3 pages and can therefore be easily set down to come back to later....a good book for the bathroom if ya know what I mean.

It was on while I was doing other things. Rabbit ran a chest pain and it was pretty accurate. Slightly exaggerated vis-a-vis the yapping spouse, but lord knows we've had ones pretty close to that. The only nit pick I had was administration of NTG before establishing a line. That was the only scene I saw and it was mildly entertaining.

I did notice Rabbit squirt three sprays one after the other...at least when Carter did that on ER the patient had the decency to faint.

8 more episodes left....yayyy!!!

I read a great book by Kelly Grayson called "enroute". It is essentially his memoirs over his career in a series of short stories. Each story relating to a memorable call he had been on. From the joyful to the bizarre to that one call none of us will ever forget for the rest of our lives, I found myself reading his book and thinking, "yup, I've been there and I know exactly where he's coming from."

Another book you might like is the memoirs of a Vietnam vet dustoff pilot. Even though there is a slight lull in the book at about the 3/4 point the first few pages and the ending left me amazed at what this man accomplished and how he ended up after the war. The book is called "ChickenHawk" by Robert Mason.

Quakefire.

The Freightliner chassis have all been tried in P.A., Nipawin, and Yorkton. They were very short lived. Thousands of dollars were spent in attempts to soften the chassis and nothing worked. Airbags either broke in the cold weather or didn't equalize going around a curve, which is an extremely dangerous rollover risk. Lightening the spring rate resulted in more side roll. They finally gave up. When I was specing a new unit last year I almost went with an International Hybrid, but they won't permit them to be used for ambulances yet. Besides which, it is unlikely a hybrid would have been much benefit for a rural service anyways.

Dang maybe I should move there and have excitment!!!

We were discussing the show at work the other day (my nursing job) and honsetly most the people that watch it like it. I just shook my head

Trust me, it's not quite that exciting....but if you're willing to uproot your family and move to another country on spec...let me know, I'll send you an application.

The Saskatchewan College of Paramedics has made it very clear to the practitioners in the province that an education seminar must be submitted to and approved by the education committee before each of these new protocol upgrades can be implemented. The College is extremely focused on all practitioners acquiring the proper education prior to engaging in new treatments and procedures.

Siffaliss States "One should not be able to give nitro without the ability to first, initiate and monitor/maintain an IV line"

The Saskatchewan BLS protocol still requires the provider to call for medical control to provide Nitro to a patient who does not have a prescription. If the patient has a prescription for Nitro, the BLS provider may administer the medication without medical control. Vital signs must be checked after every dose. The reasoning is twofold, if the patient has a prescription for Nitro, he is told to take it when he has chest pain. The patient can not check his BP, nor can he initiate his own IV therapy; therefore, the inability of the BLS provider to initiate an IV is not so relevant. Secondly, the patient is supposed to be in a sitting position when given Nitro, this provides the BLS provider the opportunity to place the patient supine if a drastic drop in blood pressure occurs and the patient loses consciousness. To date, there has been no complication of that severity.

That said, I'd like to see IV initiation become part of the PCP scope and I expect it will become fact within the next 2 years.

Trauma lovers and Haters might find this of interest.

Trauma News 1

Trauma News 2

Trauma News 3

To save you all time...Trauma sounds like it'll be gone after episode 13.

I have no idea, but I think there should be a $50.00 surcharge for each identical post placed in multiple forums.

Edit

See what time I placed my original post? See what time I added this edit? That's how long it took for me to google your answer.

http://www.yelp.com/biz/kang-david-oan-md-san-jose

Our sensors are 6 inches off the ground but there are also sensors inside the bottom of the door that cause it to open back up if the door comes down onto something that is not tripping the beam.

Example, ambulance is parked half out of the garage the bean is intact and the door can close, but will only come down far enough to hit the top of the ambulance and then open again.

The article states that the blue shirts are still available, but are not issued and must be purchased. Why not just buy the blue shirt if one doesn't like the yellow?

I remember about 20 years ago I was driving down the road at about 4:00 am when I saw a 30 foot tall "Tony the Tiger" only pink where he should be orange. He was wearing a top hat and spats whilst carrying a cane and tap dancing across the highway. The sound of gravel hitting the fenders woke me up and I eased my way back onto the road, I woke my partner and made him drive the rest of the way home.

As for seeing faces, lights and shadows can make people see many things, all that's needed is the power of suggestion. Remember the "Face rock" on Mars that people claimed as proof that there was once life there?

Here's what it really looks like with newer technology and without the shadows.

http://apod.nasa.gov/apod/ap060925.html

Nothing drives me battier than to be called to our local hospital to transport a 200 pound 55 year old male who is having an active MI and 9/10 chest pain to the cath lab only to discover that the "pain management" consisted of 2 or 3mg of morphine. First thing I do for the poor guy once he is settled into the ambulance is do drop in 5mg and usually another 5mg 10 minutes later...then another 5mg until that pain is under control. I really don't understand what the issue is that some people have with pain control for the patient.

Oh, and we don't need pee tests any more...they have saliva tests for that now.

Deja Vu?

Or has this just taken you 4 years to come to grips with? In this case however, the couple was estranged, thus it shouldn't have been a surprise.

I don't know about Swine flu, but the H1N1 Flu Virus can live outside the body on hard surfaces, such as stainless steel and plastic, for up to 48 hours and on soft surfaces, such as cloth, paper, and tissues for less than 8-12 hours; however, it can only infect a person for up to 2-8 hours after being deposited on hard surfaces, and for up to a few minutes after being deposited on soft surfaces.

http://www.phac-aspc.gc.ca/alert-alerte/h1n1/faq_rg_h1n1-eng.php