AZCEP

It is an interesting device, but it does nothing for the vomitus occluded scenario. Any other difficult intubation situation is much easier with it. Like all tools, it has its time and place to use. They are a bit more expensive in the U.S. also. Last I checked, $500 for a case of six. For a single patient use item, we will probably never be able to afford them. :x

It is for everyone, but is being focused more for the healthcare provider that seems to get sidetracked with other things. Two minutes of uninterrupted compressions before you do anything else. If there is another rescuer, they attach the defib pads/monitor. Maybe start an IV, no ventilations usually because they will have to stop compressions to perform, no meds.

This reeks of "cookbook" providers. By using vasopressin "just like it was epi" you are not following the recommendations from the manufacturer or the current ECC guidelines. Beside not allowing the drug to work, have you had any success following this regimen? Is this outlined in your protocols? Did your medical direction sign off on this?

The search function is your friend on this one.

The rural population is actually the one least served by this mindset. Giving an uneducated provider a few select advanced skills does nothing to improve the treatment that the population needs. The patients that are furthest from the hospital wait the longest prior to asking for help, in my experience. They are also much sicker when help finally arrives. They do not need a few, select band-aid add on skills. They need someone with a full armamentarium of experience/knowledge to draw from when that provider walks in the door. No starting lines or using intraosseus devices, even the advanced blind insertion airways are not difficult. Knowing the why of each of them is much more challenging. These guidelines do nothing in terms of actual education. They merely change the names of the providers that are introduced to the unknowing public.

It's a good idea, but the implementation of it will not get the result that is needed. I've been pretty vocal about the need to increase everything in EMS education. I've gone so far as to outline how I think it should be accomplished. Looking at the new recommendations, the only significant change is one of title. If this is approved as it is written, you will have undereducated providers at the advanced level doing things that the current basic level is performing now. Changing a title does not endow those providers with what they will need.

All that happened was a change in the title. Basics are still allowed to help with "self-administration" of several meds. The new "Advanced" EMT is identical to the current basic with all of the add on skills. No education increase beyond a few clock hours.

An equipment failure is a possibility, but the likelihood of it being a significant medical problem is very real. Considering this is a patient you see regularly, two readings from the same device should not vary that much. Especially when done that close together. This patient's response to her medications, and any thing new to throw her homeostatic balance off is a much more likely cause.

The need for an education in nutrition is apparent. The initial blood sugar level was probably due to a combination of factors. Several of which aren't even mentioned here. Is it possible this patient was experiencing some other medical problem as well? Standard issue infections can cause a change in the response to a typical dose of insulin, and are pretty common this time of year. The first dose of dextrose you administered was used up rapidly by the cells that were responding to the insulin that was there. Once it was gone, the BGL started dropping. Using OJ can be acceptable, but the amount you will need to give is enormous and can cause some nausea. Excess acid load into the stomach, where the sugar isn't going to be absorbed from. Apple or grape juices are a more readily available source of fructose. They pass into the small intestine and are absorbed more quickly. With the OJ, you were waiting for the sugar to make it to the small intestine to be absorbed. This can take some time, particularly in the patient with other medical issues. While waiting, the body is still burning the "quick fix" dextrose that you administered. Glutose gel works much the same way, and should not be used as a substitute for something with a mixed macronutrient present. Peanut butter and jelly is good because it is relatively cheap, and it has protein, fat, and carbohydrates to balance the absorption. 70/30 is 70% long-acting, 30% short acting insulin. The idea being to mix the onset and durations of the two into one simple to administer solution. This patient obviously needs to consider that there are some better options available, but that is for the endocrinologist to decide. I am curious which "heart pill" she is taking though. Most cardiac meds do not mix too well with insulin, and have to be monitored very closely until the dose is figured out.

A simple hello works for me.

I suggest mandating helmet usage for the patient compartment. The gravitationally exceptional are not the only group that flight suits don't work for. Since a shoulder mobility restricting injury a few years ago, I've not been able to find one that I can get into/out of quickly. Besides, they are god awful hot in the AZ summer. I like it so far. What's wrong with Navy pants? Many places require a designation of level to be clearly visible. Knowing that every employee is a paramedic isn't good enough for the bureaucrats. All well and good, but how do you propose to keep this business running long enough to demonstrate it is worth being a dream destination? IFTs are where the money is made, not 9-1-1. A little editing does wonders for making sure you don't check the wrong boxes. There are dozens/hundreds of different vendors for this, and the QA/QI aspects alone are well worth the investment. Handwritten charts are working their way out of everyday use for most places. To be a targeted employer that is going to be seen as progressive, and highly advanced, we've got to look at every possibility.

Something I forgot to mention, shifts would be no longer than 12 hours. Performance suffers with anything longer and we want to maintain a quality level of service.

SSM does not work. It never has, and likely never will. There is no proven way to predict which areas are going to need emergency service with any accuracy. Yet another myth to do away with.

BLS first response, paramedic intercept. Tough to remain financially stable using only 911 Absolutely. As much as we dislike them, these calls do tend to pay better than 9-1-1.

Once a policy leaves the adminisphere, it only applies to the underlings it is targeted at. Jeez Dust, I thought you were familiar with this. :roll:

When you use the search function on eMedicine, it will pull articles from a number of different specialties. Aortic dissection might be covered under emergency medicine, cardiology, and vascular for instance. Just like anything else, its good to have more than one reference for what you are looking for. I'd guess that some of the information on eMedicine is added to more often than a textbook, but each will give you different views of similar issues.

You've obviously never actually seen one of the King devices then. It occludes the esophagus, and has a "ramp" at the level of the glottic opening for the bougie to pass into the trachea when properly placed. It is really quite simple to exchange for an ETT if you so desire.

It is not a matter of believing you tsk, it is entirely understanding how the pathophysiology works when managed with this particular agent. Due to it's short half-life, the effects on the AV node typically don't last very long. Because of the slowing of conduction, the initial response will be one of a bradydysrhythmia. Following the elimination of the drug, the AV node will be return to it's original ability to conduct impulses. When the heart is inadequately perfused for a period, it's first response will be to increase the rate. Sinus tachycardia is not pharmacologically possible from administration of adenosine, but is relatively common following it's use.

Saving the emesis would equate to carrying an extra 3-4 five gallon buckets of biohazardous material unsecured in the transporting unit. Just like with snake, or spider bites, the ER staff does not need to see the actual volume.

Sinus tachycardia is not a transient dysrhythmia that is caused by adenosine. Most of the dysrhythmias caused by administration of adenosine are self-limiting by the half-life of the medication. Sinus tachycardia is a result of the heart's compensation for decreased cardiac output from the SVT episode. The adenosine allows the SA node to resume the pacemaker duties, and the tachycardia results.

Sounds like an EMT that read too much into their night school first aid course. :roll: The lack of professionalism is not entirely surprising from the sound of the system, but that does not excuse it.

As someone that deals intimately with the upper respiratory system, all EMS providers should be careful with these things. Honestly though, I'm more concerned with catching something that fellow EMS personnel have left on some of the non-porous surfaces at the station than I am with the patients I transport. :shock: :shock: Perhaps because I am more vigilant with my patients than I am with my co-workers.

Rain X attracts too much dirt to be useful in the desert.

Just to gather the information take a look at the calls you've run for the last 6 months to a year. Objectively determine if there is something that a paramedic would have been able to do that would produce a benefit for the patients. You can also look at any developments in the area you work. Increasing population, more elderly, changes in the demographics, etc. Once the information is gathered, you might consider looking for some support from the service population.