AZCEP

Way to go Mike. Make the rest of us look bad. I'm not going to sugar coat this, you need to put up or shut up. 200 hours is ridiculous to complain about. Much like the fact that you are willing to volunteer your time. Especially considering that Idaho is home to one of the more progressive departments I've ever heard of. Ada paramedics ring a bell? You are not going to find any sympathy here, but welcome to the site anyway.

Ummm, actually the University of Kansas is KU. The University of Kentucky is UK. KSU is either Kent State or Kansas State University. But unless you are paying tuition to attend them who really gives a...?

Hydration cannot be over emphasized. This coming from 28 years living in the desert southwest with summer highs easily over 130 on the asphalt. Leave the carbonated/caffeinated beverages alone, or only in strict moderation. Drink enough so you are peeing clear, and you won't falter quite as quickly. The cooling bandanas are also a good idea, if a bit ungainly. Dark uniforms suck, there is just no way around it. Long pants will actually help you to repel some of the heat, and offer better protection from direct sunlight and other assorted nasties. Second degree burns on the knees suck worse than black pants. Under Armour in light colors works pretty well, and there are a number of manufacturers that make shorts/shirts out of similar material that are quite helpful.

The simple way to explain it is education allows for better decision making as to what treatment does/does not need to be performed. Example: Patient complains of generalized pain. Do you need to use a medication to relieve it, or will positioning work just as well? How about what type of medication? A narcotic, or perhaps an anti-histamine? Does this patient come from an environment that frowns on medication use at all? There are so many different angles to take on a given patient situation that an educated provider will be better equipped to look at.

Paging Dr. Bledsoe

There's always the catch-all "WHOOPS"

That's one way to make illegal immigration more difficult.

Nobody saw this coming when FDNY took over EMS? Is the union involved the IAFF? If so, did anyone really think they were going to go to bat for EMS? The fire commissioner can step up and decide to make things right, or cut EMS loose.

Very interesting suggestions you make tout. Sounds like quite a bit of thought went into them. Bravo. The difficulty with finding the "middle ground" you speak of is the lack of providers that are willing to gain the education before they are given the "skills" they are after. The current BLS curriculum is where the intermediate was ten years ago. The intermediate level has all but been replaced for most areas because it is obsolete thanks to the current BLS. A rather vicious circle, yes? Allowing for lesser levels does not improve the situation. This is not an easy problem to solve, but it is one that is definitely needed. Some tough choices will have to be made, and some feelings will get hurt in the process.

We walk through masses of people hoping none of them fall down so we don't have to lift them. Social gatherings are used for airway/IV assessments. Two relatively inocuous words drive us up the wall. "AMBULANCE" and "DRIVER".

None of the current software is all that good at interpretation, and they shouldn't be expected to be. At best, the computer will be close to right 50% of the time. The providers have to be able to identify when it is wrong.

Need to look at that a bit closer firedoc5. Morphine is not a diuretic, and you are not using it as one. That is an entirely separate discussion.

Calcium is not going to help manage a beta blocker OD. The calcium channels are closed due to the beta blocker, and adding more will not change that. Calcium chloride is the preferred preparation for critical patients as it has roughly three times as much ionized calcium available when compared to calcium gluconate.

UMC is the only university affiliated "teaching hospital" in AZ. There are several others that are contracted sites for numerous residency programs.

This situation shows a need for nutrition in the prerequisites to EMS education. Wake them up enough with the D50, then supervise them eating something more conducive to maintaining the elevated blood glucose level. Something with protein, and some fat in it.

BINGO!

Correct. By eliminating the PNS effects, the SNS will be able to have more effect. Chances are in the neurogenic shock patient, the SNS will be eliminated as well, but eliminating the PNS from the equation will not be a detrimental action. The situation doesn't change too much. You would still be trying to eliminate the cholinergic effects so the adrenergic could have an effect.

Atropine will preferentially affect the muscarinic use of Ach by limiting the neuromuscular junction's ability to reabsorb the acetylcholine that is released. When this happens in PNS nerve fibers the response is a blunting of effects.

There are some agencies that should lock the laryngoscopes and ETTs up so their providers can't get ahold of any of them, adult or pediatric. :shock: You do make a good point Vent. A provider has to have a nth level of comfort prior to engaging in some procedures. If they don't then they really shouldn't try to "wing it" to impress someone. I think Flasurfbum was looking for insight as to how aggressive some providers are in general, and not specifically with pediatric patients though. Do the absolute minimum until the patient decides that they really need more. Once that happens you have to be able to escalate rapidly and accordingly.

Are you arguing for the sake of argument, or do you really not understand atropine's mechanism of action and pharmacodynamics? Using atropine does not eliminate the release of acetylcholine from the CNS, or the preganglionic sympathetic nervous system. It will reduce the effects of acetylcholinesterase in the neuromuscular junction resulting in less breakdown of the Ach, but it does not stop it from functioning. The neurotransmitter functions will still be present as atropine works predominantly at the muscarinic receptor site, not in the NMJ.

Status asthmaticus, perhaps. I'd tend to use dopamine first for sepsis, just out of familiarity then move to epinephrine.

If you eliminate the muscarinic stimulation, where atropine exerts it's effect, you will leave the SNS unopposed. Doing so would not be contraindicated in a neurogenic shock patient, but it will probably not give you the result you are looking for either. When using atropine, we are assuming the SNS is able to function. The atropine does not induce an increased heart rate by itself, it merely allows the sympathetic system to exert an effect unimpeded.

I've used an epinephrine infusion on a few cardiac arrests, but I don't think that is the information you are looking for. With the availability of TCP, I've never used an epinephrine infusion for bradycardia. Can't say I wouldn't consider it, just have never needed to yet.

With the number of different methods that are available no one should be forced to endure pain. Items as simple as splinting or positioning can be used, and if they don't work move toward pharmacology. Everyone tends to want to use a drug first, but that isn't always needed.

If the city council truly cared about saving "heart attack victims" they would push for better public recognition and CPR classes. Take those paramedics off the first response engines, and have them educate the public they ascribe to being so concerned for. Or better yet, instead of having an antagonistic relationship with the EMS provider why not give them the funding they need to better cover the area?