AZCEP

It has been a while since I've had to rely on one, so I can only hope the technology has gotten better. My experience with them has been that they are too inaccurate to rely on. For all the attention that motion artifact gets with cardiac monitors, it is just as bad for NIBP units.

If the patient is critical, and I don't have another set of hands to help, then the trending that they do is useful. Otherwise, I don't care for them.

In AZ, the actual title is Certified Emergency Paramedic (CEP) and the job description follows the National Standard Curriculum pretty closely. We are allowed to perform advanced airways up to surgical cricothyrotomy. Vascular access includes the sternal I.O. and central lines (IJ,SC, Femoral). We carry 35 different meds, but lack a beta blocker. Our scope of practice is limited by the medical control physicians, which are usually one of the staff doctors in a receiving facility.

In AZ there are really two different areas. Metro Phoenix/Tuscon, and everything else. The frustrating part is that the powers that drive where EMS is going in the state are mostly from Phoenix/Tuscon areas. Huge difference in what you need to have at your disposal when you are 40 minutes from a facility versus 5-10 minutes.

We also have 4 different area councils that help to push for things that will be helpful for everyone in the different regions of the state. Helpful in providing grant funds, finding educational offerings, putting on CE classes, reimbursement for upgrading certification levels.

Just so you folks from the East Coast realize, there is more to AZ than sanddunes and cactus

I am all for using new technology to help with patient care, but I share the concern for cost and utility. This sounds very exciting, but carries the same issues of all the other exciting technology that has hit the prehospital arena of late.

I work in an area that has been historically hesitant to invest in new technology that has not shown a definite benefit in changing the ways that a patient will be cared for. As examples, some of the local agencies have balked at buying TCP capable cardiac monitors, 12-lead capable cardiac monitors, waveform capnography, even pulse oximeters met resistance.

So while I am sure that this new monitoring tool will prove it's utility to a specific group of patients, how will it improve on a thorough history and physical exam?

The right nostril has two turbinates, the left has three. The difference is the amount of trauma that you can cause to the capillary bed in the side that you choose. NPAs are manufactured with the bevel where it is for this reason. You can use the left, but you need to insert the NPA reversed until you meet resistance then rotate it into position, much like an OPA. Judicious lube, and a little neo synephrine limit the bleeding that you will cause.

The dry NPA is a really good painful stimulus to the unconscious patient that you don't feel too compassionate for.

We can only be "Para-gods" when there are two of us on a scene.

You need to keep in mind that the drug itself is not converting the rhythm most of the time. In the case of VF/VT arrest, the early application of defib is changing the rhythm, the drug is only preventing a recurrence, hopefully.

That said, I have had moderate success with both, and can't really say that one is better than the other.

Lidocaine is typically faster to use, because it comes in a prefilled syringe. Amiodarone, as it is supplied for us, is in a vial that has to be drawn up slowly so that it won't saponify(turn to soap suds). Once ready to administer they are about the same.

Long term survival hasn't changed too much since Amiodarone became available for us. Lidocaine is still much more popular, based mainly on familiarity with the drug.

What are you basing "Amiodarone is the better drug" on? I have not seen a significant difference between the two. Hopefully, you aren't using the studies that have been funded by the manufacturer of Amiodarone to draw your conclusions.

Since through most of my career, my scenes have been more than 40 minutes to the hospital, the only treatment that I will perform on scene is the provision of an airway. Sometimes basic, sometimes advanced, but once air is going in and out, the patient will be moving to a position above some sort of wheels. In the event an aircraft is available they count also.

Using technology has not significantly changed how pain is treated here. Most of the medical control physicians are less likely to allow it than before, but not because the patients have changed.

PRPG, I tend to disagree that pain is intangible. The person that is feeling it will tell you that it is very real. It is very subjective, because each patient/person that feels pain will rate it differently. Most of the time we are looking for changes in the pattern associated with the pain. If we assess a 9/10 to start with, and this changes in either direction, we have, in effect, monitored the pain.

Thank you Breath,

In the words of Nancy Caroline,"Beware of the silent chest."

A lack of wheezing doesn't necessarily mean that the patient has another disease process. More often it reflects a lack of air movement altogether. For this group of patients, if they can't move the breathing treatment into the distal bronchioles/alveoli, there is no way for the medication, regardless of type, to have a significant effect.

Add to this the dehydration, and electrolyte abnormalities that go with repeated bronchodilator use, and we can guess that no amount of psychological placebo will work either.

Of course the fact that most meds that are prescribed will add to the problem with increased heart and respiratory rates, and the problem gets even bigger.

Ditto Rid.

I too am an instructor/coordinator of both and get this question frequently. My standard answer is PEPP is PALS al-fresco. You are going to get the same information, just presented in a way that you can take outside.

It really comes down to the instructors as far as the content goes. Both come from the same place, so any variation is from the instructors.

We offer both cards in the same class, but then our regional faculty doesn't see the value of teaching the same class twice for more money.

www.lbwllc.com

jvwain,

The new KODE that you asked about before your thread got hijacked looks like it will be much easier to get into place.

It has a panel under the upper strap that usually goes around the chest. The middle and bottom straps are on one panel that acts independently of the upper one. This simple change, by itself, should make the device work better for patients with a short torso. It should also help with the patient that you do not want to restrict respiratory expansion.

Without having one in front of me, I can't really comment on how much better it is to use, but, hey everyone wants a new toy!

what was Gargamel's cat's name?

Azrael. The Smurfs spinoff--the Snorks, the Justice League of America("Wonder twin powers activate!")

"Tastes great! Less filling!" with John Madden bursting through the Miller Lite logo--"And another thing!"

Star Wars episode IV without Jabba the Hut. GI Joe with Kung Fu action grip.

The Super Bowl Shuffle, Harvey's Wallbangers in Milwaukee, no hockey in AZ or FL( I mean really, WTH?!)

Just to go back even further, waiting for the picture tube in the TV to warm up before the picture came on.

Over the last few weeks, I have noticed that a trend seems to have been forming. It seems that every post that discusses the right/wrong of patient care/management leads back to the shortcomings of the current educational process that providers go through.

I have noticed that this trend doesn't really cut along the BLS/ALS lines either.

My question is, "How do we fix the problem?"

Just so you get a feel for where I am coming from, I have been the program manager of the local hospital's paramedic program for the last three years. 32/40 students successfully passed their NREMT exams, and most (maybe 26/32) I would not have a problem letting to treat my family.

Give me some ideas, so I can start to improve the system in my little corner of the world.

I like to have an MD/DO when I need to ask a medical/legal question.

Otherwise, patients will receive the treatment that they need without asking permission.

ANY problem with the A-B-C's gets treated with everything that I have, then the receiving facility is notified.

Beg forgiveness, don't beg for orders.

Most states/counties/etc won't recognize the I-85 anymore, so if you take it you will effectively be wasting your time if your region is one that doesn't.

Your instructor could very well be looking out for his own job in discouraging you to take the I-99 test. By limiting, or promoting his students to take the I-85 test, he won't have to work nearly as hard to prepare, and he will be able to hold another class later for the students that want to advance.

I hope that I am wrong of my take on the situation, but something smells of fish.

Aren't endorphins wonderful little animals?

The local community college does an EMT class every semester, depending on interest.

www.mohave.edu is their website. The classes should be listed under EMS, but I haven't looked in a while.

For anyone interested in a paramedic class, I am currently accepting applications for a class starting in Jan 2006. Send a PM or email, and I will get you the info.

I know that I tend to get myself into A LOT more trouble after about hour 30 without adequate sleep.

It doesn't matter who it is that I am talking too either. My wife/kids/parents/in-laws have all had to deal with some pretty anti-social behavior at one time or another. :twisted:

Don't take anything into a fight that you don't want to have taken away from and used on you.

Good for immobilizing kids, and the occasional fx pelvis/hip.

I have to agree with Beagle, if the patient is critical then do a rapid PHTLS style extrication onto an LSB. When they can tolerate the longer extrication time, use the KED/KODE/IDEA etc.

Rid,

I can agree with looking up the info when there are resources available to do it, but when the limitations of the prehospital environment are factored in, I don't think it works real well.

On the plus side, most prehospital providers don't have as many options as in the hospital. That by itself should make things easier to remember. The greatest difficulty that most have is being able to recall the information in a stressful environment of a code.

For what it is worth, the "kinder, gentler ACLS" is for all involved a huge disappointment. Those of us that have been around for a while can remember walking into an ACLS class not sure if we would leave with a card.

Now it has become, sit through 2 days of class, give an inkling of desire to do something right and you expect to get a card.

In teaching ACLS the last 4 years, many students ask me to sign them off without them providing understanding of the guidelines. While it makes it very easy to trip these people up on simple concepts, the expectation is still there.

My medic students do not get a card if they are using the reference materials that the Dr's and nurses are allowed to use. There definitely is a difference in the amount of information that prehospital and hospital providers carry with them.

Hopefully, I'm not alone in noticing this difference. Even with the advent of the ACLS-EP class, the hospital folks want to look treatment options up in a reference book, and medics tend to treat with what is available to them.

Don't want the neighbors to know there are large emergency, highly reflective vehicles with large diesel engines a couple houses down. Maybe the lights and siren would put them into stealth mode like happens on the road with the critical patient.

What! There's stress in this line of work?!? I just can't believe it! Oh, wait, I had my rose colored glasses on again. Now that I can see what is really happening, I think I will be hiding under my stairs again. Thanks alot. :shock: