AZCEP

I could be wrong but isn't this an EMTALA violation waiting to happen?

Wallet biopsy has no place in EMS.

Good point firedoc.

I guess the term would be a bit subjective, and if the patient describes it that way I'd use it to relay the information.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

--Hippocratic oath

I'll usually use "tight" to describe minimal tidal volume with end expiratory wheezes. Kind of what it would sound like to breathe through a swizzle stick, I guess.

Take a look at the date of the article you posted.

Since at least September 2007 diltiazem has been unavailable in the powder form. The only version that is still available is a prefilled syringe that has a shelf life of 30 days at room temperature.

Are you not using it because it is not indicated, or because you are not being allowed to do so by medical control?

If you have to call for the okay to use something, your system sucks. If you are not being allowed to use it after calling for approval, your medics suck.

If you aren't allowed to use something because it isn't indicated, and can't justify the expense of having it, what is the problem exactly?

Right now the changes are in the discussion phase, and if you want to have your voice heard AnthonyM83 started a thread about that very subject.

The intermediate level is obsolete. It was put in place to supply advanced providers to areas that couldn't justify paramedics. Those areas that are currently using the I99 level are doing it so they don't have to employ paramedics and still get the same level of service.

The current basic curriculum is closer to what the original intermediate level was intended to be, and the I99 is a lesser version of the current paramedic curriculum which is woefully inadequate. INCREASE the requirements for everyone, eliminate the intermediate altogether, require a degree from the providers, and offer licensure for those that take this seriously.

Sounds like you are mixing the three together.

The chest pain indicates to contact the medical control prior to administering NTG/MS with signs of a right sided event. The cardiogenic shock seems to indicate that you don't have to contact medical control before starting fluid replacement and pressors (dopamine).

If you want to use NTG/MS for cardiogenic shock, it would be a good idea to get advice from medical control first.

Did you search here? There are always new and exciting sites popping up in any number of discussions.

For strictly conditions, www.emedicine.com is one of my favorites.

Despite what everyone is saying, there are plenty of good resources to assist you with learning to interpret ECGs. Dubin's book is just one of them.

Personally, I never liked it. I much prefer Mary Boudreau Conover's text, but that is the detail orientation I have to bear.

http://www.amazon.com/Understanding-Electr...r/dp/0815119275

Also makes a great learning tool for teaching FNGs how to play dodgeball (If you can dodge my MagLite, you can dodge a ball).

We just send them into traffic. (If you can dodge a car, you can dodge a ball!!)

Three items I always have:

1. Two pens--one always walks off

2. SHARP scissors--the ones the department offers suck

3. Gloves--usually two pairs

You do not want to use calcium to counteract the effects of magnesium if you are using it for seizure control.

Ideally you would be able to use the magnesium prior to the onset of the seizure. If the patient is actively seizing, the BZD will have a better chance of breaking the seizure, but can also cause problems for the infant.

Most of the current generation beta blockers are beta 1 specific until you use unusually large doses. For the most part there is limited risk in COPD or Asthmatics from them.

Cardizem is also a negative inotrope/chronotrope. It will work much faster than most of the beta blockers and carries many of the same risks.

You've made a good point al. The criticism has to be placed on the administrators that are setting these students up to fail with their shortsightedness.

Saying that the ex-military providers can't be excellent civilian providers is much like saying there are no decent fire department medics. They can be, it's just rare to find the one that has done it. Because there is so much more to the transition than just "brushing up" on the medical situations, the fast track route should be round filed.

Well that's not what I thought the topic was going to be. :?

Congratulations, but I was hoping to discuss music on vinyl. :wink:

What, he couldn't find a paring knife? Some people just want to be dramatic I guess. :wink:

Keep in mind the adult human tends to do pretty good with slow heart rates. 30-40 can typically be tolerated for quite a while.

It is not uncommon to find a patient with a vague complaint that you would not suspect to be cardiac in nature and go through all of the other possibilities only to place them on the monitor and find something dramatic.

In those cases, vascular access has already been achieved, and a trial of atropine can be used. You might also consider that if your protocols were taken directly from the ECC guidelines, chances are the wording wasn't altered to make more sense for the prehospital environment.

jeffline.jefferson.edu/JMCstudents/usmle2cs/Cardiovascular.doc

It is basically a way to document the level and degree of the edema.

Have you worn crocs, very comfy.

Comfy isn't going to protect your feet very well from the wide range of things that can fall onto them in the healthcare environment.

Leather duty boots with a rigid sole, preferrably with a kevlar insole for me thanks.

I'd cut as much of it off as possible. Using the analgesic prior to attempting would greatly facilitate doing so.

One IV would be plenty. I'd guess from the given information the patient has a blood pressure enough to get some pain relief. Allergies and meds would be good to obtain first. Some morphine, cut the boot off if you can, immobilize, transport.

Also do not forget you can always just immobilize them in a car seat.

This is suggested for those patients that are found in a car seat prior to immobilization. The car seat also can't be damaged from the impact of the incident.

If the child is out of the seat, or the seat is structurally damaged, don't bother using it.

Those firefighter/paramedics didn't want to be paramedics in the first place and didn't put the effort into being good at it while they were one. They did just enough to not get in trouble, but not so much as to show they were incompetent.

Everything still comes together to even create new opportunities if you use your education and not just rely on skills.

Brilliant! Now if people will listen to the wisdom of it.

Sometimes helping someone means telling them the things they don't want to hear. A true friend won't blow sunshine up your @$$ when they know you are wrong, or misinformed.

That is the truly great thing about many of the EMS forums. Opinions are everywhere, and some actually make good sense when you take the time to figure them out. Having thoughts typed out makes it easier to review the matter, anytime you want to.