AZCEP

Responding in that manner to an incident that didn't warrant it should be criminal. The call taker was told that the boy did not need an ambulance "right now, but send them anyway" Yet another example of why lights/sirens should not be used for every response.

You need to have your stethoscope so you will remember to check lung sounds? :shock: WTF man?!

Sin City, No disrespect intended, but it seems there has been a lot of turnover in the agencies in Clark County with more and more going to one of the fire departments. AMR will run you into the ground given the chance. When I did my orientation with them, we saw 2 truly critical patients over the course of the month. Then I had to be extended because I couldn't be evaluated adequately on "critical" patients. In my experience, my favorite location was Albuquerque NM. High desert environment, cooler temperatures, non-profit ambulance service. I wasn't really a fan of the amount of domestic violence calls, but the company and the providers were excellent. Pay was pretty good as well. All that and you didn't cow to the fire departments.

I'm glad that I got my degree quite some time ago. If I had to go back and take all of those classes again, I really doubt that I would be willing to. Now that I've reached this point in my career, my joints tell me it's time to move on to something with less physical demands. Because of my appreciation for the medicine, I'm going the medical school route. I hope to keep my hands in the education side of EMS providers as an interested observer.

As has been already mentioned, because capnography has a +/- of 5 mmHg, I tend to use a range of 30-50 mmHg to maintain. If the range is beyond that consider using other tools to make a decision. Adding information to the equation can help considerably. Is the SpO2 staying where it should be? Is the ECG staying about the same? What are the other vitals doing at the same time? Capnography is highly sensitive, but it does not tell you everything about what is happening.

The Las Vegas system is fantastic if you like the idea of SSM in 110 degrees. Never mind the lack of stability from the EMS providers. You can keep it.

Not often that you get all the titles into one line though. "EMT paramedic ambulance driver"? Must be writing to a third grade audience in Naples, eh? "Pressure from his superiors"? They don't want to have to run EMS calls so they pawn it off on the probie?

If you are interested in Seattle, check into King County Medic One before you do your paramedic school. Simply because if you do get hired by them, you will have to go through their paramedic school before you are allowed to work. Idaho has some pretty progressive systems. Ada county jumps to mind, but that comes from a distant observers view. There is a lot to choose from, and it really depends on what else you like to deal with. I prefer rural systems with minimal communication ability, but the pay tends to blow the further you get from a receiving facility. Any body can manage a patient for a few minutes. Taking care of someone for 45 minutes or more takes some real ability.

As long as ventilations remain the same, you can estimate cardiac output or more correctly pulmonary perfusion with capnography as well. It won't give you any hard/fast values to use, but it is a pretty reliable estimate of how well your managing the situation.

Sounds like you need a doorman to make sure you don't have to many people entering a residence. :shock:

And don't open it until you are good and ready to use it. I've made the mistake several times of opening the package prior to placing the tube, only to have it fouled by room air before I could use it. I'd like to add that there are more ways to confirm tube placement than MSDeltaFlight suggested, with all due respect. Capnography is the best of the bunch, but auscultation still has its place, as does esophageal bulb/syringes, BAAM devices. As we are required to have more than two methods of confirmation documented, I tend to use as many as I can think of including some that take quite some time to make changes, ie SpO2 and ECG.

http://news.yahoo.com/s/livescience/realtr...icorderinvented We might well be on the precipice of technology that was offered up in the 1960s. This is exciting news, at least in my opinion.

It will depend greatly on what the infecting cause is. Typically if standard antibiotics don't resolve the infection, it is going to be MRSA or worse.

"Enhanced Basics"? Isn't that what a paramedic already is? If you want to be allowed to perform ALS procedures, enroll in a paramedic program. Otherwise, don't bother. There is so much more to paramedic education than the occasional monkey skill.

Must be heavy into the Labatt's tonight eh? :roll: Normal blood volume does not equate to normal arterial blood pressure. I'm not sure where you misread that. My suggestion is to use the device for lower extremity fractures including pelvic/hip fracture/dislocations. Don't use it to solve a volume/bleeding issue. Use it as a splinting device. You don't have to use anywhere near as much air pressure to accomplish it.

For stable VT, I'd opt for the Procainamide. It is better suited for the situation than Lidocaine is. The dosing you describe sounds like Lidocaine. Procainamide is only used as an infusion. 10-20 mg/min is the rate of administration if I remember correctly. Just a guess, but I'd think that because Procainamide is VW class Ia sodium channel blocker, it will be more likely to cause hypotension following administration. You probably wouldn't want to use it for typical ventricular ectopy associated with an MI anyway.

This is part of the problem in how the PASG was implemented. It was borrowed technology from a device that keeps healthy, normovolemic individuals from blacking/redding out. The G suit was never intended to increase blood pressure or perfusion of vital organs. The PASG is a tool, like many others we have available. If more people would understand when to properly use them we would not continue to run into these issues.

I can tell you with all certainty it ain't about sex, and power is only an illusion. Congratulations Dwayne. Now start really learning something.

All of the antidysrhythmics tend to cause hypotension and projectile vomiting when given too fast. Bretylium anyone? Procainamide is the drug of choice for stable VT, and is very effective at converting it. It fell out of favor a bit with amiodarone's rise to prominence, but procainamide is still a good drug to have available. It is a bit unusual in the prehospital environment because you only use it by infusion, and it can take a while to start working. End points of infusion: 1. Hypotension 2. Dysrhythmia resolution 3. QRS widening by 50% or more 4. 17 mg/kg of the drug infused.

After reading your post Richard, I'm glad I don't work in that system. :? 3 years with less frequent CME, or 5 year with more frequent? I think I'd support the five-year setup, but it sounds like one size will not fit all.

You don't identify a rhythm as SVT based on the ventricular rate. If you don't identify P-waves and it is a regular tachycardia, then it is reasonable to consider it SVT. I'd still be willing to wait this out, and let some of the drug effects wear off.

With the presented scenario, I'd be hesitant to use the IO. I've just not had good experience infusing large amounts of fluid with that route. The medications can be withheld for a bit, but these patients tend to need volume replacement.

EMSDoc, I agree with most of your post, and would venture that medical oversight is not viewed as an added burden to your practice. One thing that I will disagree with is the utility of having a "well lit room" to work in. Because of the prehospital environment I work in, one could suggest that a summer afternoon in AZ provides superior lighting to any hospital room in existence. I've often found that the patient that is in a dark room is much easier to secure an airway in than the one I find outside. You do mention this in the bright ambient light situation though it seems a bit contradictory. Could be I'm just reading into things a bit much.

Nice job. A couple of tips: 1. Leave fire department ranks out of a medical scenario. They really don't mean anything in relation to the care provided. 2. The SVT that you saw was probably generated by the epinephrine you administered. Leave it alone until the epi has worn off. Stability is determined by more than the blood pressure and level of consciousness. You will have to decide for yourself what makes a patient stable or unstable. There is a list of signs/symptoms to reference, but they don't necessarily correlate to how your patient is presenting. 3. The lidocaine clock is a good memory aid for where you are currently. Eventually you will realize that if you start it at 2 mg/min (30 gtt/min) and you continue to see ventricular ectopy, you can increase it. Helps to keep from developing toxicity in compromised circulatory status.

They are going to receive refresher training from their own academy?! Holy mother of all that is decent :evil: :evil: :evil: Someone explain how this is going to fix the problem.