funkytomtom

Good responses all! I wouldn't be worried about not being bummed after a call like that. I think that's probably a strength as long as you can still empathize and treat with care.

I'm going to go ahead and be the wuss here, however, and say that I've been very affected by some of the calls I've had. One was a train-wreck of a call with two infant deaths, but others weren't that dramatic. I try to just use it to my advantage and really truly help my patients in any way I can (as I'm sure we all do).

I think you can be a strong provider in either of these categories. Just accept who you are and how you handle it, keep the patient's well being as your main priority (after your crew), and you're on the road to greatness!

I'm more than a little worried on how few of these I know...

Anyways, this is a great thread...I'm staying tuned.

Easier Method: write the blocks in order, and write CICI in order beside it (think CICI's Pizza)

1st degree C

2nd Type 1 I

2nd Type 2 C

3rd I

The C stands for consistent, the I for inconsistent. Now look at your PR interval, if it is consistent, your block must be 1st degree or 2nd type II. More than one p-wave makes it 2nd type II.

If your PR interval is Inconsistent, then you either have Wenkebach, or 3rd degree. If the PR gets longer until a QRS is dropped you know what you have. If the opposite is true, you know what you have.

This is helpful...thanks.

Wow! Thanks for the cool link.

Whelp...I've got the gun on my right arm, and the gun on my left arm. Also...Chuck Norris on speed dial.

All patient have the right to refuse medical attention regardless of their severity, otherwise its considered kidnapping, assault and battery. the only way around this is with patient who are under the influence of drugs or alcohol ( and this you would require police to take custody) and those who are not oriented X3, juvenile must try attempt of contact a parent or guardian. And if the patient is unconscious and/or unresponsive , which would fall under the implied consent. when they sign a liability waiver (which every patient that goes AMA should sign) it doesn't remove liability of the from emts, but it shows that the patient officially refused medical attention. this goes back to document everything to CYA (cover your a$)

Also, remember when informing a patient of potential risk of going AMA, don't leave out info. IE when dealing with a patient with probable spinal compromise , let the patient know on top of the mortality risk , they can also become paralyzed.

this reminds me of a story out of the New Jersey shore , a woman dives into shallow water at a sand bar and impacts at the top of her head , she is collared and board by emts and lifegaurd at the scene, the woman begins to refuse medical treatment. During the liability and risk notification of the waiver the emt stated , that the woman could potentially die from a spinal compromise. The woman understood and was released, and as should stood up and walked 10 feet and looked to her side ,instantly collapse and is permantly paralyze. the EMTs re-collared and board her and transport to the hospital. Later on litigation procceedings are brought against the township and the EMTs at the for failure to inform her of the potential of possibility of paralysis , the kicker of this story is that she wins her law suit against the township and the EMTs.. lesson learned is Document everything and inform the patient of all risk especially since everyone nowadays are sue happy.....

Holy HELL! Not calling you out or anything, but is there somewhere I can read about this story? THAT is the definition of insane litigation.

Wrong...if they are coherent they can literally sign their life away. This can become a tricky situation, but for all intensive purposes, if they are oriented and sign AMA, they could explode one second later and you would only be responsible for cleaning them off yourselves.

That's awful. Shows you the need to do a proper assessment on all your patients. It could be that one time you half-ass it you get nailed. Although it is unclear whether he was even seen by EMS or not.

Just to clarify a few points:

1) Pyruvate is a product of glycolysis along with a net of 2 ATP via substrate level phosphorylation. In addition, two NADH are produced per glucose molecule. However, the pyruvate is turned into acetyl-CoA after entering the mitochondria. Lactate is produced in the TCA cycle.

2) The Krebs Cycle (TCA) is not the major ATP producing pathway. I believe only about two ATP are produced via substrate level phosphorylation in the TCA cycle. The major site of energy production is the ETC. Hydrogen ions and electrons help run ATP production in two ways. 1) The electrons give up energy as they cascade through the cycle. 2) Hydronium ions are utilised to make a gradient and by use of proton motive force (PMF) powers ADP to ATP conversion through a protein known as ATP synthase. The oxygen "scavenges" the hydronium ions and electrons at the cytochrome c oxidase protein complex.

3) Several things actually occur beyond cell death by acidosis. We have failure of multiple mechanisms including ion channels. Then, as cells die, inflammatory mediators are released opening a systemic bag of worms. This is part of why people with say a femur fracture can develop ARDS and MODS. Clearly, hypoperfusion related to hypovolemia can be another part of the puzzle. However, it is not uncommon for somebody to sustain a hypoxic insult or an episode of hypovolemia and end up developing MODS and so on.

I am sure the Docs and JPINFV can go deeper, but I just wanted to clear a few thing up.

Take care,

chbare.

You are correct that only two ATP are produced in the TCA Cycle. I will have to investigate further on A) the ion channels, and the inflammatory mediators. Thanks for the help!

Yeah I guess it is rather late...I'm curious and impatient and figured we all had to be creatures of the night like me.

wow...not even any views yet...

Hey all-I'm wondering how hypoxia actually physically kills you on the cellular level. I know that your cells use O2 in the final stages of cellular respiration as your "terminal electron acceptor." But...with hypoxia, CO poisoning, or cyanide poisoning, this final step in energy production is inhibited. Does the cell even attempt the electron transport chain without the presence of O2? Or does it go through electron transport only to end up with free floating electrons? And...how long can anaerobic respiration sustain life...and (lastly) is it the accumulation of acids or the lack of energy that kills?

Thanks for the help! I've been having a difficult time trying to tease out the answer using my EMTI textbook, bio textbook, a&p textbook, and yes...the internet.

I stumbled across this today. A very different kind of emergency medicine practiced by some real heroes.

Sigh... You do realize that not all of the younger generation have that sense of entitlement?

I am in college right now doing my medic pre-requisites (among other courses). Not all of these pre-reqs particularly get me off, but beyond daydreaming how nice it would be to be finished with a particular class with a nice grade, I haven't really entertained the idea of cheating. It's simply too satisfying to work hard and see the payoff of a good grade.

Despite all the moralizing I just did, I did "cheat" on a non-school exam the other day. It was proctored very informally and I asked for and received an answer.

Why people cheat though is pretty obvious to me. No commitment/investment+work=cheating.

News article

RIP to the crew. Thoughts go out to the families

Very sorry to hear this. I have nothing but the utmost respect for the crews on rotary and fixed wing ambulances. They take some of our most critical patients at great personal risk. My heart goes out to friends and family effected.

I'm very actively involved in politics. I'm cool-headed. I still think this is a calm discussion. I just take offense to being told that anything expressed to demonstrate the level of the anger the American people are experiencing as "infantile." This is a very serious matter on so many different levels and requires our full attention. The POTUS was giving a speech today and making fun of all of us who recognize the threat this bill and the manner in which it was passed poses to every single American. It was deeply immature on his part and just continues to rub salt into the deep wounds they've already caused. It's disgusting. He's disgusting.

I didn't say being angry was infantile, I just said that some of the explanations given behind hatred of the bill ARE.

And when you say "American People," you have to realize you don't speak for all of us. I just did a quick search to find this: http://politicalticker.blogs.cnn.com/2010/03/25/polls-indicate-support-for-health-care-reform-has-increased-since-sunday-vote/?fbid=ty7Kb9sbz8G Now realize that YES the numbers are not in support of the bill in some of these stats, but some of those number don't support the bill because they don't think it goes far enough. And that still leaves millions who support the bill. Again, not saying that makes it right, but from what I hear on this forum, I would expect militias roaming the streets. There are A LOT of angry people, but there are A LOT of people who either aren't angry or aren't angry for the same reasons as you.

You ARE perfectly entitled to have your opinions and I think some of them are valid. The things I have a problem with are A) death threats, (I guess B ) makes a cool face) talk about revolution, and C) thoroughly opinionated people with thoroughly uninformed opinions. And I'm not saying all the dissenting voices are uniformed, but the tone of this discussion is really polarizing (from some people). The reality is that the way forward is going to be one of compromise, not of deafness to the idea's of others. BOTH sides are guilty on that one.

My problems with the bill: spending, cuts for seniors, and lack of tort reform.

What I like: more people covered and some needed regulation of insurance companies.

Still not sure about: whether or not this will actually work out as a "pay now, save later" scheme in reality.

I know we don't want to talk about history, but even besides Bush, many of the big government legislation that has been successful in the past has ended up with high levels of public approval. Think social security, medicare, and medicaid. None of those programs are anywhere near perfect, but today's healthcare system is far from perfect itself.

You know what? I am damn sick of all the exaggeration and violent talk! DAMN SICK OF IT! More profanity would be included if this were not an internet forum. But seriously people? I am ashamed that some of us are now cheering on death threats? Saying Obama has now ruined the whole country? Revolution is the only answer?

I didn't see anyone b1tching like this when the federal gov't saw its largest expansion ever under Bush. Now some of you sound like chicken little with talk of how "the sky is falling!"

I don't necessarily agree with Obama's bill or many elements of his presidency, but as an EMS professional, citizen, and human being, I know how to appropriately express my views and push for change. I am disgusted to hear some of the talk on here. You need to realize there are two sides to every issue, maybe try to look at the other side of things, or the positive in this very bill. More help for children with pre-existing conditions gets my full support!

I DO think there needs to be HEALTHY debate about the economic implications and things I don't personally care for such as cuts in care for senior citizens, but come on people, lets grow up, clean up our act, and stop these INFANTILE EXPLANATIONS of complex issues.

This does not apply to all posters or even posters who are against the bill. If it applies to you, you probably already know it.

your right he did not say that, but in my opinion that is what it will come to with the gov't paying the bill for the most part, and like I said before yes I am not cert'd so I don't know everything per se in the medical field but if I were cert'd as an EMT-B my first responsibility it to the pt. and no one else unless they are in danger and they are at the scene of any given call I may be on. But I am not cert'd so...but if I see something happen I will step up and care for that pt. till better help arrives.

I hate to threadjack, but while I appreciate your enthusiasm and apparent patient advocacy mentality, I fail to see where you make this connection. Whether or not it is a good bill (of which I'm not sure), I have an impossible time believing that ANYONE is ever going to ask you to NOT care for someone who needs help. This comment sets you up as a self-righteous crusader without a crusade.

The economic points and finer details of patient care are all up for debate, and with good cause, but lets not hyperbolize the discussion with talk of death panels, and these "mystery patients" we will no longer be able to treat. Good debate aims to tease out the truth, while debate just to win becomes eristic.

I would love to hear from the Dr.s in this forum as well cause there point of view would be nice to know....but like I stated when I first started this thread "first do no harm" I may not be cert'd yet but still I would treat the pt. no matter what the commander in chief said, yes he is the leader of this nation but he is ultimately not my boss and unless someone is holding a gun to my head saying do this and don't do this, that pt. will get the best treatment that I can provide at my level. Just for the record I am not cert'd as I said but I do have training as an EMT-B and as such I am still covered by the Good Samaritan Law

when exactly did Obama tell you not to care for someone/some subset of patients?

Who would be the contact person if someone from the public wanted to give an opinion on the issue?

good call I'd love to voice my opinion.

That's funny that they see what he's doing as a problem. While I read it I was thinking to myself "I wish we did that here." There's a huge difference between passing the in-class stuff or managing a patient for a short period of time and applying your knowledge in real life, providing care for a long period of time. I can't believe they're really bitching and asking him to lower the standards. Suck it up and meet the standards fellow healthcare professionals.

I never said that I endorse what the NLVFD is doing. What I did say is that when you're facing unemployment, self preservation kicks in. Especially with the lack of available jobs out there. Survival of the fittest. No different than a corporation trying to gain as much market share as possible, I suppose. In fact, I've said that I don't agree with FD takeovers of pre-existing EMS, except when the existing system has proven itself inept and/or inadequate. If your system is working well, there's no need to change it. Adding EMS/ALS first response to save jobs and increase productivity is one thing, but putting people on the unemployment line is a whole different matter. Again, I don't endorse a FD takeover in this case, as things are working well as it is, at no cost to the city.

I don't know about you, but I wouldn't make a career in a private service, especially where 911 is concerned. As I said earlier, it's the choice of the local gov't as to who runs EMS. A private service vs an established fire organization, it's really no contest. If I were working FT for a private, I'd be sure to have a plan B. That was my thought process when I worked hospital based 911/IFT in NYC. The FDNY could take back their 911 spots, like FHMC's 46 Frank, when they were steering pts. The hospital itself could close, as did St. John's on QB, Mary Immaculate, St Joes, and probably St Vincent's in the city. That's why I went municipal third service EMS, and then fire based when I saw how much better they have it (and being slapped around by the service). If I were able to find an available third service with the same benefits, compensation, working conditions and retirement, I would have went there. It's all about the best retirement. If your company loses it's contract, you maybe have a little bit in a 401k if you can afford it. Some retirement.

Many of you want the fire service out of EMS. More of you still want fire positions cut back to reflect call volume. Being that I'm not quite two years in, that would result in me being laid off. If you all had your way there would be massive fire service layoffs. Loss of firemedic positions, and suppression positions due to call volume. Fire takes EMS jobs and it's an evil thing. But taking it in the other direction is perfectly fine.

I know you're already getting bashed from just about everyone, but your last sentence needed a response. YES it's an evil thing to take our jobs because we do have jobs and a job to do! No one is taking FD jobs, they simply don't have enough of a job to do. No work=no job. We have jobs without taking them from fire and we've been doing a damn good job for a long time. Now that there's less of a need for fire, you see us not being willing to give up our jobs for you as TAKING YOUR JOBS?!?!?!?!?

I'm not really sure what the controversy is, apparently something to do with these forums? Either way, you've been awesome towards me and helped me out, and extrapolating that out I'm sure your a great medic too. I concur with your observation that for an internet forum, this place is surprisingly supportive. Best of luck!

Great intervention and congrats on the practical! If your patient has shallow respirations, he/she is unlikely to be properly oxygenating...I know that it seems weird to be bagging a tachypneic pt, but if the respirations are shallow, it is appropriate. As you can see, some very simple questions end up with more complex questions than before, and very little resembling a solid answer. It is a dynamic field and I hope it excites you.