mizzoumedic74

This is a big consideration when it comes to either steel or aluminum tanks. The older steele tanks have noted evidence of degradation after a while and have been noted to lose pressure after an unspecified amount of time. Now, most people don't have to worry about this since the tanks will far outdate the people using them. The newer aluminum tanks are lighter and easier to use without worry. The biggest thing about your O2 tank to remember is that the O2 inside will be exposed to the temperature as will your patient for whom the O2 is administered. Just FYI.

We switched to Fentanyl over Demerol last year. The results have been great and it's uses show far better results. Many services around Missouri are making a similar switch. ~Jared

Orthostatic hypotension happens usually if the pt has fluctuations when she changes position; i.e. from laying to sitting, sitting to standing. This entire situation sounds more cardiac related than anything else. Remember, the physiology of pregnancy means that cardiac output as well as blood volume are increasing. The pt's body must adapt to the changes. I agree that a 12 lead needs to be done to rule out cardiac.

There are a few things you can do to make your learning more effective. One great way is to get rid of distractions. A proven way to do this is to play music at a volume just loud enough to discern but not loud enough that you cannot concentrate (your favorite type of music usually works best). Make sure that when you study you are not trying to study too much at once, i.e. OB, trauma, and Peds all at once unless you are working on a pregnant woman who was in a car accident. These are just a few things. Like I said before I have been there and I am glad to help out when I can. If you have more questions feel free to ask. ~Jared

Nalbupine was taken off our ground service about 2 years ago; our flight service still carries it yet, rarely uses it. We added Fentanyl to our trucks about a year ago and have had great results. However, the use of analgesics in trauma pt's w/ETOH on board is STRICTLY forbidden; also in the use of trauma pt's with suspected head injuries. A big reason behind this is because you cannot ascertain accurately if and where the pt is having pain with enough ETOH on board. You can progressively mask any further symptoms by the use analgesics as well as further blunting hypothalamus response. You made the right decision. Great job.

I also agree with Ridryder. As instructors we need to feel very aware of our students and their concerns. Going into a new situations such as you are is difficult in and of itself. Give yourself every opportunity that you can. Trust me, we aren't as scary as we might seem. I can relate to you because I was diagnosed with ADD back in '91 before ADD was being over diagnosed. I can tell you that it is very manageable. In fact a recent nationwide study of EMS students showed between 10-15% of all Paramedic students have ADD/ADHD. Believe it or not this actually can help you in the long run if you keep the ADHD managed. You can use it to your benefit when it comes time for clinicals in keeping with rapid thinking ability. Good luck to you in class and with future endeavors.

Many ER physicians do not actually know what happens in field emergency medicine. If you act in the best interest in your patients and stand behind that...you will never go wrong. Our protocol has standing orders for Fentanyl (1mcg/kg initial; 0.25mcg q 5 mins as necessary for pain control). The great thing found with Fentanyl is the rapid onset and short duration. It is a quick alleviator of pain and yet, does not drop the BP like MSO4.

This is an interesting article. I would like to go out on a limb and simply state, "Treat your patients, not just symptoms". This was a quote my medic instructor used repetitively. Meaning one simple thing: just because your patient is not presenting with crushing chest pain does not mean you should delay immediate cardiac interventions. Case in point, elderly females atypically will not present with crushing chest pain. Alzheimer's patients, same story. Diabetics or patients with a past hx of prolonged ischemia will not present with the same symptoms as a normal, prior healthy adult. Never under treat you patients. If you suspect something, then do everything in your realm to help that patient. 12 lead EKG's are great pre-hospital diagnostic tools. Our hospital did a recent study. It stated that over a 3 month period, those patients with an acute MI who had pre-hospital 12 leads performed vs. those that either just showed up or did not have a 12 lead done in the field, had and average door to inflation time of 31 minutes. The shortest time was 12 minutes. This was a much different story for the other unfortunates.

On average, and ALS emergency 1 call generates a $900 - $1,100 charge. That means, ALS care and no more than 2 drugs used. ALS emergency 2 charge is between $1,200 and $1,350 which covers more than 2 drugs used and/or critical care interventions, i.e. surgical cric. There are limitations, however to this. On a weekly basis, our service bills between $20,00 - $40,000. We only recover approx. 40% of that. Due to either no insurance or medicare only paying what it will allow. Where we make the money is on Routine or Long Distance Transports. This carries a base of $565 for ALS care and $425 for BLS care. Plus, $11 per mile.

Bobby McFerrin, YES!! He actually did a concert at my middle school. He was good friends with our choir teacher. Ahh, good times.

Here's another great one. Today, we were dispatched as such, "Engine 7, Medic 21 - Cardiac Arrest at **** *** street. Pt is a 26 yo male who is unconscious but breathing." We were laughing the entire way to the scene. Come to find out, it was another college student passed out next to the door of his truck. Apparently he got drunk, planned to sleep in his truck...and that's as far as he made it. We laughed on the way home also.

DITCH, I do remember him and, ironically enough, he is now a Boone County Deputy. LOL. But I remember that day.

Alright, I must admit I was not born when that show was on the air. Nor, did I watch many re-runs of the show. I know, this is a travesty. I have many medics I work with tell me exactly HOW MUCH I need to "catch up". I believe the one thing that gave me away was when a senior instructor I was in class with mentioned "Rampart" and I was oblivious. I know now many of the characters are. I will catch up however. :oops:

I recently heard one of our loca fire chiefs state, "That looks Bad!, Chief 50 on the scene with command". He had pulled on scene of a Aircraft Down - Heavy alert. He didn't realize that he had keyed his mic up when he first started speaking. Don't worry, there was no one injured. A plane had lost it's landing gear and had to make a belly landing. Only the pilot was on board.

Is it possible to have an AMLS(Advanced Medical Life Support) class put on anywhere around there? This is only available to be audited but is great knowledge for even EMT's to have. Also, a basic 12 or 15 lead awareness class is a great one to put on as well. We have also found around our service, our EMT's have greatly benefited from a basic pharm. course. Not too in depth as if you were teaching a medic course. But a course that helps the EMT's feel more comfortable and aware of the meds carried on the trucks.

I am lucky in the fact I work for both an urban and rural system. Funny thing is that only the rural system allows, and has protocols, the use of RSI. It is dangerous in the wrong hands. The service needs to make sure that EVERYONE is trained and checked off on it before it is used. Keeping in close contact with your medical director should help you if you want to get RSI on your trucks. He will set forth guidelines for what each person will have to do before he sets the protocols in place.

Short transport times deffinately make you switch your sequence of events. I work for both an urban and a rural service and working in the city makes you switch into a "priority" mode, i.e., what NEEDS to be done prior to arriving at the ER. Other things that are different is my ideals to what I can do on scene prior to transporting in an urban setting. It's deffinatly a different world but the increased volume of calls is great.

I drive a 2005 Toyota Tundra. Now, in the area I live in, I am kinda looked at as an outcast, at times. You see, most people in Mid-Missouri are used to driving Chevy's, Ford's or Dodge's. I love my truck. It's my pride and joy. Plus, you should have something to show for all that overtime put in at the base.

Here is another one of my personal favorites: OTDDTR - Out The Door, Down The Road. Giving great reference to those that chose to not receieve our care.