Vorenus

Happy New Year to you all! Stay safe if you need to work!

Hey Bernhard, good to hear from you. I was wondering where you were, although I myself have been really seldomly around this last months (distance-studying takes most of my time).

Good luck with the new position, and enjoy the pay upgrade.

Respect to the Medics - this sounds horrible, especially in front of a vet clinic (if they even deserve this name!).

Uh, that's why assessment of respirations includes more than just rate and tidal volume. Rate, Rhythm/Pattern, Effort/Quality, and Depth, combined with history

Similar to pulse Rate, Rhythm, Quality or skin Color, Temperature, Moisture, all having to be combined with history.

I don't understand how respirations are so much different? (Respirations meaning an evaluation on the different qualities of respiration, not just rate or just depth etc)

The question posed at the beginning of the threat was dedicated to repiratory rates, though, and that`s what krumel meant, I think.

And the respiratory rate alone, I gotta agree there with krumel, doesn`t poses such an impressive or precise marker (which is what krumel meant I guess).

Fair enough, very low and very high most likely indicate a problem in a patient - but it`s not "accurate" as let`s say SpO2 or RR, which pose a variety of interpretations.

I`m only talking `bout respiratory rate as the quantitative date in itself here, not about possible lung sounds, position of the conscious patient while breathing, possible pathologic patterns, etc.

Apart from that, although skin-colour, temperature and moisture might be connected to your discovery of a pahologic pulse, they may be totally unrelated to that particular vital measurement and attached to an underlying or secondary problem.

Good luck with everything and stay safe! Always enjoyed your posts!

Lol!

Now I wanna buy that car, damn.

And what is On Star, btw?

Our health region has decided upon the Bone Injection Gun...unfortunately. All it means is that now I have to pay to actually get quality equipment instead of getting it for free from the region.

Same here: we have the BIG plus Cook needles.

I have never actually placed an IO. It is still outside my current protocols but had convinced myself that tibial access was for pediatric patients below the age of two and adult access is in the sternum.

So tell me how far in the ditch that idea is.

Far as I know, the only one`s still using sternal access are military medics in the field (apart from the obvious, that you`d need different IO needles for sternal access).

Gotta agree with you there : ) I always end up with OBs and babies...just because Im a lady doesn't mean I don't fear the vagina too!

Lol!

Line of the year, I`d say...

Sounds like more of a leadership issue than an ethics issue.

Agreed.

Never took something from a bystander and wouldn`t do so either (never was offered something, too).

The wife of a patient, who is a regular dialysis patient, has a bowl full of sweets standing right beside the door especially for these occations. She offers anyone who brings her husband home a grab into this bowl. Refused the first time, but she insisted, so I took one. Don`t think that`s problematic, though. After all it`s only a candy and she means it kind. Don`t always have the appetite for candy when bringing him home, but it seems impolite to refuse, so my partner has to eat two sweets sometimes.

Last christmas my partner and me were offered a piece each of a christmas stollen the nurses from the caring facility, we brought a patient to, just baked.

After half an hour both my partner and me had cramps and needed to return to the station pretty urgently, because of the strategic nearness of a hygienic facility - so I`m a bit cautious now when it comes to self-produced food...

First of all, I`m not all sure about this (never really got into this stuff, for I`ve never come near to publishing yet), but I seem to remember that agencies don`t look kindly on work that`s already been published, even in a piece-meal fashion (doesn`t matter wether it was in a non-profit way). So best look those issues up before continuing posting (if you`re serious about this).

Secondly, you need to establish what kinda style you wanna write your book in, and what your intent`ll be. Right now, it reads like a bit of a diary, which is cool in short passages, but it tends to get exhausting if this style is prolonged (exceptions exist). It may be fitting if you wanna make it really real, real obvious - if you wanna write a novel though, you might think about working on your style and include descriptions of people, places, siutations, etc... which`ll make the read more vivid and interesting.

EDIT: There`s also some irregularities in the content and writing, even in this short piece, like:

You patiently wait through the static. You wait the few seconds that feel like eternity for the microphone to key up.

He/you patiently waits but it feels like an eternity? Kinda contradicts itself.

Furthermore, I wouldn`t use as many brackets as you do (they are seldomly used in prose). Instead of using brackets, you could put these informations in subordinate clauses, which would also improve your style.

Must have been manufactured in Pacific Southwest The just put there 10 fingers spread across the chest and cross there toes and interpret what they feel.........just a joke guys.

Hey, do I hear sarcasm in that... that specific technique always worked for me!

You don't need 12-lead capabilities for a hospital based machine on a code cart. 12-leads are done using dedicated EKG machines in hospital which have markedly better diagnostic quality.

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That might be the answer- I know there was a variant of the LP12 without 12-lead, as well as the Corpuls.

Didn`t knew they did that with the LP15 too. I used an LP15 for nearly a year with my old company, and it was a nice machine, good menu handling and all (although I can`t remember where the 12-lead button was - didn`t you have to open a new menu for the 12-lead and then there was a button "Print"?).

Geographical proximity to the UK would not make UK HCPC registration any easier...otherwise it would be full of Frenchmen.

In that case, it would also overflow with freaking Germans like me (I`m about to try though, in an undefined future ).

Their ( The hospital) rational was since they could not consciously sedate me, it would be better to put me completely under. Honestly I didn't complain because I was knocked out and didn't feel a thing when they did the closed reduction. I was just struck odd that the etomidate and versed didn't put me down.

For cases like yours, we use Propofol - short sedation, never experienced problems with this med in "easy" (I`m sure it was a most "un"-easy sensation for yourself ) cases like this.

I have to pipe up as well... I have not seen continued paralysis in our ICUs. As a matter of fact, I have seen as part of early ICU mobility, people still receiving ventilator support (still intubated) standing at the bedside or marching in place. Those people often get weaned not long after that, but they are not kept totally sedated and certainly not paralyzed.

I could definitely understand keeping them paralyzed for flight, but what is the difference really between keeping them at a high level of medication induced sedation and keeping them paralyzed with sedation (as we all agree that paralyzing without sedation is a big mess)? Either way, they're not fighting you or the tube...

Wendy

CO EMT-B

RN-ADN Student

Exactly my point.

Especially since I seem to remember that continued/general use of paralytics seems to complicate/prolong the process of getting someone off the vent/weaning in the end.

Welcome, Swe112.

Vecuronium is a paralytic and will keep a patient paralyzed while the ET tube is in place. This helps in that the patient will not fight, bite, or otherwise buck the tube creating additional airway challenges.

It is not a sedative so sedation needs to be given in conjunction with the vecuronium.

What are RLS 7-8?

There is no valid reason for keeping a patient on paralytics after an ET tube is in place, apart from insufficient possibilities to sedate/keep up sedation.

Yes we were underdosing for analgesia which had the effect of being effective as analgesia as it could be, while also bringing out hallucinatory effects at lower doses. The doses aren't more sedative after the increase, although we also do use ketamine as a takedown drug for chemical sedation/restraint.

Never used it in that way (Propofol or Midaz) - wouldn`t an already agitated patient be more open for the psychotropic aspects of the drug, I wonder?

Any experience or studies in comparison to other sedatives?

First to say that I`m not familiar with PCA systems at all, since never having worked in a clinical setting aside from my apprenticeships.

Ketamine wouldn`t strike me as the drug of choice for a PCA, though, considering its rather heavvy psychotropic and hallucinatory side-effects. Former named characteristics are the reason why ketamine should be administered in a combination with benzos - I can`t really see how this could effectively be acchieved with a PCA, considering the corresponding imbalance between ketamine and the benzos.

As said, just my personal thoughts without being familiar with the PCA administration of ketamine.

I know that in most hospitals here Ketamine would not be administered as a PCA. And even when administered as an analgesic it's usually given with a small amount of a benzodiazepine which significantly reduces the halluncinations etc effects. Other than that, ketamine only really gives that sort of negative patient reaction in smaller doses. Thus recently in our service our ketamine dosage guideline has been upped as higher doses reduce the hallucinations apparently (it's not im my personal scope of practice, but I read the memo).

As an analgesic?

This would imply that you haven`t had enough in your guidelines before, or that you´re analgesic dosages tend to be more sedative now...

Pretty good sum up on Bernhard`s accounts - I can`t say that I wasn`t under the influence of personal animosities towards the propable new law while drafting my prior post (still standing behind my arguments, while acknowledging the few good parts about it).

As Bernhard states, our "scope" is pretty much inofficially depending on the region you work in - not saying that care isn`t rendered appropriately in the more "conservative" regions or procedures aren`t done in the needed situations. Point is, in many parts, you could get rather fucked up for doing so by local represantatives as stated above, which is a big failure of our EMS system - that the new law ain`t gonna be resolving (as much as I´ve understood it, as well as the corresponding statements of the represantative societies/organisations).

Congrats!

Enjoy your new position!

While not the same as a duty to act, some states (Vermont and I think Wisconsin) have Good Samaritan laws dictating that anyone stop to render assistance if you see something happening. There are specifics outlining the details of when someone should stop. These are not based on any kind of provider level or education. They are directed at anyone who happens to come across an incident.

We have something very simliar in place around here. Just by calling EMS that duty to act is fulfulled, though, at least in most cases. If you`re working EMS or have specific knowledge that would apply to that situation (proven by a degree or vocational training), you do have the duty to render more care than an untrained bypasser, as an EMS worker.

My agency only carries valium, can give 5mg, then a second 5mg, have to call for any additional dosages ... This area isn't so big onto the whole "progressive" thing (also only morphine for pain, no other narcotics). So far I haven't been impressed with the valium's ability to control seizures.

That might have been the case, because 5mg is a pretty low start dosis for someone who ways more than 15 kg.

Try picking up Albertans after they crack it up on the Coquihalla. After they pass you driving Mommy and Daddy's Tahoe at 140 km/hour.

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140 km/hr isn`t really considered something out of the ordinary around here...

Those seem like more than reasonable arguments to me.