Vorenus

Yeah, Aldi has great deals, good food and the food tastes good too.

Hm... they must have upgraded Aldi before exporting it to the states.

Around here, it`s more or less a pretty mediocre supermarket chain. They have all the normal stuff, mostly the cheaper brands, but that`s okay, I mean, in the end it`s only a different label with the same stuff inside after all. But they don`t have as big of an assortment as other supermarkets have.

But I don`t like their fruits and vegetables, they are pretty low quality and don`t taste that good.

For the generator - Check your local Aldi food store they may have them for sale there. WE paid 349.00 for ours.

Totally Off Topic: You guys have ALDI, too? Thought you could only find them in Germany until now.

Out of the top of my head, I think the "life-span" of a tooth is 4 hours in milk and 24 hours in one of these Tooth Saving Boxes. We don´t carry them, but as far as I know, some schools and kindergardens have them, as a first-aid-kit.

I respect you have substantial experience with automated ventilation and such; this is not something available pre hospital in NZ and is unlikely to become so in the near future. For now it's the trusty manual ventilator bag down here

You`re still bagging, too?

We`ll get a brand-new Medumat Transport with a digital display when the new NEF comes.

Are having a pretty normal respirator right now, with my former service we had CPAP, which was pretty cool.

Yes this is true. Something I think is often forgotten is the trusty ambo blanket and the problems having a proper body temperature can avoid. Apparently "hypothermia" is part of the "triad of trauma death" as it has some bad coagulojuju associated with it, I've yet to adequately research it. Everybody is on about cold fluids in post-cardiac arrest and traumatic brain injury but I am curious to have a looksee about warmed fluids and severe trauma.

Everybody`s going on about post-arrest therapeutic hypothermia, but I`d say most places still lack the appropriate tools for establishing that and more importantly, sufficiently monitoring it, starting with the simplest thing: a decent thermometer.

I`m not that literate when it comes to therapeutic hypothermia, but what I seem to remember is, that cold fluid is really not such a great inducent factor of it. I`ve seen some pretty cool devices that were advertised in some EMS papers, but still waiting to see someone actually have/use them.

Achieving a patient who is sufficiently sedated that we have blunted all their neuromuscular reflexes so they do not become agitated or restless and fight the tube is going to require a larger amount of sedation than a paralysed patient who needs a "don't remember" dosing.

My readings around anaesthesia and intensive care generally state the first requires anywhere from 0.3 to 0.5mg/kg and the latter 0.1mg/kg. Indeed 0.1mg/kg is the dosage used here for patients who have a neurogenic cause for coma with a GCS < 10 and require RSI.

Our Clinical Practice Guidelines say pretty much the same thing except for midazolam post-intubation it appears fixed bolus amounts are trendy down here; up to 3mg every 5 minutes (there are slightly lower dosages for patients who weigh <50kg). As an aside I'd be interested to see if a midazolam drip would be any better and might have a looksee around these here interwebz.

Giving the patient a "don`t remember"-dosage, as you put it, doesn`t mean that he isn`t feeling something in the imminent present - having an effect on normal cardiovascular response mechanism (pain - tachycardia), that you don`t wanna have, leaving aside the ethical note on a patient experiencing pain, even if he can`t remember it in the end (and they sometimes do remember).

With the dosages named above, did you mean Ketamine?

Of course it depends on wether you use Ketamine or Esketamine - with Ketamine the general literature states around 0.25-0.5mg/kg (analgetic) and 1-2mg/kg (anaesthetic). You can ruthly divide those with 2 for the Esketamine dosages.

To maintain the presence of the endotracheal tube post-intubation; using paralysis in combination with sedation is likely much safer than using sedation alone [...]; and we'll be able to use a lower dose of sedation.

To the first:

Only if you screw up your sedation.

To the second:

Don`t really understand the point - either you do a sedation, or you don`t. What you proclaim, sounds like leaving the patient half-awake, while being paralyzed, which can`t really be the goal.

Suxamethonium only has a short duration ~15 minutes or there about, vecuronium is a much longer acting neuromuscular blocker

Sure enough, but after having the tube in that throat, you don`t need the patient to be paralyzed anymore.

You just need the paralytic agent to get through the vocal cords, it`s not needed for post-intubation anaesthesia.

I will intubate using a Mac 4, 7.0 cuffed tube, anaesthetise with fentanyl 1mcg/kg, ketamine 1.5mg/kg; paralyse with suxamethonium 1.5mg/kg and vecuronium 0,1mg/kg

If her time to hospital was not so extended I would not intubate right now and see how the LMA went

No hyperventilation from me; ventilate to maintain EtCO₂ 30-35mmHg

Why would you want to use both?

Ok if yall haven't figured it out i work in the middle of no where, I'm still in trouble for going to Walmart buying a kiddie pool and setting it up in his front yard....guess the boss didn't like the mass pool party invite I sent out.

His being my boss

LOL!

You might wanna think about buying a book about nature-survival and those kind of stuff if you aren`t accomplished in the field.

I own that one, though more for the fun of sometimes skipping through the sites: http://www.amazon.co...31742749&sr=8-2 (doubt it has been translated into English though).

It includes all topics needed in a survival situation, how to set up a camp, how to design traps, makeshift weapons (even fire-arms), basic survival medicine, and even some topics about hostile encounters, etc.

I`m sure there`s something like it in English, too.

Off Topic:

Rüdiger Nehberg is a really great and inspiring person, as well as a survival expert. He`s done all kinds of cool, crazy stuff, like crossing the Atlantic on a tree stump as well as with a pedal boat. He was the first to conquer the Blue Nile from its source to its end, he bycicled around the Mediterranean Sea, and fought himself 800 km though the Amazonas region without any help or much equipment.

He also engaged himself very much for the Yanomami-Indians in Bazil, who were threatened by the Gold Rush down there, back in the 80s, and he fights against female genital mutilation.

Twice, I had the honour to hear one of his recitations - brilliant experiences, both times.

Sorry for being Off-Topic that long, just got thrown into this eulogy by mentionening one of his books above.

http://psychcentral....es/violence.htm

http://www.ncbi.nlm....les/PMC1525086/

I'm not saying they will be dangerous, just that they can be. In any case, I still think people should be avoided in said scenario.

(I do know several people with some form of mental issues themselves. They have no problem in society. What I'm more focused on are the ones who have already committed crimes, not mental health issue community in general.)

Hm... both links above seem to contradict your former statement, though (just skipped through them quickly).

Prisoners would more likely starve in their cells if someone hasn`t set them free, anyways, I wouldn`t be more concerned about them then about any other guy in a hardcore everyone-against-everyone situation.

Drug-users would more likely be weakened by withdrawal symptoms.

Mental patients? I dunno, most aren`t the axe-grinding maniacs TV tells us. I wouldn`t really worry about the off-chance of meeting demented old granny out of the geronto-psychiatric ward.

This would be more about basic survival things, best things to get into a more deserted area. In a situation where everyone is freaking out and looting, your former (now shotgun-firing-trying-to-survive) tax accountant could be more dangerous than those listed above.

So, if I really think about it...

Some shelter and such would be good - but if you really wanna be prepared, you have to cover yourself from the moment the shit hits it, so an initial survival pack (like my rucksack ) would be the first thing to get your hands on, wouldn`t it?

Congratz!

If the grid went down right now, how well could you survive for 3 days without electricity, fast food, running water and easy access to money?

Well, hm. Really? I dunno.

Although my rucksack, which I carry with me whereever I go, in itself is a small survival pack, although I haven`t really planned it. I hear from alot of people who had it in their hands that it`s much to heavvy, but I mean - I need those things!

So, three days? I guess.

In my rucksack:

-some varying amount of food

-at least 1,5 litre of some unalcolholic drink, propably some beers if the shit hits the world when I`m on my way out to some party

-various books

-a flashlight (plus reserve batteries)

-a small med pack (some pain meds, bandages, plasters, a scissor and such)

-a knife

-a small implement pack

-a rain poncho (could be used for the obvious, as a pad for the ground, the roof of a self-made tent, etc)

-and some varying items I´ve put in there at some time and forgot to unpack, which could come handy, I dunno what they are really

So, for a start, I`d be off good.

Don`t have a fixed place to go to if anything should happen, but even if you have - you`re not there all the time, are you? It would also be possible, that you wouldn`t be able to reach your shelter, in that case all yóu`re planning would be futile in the end.

I`ve heard that you guys have alot of this thinking over the pond (but it`s starting here too).

If you`re living in an area where nature disasters are likely, you should be equipped - for any other case (like the one`s the dooms-day blokes proclaim), there`s really not that much you can do anyways.

I think, any major ABC-disaster would last longer than most have rations, so after 5 months, you`ll be as screwed as unprepared me.

Only real way to get ready for that (unrealistic) case is, getting autarchic in all things.

If you wanna go for it: I recently saw something in TV about supermarkets that only sell disaster-rations (for horrendous rates), you can buy monthly, yearly and decade rations which, at least they tell you so, contain anything you`d need.

EDIT: If I`d prepare for that - I would propably built myself a wooden-blockhouse somewhere deep in the woods and plant some vegetables and stuff, get some guns (we`re not allowed to do that so can`t prepare in that direction, but after all went fucked up, I guess you could propably easily pick one up out of a shop ) and sit it out in the woods/be prepared to stay there. Go native, you know. (I`m meaning this serious, for this is the only sensible option I see).

Oh, and of course I`d plant some tobacco plants and buy a ton of cigarette papers beforehand. Some boxes of booze, too. The woods can get lonely.

And nurses see us they scatter like cockroaches after flipping the lightswitch. I cant flag one down before they barricade themselves into the med room. X-D

Same with bringing or taking a patient - when it comes to getting him over onto the stretcher, they (read: some) just seem to evaporate into thin air.

But since in most cases, it`s no emergency one has time to just wait till they show their faces again.

I`ll just wait on the corridor and look them right in they eye when they try to scud away from me.

Then, after a while, they think themself save and come along - only to find out I haven`t yet done anything, for we had no help getting the pat. of the stretcher.

Unbelieving, they tend to ask: "Haven`t you done that yet?", following me dryly saying: "Well, you`ve just got here, haven`t you?"

Makes them pissed (not that I would care ).

Kiwi, you wanna clarify: What is your actual level of education EMS-wise?

Mate, this really comes as a shock, since I myself, was under the imminent impression for you to be a Paramedic - and I think I had got every reason to believe that.

Looking back, it`s true, you seldomly directly described yourself as a Paramedic. But there have been occasions, man.

I really can`t fucking believe it?!

that would have been pretty cool at the time.

The project is slated to last till June 1. I want to get at least 1000 different stamps from at least 100 different countries.

They can have post marks on them.

I know that i can go to a hobby store and knock it out in one day but that makes the project worthless in my eyes and does nothing to give any value to my son.

So any ideas from this group would be helpful.

All your foreigners out there in EMTCity land, if you want to help by sending some foreign stamps, you can indeed help. PM me for info.

Oy, that`s alot of stamps for only 3 months (well, I guess the amount is not that hard, but the variety of regional differencies will be challenging I guess).

If you`re interested in some German one`s, I could send some to you next week, dunno how long it`ll take the letter to reach you, though, but I guess it`ll be before 1st June .

(Just got a letter from Britain which was sent on the 26st Feb, so I guess it`ll take two weeks over the pond).

I;ll bet not

So does anyone collect stamps or coins.

My son's cub scout project this year is collections.

So we've decided coins or stamps.

and if you collect stamps, where do you go to get your stamps.

do you prefer circulated or uncirculated? or whatever they call them.

I did collect stamps when I was a child (more or less enthusiastically), but never got much.

A far-related uncle of mine was a tourist guide, he made tours in a lot of countries, and he used to send me envelopes which were totally plastered with various stamps from the country he was residing in at that time.

Boyfriend of the girl, a friend of mine was sharing a flat with, was so drunk, he decided it would be a good idea/fun/whatever, to jump off their balcony - from the 5th floor... (he lived, but only barely).

Buddy of mine told me once he knew a guy who was over in Afghanistan, with the army, for a half year. Been in combat, nothing happened.

Then, at their last night, those blokes were partying hard and were pretty shitfaced.

Thought it funny to make some dirty-dancing moves, yeh know. So, that bloke got pushed into the air by his buddy - right into the friggin` ceiling fan!

I make average 16k a year, give or take a few hundreds, that is, after taxes and with top-ups for unsocial hours.

Sum stands for itself.

Oh, and my Ambulance is only yellow when the HPC give me registration as an SRP and the LAS overlooks the lack of C1+D1

Thought you have C1, mate?

I know we had this discussion before, but is a D1 really necessary to drive in the UK?

Mike? Some inside-knowledge clarity?

It seems to me that if the additional education was required, that though it would be ok I guess, I don't see why a significantly expanded scope of practice would be necessary? It's seems that for the most part assessment, excellent communication, and an ability to organize non emergent services would be more important. I've done sutures twice, handed out skads of antibiotics, but each time only because there wasn't a physician realistically available to do it instead. In an environment that has a medical clinic on every corner I'm not sure that that would be necessary. It seems that a few places have started, and the tests seemed promising, I'm curious as to why it's not taken off like wildfire...

It`s really all about the education, not really about the scope, since you guys often have a significantly wide scope of practice anyways in regards to the average time spent in school to reach EMT-P. Leaving someone at home and therefore being the only medical professional having had a look on the patient takes significantly more inside knowledge than doing all the protocol-based fancy stuff and refering to a site of higher academic education. Guess that`s why it hasn`t been widely established in a system, where EMS is mostly non-HE dependant.

It seems to me that if the additional education was required, that though it would be ok I guess, I don't see why a significantly expanded scope of practice would be necessary? It's seems that for the most part assessment, excellent communication, and an ability to organize non emergent services would be more important. I've done sutures twice, handed out skads of antibiotics, but each time only because there wasn't a physician realistically available to do it instead. In an environment that has a medical clinic on every corner I'm not sure that that would be necessary. It seems that a few places have started, and the tests seemed promising, I'm curious as to why it's not taken off like wildfire...

It`s really all about the education, not really about the scope, since you guys often have a significantly wide scope of practice anyways in regards to the average time spent in school to reach EMT-P. Leaving someone at home and therefore being the only medical professional having had a look on the patient takes significantly more inside knowledge than doing all the protocol-based fancy stuff and refering to a site of higher academic education. Guess that`s why it hasn`t been widely established in a system, where EMS is mostly non-HE dependant.