P_Instructor

"Sounds to me like there is a supervisor with WAAAY too much time on their hands writing stupid policies.

OR the company is to cheap to have more than one of these items available for each truck."

Oh, does this sound so familiar. The policy is really bogus and I agree with medicgirl that patient care is not being taken into account. Your company should have extra equipment available to get you back to service as soon as possible.

I am not sure how many hospitals you serve, but here, we have the ER put equipment out in secured lockers for retrieval later if needed. It is 50/50 if the equipment is cleaned or not.

Welcome, and you now have to supply the orange juice for everyone.

"Officials are not saying why they believe the paramedic tampered with the medicines, but the incidence of health care workers stealing drugs to use for themselves or sell is not uncommon."

Yikes! What is wrong with these idiots that are giving EMS a bad rep. The easiest way to avoid this is not give the medics the prefilled syringes of medication. Go back to the vials that are sealed and cannot be tampered with.

Typically the mouthpiece is preferred, however the patient must maintain a good 'bite/seal' on mouthpiece to have it more effective than the mask. Patients can hold their own nebs to free your hands, as long as you monitor them maintaining the seal.

The mask should be utilized if the patient cannot hold the mouthpiece, and you cannot assist.

Of course, if the patient is not having adequate inspiratory effort, then bag the med in or identify if CPAP would be better.

Many options available with different lines of thinking. Do what's best for the patient in the situation you are presented.

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.

1964 Oldsmobile Jetstar 88

1974 Chevy Nova

1979 Oldmobile Omega

1979 Chevy Impala

1980 Oldmobile Cutlass Supreme

1988 Ford Ranger

1990 Ford Bronco II

1996 Chevy C1500 Silverado

2001 Chevy C1500 Silverado

and with the family fleet: 1999 Pontiac Grand Prix, 2000 Pontiac Grand Prix, and 2003 Chevy Malibu

side family vehicles include: 1957 Ford Fairlane Tudor, 1970 Ford F100, 1963 Oldmobile, 1994 Ford Expedition, 2001 Nissan pickup, 2010 Chevy Acadia.

BIG - Bogus Interosseous Garbage

Go with the EZIO for kid and adults, and the Jams for infants.

There flippin' looking at using Ziprasidone (Geodon) here for agitated delirium....I looked the junk up and not so sure with all the contraindications and side effects. I'd rather use a ball peen hammer.

I basically think it not what you know, but if you can read a question. I practice with students on how to read a question and then respond. Tell the medics to always treat first as a basic (like you did) and then go onto the advanced crap. Seems to be effective with good results.

As for me, being old, still do the arse way (paper trail) recertifying. With the Alzheimer's setting it, the only thing I have to worry about is where I put all the documentation.

I have a real quick question about the trauma assessment portion of the licensing test. Would I be faulted for requesting ALS support if it turns out I don't need it? Like say, I prioritize a patient as a high priority but during my rapid trauma assessment I'm able to within my scope fix any life-threats?

Part of the exam is the realization that 'other' services may be needed. For the EMT crew, it is always better to call and cancel if needed. The cognitive part of the testing is that you are prioritizing and thinking (as well as stating) that ALS services may be needed, or at least 'additional help' dependant on the scenario.

When taking the psychomotor exam, perform AND verbalize everything. It's like documentation, if you didn't write it down, it wasn't done.......if you didn't verbize it, and the examiner didn't see it, it wasn't done. A good examiner should be able to follow, write down, and observe all at once, but this usually never happens.

Best action is to not leave any doubt. again say and do together.

Initial question.....sucking chest wound on left and tracheal deviation to the right? What is the tension from?

It's kind of cork the holes and diesel bolus the patient with the other interventions inbetween.

^{Written done, have you finished the practical portion? Also, great job on passing the written.}

No matter what level you are at, you study about morals and ethics. Chbare put it out there for you..........

Concerning the comment not aware of any bites or stings, are you sure that he wasn't harpooned with a blow gun in that area? Just joking. I am still formulating an opinion, but I can see your pucker factor is a little on the high side with this. Keep going.....

REDDING, California — A Cottonwood man accused of trying to kill two paramedics and an emergency medical technician by ramming his pickup into their ambulance outside Mercy Medical Center on Saturday night expressed disappointment when told no one was killed.

"That's too bad," he said. "Next time I'll drive through the front doors."

That information is included in a Redding police report issued after the Tuesday arraignment of Joel Michael Haller, 26, in Shasta County Superior Court.

Haller, who pleaded not guilty to the charges against him, including three counts of attempted murder, remains in Shasta County Jail in lieu of $1 million bail.

According to the Redding police report, Haller smiled and "nodded his head up and down" when asked by a police officer if he would do it again whenhe got out of jail.

But he told a witness he would wear his seat belt the next time.

Haller, scheduled to have a preliminary hearing on Feb. 29, was arrested on Saturday after allegedly plowing his pickup into an occupied and parked ambulance outside the Redding hospital.

"It was totally intentional," Sgt. Mike Wood with the Redding Police Department has said. "There's no doubt this guy did this on purpose."

Ironically, police have said, Haller was treated by one of the three men he allegedly tried to harm in the crash.

According to the police report, Haller's father told police after the crash that his son, who went to the hospital to seek treatment for a headache, has a history of mental illness and has been violent in the past.

The elder Haller said his son recently served 30 days in Tehama County Jail and had assaulted a sheriff's deputy.

In his police report, officer Justin Duval said he spoke with the younger Haller in the hospital's emergency room after the crash and asked him whether he rammed the ambulance on purpose.

"That's obvious," the officer reported Haller as saying.

When Duval asked him whether he had seen the paramedics in the ambulance, "Haller looked at me and chuckled but failed to answer my question," the police report said.

The men in the ambulance were Gregg Franz Herrman, 26, an emergency medical technician from Redding; Drew Alan Barnett, a 29-yearold paramedic from Redding; and Ryan Michael Samualson, a 35-year-old paramedic from Fortuna. Herrman was treated for back pain, while Barnett and Samualson weren't injured, police have said.

In November Haller was arrested by Tehama County deputies on suspicion of battering a peace officer while deputies conducted a welfare check on him at his Cottonwood home, the Record Searchlight has reported.

At 7:49 p.m. on Nov. 3, two Tehama County deputies were checking on Haller's welfare when he threw a rock at them but missed, according to the Tehama County Sheriff's Department.

Haller also kicked shut a cruiser door as another deputy was trying to get out of the car, deputies have said. He faces three counts of attempted murder.

Kudo's to the medic to treated the guy after he tried to kill him.

To add additional information: It appears this took place ten years ago, so routine Carbon Dioxide monitoring may not have been as prevalent.

Good point, however not condoning the actions that took place, there was lack of responsibility in many other facits of the call. They probably did have an adequate tube initially, but it could have dislodged when the accident occurred (speculation), the attending medic didn't recheck it after the accident because he's pissed about the crash and 'his' ass. Stupid rule to stay on scene if other driver is OK. I wonder how long it took the second ambulance to arrive? Then the secondary ambulance, whether it was the same attendant or a second, should have reconfirmed tube placement prior too and after the move to second rig and transport. Easiest check are breath sounds, equal chest rise, and perfusion of the patient back in 'those' days. Ahhh, the colormetric device was available back then.

Either way, I'm suprised that it is only 1.75 mil.

In Iowa they utilize the 1999 Intermediate curriculum that meet enough state standards to be classified as a Paramedic (only in Iowa). The current Paramedics in Iowa were then titled Paramedic Specialists as they were licensed at that level. This is all going by the wayside with the new Standards. They will only have the EMR, EMT, AEMT, and Paramedic levels. The 85I's will have to transistion to AEMT and test or fall back to EMT level. The 99I's will have to transistion to Paramedic or fall back to AEMT.

In essence, the Paramedic Specialist is really a Paramedic on the national level.

I would like to say thanks for posting this. As has been pointed out, hindsight is 20/20. While that's not necessarily great for you in the moment, it's great for many here in that they can learn from it.

That's the intent of presenting this to the class, to learn from it. I think there is a misconception I was on call. This was presented to me second hand to I tried to get as much information as possible. Just looking for other opinions with the post. Thanks.

The history is piss poor; did you ask for further information?

This is the information that was given to me for review.

No it's not, that is the bitches way out ... do you know that in South Africa, New Zealand, Australia and the UK there is no medical control?. What do you think we do? We use our brains

I bow to your knowledge not taking into consideration how this post would be disseminated nationally. I was speaking about the US where that availability of on-line medical control can and is very beneficial in difficulty cases. That is why I mentioned the prior geography memo. The purpose of this review is to have the provider think about what is happening and what to or not to do. By utilizing medical control, if available, uses the adage of 'two brains can be better than one'. Don't use this as a crutch, but don't 'harm' the patient when there are resources available to assist in 'thinking it out'.

Remind me again how adrenaline causes respiratory alkalosis? or how respiratory alkalosis causes cardiac symptoms?

You are over analyzing the post. Adrenaline causing alkalosis? The point is that the patient was very anxious with signs of hyperventilation, where the EPI may have exacerbated the symptoms and potentially cause coronary spasm leading to the cardiac symptoms described.

If you want to do no harm perhaps you need to seriously invest in a greatly expanded education of pathophysiology and pharmacology.

This is what is being done with the review of this case in class, to discuss the differential diagnosis of presenting problems and how to properly assess and treat.

Of all the drugs in the ambo bag of tricks adrenaline is one of the most dangerous but also the most life saving. You must use it wisely. .

I do fully agree with you on this.

The subjective history you presented (I cant speak to what you actually obtained) is a bit thin. I cant rule our chemical exposure (cleaning compunds, floral agents, something unaccounted for), stress, etc.

Sorry, remembered some other items told to me. No medical history other than the possible floral allergy. No other past medical history. On no medications or allergic to medication. Remember being told onset of symptoms 30 minutes prior to meeting tier.

From what I obtained from the providers, ER EKG was suspicious with T-wave abnormalities suggestive of MI. I don't know the particulars of labs, etc....

Reference scenario. Case of trying to understand the problem at hand and assessing the patient. Limited classical signs/symptoms yet presents with potential laryngeal closure due to allergen per history. You may not have availability due to geography, but would be case to bounce off on-line medical control. There was some relief of symptoms with initial EPI as well as subsequent Benadryl. Combination of the respiratory alkalosis with EPI probably did cause the cardiac symptom. Sorry for the 'Levine sign' blurb. No, don't teach just do, but assess and analyze what you have (differetial diagnosis) and treat to do no harm.

Tiered in with EMT squad. Enroute information is female with complaint of throat swelling closed.

Get on scene and enter their ambulance and see female sitting upright on cot, respiratory rate 40, accessory muscle use. Pt. awake, color pink, skin warm/dry. No adventagious sounds heard. Pt. on oxygen per NRB, sats 97%, BP 170/100, HR 120 per machine.

Initial contact shows scared look from patient, 1-2 sentance wording. Best info from squad is possible allergic history to flowers where patient was helping setting up for funeral. Onset of slight symptoms 1 hr prior.

Listen to breath sounds which are clear. Auscultate trachea, no stridor heard. With the lung sounds, no evidence of uticaria anywhere on torso, no evidence of swelling/edema. Only complaint is throat swelling. Oral cavity normal.

Monitor placed sinus tach without ectopics. Patient very anxious and moving around on cot. Epi 0.3mg given IM. IV then established by partner. 25mg Diphenhydramine given IV. Pateint states a little better approximately 2 mins later. Reassessed lungs, etc. without change. Vitals BP 150/100, HR 110, RR 34, sats 99%. Pt. is exhibiting beginning s/s of hyperventilation. Pt. breathing pattern coaxed with some success.

Calling in radio report and patient start again to become very scared as gestures throat again swelling up. 0.1mg Epi 1:10000 given IV. 10 seconds later patient begins screaming and shows Levine sign. No changes in monitor, ST. Episode lasts 10-15 seconds. Pucker factor is 15 on 1-10 scale. No time or conditions available for 12-Lead as patient very unsettled. Pt. verbally calmed for remainder of 2 minute transport.

Arrive hospital and off load to ER. ER doc meets you at door, report given. Upon doc assessment, ativan given to calm pt. but then pt. again has throat swelling sensations and doc administers Epi with same screaming/Levine sign gesture.

You leave to go back in service. Find out later pt. goes to cath lab with suspected MI.

Later in evening, Cath reveals all vessels open.

Hummmm....allergic reaction or atypical MI????

Thoughts.

News link on discrimination in my book.....If anyone can do the job in a professional and competent manner, let them do it. Carlsbad buried themselves in the cavern in my book. Waiting to see what else becomes of it.

http://www.emsworld.com/news/10618324/woman-to-sue-city-of-carlsbad-over-firefighter-paramedic-position

Young and energetic......keep the emotion and look towards a great future. Welcome.