Ace844

Here's another hint:: [stream:797b3f7be1]http://www.moviewavs.com/0085934086/WAVS/Movies/Boiler_Room/notoriousbig.wav[/stream:797b3f7be1]

The closest thing I can think of off the top of my head is that you were seeing this as part of either a neuro exam and or to document ocular findings and lack there of PEARL: Pupils Equal And R[sub:da1b3eab6b]2[/sub:da1b3eab6b]Round/Reactive {not listed but said} TO Light, Some clinicians will also add-Accommidation; as well. Is this what you were referring to? Furthermore, doing a search would have helped you as well and would have yielded additional mnemonices which you should learn. Mnemonics? EMS Terminology I Medical Assessment... Medical Patent Assessment Things you've missed Out Here, ACE844

What is P-Mitrale, and is it clinically significant in isolation-when asymptomatic, also what is the DX criteria and Phys?

Your operating under the assumption that Mr. Murphy and his pal the fickled finger will go along with your carefully laid plans. In these atypical situations one needs to adapt, iprovise, and overcome! Don't count on your plans to go how you expect, and don't expect resources that are 'suppossed to be, told to maybe, or will be, available.' For sure Ringling Bros, Barnun & Bailey will be making an appearance. Food for FUBAR situation thought, Out Here, ACE844

"Viper," I hope you enjoyed 'Ray's' program. As far as the comments about 'LifeLine' here, this company is brand new and essentially all of the old long term management of Armstrong, who left to do this start up. This includes the old CEO and HR managers, etc.. It is too early to tell if they will suffer the same myopic afflictions which Armstrong was famous for. As far as the original question. Really it depends on you. There are perhaps 2 actual progressive EMS serviecs in this state and even they have their issues like anywhere else. That being said, one of them is Paramedic only. Next as far as choices, this has to do with a myriad of factors most of which would need to be based on personal situation and information. Take anonymous career advice from an internet forum at your own risk. If you have specific questions feel free to post them or PM me I will be happy to help anyway I can. Out Here, ACE844

Here's a link to a PPT lecture which should help as well: http://www.sh.lsuhsc.edu/intragrad/211/Int...,50,Therapeutic Uses of Antimuscarinic Drugs Also, here's a great article on anti-hystamine Tox: http://www.aspca.org/site/DocServer/toxbri...ddInterest=1101 And Here's some info which i was refering to with the valium, and yes I know it uses dogs in the article{and that it is a primary vetrinary study} as an example. (Antihistamine Toxicosis by Lisa Murphy @ VMD) Symptomatic patients As with any emergency situation, address life-threatening signs first. Diazepam (0.5 to 1 mg/kg intravenously to effect) 1 is probably the most practical first-choice anticonvulsant to control seizures associated with antihistamine overdose in animals. Give diazepam slowly intravenously or intramuscularly to avoid the adverse paradoxical CNS excitement sometimes associated with its administration, particularly in dogs.1 Barbitautes or isoflurane may also be needed to control signs in animals refractory to diazepam. Vasopressors such as dopamine or norepinephrine may be needed for some patients with unresponsive hypotention, 6 but avoid epinephrine because it may lower blood pressure further. Phenothiazines such as acepromazine maleate should probably be avoided or used with caution for the same reason. There is some evidence that guaifenesin may be useful in controlling seizures. A 59-lb (27-k) dog exhibiting moderate to severe generalized muscle tremors, hyperthermia, and hyperesthesia that had ingested about 67 mg/kg of diphenhydramine and was unresponsive to intravenous diazepam (0.7 mg/kg) rapidly responded to an intravenous guaifenesin bolus (30 ml of 5% solution mixed into 5% dextrose in water) followed by a constant-rate infusion of guaifenesin (5% solution mixed into 5% dextrose in water at 1 ml/kg/hr for three hours, then 0.5 ml/kg/hr for another six hours). The dog was discharged 24 hours after admission and had no apparent residual effects two days after discharge. Methocarbamol (55 to 220 mg/kg intravenously; not to exceed 330 mg/kg/day) 1 may help control seizures, though its potential effectiveness in this situation is currently unknown. Next here's some further discription of an anti-cholinergics activity and mechanisim in the CNS..This also describes the sedation process. http://www.brooksidepress.org/Products/Ope...tingAgents.html

Care to be more specific? Are you asking about clinical PEARLS? The things you find in oysters? WHAT?

Alittle bitty PSA message as to why EDUCATION IS SO IMPORTANT IN THIS CAREER! Also, a bit of quick insight as to why we all say it's so important. Strong work and succinctly put "AZCEP," Out Here, ACE844

Do a search for pulmonary physiology, and or there is some info in the etco2 threads. Out Here, ACE844

Surgi-lube the windshield wipers of an ambulance.....

Matter of fact I believe he is a member here, and soem simple research and a PM will probably be most beneficial to you if yuo have questions or would like to know more. Out Here, ACE844

Thanks, I just had the following rationale stuck in my brain for soemreason. This is that the mulit-receptor effects of the Diphyenhydramine, and the valium, and other anti-seizure meds would cause an excess of neurotransmitters in the CNS, as well as potentially inducing seritonergic syndrome...not sure, but I'll look it up and check the link, thanks again, ACE844

"Ruff," I'm sorry to hear of your tragedy...No one should have to live through that. ACE844

"ChBare," Now I may be recalling incorrectly, but isn't there some kind of mechanisim or clinical pearl which says not to use valium for this?{the seizures} ACE844

I never stated an opinion about this matter, but as far as the Russian side, just facts. Next, I happen to know someone who spent 10 yrs in Lubyanka as a political prisoner for printing an 'anti-state article in a newspaper. The guy didn't even write it, he was just working the press the night they printed it at the paper. As far as the executions being anonymous, perhaps in some areas. The individual I know said they knew when they were executing people because they only did it on nights where the elevator worked (this was sporadically) and it made a hell of a rucus, and also some of the guards there would tell the prisoners. Makes for some interesting stories when he feels like talking about it. Best of luck with your lethal injections, YMMV, ACE844

It should be noted that the 'Russian bullet option' which you mention was often preceeded by a (potential 3k mile walk, later train ride to Siberia, but not always) period of sensory and vital needs deprivation and torture...The bullet came after all of that usually, and mostly you hoped the guys pulling the trigger were sober. ACE844

A 'Non-profit, private Transport Company'..... That AMR bought, and yet there was no profit involved???

Your papa....

Most antihistamines cross the blood-brain barrier and produce sedation due to inhibition of histamine N -methyltransferase and blockage of central histaminergic receptors. Antagonism of other central nervous system receptor sites, such as those for serotonin, acetylcholine, and alpha-adrenergic stimulation, may also be involved . Phenothiazines are thought to cause indirect reduction of stimuli to the brain stem reticular system. Now to break this down into some easily understood english. 1.) The basic ethylamine group common to antihistamines (Read molecular structure) is also common to anticholinergics, ganglionic- and adrenergic-blocking agents, local anesthetics, and antispasmodics, some antihistamines may exhibit some of the activities of these other classes of drugs. They do so by competively binding, in some cases blocking, and or activating these receptor sites. 2.) The 1st generation of H1 Blockers like dyphenhydramine are able to croos the blood brain barrier due to their lipophylicity. (READ THEIR ATTRACTION TO THE FAT IN THE CELLULAR MEMBRANES WHICH ALLOW IT TO CROSS THE BLOOD BRAIN BARRIER) 3.) Because some of dyphenhydramines action is in the 'higher brain centers it's neurotransmitter effects this is how you get soem of the sedative properties. HTH, ACE844 Here's a link to a study describing the pharm dynamics: http://dmd.aspetjournals.org/cgi/content/full/34/6/955

"Fiznat," Here is some information related to your request. Antihistamines and anticholinergics (agents that block the action of acetylcholine) may be effective in the treatment of motion sickness as the result of a similar action: the ability to block the transmission of information from the vestibular apparatus (the part of the middle ear that is involved in balance) to the emetic center in the medulla oblongata, which is a part of the brain involved in coordinating various reflexes (e.g., swallowing, vomiting). Why is drowsiness a usual side effect? Histamine, acting via H1 receptors in the central nervous system, increases wakefulness. Therefore, antihistamines that block the binding of histamine to H1 receptors and which enter the central nervous system cause drowsiness. In addition, anticholinergic agents cause drowsiness and, thus, antihistamines which possess anticholinergic activity also produce drowsiness via this action. Thus, older agents, such as diphenhydramine, which enter the central nervous system, cause sedation, while newer antihistamines, such as astemizole (HISMANAL) and loratadine (CLARITIN), which poorly penetrate into the CNS, are nonsedating. Patients vary in their susceptibility to the sedative effects of antihistamines. HTH, ACE844

JVD, NArrowing Pulse Pressures, and muffled Heart sounds found in Cardiac Tamponade. What is Grey-Turner's sign and the physiology behind it?

"MissingLink," If your an 18D guy whom it is not unreasonable to presume that you have alot of time 'down range,' and 'in the box', you will find CONTOMS and most probably event the H&K style courses a waste of time. They won't compare even remotely to what you encountered at 'the stockade' {if you went that far} or out at SOMC-McCall-Pope. If you have contacts at the Q-SOMC you may consider 'auditing' some courses there or even re-running the 'goat' lab a few times to get back in the swing. IMHLO, the big sifference you will see from Military medicine and Civilain is the 'medical' side which as a vanilla military medic you may need more exposure to as oppossed to the majority of 'trauma' which they see. Yet again though with your 18D I'm sure you've practiced more autonomous medicine than most here ever will. Depending on your situation and opinions it may be a good idea to do some intl stuff for a few years post-service and this will help you get your warchest in to an ideal position for later when you want to settle down. "Dust," mentioned a few and I will also add SOS Temps to that list. You may also try to look at contacting the Natl Regisrty and they may allow you to challenge the exam although they may force you to entertain the possibility of 'taking a refresher' through USASOC-SOMC. Food for thought, Hope this Helps, ACE844

5-10 ml (0.5-1 Gm) of 10% calcium chloride. May repeat in 10 minutes. What is TETROLOGY OF FALLOT?

Because 'testing' is not necessarily synonmyous with lab results or radiological surveys. Testing can also mean parts of the P/E and H&P which include psychomotor actions and interactions one on one with a pt. Example, Lung sounds, Kernig's sign, Dolls eyes test, webber-rhine test, caloric test, stereographic function, graphestesia, etc......Those are things whaich could be done in the field, and don't require a hospital or technology. Out Here, ACE844

“Aussiephil,” I disagree with your last statement, and since you have yet to provide ANY evidence as requested, to support your claims, I think now would be a prudent time to make sure we are clear about what we are talking about.It seems we need to be sure of the terms that we are using here freely. Below are a few sources and definitions to help us all. As you will see what we do and what physicians do are relatively one and the same. Now let’s further see what the other definitions we are using are. Now lets see another source in addition to all of the above in my original post which support my point and claims. Hope this helps, ACE844