Arizonaffcep

Where do you see the WPW? I would call this a standard paced rhythm...a wide qs leading into slightly elevated st segment with a large t wave. Fairly indicative of cardiac damage (previous). This is the same reason that the best indicator for an MI with a pacer is not necessarily a 12 lead, but the troponin.

Short little story: I was working an overtime shift in south Scottsdale, when we get called for a CP. Pt is elderly gentleman who has a pacer, but no defibrillator. Not once, but twice he went into V-Tach around 180...his pacer kicked in...overdrove it at a rate of damn near 300, and backed it down to the 70's. Coolest thing I've seen in a while. I've done it with external pacing, but never seen it with an implanted pacer.

Unfortunately, I can't find the post I wanted to quote...had to do with "obese" people having bad veins...just personal experience, people don't look hard enough for them. I discovered this after my wife (who I had considered a hard stick because she was obese) had surgery, and lost 150 lbs, she now has "ropes" for veins. Now, obviously, they weren't small/not there and then suddenly there...and I've found (now I work in and ED FT) if I take a few extra minutes to look hard, I can usually find something sizable. Some techniques I use: a double tourniquet...one a little more proximal to the first tourniquet (an IV tourniquet also works well for stubborn venous bleeds, place one as you would for an IV start just distal to the injury...works great!). This can help pop up veins. The biggest thing though, if time allows, is to LOOK. Look everywhere. In AZ, we can do ANY peripheral IV (an EJ is a peripheral IV) and 2 types of central lines (subclavian and IJ). I've found shoulders are a great source for veins, and I've even started (it was only a 22ga) in a very superficial vein on a quad's abd. The biggest thing is just spend an extra minute (if time/illness/injury allows) and you'll be surprised what you might find. Also, get out of the "box" with sites. If you can...feet are great (although shouldn't be used on some patients, but again, if it's all you got...and you absolutely need one). Sometimes, when I have a patient who needs an EJ, I will bend the catheter slightly (about 10-15 degrees from flat) to help with insertion...we use the INSYTE AUTOGUARD, which has a long, ungainly portion where the needle retracts by spring action. I have never needed to try this with other brands, but I don't see why it wouldn't work. Also, if you think you are in, good flash, etc etc, but having trouble threading, you can try to float it in or you can "twist" the catheter off the needle, much like "screwing" it into the vein. Just be gentle.

What it boils down to is: Private Sector=Crews are temporary, ambulances are forever (extreme generalization) Public Sector=Ambulances are temporary, Crews are forever (again, generalization) I have found this to be the most significant difference between the two. Not to say those opinions/statements can't be flip/flopped, but at least in Pima County AZ, it is "dead-on balls accurate."

The latest studies by the AHA have found the heart is most receptive to the defibrilation for only a short time after the arresting rythm, due to the inherent hypoxia in the myocardium. This is why the new CPR standards say 2 min of CPR, followed by defib, followed immediately by more CPR. This builds up the "pressure" needed to perfuse the heart.

Ya...the 70% ETOH can cause real damage...Some of the ED docs I work with will occasionally (seen it once in 2 yrs) will squirt a little (very little) NS in the back of the throat, to trigger a gag (this is VERY LITTLE NS). I do have a funny story about faking...had I not seen it with my own eyes, I wouldn't have believed it. Ok...I was working FT at a FD, and my wife (gf at the time, who is also a medic) is out volunteering with us. We get a call (the unit was dual medic) for difficulty breathing. U/A, we found the PT, a 30's yof, supine in the throws (per her fiance) of a BAD asthma attack...Ok...so we get her loaded on the cot and start to drive to...the most distant hospital in town (of course). My wife was attending, I was driving. About 1/2 way there...I here the PT say "I think I'm gonna have a seizure." So I ask my wife if she wants me to pull over and give her a hand...She says no, and I here her tell the PT (who is now doing the "fish out of water" routine), that if she doesn't stop, she'll have to sing to her. Yes, you did read that correctly . So...PT continues to seize, and so my wife puts one hand on her hip and holds the railing on the ceiling, and starts singing "I'm a little tea pot!" No kidding, the PT started to laugh so hard (yes, still doing the "fish out of water"), that she couldn't "fake it" anymore and laid still for the rest of the trip.

From the research I did several years ago...the reflective striping on bunker gear doesn't even qualify now as "safety" reflective gear for working on the roadways.

Why not? It works for other types of city buses...

Getting back to the original posting... In Arizona ALL EMT/EMT-I/EMT-P (this includes federal agents) MUST be under medical control to practice at their AZ equivalent. Now, this is when the person is OFF Federal Land. For instance, BorStar is based (in the Tucson area) with Saint Mary's or Kino Hospital, or Tucson Medical Center (I don't remember which). The Army Air National Guard Medics weren't allowed to do anything until the last year or so when they got based with an area hospital, and can now practice at the air port (Pinal Air Park) where they train (Pinal Air Park is owned by Evergreen, a private company, the AANG have a small "base" on the far west side, but mutual aid with Pinal Air Park FD). So...if the NPS wanted to put their "medics" or whatevers in service in Arizona and be able to operate in anyplace other than Federal Lands, they must have a base hospital.

Does the law state what type of ANSI class vest is needed? I've done some very minor research on this several years to get ANSI class III vests for the department, but they stated they were too expensive (which is funny now, because of an MVA w/HazMat and OSHA fines add infinitum...are in a severe world of hurt). I left the department before trouble brewed...kinda funny when they don't listen to the safety officer... Anyway, back on topic, there are several different classes of ANSI vests, ranging in length and "reflectiveness." Just curious...

Correct. All BP's are NIBP unless they have an ARTERIAL LINE, where they INVASIVELY measure the pressure. The discussion is auscultation vs. machine...as has been stated a lot previously in the thread, the machine NIBP, due to road noise and other things, isn't always a reliable tool, which would make auscultation more reliable. Of course, the trick is to know when EACH is being "questionable." I have found it's not necessarily always about the numbers per se, as opposed to the trends in the pressures taken.

Manual BP is best over bare skin...etc etc etc, like everyone has said. The one thing that I find interesting is that most modern monitors have attenuated leads, meaning they are ment to go on the chest, not the arms/legs of old and will give the same reading, chest or arms/legs. This doesn't always hold true for a 12 lead, but for 3/4/5 leads, it is.

The biggest problem I would see with this is the possibility of medication administration, along with unncessesary radiation administration. Although they of course have the right to refuse any/all procedures, will they? The radiation is potentially dangerous, especially if the "mystery shopper" gets several chest CT's a year-especially if the shopper is a woman. This greatly increases the chances of breast CA.

I am FT with University Medical Center in Tucson AZ. Most hospitals in the Tucson area do hire medics in the ED, also it's kinda cool here 'cause we are the only true teaching hospital in AZ, and also the only level 1 trauma center in Southern Arizona. The only places we can't work is in triage, or on the telemetry (orders for field medics via radio). My personal fav. place to work is in the trauma bays.

Another option, if available to you would be working in the middle east as a medic. I am friends with one medic who was there for 2 years, working as the King of Saudi Arabia's personal medic...you may have to have several years experience for this though...good $, something like $150,000.00 tax free a year for a 2 year contract.