vs-eh?

rift

We mix 150mg amiodarone in a 30ml syringe with normal saline and push it over ten minutes...

I was under the impression that the impression that amiodarone was mixed in D5W because the dextrose is rapidly taken up by the cell and in turn acted as sort of a facilitated transport for the drug... Also while D5W is initially an isotonic solution, it becomes hypotonic rapidly (again due to the fast uptake of glucose) in the form of sterile water. As I recall...

I think most paramedics will concede that pediatric assessment and management is not on their list of forte's... I'm curious as to your frequency of starting IV's on pediatric patients while working land EMS. For this poll we'll say a pediatric is a patient 12 or under... If you could also briefly list... - Why you start the IV - i.e. critically sick child? simple post-ictal? simple trauma? critical trauma? - Why you don't normally start IV's on children - non-confidence, children don't generally need IV access by EMS, child is too scared, parents don't want it... - Your general proficiency. - How many (if any) IV's you attempted/successful during your clinical/preceptor experience prior to autonomous practice. Peace.

Break it down... ANTLANTO = Atlas = C1 = first neck vertebrae. OCCIPTAL = Occipital bone = 1 of the 2 major non-paired "flat" bones that make up the cranial vault. Put your hand on the back of your head. That is the occipital bone... There are facets on the atlas which articulate with protuberances (I don't remember that they're called) on the occipital bone. As I recall around the foramen magnum, is the major point of articulation. SUBLUXATION = displacement of a vertebrae. Basically this patient died because of a "broken neck". More accurately I assume that the atlas was displaced on impact cause perhaps cord transection or significant pressure to cause mass injury and interruption of afferent/efferent impulses. Remember high spinal injuries are especially dangerous d/t phrenic nerve damage and signal interruption, with no "back up" with the intercostals. Probably died of hypoxia (because they literally could not breath) and mass vasodilation? EDIT - DAMN YOU ALL...I WALK AWAY FROM MY COMP WHILE POSTING FOR 5 MINS!!!!!!!!! GAH!!!!!!!!!!!!!!!!!!!!!!!!!!!! :x

The point is the FSM is as plausible as whatever your higher being is. That is the point. Relativism, it's the same thing.

I'm not making fun of anyone actually. I enjoy stimulating conversation. The poll options (while silly I admit) are legit.

Meh, I am. I just make posts like this to illustrate points (and hope they aren't locked). I disagree with PRPG that there is no "God" (read: higher being). You can't really disagree with that because an omni-being can make you think whatever it wants...So that becomes moot. Hence my point that my keys as God are equally valid. I have issue with you inferring that women and gay's have no soul. Hence my post. Yes, you did say that. But whatever...

You are obviously a very open minded individual. You quite eloquently illustrated an aspect of my point but anyway... So the creator of infinity...one who is all knowing...all seeing...all powerful...is a human man... ... ... And you call Jehovah's Witnesses' "annoying" likely for preaching their stance, yet it is quite evident that you have very strong views about things. Do you not think that the Jehovah's Witnesses' stance on a higher being is valid? Hypocrite.

Any mottling? Pupils?

Sarcasm? In case you're not being sarcastic... That's fine...You are attributing human emotion (which a supreme being isn't) on to something that is intangible and has never (without serious extrapolation) shown itself to be. At least if I believe that my keys love me and are my supreme being I can show them to you. And in reality, these keys could be your god (by definition). So, this loving supreme being (God) wants us to believe we are living in some kind of "Matrix"-like reality? Why would this God allow us to have tests and find evidence that evolution occurred and that the earth is billions of years old? Why would it care if we knew or not? The 6000 year thing is arbitrary. Fine, so on that scale a year = 1 million of our years....whatever. It could be the year 0.5213!$-^2 for all I care. It's just an arbitrary assignment, but at least based on observable things to a point. Here is a question... I believe the supreme being wants the bank to give me a million dollars. Why? Ummmm... because I just found my watch that I'd been looking for. I prayed for the higher being for me to find it, but if I did I knew that the bank would also give me a million dollars. Why is this unreasonable? God obviously wanted me to find my watch and ergo wants me to be a millionaire. Sounds ridiculous I know. But it is deemed perfectly reasonable in other contexts within religion.

I missed this point before... http://www.amazon.ca/gp/product/1882742427...ce&n=916520 Great little thing. Everyone should have one on them at work.

I'm going to mirror a lot of what JPINFV said... Pre-hospital (and in many cases in hospital) medical cardiac arrests need 4 things (traumatic arrests need 1....a phone ). Right people, at the right place, at the right time, with the right equipment. Loose any of those elements and mortality (my inference) increases rapidly. Let's face it, if you have a cardiac arrest you aren't doing to well in the first place. PAD programs and public CPR (and hell, first aid) are great...but how often do you go to an arrest, even with peoples own family members...and no one is doing anything? A lot... Again, judging by the education that the majority of EMT-P's receive, RSI is a no go. When you start doing 50 OR tubes and 10+ field tubes PRIOR to practicing autonomously then MAYBE you could start to think about it. RSI should only be reserved for REAL critical care paramedics and special teams. PAI (which I'd be more open to) is often just as effective. Once you start introducing a paralytic, vastly more problems ensue. Again, pretty useless for practical land EMS use and should only be reserved for special teams who have a real use for it. If you die from a trauma prior to reaching the hospital, then whelp...you very well would have likely died anyway. Secure ABC's and drive safely to the hospital. We are getting computer based ACR's soon (apparently). Money better spent on other things IMHO...But yes...working in a large service I do see the benefits.

So why make it seem like it's occurring over hundreds of thousands or millions of years? If it sees an issue with one of its creatures then why not simply make a change instantly en masse? If God saw something that it didn't like and could be "better", why doesn't he just do it now? Why give the illusion of evolution? Doesn't seem very gracious and noble now does it?

Good points. Unfortunately God (or a supreme being) by definition (omnipotence, omniscience, omnipresence) cannot really be proven or disproven. Thus the circle... My point was that belief in God (or a higher being) is as equivalent to believing Optimus Prime or a spec of dust is said God. I'm interested to see if people see that point and agree that it is just as probable (think about the above 3 omni's). If you do not see why this is just as possible then I will be more than happy to explain, it's pretty easy. Ummm, we did not EVOLVE from "monkey's". We evolved from a common ancestor. It always amazes me why people "hate to think" that we evolved from a "lower" life form. To me it's amazing to contemplate the time and beauty of it. So by what mechanism do YOU think Homo sapiens appeared on earth?

I'm serious. I think believing in God is as probable as believing that Optimus Prime created the universe or guides life. For reference... God (and for most his son Jesus) http://en.wikipedia.org/wiki/God http://en.wikipedia.org/wiki/Jesus Optimus http://en.wikipedia.org/wiki/Optimus_Prime I appreciate your comments... In Jesus name, Amen

I think that is weirder than the fact he heard stuff while he was "unconscious".

Ouch to those whoose services don't carry NPA's....ouch....They are a tremendously underated airway adjunct. I used an NPA on a GHB OD last week. Worked very well. I probably use an NPA a handful of times a year. He was about a GCS of 5 and I elected not to intubate the patient (those that have had GHB OD's will attest to this). OPA's are generally only used on arrested patients prior to intubation and subsequently as a bite block. A helpful hint to those BLS providers or ALS providers in a can't intubate scenerio with no rescue devices available...2 nasals and an oral works very well at maintaing an airway...

In Toronto (and all of Ontario), if you are transported to the hospital via ambulance it costs $270 (roughly, I don't remember the exact cost). HOWEVER! This cost 99.5% of the time is subsidized down to $45 by the province to the actual out of pocket expensive to the patient. The 0.5% of the time where the patient is actually charged $270 is if the transport is deemed "non-essential". However this has to be validated by the crew, and the triage nurse and doctor (I believe). It is virtually never done... So this $45 is charged to the patient regardless of the call... - Ambulatory psych patient who "feels like hurting themselves" that you don't do anything for? $45. - Cut finger and put a band-aid on it? $45. - Full arrest and post-arrest to the hospital? $45. Does not matter what medications or procedures are done. If you are transported to hospital you get a bill for $45. If you are not transported (regardless of what is done on scene), there is no charge.

You have already seen the percentages for Toronto EMS. A city of 4-5 million people (depending on the day) and a call volume of 350,000+ per year. All calls are handled by one municipal service, there are no other ambulances period that do 911 calls in the city. I can't give an exact formula because I have no idea of actual numbers, I can only speak of experience and extrapolation. The 9% patient REFUSAL, I would deem as accurate (and obviously it was as close as possible for the study). This is a patient being explained risks, being assessed, etc...and having to sign a form which is usually witnessed by another person. It should also be noted that Ontario uses a standard ACR for the entire province, which includes cancellation criteria on the back. Now doing a call and NOT TRANSPORTING a patient is different and lumps in to the above, with obvious examples that I made in my previous post. These percentages will obviously be higher and as I said I would wager one out of every 5-6 calls is a non-transport (say 16% or roughly double refusals). This of course is going to vary depending on where you work in the city. Obviously those who work in the downtown core, rather than outlying areas are likely to have an increased percentage of certain types of calls and inherently a higher percentage in the grouping of NON-TRANSPORTS. Whatever...using stats of 36% and 50% just leads to controversy and things have to be separated and variables stated in order to justify said stats.

Just to comment on the Toronto EMS stats... Speaking from personal experience, 9% non-transport does seem pretty accurate. I think Toronto (or any large American city) would be a good model for analysis of refusal or non-transport. The non-transport numbers are absolutes for EMS transport as well as Toronto EMS is the only service that transports 911 patients. Varying non-transport rates will likely vary depending on what area of the city you are in as well (my opinion). There is a difference however between refusal and non-transport. Refusal is where a patient is assessed (hopefully) and given the option of transport, but refuses and a signature is obtained. Non-transport could be many scenarios, HBD walked away, no patient found, police canceled/transport, fire canceled (us off a fire), call concealed prior to arrival, etc... That could skew numbers if it was incorporated. On an average shift (5-6 calls) I would say at least 1 falls into the refusal/non-transport category (at least one). I find it very very very hard to believe services have numbers of 50% and 36% refusal/non-transport rates, unless, as said before, they are "handing" patients off to another transport service. The patient is still going to the hospital by ambulance, just not theirs. We don't have that option here though...

GA...You seem to be focusing on nudity and foul language... Would you consider it appropriate to watch (for lack of a better example) the opening scene of Saving Private Ryan? Which as I recall has no nudity or swearing... If so, why?

Do a blood glucose... He is lying about the drugs or alcohol... He is potentially in compensating shock...No skin or diaphoresis though? How much does this kid weigh and general appearance? Meth, Crack, Cocaine, E, whatever...Oh wait....GHB....It's GHB right? What do I win...I win reps... Whatever monitor his sorry ass and drive to le hospital...

OH YA!!!!! WHO CALLED IT!!!! GIMME SOME REPS YO! PS - The second strip looks more like an SVT than the intial set of strips. I can't make out any p-waves, even though it is only in lead II. If she is hemodynamcially stable still I'd let the hospital sort it out. Did you try vagal maneuvers before the adenosine, and if not...why?

Go Go Go Go Go...(I'm gonna say now it's atrial flutter just because of the build up *pops collar*). :rr: