DFIB

First of all welcome to your own thread! Good on you for stepping out and asking a very good question! I am only an EMT so I hope some of the medics will chime in. I am interested in their opinion as well.

I have found that many patients with dyspnea that are alert are not receptive to rescue breathing. I find that pulse oximetry is a useful tool in determining how well a patient is perfusing and shape my interventions accordingly. If they need oxygen, that is a good place to start. I try to keep the pulse oximetry around 94%.

Discovering the underlying condition that is the causal factor for the difficult breathing will ultimately be the key to improving their ventilation through interventions. The patient might benefit from nebulization or a dose from their measured dose inhaler. The patient might be having an allergic reaction, or have a host of pulmonary and cardiac pathologies or diseases that could be causing their increased work of breathing. If we can identify and rectify the cause we will do the most good in reducing their respiratory distress.

I always ventilate adults at the same rate for rescue breathing although there are cases when we would want to ventilate slower of faster such as head trauma or preparing for an advanced airway intervention.

In pediatrics I only ventilate if the patient will accept the ventilation. A child that will let us breath for them is an indication that they need the help. If the baby is well enough to fight off the mask he most likely is ventilating well on their own with the exception of an occluded airway which would require other interventions.

Good on you for starting an airway thread!

In Mexico people are not required to render first aid and face at least the possibility of legal action if they do. This usually does not happen but is a real possibility.

All persons are required to call for help and not abandon an injured person which seems kinda like they are telling people to say "I can't help you but I am happy to sit here and watch you bleed".

I disagree with this a little. I think they had a duty to act, but I don't think their duty should require them to purposely put themselves in a dangerous situation without the proper equipment.

I am picking up what you are throwing down.

Interesting article. http://www.jems.com/article/news/judge-california-responders-had-no-legal

My grandmother has a solution, press the mute button

Just turn down your hearing aids ...

I think I remembered Doc talking about this before http://www.emtcity.com/topic/20644-military-approves-tranexamic-acid-for-major-hemorrhage/?p=264201

How long is your Surgical Technologist program, and how do you like the OR? I've been a ST and then a surgeons first assist for ah...well I started in 1986. You have a lot on your plate if you're taking medic and ST classes. Vacillating a little bit on the career path?

First assist, cool,

@Defib: Sure, why not?

Simply curious.

I am an ambulance driver, usually in the front seat, I mean, when I am Not an EMT-B riding in the back!

So assuming that you have no problem with a transsexual/crossdresser working with you. Would you feel comfortable in sharing hugs on special congratulatory occasions?

Death bothers me not,

I can also catch bullets with my teeth, stop a speeding train and jump a tall building with a single bound.

Yep, it doesn't bother me at all

However, a requirement of gender reassignment is for the candidate to live and work amongst the populace as that chosen gender for a particular period of time, (typically 12 - 24 months) prior to being considered for reassignment surgery. Transgender individuals are not a sexual orientation issue. There are many schools of thought and no one has actually proven one specific cause to transgenderism. What has been agreed though is that all of the causes boil down to two specific categories. Medical or psychological. Hormone imbalances in-utero, Chromosome abnormalities, an innate feeling that an individual is trapped in the wrong gender. These people go through a very strict psychological assessment prior to being considered for reassignment. Transgenderism is not a mental illness.

Therefore, to discriminate against an applicant who is transgendered is not a discrimination based on sexual orientation, but physical disability.

Interesting.

But to these individuals, these are not costumes, they are part of their identity. If they are in the process of gender identity change, they are not in costume are they?

I might have not explained my thoughts well. What I meant to say is that the reason that the differences would be accepted would need to be a sexual orientation issue. If a hetero wears a dress it is a costume so for this to become a legal issue, sexual orientation would almost by nesecity come onto play.

It would be a sexual identity issue maybe? I'm not in HR so I'm not sure what it would be but I'm sure that this has already been tried in the courts at other companies so the definition of what kind of legal case this is is out there in the vapors.

I'll leave that up to the lawyers to decide but HR would have a hard time justifying why they didn't hire that person over another if that person can prove they were better qualified than the one who got hired.

Well I guess it would have to be a sexual orientation issue and the real deal. Companies don't usually let people wear costumes to work.

Defib: I have worked for upwards of three hours on a code where we did get return of pulses, then lost them , then got them back a total of 8 different times.

We shocked over a dozen rounds of V-Fib over the course of the code. We did transport and worked alongside the hospital code team for an 1 1/2 hrs in the ER.

Finally the decision was made that she had been down long enough without good perfusion to have suffered life ending brain activity. We stopped and she held on for thirty minutes more then finally her heart gave up.

She Was a good friend who's husband had died 6 months earlier from cancer.

We believe she died of a broken heart , and just wanted to be with him.

I am sorry that you had to resuscitate your friend. That must have been very hard for you. She was fortunate to have people that loved her around in her final moments.

I read an article a while back that has changed my thoughts about the duration of CPR but not the practice. We don't have the luxury of ALS so all codes are actively transported. Most are declared DOA at the hospital..

Here is the article. http://www.nytimes.com/2012/09/05/health/research/doctors-may-be-ending-cpr-efforts-too-soon-study-says.html?_r=0

Funny thing about that: We all will die someday.

We can make a determination of death here by several methods. Obvious injuries incompatible with life, Rigor, dependent lividity, Pulseless and asystole in 3 leads for more than 20 minutes after resus attempts or not. They do not want us to transport a "working code" to the hospital.

The current protocol is to work a fresh arrest for 20 minutes and 3 rounds of acls protocol. If no ROSC then call it and notify Medical control Dr that you have ceased efforts and time of death. We can get approval on the phone from Pt's physician to have them sign the death certificate.

We do have the ability to transport any pt that is hypothermic and children, or anyone with near drownings.

I read an article a while back that has changed my thoughts about the duration of CPR but not the practice. We don't have the luxury of ALS so all codes are actively transported. Most are declared DOA at the hospital..

Here is the article. http://www.nytimes.com/2012/09/05/health/research/doctors-may-be-ending-cpr-efforts-too-soon-study-says.html?_r=0

Strangers dying have no affect on me whatsoever.

Every patient contact changes me, in particular when they die.

It might wor tryk if you to save the powerpoint to your computer in an editable format.

Tacos, tortas, tostadas, tamales from street vendors.

In the wise words of Dr. Eminem ...

Eminem quotes

Welcome,

Welcome to the City! Participate and have a good time!

Where are these places in the US where firetrucks are being replaced with a paramedic with an SUV?

Shreveport, Louisiana has something like this. It is called SPRINT is an acronym for Single Paramedic Rapid Intervention Non-Transport

Here in WA a new law took effect on Jan 1. It requires all Ignition Interlock devices to be equipped with a camera and to take a photo of the person blowing into the device. They can then take enforcement action against both parties.

This measure will surely save lives. I just could not believe that people would help a person who had been drinking to operate a motor vehicle.

EDIT: Well, I can believe it but it was still a little shocking.

and what do the "oysters" taste like clutzy.

Yes I know what they are

Taste like nuts.