RichmondMedik

Check NORTHFIELD LABS they should have all the info you need Paul

Devin -- I am no critic but I know what I like and I laughed way to hard with BOTH your books thanks for the personilized copies Paul

Yes We us it !!!!!!!!! J.P Ornato is our Medical Director who pushes us to be aggressive and do what is right for our patients -- our protocol for cardiac arrest is different from anywhere else I have seen VF/Vtach Vaso 40u WITH 300mg Amio 5 minutes later Epi With Amio 150mg 5 minutes later Vaso 40u WITH Amio 150mg of course that is just our drug regime .. We can keep going till we either call it, get ROSC or run out of Vaso and Amio - of course we can also push,if indicated,Narcan,Sodium,Calcium Etc... when we have a workable arrest we put the AUTOPULSE on first ( defib pads at same time) and get it running for 60 to 90 sec ( takes approx 3 minutes to deploy), intubate ( with ETCO2) ,IV and by that time we are checking the rhythm (we don't shock first unless it is witnessed by us)shock,if appropriate, and then start the drug regime. Dr.O. has explained to me plenty of times that there is no magic bullet for out of hospital SCA but they are all little pieces of a pie/puzzle that help one another to work better any ??? PM me I will be more that glad to pass on what I can Paul

ACTUALLY if you do a little research on Boston H&H you will find they are run by Boston University and are no longer under the city -- so technically they are a private service with a real big ego Paul

My Medical Director is part of the ACLS committee -- his picture is in the top left hand corner of the old acls book ( stripe is covering him in the new one) so with all the studies being done he adapts what we do in the field to the information avaliable -- reread a couple of posts up were the statement is made about being a thinking cook --- that is what we are encouraged to do -- think on our feet --- the only thing taking a class does is give you the info needed to understand the job -- it is up to us to tailor it to our patients needs -- the first time one of my fellow providers heard that I "bagged" a neb treatment in he told my I was going to get fired --- what would you do if you heard from family members that the patient was on the way to get a breathing treatment and after he was inubated you had lousy compliance with the BVM ??? just because something is not done in one area that is done in another makes it neither right or wrong -- just happens to be the way it is as always follow your own med directors protocols and you will be covered Paul

We have a slightly diffrerent protocol confirm arrest 90 sceonds of QUALITY CPR ( autopulse ) as the autopulse is applied put the patches on check rythym --shock if indicated ( with autopulse running ) ETT -- IV -- leave autopulse running as much as possible Vaso AND Amio ( if Amio indicated ) Epi AND Amio ( if Amio indicated ) alternate between Vaso and Epi every 5 minutes shocking when appropriate and Amio when appropriate and yes as always check for a pulse and ventilate where appropriate as we get into the code we can give the standard meds of atropine, bicarb,calcium, et al -- we have also been known to bag neb treatment or 2,depending on the patient we shock our patients with the autopulse running and time it to the downstroke of the machine. We have a very forward thinking Medical Director --- hell he is involved in half the studies for cardiac arrest going on out there Paul

amazing what a few adjuncts can do to the QUALITY of cpr -- AUTOPULSE -- SMARTBAG and a medical director on the cutting edge -- if we were to believe half the posts and opinions out here there would never be any changes to any of the treatments we perform ..... I believe Richard has on the bottom of his post -- treat people the way you are suppose to in your area -- just cause it is different doesn't make it right,wrong or indifferent -- just happens to be the way it is done EDUCATION -- find out what the latest that is being done in the area you are interested in -- who are the names doing the research ?? Pepe??Ornato???Halperin?? or go to the granddaddy of them all CASTELLI -- what has he found for the what 4th or 5th generation of families involved in his study The last code I ran we had 2 students that couldn't believe the drugs we pushed-- how we shocked with the autopulse running -- how little we ventilated -- and it was the first one they were involved in that achieved ROSC how are we going to know what works unless the studies are tried and info passed along ??? Paul

Vasopression is actually our first line drug we alternate between that amio and epi -- my Medical Director has found that it is the actual combination of the drugs that work best and not one or the other Paul

polyheme is from humans and hemopure is from bovine(cows) Paul

what he said !! Paul

so having the distinct pleasure of the most uses in the United States --35 plus and counting I highly recommend it -- wouldn't even want to attempt a code without one now -- the local hospitals are now using them also -- any info you want I can e-mail you some stats just PM me Paul

March 19th 1963 -- yup just turned 42 and feel like I am just starting to live -- had a better time with life in general since I hit the big "40" Paul

Were you can't tell the patients from the employees !! Paul

If I have no students I am a black cloud -- to the point when I walk into the level 1 trauma ctr -- the staff looks at me and says " no students today?? " -- when I have the students I can't even beg a good learning call Paul

I tell people on my rig the closest "APPROPRIATE" facility -- may not be the one the patient wants and I explain out how they will have to be transported a second time to go to the right facility -- it is usually recieved pretty well when explained properly Paul

Moosey, If you think that affected just NYC then you need to look at the implications of that day -- but as you said you were only 14 -- wait a few more years and you may understand how it affected the WHOLE country and not just one city Paul

right you are -- but apoligize anyhow ---- Paul

what he said --- and to add -- not to put the fire side down -- but I remember the IAFF scrambling to figure out how they were going to keep FF jobs with such a good job they were doing with awareness and fire safety --- I remember my Dad coming home and talking about so and so being punished by being put on the ambulance for a month -- unfortunately there are still depts that use it as punishment --- and not many options for those of us that want nothing to do with the big red truck --- there are quite a few that want the engine and not the meat wagon -- that is why they joined an FD --- and just think they could be the ones that come for your loved ones Paul

had a minor fender bender with an EMT on scene -- got up to the car and found out he stopped after PD was on scene -- he tells me she was unconscious and moaning --pt states " NO I was not -- I was crying " the EMT then proceeds to tell me the patient is a trauma alert--she wasn't .he then told me the patient is to go to the level 1 trauma center and no where else -- at that point the patient started to cry --- I calmed the patient down,had my student take up c-spine and thanked the emt for his help -- all very nice --- the emt stuck around and continued to offer his advice on how we should treat the patient and he will pre-alert the trauma hospital --- at that point ( after telling him for the 3rd time we were all set and he could leave) I called over PD and had the emt escorted off the scene If you are going to stop and help 1st make sure they need help and when the on duty crews or who ever is in charge says thank you we got it from here,then leave so the condition of the vehicle was she got hit in front of passenger door and the window broke -- no airbag deployment -- patient had no injuries other than a panic attack Paul

I agree if you cannot get the treatment done then by all means PUAHA -- what I see is providers not even starting or trying because " we were to close to the hospital " that is in my opinion the attitude that needs to be changed Paul

This attitude of "if you didn't do the skill in the field, you are just lazy/incompetent/etc. etc." needs to stop. Too many providers are putting their egos above patient well being. unfortunately being one of the people that is involved with QA/QI, I find to many providers that fit this statement -- they are lazy, incompetent and if it is not "THE BIG ONE" they want nothing to do with the call -- so the EGO also works in the other direction We,as advanced care providers are the ones on scene and have to make the decision on what is right for the patient at that time -- but if you have to make excuses for why you didn't treat a patient -- my opinion is then you know you should have Paul

I ask all my students -- " did you get your patch just to be a glorified taxi cab driver or to better treat your patients " doesn't matter how far or close you are TREAT your patient -that is what we are there for I had a patient that fell and fractured her ankle at the end of the hospital driveway and I still managed to start a line ,give MSO4 and 2 sets of vitals. how aggressive do you want to be in your treatment or what would you like done for yourself ?? Paul

I have used both --prefer the pads -- if put on correctly you don't have to worry about the 25#'s of pressure Paul

I am still amazed how we treat our pets better than our "loved" ones -- terri is not the one grieving or in pain but the people who were selfish are !!!!!

Stephen Wright -- I wish I had a pony --- funny stuff so dry is his humor -- my vote is with him