b.anderson

I found this University of Queensland article about the use of UHT (ultra-high-temperature processing) milk for the preservation of teeth: http://www.uq.edu.au/news/index.html?article=1413

I was taught to put teeth in saline with a 4x4 or two surrounding it. So water, or ice water would likely do the trick as well. Glucose gel in my opinion would damage the teeth more than preserve it for reattachment, and I can't see how isopropyl alcohol will help preserve them. I'm not sure of milk, I'd be concerned about the sugars in it that may damage the teeth. I would have answered, ice water.

I'll be one to admit that I assumed Kiwi was indeed in some way formally attached to pre-hospital care. I go by the phrase "trust, but verify." Of course, I don't know Kiwi all that well, besides a few exchanged words in chat (If I remember correctly). I can't recall a post where I saw him expressly identify as someone who had formal EMS credentials.

To me, it doesn't make much of a difference. I personally (with no offense to anyone--I'm sure you can understand) would verify anything I solely learned from the Internet, professional forum or otherwise before applying it to a real patient. That's just common sense in my books.

As for the original threads topic and Kiwi's accusations of such, I can't really comment. I wasn't able to follow it all that well. In my mind, he's just a guy that doesn't realize some of the negative implications of posting his real world identification on the Internet. In any event and in following with what I originally said, I'd verify (via an instructor, medical director, preceptor or otherwise--that's not to imply that I have the latter two yet) what I learned here before using it in the real world. So having or not having real world credentials is merely a plus and not a necessity to me in terms of learning valuable information.

I'd ask myself, "Will this article of clothing prevent me from assessing this pt?" and "Will this article of clothing prevent me from rendering proper care and treatment?" If the answer is yes to either of those, then the clothing in question should come off.

Personally, I was taught to use the trap squeeze method. I think even if the plantar reflex was an acceptable method to illicit a response to painful stimuli, I'd assume after shouting at the patient a few times and then going to remove their shoes/socks to use that method would simply be more redundant and complicated than it needs to be.

I am however considering the idea that the plantar reflex may be useful, but perhaps further down the list of assessments, perhaps when checking the patients CMS/PMS in their feet? I have limited knowledge of the plantar reflex (I'll use this as some motivation to learn more) so quite honestly I'm not sure the information gained would be useful during pre-hospital care, though perhaps it would be a useful tidbit for the receiving ED -- I'm not sure how emergent it is to have that information though.

I've had a similar experience, though it came from the female students more-so (the younger majority of students). For the first week of EMR, we were allowed to choose our own groups. This allowed ample time to get comfortable with each other and those who were shy could practice within their comfort zone for a while. The following weeks our practice groups of three were randomized (students selected a colored bouncy ball from a box which coordinated with two others). The randomization gave us a chance to work with others (and learn how others approach certain tasks), and for many get outside their comfort zone.

In my opinion, the notion of having to allow students the option of "opting out" of contact with certain classmates based on gender is counterproductive. You can't opt out of dealing with certain genders in the real world, and if it's anywhere you should be learning how to deal with those whom you are uncomfortable with it's in the classroom.

I have to disagree that instructors should have to give students an incentive to conduct themselves properly and professionally. Telling students that they can (metaphorically) have a cookie each time they act their age (or at least the level of maturity the profession requires) is also counterproductive. Additionally, letting students treat others in the class as a walking box of cookies, for if and when they act professionally with that student would in my mind leave the wrong impression. I believe there to be a line between telling a student they completed a good assessment (or task), and giving them points or prizes for completing a good assessment (or task) on a particular person or gender.

I think students should be given a reasonable amount of time to work within their comfort zone, and work outside of it when their able. That said if it begins to continually effect the rest of the class a discussion would be in order, either with the particular student or the class as a whole.

I haven't heard of it until now. This seems like a step backwards in terms of sharing scientific research and a step forward for the government to make some more money. Shouldn't the people paying (the taxpayers) for the research be able to access the information with relative ease? I'd be interested to hear the opinions of some of the more politically-minded individuals here. My grasp on politics is admittedly low.

While I'm not sure about ILS scenarios, I can't imagine it would be much different. If I'm not able to find a particular scenario I try to create my own. I consider a particular injury/illness and go through what would be commonly seen. Hx, vitals, head-to-toe, etc. I ask myself questions, "What range would this patients vital signs be in for this injury/illness?" "What would I likely find on examination?" "Why would I find that?" "What's my treatment plan?" "Why have I chosen that as my treatment plan?"

It's probably not for everyone, but I always found it useful to go in reverse. It helps me to understand the why, and not just the what.

This forum also has a good scenarios section, http://www.emtcity.com/forum/35-scenarios/ -- I haven't personally participated yet, but I do plan on it. I've found many of the topics to be useful, some of them to be more obscure that I've never even thought of before.

Good luck on test!

I believed this for the first paragraph. Weapons of math instruction, nice.

I noticed the image shown, from what I can see doesn't have much in the way of obvious amounts of stretching, and I can't see any highly visible veins. I've noticed that obvious stretching and visible veins to be common when I've seen images of patients with ascites. I can only assume it's caused by the rapid distension of the abdomen and pressure against the skin. It seems this case was more progressive, possibly with the localized accumulation of fat and possibly in addition to mild to moderate ascites. Maybe?

I've seen one person before, whom had a quite similar shaped abdomen but a little smaller in size, with his naval protruding. He didn't appear to have any other immediate health problems as he was wandering around the beach. I have no idea what it was caused by however.

I'm interested to see what some other ideas are, in addition to those already posted.

Seems like a very expensive pair of Adspecs. A similar principal of variable lenses to be able to be used in poor populations of Africa.

http://blog.arenasol...emerging-world/

That's the first I've heard of those. Very simple and neat design. Never thought the day would come when glasses were powered with oil.

Seth,

I don't personally discourage you from taking on the project you have described. Though if you're looking for help when researching this topic, I'd recommend answering the questions (even those that are negative) that are asked. Ignoring them or replying with a purportedly satirical response won't earn you that much respect, which in turn won't earn you much help either.

Think of it this way: how would you feel if I came onto a journalistic forum (if there is such out there--which in making a bold assumption, I'm sure there is) and claimed I wanted to benefit budding journalists get started with their career. Then when asked questions about my project or my own integrity I ignored them or skipped around it using a satirical response. Would you sit back and think, "I respect this person and would like to help them" or would you think, "this person is asking me for help on their own project and doesn't respect my profession enough to warrant me with a legitimate answer"?

That's what I thought about when I saw a few of your recent posts. I can't speak for anyone else.

If you're here to learn (just as I, and a lot of others presumably are) then I support you. If you're here for your own personal gain then I do not support you. I'd be more apt to helping (albeit I can only speak of things in BC, Canada) you with your project as I'm well aware it's difficult to get a grasp of all the information that's available without conversing with others at the very least.

The gist: respect others and get respect in return (maybe some helpful tips along the way, too). I say this from the perspective of someone who respects the other, more intelligent minds here (because my general intelligence, and knowledge of EMS is likely a lot less than a lot of others here).

That's my opinion at least.

Seth, no offense man, but I have to tell you that this has a really bad aroma...

A man that wants to be an EMT, but decided not to, but now has so much passion for EMS, something he's no understanding of, that he's willing to spend hundreds, or likely, thousands of hours creating an all inclusive page for EMS wannabes? For free? Without competing with this site? Yet is unwilling to take a 144hr college course to see what it's all about?

It almost seems to be a secondary/high school type of project, to me at least.

From one new member to another, welcome! It's nice to see younger people (like myself) interested in and participating in the EMS community. I think you'll come to enjoy this forum. I know that I do and appreciate what I've learned since joining.

I don't believe that he can, as the paper quoted the police dept and are not making accusations of their own. I mean, of course they are, simply by the lopsided way that the story is reported, but I don't see how you can hold them to it...

It's unclear as to what's true and what is not in this article. Due to the obvious double negative as the incident is presented as both allegations, and as fact. It's difficult to discern if the police presented the incident as allegations or fact originally. Either way, the newspaper should have taken better care to not have the double negative, which immediately reduces its credibility. I doubt that, even if the newspaper is the one in the wrong (in terms of libel) that any case would be made against them--the medic in this article is likely concerned about other issues at this point--guilty or not.

I do hope, for the sake of the profession, that this turns out to be another case of greed on behalf of the accusing party. If not, I would hope that he gets more than a $25,000 fine for sexual assault.

To me, this appears to still be considered an accusation, and a big one at that. I highly doubt that a person, whom has been accused of sexual assault with any verifiable evidence would be released on bond, with only an administrative leave from their employer.

I do hope that readers outside of the EMS community are diligent enough to understand that accusations do not represent guilt, and that a single case of wrongdoing in a particular profession does not represent the profession as a whole. Only in a perfect world though.

The sad part in this case, for the accused medic, should he be found not guilty is that this article will likely be forgotten in the eyes of the public. It will be dinner table discussion for a while, and it will disappear. For the medic however, this will leave a lasting mark on (as MP-EMT22 said) whatever reputation he has left. I'd be surprised if we heard much of anything going forward regarding this particular incident.

I saw a woman get hit by a taxi. I saw her go cartwheeling through the air. I ran to help, as I'd seen accidents before and no one seemed to want to step up to the plate. Both arms and legs had multiple breaks, her face we nearly unrecognizable. I had no idea what to do. So I did the only thing that I could think of. She was wearing a short skirt with no panties....so I pulled her skirt down for modesty.

What you did for the woman (as you know) was likely more than anyone else would have done. Good on you. It's sad we live in a world where many people worry more about legal liability and lawsuits than they do of their fellow man.

I talked my son into taking the course with me in hopes that I would spark his interest in medicine. It was a great opportunity to spend time with him as well.

That's probably one of the most productive ways to spend time with someone. Very nice that you took the course with your son.

All the best,

B. Anderson

You're still kind of new to the site, so you didn't know to use the search function to find previous entries on this topic.

I did, and didn't result in anything. Couldn't come up with anything relevant (even with advanced search). Obviously, I'm just a little slow, do you have a link?

Very interesting story, Richard. Sorry to hear of your injuries, and the untimely end to your career. I wish you the best, and you're doing better. If it means anything, I appreciate your contribution to EMS.

All the best,

B. Anderson

This is the first time creating a thread here, before I begin though; thanks for the warm welcome. I appreciate it.

I'd like to ask all you fine folks: what got you into EMS? I respect those that do not wish to spout off their reasons and choices on an Internet forum (or otherwise) so feel free to simply ignore the thread.

--

What got me into EMS:

For quite a while I had an interest in forensic sciences. A goal was to be a forensic identification officer with the RCMP. That goal shifted after a while. I learned that to be in the Ident. section of the RCMP, they required 3-years experience as a patrol officer/constable and they weren't actively hiring civilians (or considering it for that matte). Being a full-time patrol officer/constable was simply not something I was dedicated to doing and in doing so, I thought would be unfair to the community at large.

I started getting interested in EMS when I was 15-years-old. I found the idea of emergency medicine intriguing and it helped that I had a strong interest in the sciences as well. By the time I turned 17-years-old, I was confident that it was something I wanted to do as a career. I got first aid/CPR certified by the Red Cross, and was amused by how many people who were now certified considered themselves "pretty much a paramedic now." I was also bored with the material (no disrespect to those fine folks though--it just wasn't enough for me personally). I wasn't expecting medical school content here, I just wanted more. A week later I registered for the EMR course at JIBC and here I am now. I still have a good ways to go however and look forward to it.

--

All the best,

B. Anderson

Congratulations!

All the best,

B. Anderson

The NREMT now uses a Computer Adapted Testing combined with the Item Response Theory. This combination test tailor makes a test for each person according to their competency level. Essentially every NREMT test now seems to be the hardest test for every person because the more you know the harder your questions will be until the computer can define your level of competency. Every time the candidate answers a question, the computer re-estimates his or her ability.

That's interesting, it's the first time I heard of that. Of course, I'm up here in Canada. Good luck on the exam, DFIB.

All the best,

B. Anderson

From one new member to another, welcome. I admire your courage, and as DFIB said, determination to keep going forward in EMS.

I wish you nothing but the best and hope you have a good and quick recovery.

All the best,

B. Anderson

As for your posted question, my suggestion is try to think as far out of the box as necessary. Splint boards are great...but aren't that easy to conform to an angulated forearm fracture. Use your environment and the patient's belongings if necessary to aid in splinting. Also, practice practice practice and more practice. You can not possibly go through splinting scenarios enough in my opinion. No two fractures or dislocations will ever look the same so try and practice different possibilities. As with much in EMS, challenge yourself to be more creative and find a better way to do something.

I appreciate the advice, and agree with you. I'll use this as incentive to get some more practice in and learn more. Thanks for the warm welcome! I've been enjoying my experience here so far.

That being said, it wasn't you who had to play with the hand you were dealt. It was your patients who had to play. That's why being a patient was such an informative experience.

Well said. I can't say I envy your experience as a patient, but I can appreciate it as an informative experience.

I don't think the use of any analgesia currently on the market can bring pain down to a zero. The other thing I learned about in the hospital is a nerve block. Its what they did on me prior to surgery. That made any pain a 0. Of course I couldn't move my arm for a good 12 hours or so. I liked Entonox not so much for its analgesic effects but for its dissociative effects. For me it kinda more dulled the pain, which was definitely still there. Morphine, fentanyl, dilaudid, they're fun and they do work to some extent, and the euphoric side effects are a nice distraction, but still for pain control in an acute injury they can be lacking.

Entonox isn't the best, and there are much better alternatives that you've described. We were given the opportunity to try it in class and it certainly doesn't get rid of pain, but it as you said does disassociate you from it (though, my experience was only with newly inflicted pain, not withstanding pain. I doubt it makes much difference though). Though, I am thankful that BLS in BC have access to it. I'd have to assume that some pain management is better than none. I've discussed this with some EMT-B friends from the US. Most of them don't have access to it (in fact none that I know actually have access to it) even though it's widespread in Canada and in the UK.

ALS is definitely better equip to deal with pain management. I can't disagree with that. I'm not sure about fracture management however, I'm only somewhat familiar with the BC EMA fracture management protocol and it's the same across the board for EMR, PCP and ACP levels. Link to the relevant protocol here. So from what I gather the point is basically that ALS can provide better pain management thus better fracture/orthopedic injury management?

As a side note (for unfamiliar or not in BC), ACP's in BC have an additional pain management protocol with Morphine and Nitrous Oxide. I'm not sure if they have anything else though, the protocol I looked at only included Morphine and Nitrous Oxide in addition to the separate pain management with Entonox protocol.

Forgive the long winded post.

All the best,

B. Anderson

Everyone starts somewhere, and we certainly aren't perfect. I also admire and thank you for helping him out. If all works out, that'll be one more dedicated health care professional. Best of luck to the both of you.

I agree, the EMS profession can seem intimidating from the beginning (albeit, I'm still beginning myself) and it might be so intimidating for some to push them away from it all together. You have to remember that EMS is about the patients and the care they receive. When you enter a profession where real human lives are on the line, one has to expect a bit of hard honesty. At least that's how I look at it.

All the best,

B. Anderson

I'm a bit late to post here, but I thought I'd jump in and give my opinion from a student perspective. As a disclaimer though, my only knowledge of what the NREMT exams consist of are from friends I have from the United States (I live in Canada). So take what you want from this.

I can say with confidence that many people have been able to pass the NREMT-B exams. I don't have an opinion of the exam itself as I've never taken it. Obviously however, it's not impossible.

I know a few people that simply have trouble with written exams, no matter the format or subject matter. I've read over a few NREMT-B practice tests a while back a friend sent me the link to, just to see what the similiarities and differences are to the exams in BC. It seemed quite simplistic, but I've never had trouble with written exams.

If what you've said is true, that your trouble with the exam is focused more on how it's presented, perhaps you could learn more about the common mistakes people make on multiple choice questions (any M/C questions, not just those EMS related) and work from there.

I found this non-EMS resource from a University of Wisconsin geography class. It provides some good information to those that have trouble with multiple choice exams. Don't stop with that one only however, I'm sure there are other resources available somewhere as well. http://www.uwec.edu/geography/ivogeler/multiple.htm

I digress however, Dwayne made some very good points as did many of the others. Your attitude seems like you're looking to blame an established exam for your failure. Don't blame the exam or anything else. Focus on the facts: you failed, now you have to figure out why you failed, correct the problems (ie., study), and pass it the next time around.

I remember something one of my instructors told me a while back: "If you find the answer, use it unless you are absolutely sure it's not the correct one. We're wired to get it right the first time." Which is absolutely true.

Good luck on the exam the next time around!

All the best,

B. Anderson

From a post-BLS student perspective: I agree. I found that during the EMR course (equivalent to EMT-B in Washington) there was a strong focus on respiratory, and cardiac emergencies. In whatever spare time we had we'd talk about splinting and throw in some pain management stuff as well.

Luckily, in BC, EMR's and above are licensed to use Entonox for pain management. It's difficult to mess up, and the only way you can is by failing to rule out the contraindications. Basically, 50% nitrous oxide and 50% oxygen mixed together, and self-administered by the pt. with a bite stick they suck on to get it out. It works quite well and gives us BLS folks something to work with at least--though it's certainly not as good as anything that can be pushed through an IV. I know it's not commonly used in the United States, if at all. Here's the drug monograph for anyone who isn't familiar with it: http://www.paramedic...mc/Entonox.html

Even though we're licensed to use it, it's not emphasized during the course work. I find that, at least in my experience emphasis is put on "the other stuff": cardiac, respiratory, spinal, patient assessments, etc. It doesn't take much experience to realize that a pt's main concern is simply when their pain will be gone in most trauma and medical cases. That's not to say emphasis should be removed from any other topics, but I do find pain management is something that's rushed through, at least in the EMR courses. I can't say anything for EMT-B courses, or the NR.

As far as splinting and limb management goes, I'm only really in a position to say that just like pain management, splinting and limb management should have more emphasis. At times it can be just as important as proper spinal management, especially in pt's with a polytraumatic MOI. (I recently learned that term here on emtCity--so thanks!)

I'll be the first to admit that I personally am not the best with splinting, and with all sincerity, I hope I'm not the best in any other areas either. It would be a sad day for EMS. Faux self-loathing aside however:

I agree more should be done in the way of educating students of the importance of pain management and splinting. I'm only familiar with the BLS ways of dealing with orthopedic injuries, so I can't form an educated opinion on if they should be dealt with in any more capacity than BLS. I'll trust the far more educated though that there are likely better ways to deal with said injuries apart from the way BLS is taught.

Speaking of the far more educated: what are some common things that irk you when you see BLS managing orthopedic injuries? Of course within the limited and varied protocols we have to work with, I'd like to do the best I can.

All the best,

B. Anderson

P.S. Asysin2leads, accept my best wishes for a full recovery.