THE_DITCH_DOCTOR

By the way, speaking as the staff RT here, , a CPAP unit is not a ventilator. Yes, CPAP is a mode of ventilation but it technically does not ventilate the patient. A BiPAP unit is akin to a pressure ventilator because you can set an inspiratory time and pressure, over the EPAP setting. If push comes to shove (you have NO other choice) you can actually ventilate an apneic patient using some BiPAP machines (either non-invasively (by mask) or after the patient is intubated; but the machine MUST have a time setting in order to set the RR), you can not ventilate an apneic patient with CPAP. For the benefit of those who don't work with ventilators or CPAP and BiPAP on a regular basis, CPAP has one pressure setting- measured in cmH20. BiPAP (bilevel positive airway pressure) has two settings- for instance 12/5, also measured in cmH20. The first number is the inspiratory positive airway pressure (the maximum pressure being delivered (akin to the systolic pressure in BP readings) and the second number is the EPAP- expiratory positive airway pressure) is the same thing physiologically as CPAP. It is the lowest pressure that occurs during the cycle with a level of 0 indicating ambient (atmospheric pressure). EPAP or CPAP is also the same thing as positive end expiratory pressure (PEEP) which is a term used in other modes of mechanical ventilation). Also Pigginsick, have you read any of the studies stating that atrial fib is a relative contraindication to the use of CPAP, as the increase in intrathoracic pressure that accompanies CPAP usage can impair venous return and can drop cardiac output, thereby decreasing BP. It's not a reason to withhold needed care, just a very good reason to be cautious and not overly aggressive.

Probably the albuterol is responsible for the rapid ventricular rate, but the underlying AFib is probably the result of the pulmonary congestion or as a secondary effect of another underlying condition like COPD. High doses of albuterol can cause arrhythmias in anyone, but that's not what's happening here.

Tough call.....I would have held off on the NTG because when you bottom out a RV infarct patient's BP, it tends to be hard and very quick. I would have gotten on the radio and consulted with a doc before proceeding with the NTG. No 12-lead? Ouch.....

Crap....I need to go up there.

He tried to pull that with me when I first started on this site, Asys. New....yeah, sure.....granted I don't have Rid's or Buddha's level of experience but I'm pretty far removed from being a wide-eyed newbie. I get the feeling that 1EMT-P and Ace844 are the Kings of Cut and Paste posting. :roll: Reading their posts reminds me of reading the little bullets of information you find smattered around various websites about health care......Hmmmmmm...... :?

"69-Baker (one of Terre Haute PD's units) respond to the Drury Inn, report of a large snapping turtle on the move across the parking lot. Caller advises people are out there poking at it with a broomstick." "Rescue 12, Engine 12, Medic 3, respond to -----------------, the pond to the left of the driveway for a shark attack." :shock: Mind you, this is Indiana.....This is how the call that has since become known among the old gang in the chat room as "Chomper's Day at the Pond". Turned out to be a snapping turtle bite.

Just a few minutes ago, I heard the following on the sheriff's dept frequency: "Unit 89, Unit 74, respond to Walmart on a report of a 10-10 verbal (argument) between a woman and a seven year old. RP (reporting party) reports that it appears the 7 year old is winning" Anyone else have any good ones?

Nice to see that even doctors are not exempt from the simple pleasure of postwhoring

Jeez, Asys, I agree with your statement that protocols say that- our protocols as EMT-I's say the same thing (seeing as we deliver basically paramedic level trauma care (intubation, IV, needle decomp when called for, etc). Don't treat me like some dumbass BLS provider, because I'm not. I'm sorry if I caught you on a bad day but damn, I didn't need my ass excoriated because of it. I hope the rest of your day goes better.

How's this for evolutionary theory: this thread has failed to prove itself worthy of continuation and has been selected for extinction. Who are we to stand in the way of the natural order of things?

ALS is a luxury on trauma scenes. Nothing more, nothing less. How does having someone who "knows more" which is really questionable in many cases, not beneficial? Ever looked at scene times? Paramedics are far more likely to sit on scene and dick around trying to start IV's and secure an airway, etc. The point is that until such time as we start putting trauma surgeons in the back of ambulances, the ONLY treatment for trauma in the field is and will remain rapid transport with airway management and MAYBE IV access (access, different from fluid resuscitation) EN ROUTE. Yes, the survival rates for intubated trauma patients are miserable, but that's to be expected because of how bad things have to get before you need to insert an invasive airway- many of those patients have significant head trauma and we all know what the consequences of that are. And what is wrong with statistics? You only have a problem with these particular statistics because they contradict what you believe. Period.

8 pages. F--- you Tibby for starting this. Just kidding. I do think this thread has about run it's course though.....

Airway management review of ALL options, not just intubation. CPAP and BiPAP EKG recognition "Disease/Disorder" of the Month (I used to do these at a service I worked for and they were quite popular- we had people coming in from other services for them.)

I hate to break it to you Dix, but chickens aren't made in factories.

Nicely said Dixie......By the way, congrats on your cert.

But the point is to open more doors. That's why we're advocating for the increased educational requirements.

Versed = midazolam Ativan = lorazepam Both benzodiazepine anticonvulsants and sedatives

Try being someone who planned on being a minister then had a "falling out" with God and then became an atheist... People always tried to bring me "back into the fold" but it never worked....I could just ream them with great effectiveness. By the way, I am now a churchgoer again....albeit I am far more skeptical than I once was. Oh, about the evolution thing....I believe in it.

I'm not saying it hurts, just wondering HOW it works- whether it is the power of suggestion or really some effect of the medication. That's all. This questioning stems from the fact that many COPD patients have more of an emphysema component (tissue destruction and loss of elasticity leading to air trapping) than they do the bronchospastic effects of asthma. On either hand, remember the study is discussing patients who are having no overt wheezing and therefore are likely to be presenting with less bronchospasm and a greater degree of other issues. By the way, one needs to remember that in common use, COPD is an umbrella term encompassing a myriad of diseases and it really depends upon who you ask which fall into this category. The ones I was taught in school were: -Emphysema (your "classic" COPD patient) -Chronic bronchitis -Asthma -Cystic fibrosis -Bronchiolitis obliterans -Bronchiectasis Specifically speaking, in the eyes of the American Thoracic Society and the authors of the leading RT textbook (Egan's), COPD is technically emphysema combined with chronic bronchitis- airway hyperreactivity ("asthma") is a secondary, additional finding that is not present in all (or according to some- not even most) COPD cases. Technically, asthma is no longer considered to be part of "proper" COPD, but when they occur together it is referred to as "asthmatic COPD". There are also "asthmatic forms" of bronchitis. Remember, that when emphysema or bronchitis occur alone (without the other) the patient does not have COPD.

As a rural volunteer EMT in the US, I think my background in this field has made me even MORE a staunch advocate of increasing the educational requirements. I'd personally like to yank the certifications of roughly one-third of the EMT's and medics I know or have worked with for lack of intelligence or an ability to function effectively. It's time that before you advocate holding the field back to keep the numbers of new people high, then perhaps you should look at a qualitative measure of the personnel in rural America, as opposed to being concerned with simply maintaining warm bodies on the rigs- otherwise, you are likely to continue to see the number of cold bodies arriving at the hospital in those rigs not change much.

Associates degree = "Community college learner's permit"

Since nursing was brought up, why do you think nurses get paid so much? Because they have to go through so much crap to get their nursing credential, that a lot of people are weeded out, there is a greater demand than supply and therefore they create a situation where they are needed and can demand what they want. Without the degree, nurses would be getting paid just like EMS is currently. And as for the "volunteer" problem, you know what? Perhaps rural communities should just remain as BLS operations- no one demands that there be volunteer paramedics (Need I remind you all that in many cases ALS has been proved to be little or no benefit?).

Personally I think those who voted that more education is a bad thing should have to defend their reasoning. We've stated why it's a good idea, now let us hear why it is a bad idea.

So you're saying we should except morons, egomaniacs, and assorted whackjobs simply because we can not recruit the intelligent, the humble and mentally sound? Nice theory Tibbs.

Yes, the EMS "herd" needs to be thinned....but at the same time I don't take the attitude that the "load and go" scenario needs to be done away with in it's entirety. There are far too many wannabes in this field and one of the quickest ways to eliminate this problem would be to increase the education requirements.