pyroknight

Impending "CLICK" sound.

Why not? If you are suctioning copious amounts of blood from the airway you do NOT have a secure airway, not to mention the problems that you are having with BVM seal even with two-rescuer technique. I do not believe most of the BIAD rescue devices would be acceptable in this case because the hemorrhage could very well be pharyngeal and one could end up bagging blood into the lungs even after airway placement. The LMA is the only device I can think of that might be worth a shot. Whaddaya think?

IMHO, that would depend on your medical director and your protocols plus what you observed in attempt #1. If your protocols require two attempts before calling a failed airway, then a second attempt is in order. If you believe you will be successful, then a second attempt is in order. If you know there is no way in hell you are getting a tube in this guy and you know that your medical director has your back, then skip the second attempt, do not pass go, proceed directly to PERTRACH.

What good will this knowledge do me? If the twelve-lead could differentiate between ovarian cysts and endometriosis would that knowledge assist me in delivering patient care? Even that would be more useful than knowledge of tamponade in a patient with a GCS of 6. I could at least explain to my conscious pelvic pain patient the difference. This organ donor could care less what his diagnosis is. As far as the scenario: I am sure each provider's definition of "copious" varies considerably, but let's assume that copious indicates airway compromise. RSI. If unsuccessful, PERTRACH. Keep the patient warm and get him to a trauma center for harvest.

My last two state symposium topics were seizures (with a lot of information on treatment options, different types, patient rights issues specific to seizures, etc.) and the top twenty prescription medications in the US (indications, contraindications, side effects, interactions, and fun facts). I agree about AMLS. I took it for the first time a few months ago with a very diverse class. We had EMT-Bs who were mostly befuddled, but I believe they did expand their perspectives. I think a smoke inhalation/CO/cyanide class would be good.

I might check a CBG, but I really do not see the point of performing a 12-lead. There are more effective diagnostic tools at the hospital and they might actually be able to DO something about a tamponade.

I am NOT a butt-wiper. Okay, well, I have wiped a couple of butts, oh, never mind. I refuse to bash myself, but Let me tell you PCB, if you DO get a great-looking nurse, you are in pain, and you have to have a procedure involving your "package", you will wish you had nurse Cratchet!

In-line spinal immobilization, intubate, expose, secure to long spine board, initiate emergency transport to nearest trauma facility, and establish two large-bore IVs during transport. The avulsion can be covered with a moist dressing. Notify the receiving facility to prepare for an organ harvest operation.

Pay attention, Dust. He is a FORMER EMT and future chef. His contributions will be in saving palates from boredom, not saving lives.

I am pretty sure the Constitution guarantees each of us certain rights. I would expect that the right to choose your hospital (provided there is a choice, I feel your pain spenac) is one of those rights. I have never worked in a state (and I have worked in four) where patient preference did not trump all protocols unless you could damn well prove beyond a reasonable doubt that the patient was incapable of making their own decisions. If I remember correctly, is there not a federal law requiring health care providers to honor patient preference? Regardless, an educated, coherent patient has the right to make decisions about their health care regardless of what the provider thinks.

They're not clear-handled, but they look pretty cool. Kinda pricey, but cool. http://www.bigshears.com/

Once again economics comes into play. Even agencies fortunate enough to have dual medic crews can likely not afford to pay EMT-Bs to ride third person. If they do not get paid, then they are basically volunteers. We are right back where we started. EMT-Bs, in a perfect world, should get their experience and hone their skills (like building rapport, documentation, and transfer of care) doing interfacility transfers and transporting patients that have been assessed and deemed appropriate for BLS-level care. In an IMperfect world, there are plenty of opportunities for EMT-Bs to get experience and hone their skills while working with a paramedic partner on EMT-B/EMT-P staffed ambulances.

No. It is just more entertaining watching a gluttonous fool spout off than some grass-eating, malnourished pinko. You can easily imagine Mr. Moore dashing back to his trailer as soon as they yell "CUT!" so that he can down a dozen Twinkies and a bucket of KFC Extra Crispy.

Okay, Dust. I am going to stick my head up out of the foxhole here. I would argue it is not about skills OR education - it is about having skills proficiency AND the knowledge (acquired through both education AND experience) to know when to apply those skills. I would rather have a paramedic than a cardiologist insert my IV catheter ANY day. If, heaven forbid, someone I cared about needed intubation, I would absolutely prefer that a paramedic be called upon to perform that skill over a dermatologist. The dermatologist has A LOT more education than the paramedic and he studied all aspects of A&P in medical school, but he does not have the competency in the skill of intubation required to have a respectable likelihood of success. There will always be those individuals who will do the absolute minimum at whatever level they are at. I have told the story on here before of my paramedic partner back when I was an intermediate who rifled through the drug box frantically looking for the Narcan. I reached over and handed him the naloxone and had to firmly reassure him that it was indeed the generic form of the narcotic reversal medication that he was searching for. Education does not ensure competence. BLS transports should be handled by BLS-staffed AMBULANCES. It is a tremendous waste of resources in many systems to have two highly educated, highly trained paramedics trucking granny back and forth to the MRI suite. Every patient should be evaluated by a paramedic, NP, PA, DO, MD, or the like. Those who need continued advanced level care should be transported by ALS, those who need a horizontal taxi can go BLS.

Yeah! What Dust said! Brilliant reply chaser. Apparently posting a reply is not always a positive factor. One can have dozens of diplomas and still be vacuous. As has been noted and discussed many times on these forums, education alone does not make you smart, or competent, or pleasant, or anything else. Education is a tool. Michael Moore is fat. Absolutely zero education is required to observe that. Michael Moore is a babbling idiot. Again, zero education required, but some are blinded by their insistence on supporting a political perspective in the face of overwhelming evidence that their core beliefs are based on false truths. You can lead a (hu)man to the obvious, but you cannot make them accept it.

Now your education REALLY begins!

I spent two years in grad school with a bunch of liberals. I have no problem with liberals, they are often fun to aggravate. Fascists I have less tolerance for because they obviously do not have a clue. Narcissists could care less what I think, so why should I waste my energy? Their obesity or dearth of girth (I amuse myself, lol) is irrelevant. I was merely pointing out the obvious fact that Michael Moore is obese (I think it is obvious that he is mentally challenged as well, but that may have a tinge of opinion). I would agree with three, not two. I was referring to him as a narcissist who happens to also be fascist and liberal. Since all three words can be used as a noun or an adjective, it becomes almost as difficult to understand as how anyone could think that Hillary has a snowball's chance in hell of winning in 08. Was that my outside voice? Damn, I need to keep my internal dialogue to myself.

Warning, the N.O.W. troops have arrived!

In a perfect world, I would LOVE to see two paramedics on every ambulance, a Volvo in every driveway, and fire sprinklers in every home. The world we live in, however, is somewhat less than perfect. It's not just being able to apply the stickers or "stick the thing in the thing", it's about knowing when to do it and doing it without me having to tell you to. I believe being able to coolly assist when someone's life is on the line is a skill. I believe being able to keep your adrenaline in check and provide a smooth ride for the attendant is a skill. I do not believe you can teach any monkey how to perform these skills in an hour or two. I believe that a competent EMT-Basic partner who can think on their own enough to anticipate what I will be asking for next is far superior to an incompetent or inexperienced EMT-P partner who would rather second-guess or question my care than do something helpful.

vs - Stop going off half-cocked. If you have a tackle box or a Pelican case or a soft bag filled with medications, you can pull out each box and read the label or you can KNOW what color some of the medications are. If you are working a code, I would like my EMT partner to know the epinephrine boxes are grey so that when I need an epi, he or she does not have to pull out each drug to find one. How can anyone logically argue that BLS is NOT the majority of what EMS does? For every serious ALS call EMS agencies run 20 or 30 BLS "emergencies". It's all about economics. I live in a community (island, more or less) of 30,000 people. We have zero cardiologists and zero neurologists. If you need sophisticated medical care you fly for nearly three hours. Would it be acceptable for a Cinncinati or a Tucson or a Savannah to not have at least one hospital with a neurologist and a cardiologist on call? No way. Would it be acceptable for those municipalities to have single medic ambulances? Not in my opinion. When you have agencies with call volumes in the double-digits, however, I think a BLS partner is justifiable.

I prefer to call it "protecting my mental health". The term "garbage in - garbage out" comes to mind. If I KNOW someone is a liberal, fascist narcissist, why on Earth would I want to expose myself to the inanity that they spew? If I found watching the mentally-challenged obese in our population expound on topics with no evidence to substantiate their views entertaining, then I guess I would watch it. I know, however, that if I were to subject myself to his diatribe, I would merely leave the theater with a dangerously elevated blood pressure and a burning desire to firebomb a church of scientology (intentionally lower case).

Whether you are an EMT-B or a PhD, people will respect your posts a LOT more if: a) you use spell-check and you use the "preview" button (for crying out loud, people - at least proof-read your replies ONCE - spell-check will not catch substituting "are" for "our")

I had an acute coronary syndrome event in January which gave me the unfortunate opportunity to increase my empathy capacities as both an EMS provider and a nurse. Part of this wonderful experience was my trip to the cath lab. Like an ambulance, my cath lab was staffed by TWO providers. Interestingly, they were trained to different levels of expertise! One cardiologist performed the catheterization and flooded my coronary arteries with radioactive dye then called the second cardiologist (the "interventionist") in to place the stent. Shouldn't ALL cardiologists be trained to the interventionist level? No thank you. Give me the guy who SPECIALIZES in placing the stents. There's still a risk, but I am much less likely to wake up in recovery with the highly experienced guy leaning over my bed explaining to me how there was "a complication" and how they accidentally perfed my LAD and had to cut me open from chin to groin to go in and fix it. There is a place in EMS for EMT-Basics just like there is a place in the cath lab for cardiologists who are not interventionists. In high traffic, metropolitan settings (side note: many of the people who post in here ranting about an "all EMT-P" system remind me of the talking heads at the NREMT who often fail to address the needs of providers outside the populated states in the Northeastern US - one size does not fit all), dual-medic ambulances are completely justified. I would even argue they are the standard of care. When you move your focus out of the urban areas, however, and look at the call volumes in rural settings, the situation becomes much more complicated. I digress. Back to the question at hand - what makes a good basic? A good basic: - remembers that "EMT" is 75% of "EMT-P" and makes sure that good BLS is provided for any "ALS-centric" partners, - knows enough about the paramedic's "job" to allow them to anticipate their partner's needs (set up IV lines, apply electrodes, open the drug box (at least know which drugs are which colors, preferably know what they're used for), - has provided BLS care in the back of an ambulance and knows how to drive so as to provide an environment that is safe to work in, and - does not tolerate anyone with a higher level of credential belittling them. Many, many, MANY years ago when I was an EMT-B, nothing made me more proud than to illustrate my second point. I would stand back, take in the scene, and watch the gaggle of paramedics working on the patient. I would quietly gather the next piece of equipment they would need and hand it to them when they asked (or, usually, shouted) for it.

I vote for REPLACING furosemide with CPAP or BiPAP, not just removing furosemide. I think paramedicmike was partially right. This IS a fluid problem, but it's WHERE the fluid is, not the quantity. PEEP will keep the alveoli open (and the patient oxygenated) until the pump problem can be dealt with AND it will GREATLY reduce the likelihood of the patient requiring intubation. This violates my belief that we thwart Darwin too often as a profession, BUT, by reducing intubations we will reduce nosocomial infections and thereby reduce the number of gomers we send to an early (by a few months?) grave.

I am a member of the EMS steering committee for my fire and rescue department. We brought up the topic of removing furosemide from the rigs earlier this month. It will be brought up again next month and I fully expect we will decide to remove it. In the pre-hospital setting, we feel like the evidence is mounting that it has the potential for harm and little potential to help.