Doczilla

Why fixed bolus dosages for combative pt/RSI rather than a weight based dosing as you have done in trauma?

Concern for overdosage in trauma. Too much ketamine will dick up our neuro exam in a trauma patient if the ketamine is given for pain when the intent is not to knock them out. For the RSI/STI/sedation, there is a wide therapeutic index for the dissociative doses, so we are not as concerned about an overdose.

'zilla

It really is the highest form of flattery, when a criminal enterprise evolves to broaden access to your training program.

Okay, forget the wait list now. It's up to 80.

It seems this will be the only way to get in to the class anymore. We are 20% overbooked both days and 80 on the wait list. But Kate and Anthony, I've got your slots reserved.

We are adding Ketamine this year to the regional protocol for agitated delirium/combative patient. 100mg IV/IN or 500mg IM.

We are also allowing its use in the RSI and sedate to intubate protocols. 100mg IV/IN

A couple of local services (mine) will be using it for pain control in trauma, 0.5mg/kg IV.

'zilla

You'll have to put in your time before you can try out for SWAT. SWAT is a high risk endeavor for police departments/officers/chiefs, and whether you are a sworn officer or not in addition to being a paramedic, you will have to have proven yourself in the street over a few years. The team wants to make sure they are getting someone who makes good calls under pressure, and the only way to demonstrate that is through field experience. Our SWAT medics (they are not sworn) have a minimum of 5 years full time EMS field experience, and most have 10 or more years. For an officer getting on the team, you will have to have put in several years (3-5 years is a common minimum, but it varies by department) on patrol.

Thank you for your service to our nation. At this time of Thanksgiving, I hold dear the sacrifices that those, like you, in uniform have made to ensure our freedom and security.

'zilla

Anthony, you're buying the beer this year.

The wait list is a good way to go. We take several people from the list every year as people cancel.

If you didn't win the EMTCity scholarship or register already, I'm afraid you're too late. We're (over)full.

http://med.wright.edu/em/caplab

It's on, bitches!

Registration opens tomorrow.

Registration opens October 15.

No, it was a copy of ours. We use selective spinal clearance with NEXUS like everyone else, and have for many years. This memo is specifically a back boarding/transport policy.

Job: We've not addressed the n/v thing specifically. We are still log-rolling, but if adequate personnel are at hand, the lift-and-slide is encouraged.

One of our FD LTs is at the NFA this week training. Someone from another state 2 time zones from here showed him a copy of our own spinal memo, and said they were adopting it. I think that is kind of cool, but I'm wondering where they got it from, since I haven't sent it out nationally until tonight.

'zilla

Just steer clear of Michigan stuff and you're good.

No, we had one good year. The others, I was washed, blown, or slid out of the parking lot at the end of the lab.

Yeah, the weather hates the CAP Lab. It can be sunny and 60 degrees the week before or after, but not during. We've endured all kinds of weather for this: snow, sheet ice, howling wind with freezing cold. We talked this year about moving it to a different time of year, but honestly, the local EMS community has come to expect it in November/December. I'm sure that it is doing nothing to improve tourism for the Dayton area, which is actually quite beautiful and sports more park space than any other city its size.

For content updates, watch the Facebook page. But I'll give you a hint at one particular station: think Kathy Bates in "Misery".

Wendy, I'm totally telling Rupi that you said that.

FIRST ANNUAL MINI SOMA CONFERENCE

TUESDAY 18 SEPTEMBER 2012

0800-1600. FT. BRAGG CLUB (LAFAYETTTE ROOM) FT. BRAGG NC

To better serve our SOF medical community located at Ft. Bragg and environs, the SOMA BOD has decided to hold our first annual "mini" SOMA program at Ft. Bragg. The program is open to all SOMA members and non members who have an interest in SOF medicine.

FREE PROGRAM—OPEN TO ALL

The program is free (estimated cost of program is $21 per attendee) but seating is limited so preregistration is strongly suggested. If you pre-register on our site, please show up by 0745, on 18 SEPTEMBER to be first seated. After 0745, any open seats will given to walk in attendees.

FREE LUNCH

Refreshments will be provided during our morning break and we will have a free buffet lunch provided to all attendees from 1200-1300.

FREE CMEs

All attendees will have option to obtain CME/CEUs for attending the full day program. SOMA is in process of applying for 6.5 hours of credit.

FIRST ANNUAL MINI SOMA PROGRAM 18 SEPTEMBER 2012

0800-0815; WELCOME COL Robert Harrington SOMA President

0815-0830; KEYNOTE WELCOME MG Paul LaCamera

0830-0840; WELCOME COL Peter Benson, USASOC Surgeon

0840-0910; TC3 Committee Update. Rick Strayer TCCC Committee Member.

0910-0930; Head Trauma MSG Jered Eldred

0930-0950; Ultrasound Review CPT Bill Vasios

0950-1010; SOF CA Medical Update, MSG Dennis Lyons

1010-1030; BREAK

1030-1050; SOF Med Equipment Update, MSG Kyle Sims

1050-1130; SOCMSSC Update, Win Kerr

1130-1200: SOF Medicine in Perspective, COL. Warner Anderson

1200-1300; FREE BUFFET FOR ALL ATTENDEES

1300-1320; Medical Lessons Learned, 18D, TBA

1320-1350; USASOC Mental Health Issues; Maj. Kim

1350-1420; Military Working Dog Vignettes, Maj. Baker

1420-1440; MARSOC Medical Update, TBA

1440-1500: SOF Dentistry, COL Harrington

1500-1600: USSOCOM CASEVAC Program, Mr. Luciano. With hands on

demonstration of equipment

1600. Program Finish

TO REGISTER:

Go to www.specialoperationsmedicine.org, create an account, and register. YOU DO NOT NEED TO BE A SOMA MEMBER TO ATTEND.

I can't access the video for some reason, so I can only speak about some of the points brought up here and in the article.

The officer's job is to address the threat, which was first the dog, and then later, the angry crowd. Unless he can ensure some amount of scene safety, the medics won't be able to help the patient at all. The police may attempt to render aid, but to do so at the neglect of their police duties in creating a safe scene would be very poor use of resources.

Regarding the shot in a crowded area, there is nothing that is truly cut and dry here. There is the very real and present threat of the dog that has already lunged at people, and there is the theoretical danger of a shot ricochet or fragment harming a bystander. It's a lose-lose situation all the way around; if the dog lunges again and hurts a bystander, the police will be criticized for not shooting him sooner. If a bullet fragment strikes a bystander, they will be criticized for shooting in that crowded environment. I tend to favor addressing the threat that you KNOW is there, rather than a "what if".

I love dogs. I just put my dog down this week, so I really feel for this dog and the owner. But a dog who lunged at police and a bystander is an immediate danger to everyone there, and the right thing to do was to shoot it. That is the fastest way to eliminate the threat.

'zilla

We have a Facebook page now. Content will be updated soon.

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It is in the same class because of similar actions on the cyclooxygenase pathway. Either medication can shunt processing of arachadonic acid through lipoxygenase to create leukotrienes, which cause bronchospasm. This is the reason that the NSAIDs have a precaution when using them in patients with a history of severe asthma.

If the patient says they get short of breath with NSAIDs, I would give a different drug, like Plavix, for suspected acute coronary syndrome. If they said "it upsets my stomach" or "I get nauseated" or "it decreases the strength of the dilaudid", then I wouldn't have a problem giving aspirin for ACS.

'zilla

However, we're talking about the U.S. here, land of the most sophisticated medical system, if I recall correctly...come on, "drug shortage", really, please?!?

Preach it, brother. Unbelievable how in one of the greatest nations on earth with outstanding health care, we can find ourselves wanting for morphine, which has been around for TWO CENTURIES and costs damn near nothing. All because of regulatory crap.

Regarding ketamine as a PCA drug, Bernhard has it right. There are also pain specialists doing ketamine infusions (yes, it's legit) for complex chronic pain syndromes such as reflex sympathetic dystrophy. These infusions are at higher doses than the PCA I think, since you are trying to get the patient into a bit of a twilight and keep them there for about 4 hours. These are often done on an outpatient basis, and have some fairly good outcomes.

'zilla

http://med.wright.edu/em/CAPLab

Registration to open mid October.

Now you have a reason to come to Dayton in the winter.

'zilla