als_medic_uk

I gather this is aimed at children, not EMT's lol, sorry for my Rhetoric. Regards

Glad to hear you have graduated as an EMT, you seem to be making good progress, keep absorbing the information, however, both the white blood cell (WBC) count and the platelet count are increased due to amplified marrow activity, plagiaristic to chronic haemolytic anaemia. Hope you will remember these physiological motions. Regards.

Patients with sickle cell anaemia have baseline [cp] anaemia, that varies in severity, usually the haemoglobin levels are between 6-9 g/L typical. Reticulocyte counts are elevated, which are indicating the new red blood cells being produced to compensate for the destroyed cells - red blood cells die much faster because of this disease. The white blood cell and platelet counts are also on the up, and these cells may also be indicative [relationally] to vaso-occlusion. Regards

We use the Phillips MRX, with all the extras, except the CPR talking option [no need], I am impressed with this defibrillator, unfortunately I have no experience on Zoll defibrillators, but I would imagine that the Phillips is superior. The long battery life is an extra plus for the Phillips, ans it's easy to use menu is another positive enhancement, prior to that defibrillator we used a Ge defibrillator.

I read the BSc(Hons) Paramedical Sciences degree, which is 3 years long and costs $2500 per year (approximate), the course is paramedical science with chemistry, anatomy and physiology/pathophysiology and physics. To complete the course (after 3 years) you must have 30 weeks of clinical practice which includes 15 weeks anesthesiology (hospital) and 15 weeks with LAA (Local Ambulance Authority). It's a great degree which covers both anatomical and clinical emergency medicine, and you have the opportunity to complete an MSc then PhD [MSc - pays you, not much], it might be cheaper for you to come here to study these degree(s), although I am not sure if they are accepted in the US, I would hope they were. Regards

Anatomy and Physiology [Human Biology] is always a step in the right direction, when wanting to increase your medical understanding, the best idea would be to take a night course [if available] of Anatomy and Physiology/Pathophysiology, it is much more interesting to be taught by an experienced professional, rather than trying to do it at home. I have read Anatomy and Physiology to a degree level, and I can whole heartedly say that to gain a better understanding go to a class. Best of luck Regards

Acute Pulmonary Edema is due to an imbalance of the Starling Forces; it is the 'central' point to fluid accumulation in the interstitium and alveolus. Regards Sorry for the delay

First of all oxygen is a diatomic molecule, that has many uses, oxygen therapy as know in the medical field, is the use of oxygen as a drug, for acute and chronic medical purposes, oxygen can be beneficial to a patient when administered as a drug. Although that there could be a case to argue that Oxygen is not a drug, due to the fact that it isn't a chemical compound, it is an element [that exists as a diatomic molecule - due to electron cloud stability], however, it is used as a substance in a medial component, so it can be validly classed as a drug. Oxygen therapy can have a negative impact on a patients condition, although it is not normally withheld. Regards

Methaemoglobinaemia is treated with the use of methylene blue, which reintroduces haemoglobin to its normal oxygen-distributing state.

Capnography has its advantages, when relating to correct endotracheal tube placement and the obvious monitoring of the lungs [condition and efficiency], and yes rather simple to use, however this analytical instrument is not a robotic doctor, it will not tell you how to treat patients. Moreover, it may provide the medical team with more sustainable respiratory indictors, to help maintain successful respirations, I am sure my Philips MRX has this capability, although I have never used it, but may give it a try, I have seen its extensive use in ICU/CCU. It's like when pulse oximetry first came on to the general market [handheld ect.] many people thought of it as a robotic doctor,and yes we are very fortunate for these instruments, they play a vital role in emergency care/surgical care, but I doubt [in our lifetime] we will see a portable AI doctor :-). My opinion if it helps the patient, then why of course, use it, or use both until you feel comfortable! BUT professional training must be a necessity [unless you understands those manuals lol joking] Stay safe and regards

Akroeze: “This wasn't a simple asystole, it was hyperkalemic induced.” I understand that Hyperkalaemia was present, due to acidosis, and yes I can see a reason for using Calcium gluconate if the patient was not asystolic [the Calcium gluconate would not lower the Potassium, but would improve ECG] however the patient was asystolic, and the use for Calcium gluconate as I previously stated is not warranted. Sometimes doctors may over try to resuscitate a patient, and I'm afraid this is what happened, they may have been more successful, if the Calcium Gulonate had been administered prior to asystole. And just to inform you, Sodium bicarbonate is not recommended for treating hyperkalaemia as it fails to lower Potassium serum levels. Regards

Although some doctors still use calcium chloride in the treatment of asystole, it is not supported nor recommended as an effective drug to use when a patient is asystolic. There was [a while ago] a report into the use of calcium chloride [during asystole] and it showed NO effectiveness, they compared it with saline, and the results were both as futile. Most reports have been anecdotal, and have failed to substantiate its effectiveness. Calcium chloride is of no importance in resuscitating obstinate asystole in the pre hospital cardiac arrest setting. So I would just forget you ever heard it :-) if that is possible? Cases Study - APP - BJM - 1992 pp135-149 I looked up the case, of what I remembered, as an avid Journal reader. If anyone is interested?! Oh I am rhetorical today.

If there was a life threatening GI haemorrhage then blood would be present in faeces or via vomit, the patient didn't complain of abdominal quadrant pain or oesophagus pain did she?

Sorry CRT = Cardiac Re-synchronization Therapy, a cardiac pacemaker.

Yes I would be interested in the 12-lead ECG, the 24 hour monitor perhaps is more of a long term cardiac diagnostic tool, not really for the EMS.

The things I am thinking of are dehydration, prolonged bed rest, diabetes or maybe related to an anti-depressants was she taking any?

But it reduces capillary fluid filtration and edema formation, and hence reduces an increase of fluid.

High hydrostatic pressure of the veins, leading to poor reabsorption of fluid is the classical problem for hypervolaemia, hence you need to reduce the proximal pressure, which is what a vasodilator does.

Sorry that wasn't very explanatory, should I say reducing venous pressure decreases proximal capillary hydrostatic pressure, which reduces capillary fluid filtration and edema formation.

Nitroglycerine (NTG) is the most effective medication available for preload reduction. Think of the loop effect when dilating blood vessels.

First of all congestive heart failure will cause an enlarged [and] or pulsatile liver, the dyspnoea is often very worrying, I would have given the vasodilating agent, as people with CHF need to maintain a euvolaemic state and the Nitroglycerine will help this. I would have also given a beta blocker and a positive inotropes. Did this person have a CRT fitted? And no 12 lead, tut tut