Ridryder 911

Basically a saline locke (formally known as a Heparin locke) is a small IV tubing with a port attached & clamp device, that attaches to the IV catheter. It is flushed with 3-10 ml of saline solution to prevent clottage. Acess can be obtained to it any point. Be safe, Ridryder 911

Thought it would be interesting to see what folks prefer or have access to. Of course we know we hang fluids on Trauma & Hypovelemic, Dehydrated patient. This is pertaining to medical calls

My company supplies to the e local "vollies" for their rig or squad... it is frowned upon to give supplies to individuals. We also, do not encourage private "medics" at the scene, unless they are associated with some agency. Be safe, Ridryder 911

Tunnel why are we bumping "so old a threads ?".. Ridryder 911

I would definitely, keep reminding them. It is a shame that a program was conducted in such a malicious manner. I am also surprised that school administration is not able to help you, since this was conducted in their school. Be sure to keep a paper trail, with times, names, discussion(s) of phone calls, & copies of transcribing events. God luck, Ridryder 911

Didi you talk to the school administration ? You need to follow the "chain of command" & file grievance. If this does not work , contact the State, the need to do a fromal investigation. If you do not get your questions answered I would consider possible legal action. Be safe, Ridryder 911

If your asking this I presume you are probably new to the field. Yes, we all have had such feelings. You will find out with time, that we really do not change fate. If is is for the person to die, it will happen no matter what we or anybody does... of course our job is to be sure all preventable measures was taken.... good luck..I suggest talking to an veteran medic privately & discuss this . Good luck, Ridryder 911

I am sure Steven, will be able to fill in the guess work on this one... Ridryder 911

thought this spark some debate... Studies Trials Abstracts Giving oxygen may do more harm than good, new report shows By Jul 11, 2005, 12:13 Courtesy the EMS House of DeFrance http://www.defrance.org Doctors and paramedics who give their patients oxygen – the most commonly administered "drug" in the world – may be doing more harm than good, a Queen's University researcher contends. And although there's a simple solution – adding carbon dioxide to the mix – it isn't being used by most Canadian hospitals and emergency services networks, says Dr. Steve Iscoe, a respiratory physiologist. This has implications for treating a number of serious health conditions, including heart disease, stroke, diabetes, difficult labour and delivery, and wound healing. Dr. Iscoe's commentary, based on his own and other researchers' findings, is published in the July issue of CHEST, the Cardiopulmonary and Critical Care Journal. Co-author of the article is Dr. Joseph Fisher, from the Toronto General Hospital's Department of Anesthesia. "Pure oxygen can reduce blood flow to organs and tissues by increasing ventilation," Dr. Iscoe explains. "The increase in ventilation, which is almost never considered, 'blows off' carbon dioxide, and this fall constricts blood vessels. When carbon dioxide is added, however, the blood vessels dilate, increasing blood flow and causing more oxygen to reach tissues in key areas like the brain and heart." Researchers in the early 1900s observed that breathing pure oxygen increased ventilation and lowered carbon dioxide levels. Based on their observations, several tried adding carbon dioxide and claimed success in resuscitating people and infants and treating carbon monoxide poisoning. But the practice of using expired air – even before it was known to contain carbon dioxide – dates back much further. The use of mouth-to-mouth resuscitation on infants was recorded in a 1754 book by Benjamin Pugh, A Treatise of Midwifery, and there are biblical references to the custom. Yet modern medical texts do not mention that inhalation of oxygen decreases carbon dioxide levels and the effects on blood flow; consequently it is not part of standard practice. "It's puzzling that a simple idea like this has received so little attention from clinicians," says Dr. Iscoe. Although there has been some concern about the possibility of patients receiving too much carbon dioxide (which can cause discomfort), he points out that new designs for oxygen masks allow precise monitoring of levels delivered or, in fail-safe mode, prevent inhalation of carbon dioxide. One can even use the patient's own expired carbon dioxide, the researcher adds. "The reduction in oxygen delivery to the fetus, the brain, the heart, and other body tissues that might be induced by oxygen administration is, as this paper points out, largely unrecognized even by respirologists such as myself," says Dr. Peter Macklem, professor emeritus of medicine at McGill University and 1999 recipient of the prestigious Gairdner Foundation Wightman Award for outstanding leadership in medicine and medical science. "If we respirologists are unaware, then internists, surgeons, obstetricians, pediatricians and family physicians who are at the front line of treatment for most of the clinical conditions they describe are unlikely to be better informed," Dr. Macklem continues. "The magnitude of the risk now needs to be quantified by appropriate clinical trials. While it will take a few years before we will know for sure, the wisest course of action in the interim is to administer low concentrations of carbon dioxide along with oxygen therapy." Among the areas where Drs. Iscoe and Fisher see particular benefits for patients from improved oxygen delivery are: heart attack; stroke; carbon monoxide poisoning; wound healing in hospitals, where drug-resistant infections are on the rise; cerebral blood flow to fetuses during difficult birth procedures; and treating foot ulcers and gangrene in people with type 2 diabetes. Dr. Iscoe hopes to evaluate the promise of the new technique in a study of diabetic patients. As the incidence of obesity rises, diabetes is expected to affect a growing number of people and exert increasing demands on the health care system. "I think it's incumbent on health professionals to consider carbon dioxide when administering oxygen, since we know that carbon dioxide levels control blood flow to so many parts of the body," Dr. Iscoe says. "We should look at carbon dioxide not as an enemy, but as an ally." ### Funding for Dr. Iscoe's research comes from the Canadian Institutes for Health Research, the Canadian Lung Association and Ontario Thoracic Society, and from the Wm. M. Spear Foundation and the R.K. Start Memorial Fund. First of all, Dr. there has been masks invented before you were probably a physician called venturi.. that allowed ambient room air to mix. Also do you really ever get "pure" oxygen if with non-rebreather mask, that mixes C02 .. hmm, never seen that study either. Also they do have oxygen therapy for diabetic ulceration using oxygen... it's called hyperbaric chambers (HBO) duh... Looks like another scientist spending Canada's $$$ to make a name for himself... without really investigating products used or out there. Where are we getting these so-called scientist ? Be safe, Ridrder 911

Actually, there have been several cases of where mother was in full arrest & emergency C-section was performed. I am glad it was successful, it took large gonads to do so. If the outcome was not as bright, we might be reading a different report. This does remind of a call where a Paramedic called to do a C-section on a traumatic arrest.. after lengthy debate.. & unable to detect fetal heart tones.. was denied... fortunately.. the woman was NOT pregnant, just obese....oops! Be safe, Ridryder 911

I agree with you too, on some points. I too would administer diazepam on some active seizing patients.. like I said.. both are correct. I myself, personally do not like administering Glucagon over Dextrose. I find Dextrose to be more rapidly adsorbed. This way I am also, aware of amount of glucose is given for comparison of baseline. Again, this just my personal bias. I do like Glucagon for the no IV accessibility's patients. I have found Versed nasal atomizer to stop most seizure activity & now is my preferred med for such. With this route, an IV access does not have to be obtained. Studies has also shown that absorption time is about or may be greater than IV route. I like the half-life time of the medication, so that Nero eval can be performed in timely manner. Ridryder 911

Asysin2leads also remember, the seizure is just the symptoms of the underlying true problem. True seizures are dangerous, the brain without glucose is as well too... remember glucose to the brain ..for metabolizing, without such can also cause major brain problems ... It is a double edge sword... I truly believe either one would be appropriate. I would hope, administering glucose would stop the seizure activity, & thus resolve the problem as well as not having to deal with a sedative. Be safe, Ridryder 911

We work 24 hr shifts & have an average of about 15-18 calls per truck, the problem is our call lengths are > 30 minutes due to rural area. We allow the crew to "nap" as much as possible. Sleep deprivation studies have prove to be as fatal as intoxicated drivers. I highly suggest it may be time to contact OSHA, Federal Wage & Labor Board for possible insight. Be safe, Ridryder 911

I also agree.. either a possible psychogenic reaction or even maybe a panic attack.." Be safe, Ridryder 911

Because, some states say you can not legally tell alcohol odor on someones breath ... it could be other sources. So I chart " of ETOH smell" or "fruity odor"... if they admit to drinking.. I document "patient admits intake of alcohol beverage"... So check local laws & policies.. be safe, Ridryder 911

You did the right & legal thing .. may be even protecting your own medical license. Why feel bad.. the jerk had ETOH, he is responsible for it not you. If he does not pass the sobriety test or breath analyzer.. he will not be arrested. Would you had felt better if he had drove & had another MVA or slaughtered a family ? You did not place him behind the wheel, again responsibility. I personally do not change my care for drunk driver... but, I sure do not have any extra compassion.. personally, I have seen too many wipe out families. I f I see possible drunk drivers on the highway or reckless behavior I report them to the Police as soon as possible. You would not want to know.. how I wish justice could be served to them... Be safe, Ridryder 911

Welcome to the forum. I would contact your administration, of the school. If you do not receive an appropriate answer, I would then contact the EMS Licensing/certification bureau of your state for investigation. Sounds like he is trying the "old I pass only those that pass the cert's" game to keep his pass percentage high. Be sure to leave a paper trail, with whom, when & what was said. Best of Luck, Ridryder 911

I like Physio/Medtronic LP12.. too much artifact in Zoll (12 lead), also all the ER's here use Phsio control so quick connect is easy to change. Had nothing but bad service here..with Zoll's Be safe, Ridryder 911

Not only 1985, .. but last posted March 2005. I got excited I thought Whelson was back... man you must had dug through some old post... Ridryder 911

Probably greater than > 85 % of our calls are really non-life threatening. These of course are called in 911. We also have a transport truck for wheel-chair etc.. Before medics ramp & rage... although I do too.. let us remember do we educate the public, on the needs & when to call for emergency services. I suggests public service ads for "What to Do" ads, such as when to call .. what defines an emergency, even what to do when an emergency vehicle approaches .... Be safe, Ridryder 911

Here is my 2 cents worth.. if this not a usual habit, I tell him ....need to go home now... tell him you are helping him this time. He can deal either PDO or whatever. If he refuses, tell him you have no other choice than to contact supervisor. Would you do the same action for someone on cold remedy medicine ? Be safe, Ridryder 911

With all the recent posts, regarding alcohol & substance abuse. I thought it would be an interesting debate to see what you would do. You are at shift change, your relief comes in somber looking & you inquire "Whats wrong ?" He informs you that "he partied all shift off.. & did not get into bed until about 5 hrs prior to shift change." You do not smell obvious alcohol on his breath, and notice no unstable gait or loss of hand eye co-ordination skills with his movements.. you do smell of hint of alcohol with his perspiration. NOT WHAT YOU SHOULD DO ,..... BUT WHAT WOULD YOU DO ? Be honest... I am sure many of you have been in this dilemma before. Let the debate begin.... Ridryder 911

Will the number of compressions really matter if we are performing in-effective compressions ? Studies Trials Abstracts CPR often done inadequately by doctors, paramedics, studies suggest By Jan 18, 2005, 14:43 Courtesy the EMS House of DeFrance http://www.defrance.org CPR is often performed inadequately by doctors, paramedics and nurses, according to two studies of resuscitation efforts during cardiac arrest. Whether a stricken patient is in the hospital or on the way, the guidelines for administering cardiopulmonary resuscitation frequently are not followed. Among the problems commonly cited: Rescuers did not push hard enough or frequently enough on the victim's chest to restart the heart, and breathed air into the lungs too often — either mouth-to-mouth or through breathing tubes. Both studies used an experimental monitor that assesses CPR quality, and both received funding from Laerdal Medical Corp., a Norwegian company that developed the device with Philips Medical Systems. The studies appear in Wednesday's Journal of the American Medical Association. The researchers explained that skills learned in the classroom can fall by the wayside in the stress-filled chaos of a real-life emergency. Also, they noted that chest compressions strong enough to break ribs are sometimes required, and rescuers can tire quickly. In one of the studies, involving 67 adult patients at the University of Chicago, doctors and nurses failed to follow at least one CPR guideline 80 percent of the time. Failure to follow several guidelines was common. "Patients who had it perfectly done were in the distinct minority," said Dr. Benjamin Abella, one of the researchers. The other study involved 176 adults with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden; Akershus, Norway; and London. Chest compressions were done only half the time, and most were too shallow. More than 600,000 people die from sudden cardiac arrest each year in North America and Europe. The heart suddenly stops beating, either because of a heart attack or other underlying heart disease. The combination heart monitor and defibrillator used in the studies includes a small sensor that attaches to the patient's chest and evaluates depth of chest compressions and other aspects of CPR. The monitor includes an automated voice that provides on-the-spot coaching, telling rescuers when chest compressions are not strong enough or frequent enough. But that feature was not used during the studies. Both studies were too small to determine whether using the device saved lives, but the Chicago researchers said it could improve patients' survival chances. "Without a device that gives you feedback in the heat of the moment, you can't drive an airplane that way — and we can't take care of sick critical patients without the appropriate monitors," said the study's leader, Dr. Lance Becker, director of the university's emergency resuscitation research center. The device is approved for experimental use in the United States, and the manufacturer is seeking Food and Drug Administration permission to sell it commercially in this country. While other studies have found CPR techniques lacking, the JAMA studies are the first using a monitor to evaluate "what's going on during real cardiac arrests and in real people," said American Heart Association spokesman Vinay Nadkarni. "It's outstanding information." The studies will be taken up at a medical conference next week in Dallas that could lead to an update of the CPR guidelines, Nadkarni said. The studies add to evidence that the guidelines need to be simplified so that they "can be readily used in the real world," Drs. Gordon Ewy and Arthur Sanders, emergency medicine specialists at the University of Arizona, said in an accompanying editorial. Be safe, Ridryder 911

Personally, I would administer the D50W.. first treating the etiology.. hopefully, this will stop the seizures. If not then Valium, to prevent the status portion.. yes, this is a life threatening emergency. I personally, like Versed (nasal atomizer) I have better success with cessation of seizures. If I was unable to obtain a line, I would administer the Versed.. stop the seizures, then administer the D50W. Glucagon is a good medication, but is not adsorbed as rapidly as D50W.. recheck glucose then consider glucagon I.M, with D50W I.V., if glucose is still to low. Be safe, Ridryder 911

Damn... you & Steven have more than my Critical Care Rig does... or for that goes.. my Trauma Ctr..does...LOL Be safe, Ridryder 911