chbare

Scaramedic, 1112 Ponderosa Lane City of OZ, 91111 The neighborhood is a middle class area of town. Take care, chbare.

You are snug in your bunk after 16 hours of sitting on your butt watching "General Hospital" reruns. You have not had such a perfect shift, and you start to doze off, and in a dream you finally realize the Sarah is alive and her twin sister seperated at birth is actually the "Phantom Killer." Then, your perfect day is ruined by that evil tone. Your unit is called to the scene of a 64 year old male having chest pain. What would you like to know? Take care, chbare.

AZCEP, thank you. That was my impression as well. I was able to use the Cobra at SLAM earlier this year and I cannot say that I would recommend using it. It looks like even the LMA would provide a better esophageal seal than the Cobra. However, I have not used the Cobra on an actual patient. Now, I will shut up and allow the thread to go back on topic. Take care, chbare.

This may be a little off topic, however, I do not want to start a new thread or bring an old one back for a small question. Does anybody have experience with the cuffed OPA? Take care, chbare.

MrSpykes, Ahhh, the old sulfa and sulfate question. We are talking about two different things. When a patient tells you they are allergic to sulfa, this generally means that they are allergic to sulfa based medications such as the antibiotic Bactrim. Sulfate is a different structure than a sulfonamide. The person is not actually allergic to Sulfur, but rather they are allergic the sulfonamide. I hope this helps. Take care, chbare.

Fiznat, perhaps you are not looking at this in broad enough terms. Antagonism of the parasympathetic nervous system is only one the actions of Benadryl. You must take in to account all of the other physiologic interactions of this medication to fully appreciate some of the other side effects. Please do not fall into the trap of thinking sympathetic = awake and active and parasympathetic = relaxed and "chillin." The sympathetic nervous system reacts to changes in consciousness and to CNS stimuli. So, if I need more energy to wake up and fight that tiger, my brain activates the sympathetic nervous system to help provide more cardiac output, produce and use energy, and redistribute blood to vital organs. I hope this helps. Take care, chbare.

Ace844, I am not sure. I have not heard that Valium is specifically contraindicated. However, in very severe cases benzos may not work and the use of Physostigmine may be required. Here is a good article covering toxicity of antihistamines. http://www.emedicine.com/EMERG/topic38.htm Take care, chbare.

Ridryder911, some of the problems I have seen with a major Benadryl overdose included,seizures, altered mental status, and ECG changes. I have heard that hyperpyrexia can occur as well. Benadryl can have class Ia cardiac activities so, you may see BBB, QT prolongation, other associated ECG changes. These would be in addition the the other Atropine like effects of Benadryl. Take care, chbare.

GBCFire192, that depends on what your team commander or command requires. I would say get a little experience as a street medic before specializing in tactical medicine. National registry does not recognize the various forms of tactical medic certification. If you obtain CE's that are CECBEMS approved, the education can count toward State or NREMT reregistration. Some tac med courses may require NREMT or state EMT credentials however. If you want to learn to shoot and manipulate your weapon, (tac loads, NSR's, emergency reloads, controlled pairs, presentation, mind set, basic tactics, hammers, basic movement, and other drills) Gunsite tactical medicine or a similar school may be helpful. (very expensive) If you want more intelligence, planning, and a general overview of tactical medicine, I recommend CONTOMS. CONTOMS requires affiliation with some kind of team and NREMT credentials and slots are at a premium. I would still recommend solid street medic experience. This is where you will learn how to be a medic. Then, you can worry about learning to be a tactical medic. Just my opinion however. Welcome to the city. Take care, chbare.

33mongo, do a thread search on "rescue devices, the good, the bad, and the ugly", "to combi tube or not to combitube," and "LMA." You should find a wealth of info on the LMA in these threads. I have used the LMA in the ER and I have had great success with it as a back up device. It is hard to secure and is prone to displacement and may not be the best device in the field. An interesting development is many experts are now recommending good BLS over advanced airway placement. Even ACLS is recommending you carefully consider the placement of an advanced airway device in a code. (not that ACLS is the absolute authority on airway management) Take care, chbare.

NREMT-Basic, I agree. Now, go get me some coffee. Take care. chbare.

Ace844, good thread. The history and physical exam is a dying art. Take care, chbare.

Ghurty, it sounds like vasovagal syncope. Take care, chbare.

Unfortunately, medicine can attract type A people with all kinds of personality flaws. I have seen nurses as well as other providers develop a condescending attitude toward students. We should never forget where we came from. It is too bad that these people are able to ruin a clinical experience for a student. This is my take on students. As an RN I am responsible and held accountable for the actions of my co workers and students. I have no problem with students, however, I have been told I am a little harder than other nurses. If a students is going to perform a procedure or give a med, I will quiz them and require them to convince me that they know how the med works and what problems to expect regarding the med/procedure. This is to ensure that they know what they are doing and to ensure that the patient does not receive poor care. For example, if you are going to give a patient toradol, you will have to tell me more than "it is for pain." I want some basic patient history to include allergies and will want you to tell me how the medicine is thought to work and common problems associated with giving this med. I also make sure to keep close and available while the student is performing a procedure. As far as grunt work goes, I do not believe that students should have to do this kind of stuff. (help with grunt work but not do it all) If one of my patients is incontinent I may ask a student to help me, but it is my job to clean my patient up. Just my take on students. Take care, chbare.

Here is a link to an abstract on this device. You will have to log in for the full article. http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract Take care, chbare.

Ridryder911, you may be on to something. Most of the sick kids I see are brought into the ER by family and not by EMS. Perhaps this is because the little critters compensate so well and do not look too bad to the family, but are actually knocking on deaths door. Most of the kids that come in by EMS are BS cases from Mexico and kids from fender benders where the parents get taken to the hospital. However, when EMS brings in a sick kid, that kid is usually critical. Take care, chbare.

Vs-eh, that was my thinking along with Ridryder911. The solution is initially isotonic upon infusion. Then, as the dextrose is taken into the cell, the tonicity of the solution changes. Hypotonic water is left behind and the water wants to shift with it's gradient possibly promoting transport of the medication. Perhaps this is changed by the fact that a medication is mixed in the solution. I guess the quickest and easiest answer for using D5W as a delivery vehicle for some medications is because they will mix are there are no problems with compatibility. Take care, chbare.

:puke: Take care, chbare.

FL_Medic, ACE844 beat me to the punch on the links. He posted the same link on the "body armor" thread that he did on this thread. I was trying to direct you to that link. I think there are a couple more links to other sources of information on the "body armor" thread however. Take care, chbare.

FL_Medic, check this thread out. http://www.emtcity.com/phpBB2/viewtopic.php?t=3111 The armor I wear is IIa, I would recommend IIIa for people in the field. (Yes, I should upgrade.) So, I would not really recommend it for EMS use. Take care, chbare.

I went with, "2.) Standardinzed accredation and Educational standards for EMS professionals and educational institutions." I agree with AZCEP that a clear goal of an educational program must be established. Education is the key. I think that licensing is very important as well. This is the opinion of a non paramedic however. Take care, chbare.

I figured something as asinine as a uniform guideline would get in the way. It is ok to wear cool guy EMT pants packed with hundreds of dollars of toys but heaven forbid we let our front line providers wear the proper personal protective equipment. Change the guideline. I wear a vest under my scrubs and most people have no idea that I am wearing armor. If you are going into a scene that police officers have cleared with firearms or may need to be called, you should at least have some chance of surviving long enough to get out or call for help. You can tell management that you will look real cool for the public laying dead on the ground in your department issued tee shirt. Take care, chbare.

"Perhaps if you don't wear it you may consider this a sign of the need for body armor..Just a thought, ACE844" ACE844, you bring up a good point. How many EMT's wear body armor? In many cases they are entering and working in many situations that may have the potential for violence. Many of the new vests offer good ballistic protection, are light and inconspicuous, and affordable. (People can blow $400.00 of their own money on a personal pulse oximeter.) Take care, chbare.

In the ER we would perform supportive care and monitoring in addition to the prehospital treatments already talked about. The patient would have labs drawn. (CBC, CMP, UDS, ASA, APAP, ETOH, HCG) We would probably do a base line 12 EKG and base other tests around this "toxic workup" and the patients hemodynamic status. If the patients condition and time allowed, Activated Charcoal would probably be given and the patient would be admitted to ICU for monitoring. Take care, chbare.

52 year old female presents to the er C/O pain to her tailbone. States she sat on the metal part of a seat belt one week ago while cleaning out her car and her tailbone is still hurting. X ray negative. :roll: Take care, chbare.