chbare

Thought I would give the up and coming EMT's a little more information on cellular respiration. The following is a link to a web site that give you an easy to understand introduction to glycolysis, TCA/Krebs/citric acid cycle, and the ETS. I was talking with an EMT I student the other night about these cycles and he was very interested to learn more. His text book only had a couple of paragraphs that did not even explain the basics of we make energy, and I even remember a sentence stating that knowing the exact processes were not important at this level. We spent a few hours talking about these cycles and at the end he looked up and stated, "so all of this only explains how you turn ADP into ATP, there must be millions of things going on inside of every single cell." Yep, but this is a start. He ended up finding this site as a resource to help him learn. I hope this will dispel some nasty thoughts people have about cellular respiration.

http://www.bbc.co.uk/scotland/education/bi...tion2_rev.shtml

1) You breath in O2 and it is turned into CO2. As you can see, CO2 is produced during the break down of pyruvic acid and O2 is actually used in the ETS and binds with hydrogen to produce H2O.

2)All of this cell stuff is not important. Then all of that airway and shock stuff that we learn must not be important. The reason we need to have an airway and adequate gas exchange along with an intact circulatory system is to ensure cellular respiration takes place.

I hope people find this helpful.

Take care,

chbare.

Ridryder 911, thanks for your post. I hope allot of people read it. Licensure is required for a profession. I hope more people see this and realize that states need to strongly consider going to licensure. I am sure this could be arguable, however, most people recognized as a professional are licensed and not certified. (physicians, pilots, nurses, teachers, etc) Every other profession requires state licensure why not EMS?

Take care,

chbare.

Sasha, no history of a hanging or haunting at the station I worked at as an EMT. However, I have had fellow coworkers swear that strange things have occurred in the er. Two people that I work with were charting at the nurses station when they both herd a scream followed by incoherent words come from one of our open bays. There were 3 patients in the room and they denied screaming or hearing anything. I have also had fellow coworkers talk about hearing strange voices especially after really bad codes and one person states she felt someone grabbing her shoulder after the doc pronounced a trauma code. These are all respectable people and I do not think they would lie, however, all of these incidents have occurred at night or early morning during or after a stressful situation. So, you combine stress, fatigue, and lots of caffeine and who knows. I have never experienced anything strange or paranormal. Not to say that I do not believe in something beyond our world, I just do not have any personal experiences.

Take care,

chbare.

Ridryder 911, :shock: WTF :?:. With a printed out strip of the wave form and good Et CO2 values?

Take care,

chbare.

:laughing3:

Take care,

chbare.

PRPGfirerescuetech, there are no rules when it comes to ballistics. I am glad you enjoyed the scenario.

Take care,

chbare.

This was a pretty unusual case. Here is the story. The guy was a few days out of prison and ran into a few people that did not like him. I believe it was related to a drug debt. His friends attempted to knee cap him and shot him in the area of his knee. In addition, he took a round to the chest. The bullet that hit him in the chest contoured the third rib and exited out of his axilla. Unfortunately, the bullet intended to knee cap him went through his leg and tore through the popliteal artery. Ballistics is a strange thing.

Take care,

chbare.

Asysin2leads, good point. I will agree that anything other than 1mg/kg of divine intervention IVP will probably not help the person who has been in arrest r/t a massive MI or trauma, or the guy who has been in asystole with no correctable causes for 20 minutes. However, in critical patients that are on their way to code land, ALS and meds may very well be life saving. The head injured obese guy with a bad airway is a good example. Other examples could be that bad CHF guy with a long transport or somebody in a third degree AVB who is circling the drain. In addition, what about an often underlooked and undertreated problem? What about pain control?

Take care,

chbare.

AZCEP, you cut the rest of his clothing off and note that the pants and several layers of long johns are blood soaked. You find a small wound to the anterior aspect of the patients left knee. The wound is just inferior to the patella. You also note a larger profusely bleeding wound to the posterior aspect of the knee. You are able to stop the bleeding with direct pressure and elevation. A pressure dressing is applied and no further bleeding is noted. You are correct, all of chbare's ambulances in the land of Oz are the epitome of cool guy.

Take care,

chbare.

Good conversation everybody. It just so happens that you have a cool guy ambulance that blocks out all background noise. The heart sounds are not muffled and the lungs are clear throughout all of the lobes. The BGL is 102. You notice blood on the floor of the ambulance however.

Take care,

chbare.

AZCEP, you do not note any JVD. There are clear lung sounds with equal and bilateral expansion noted with ventilations. A dressing is placed over the small wound to the sternum, you also note what looks to be a slightly larger wound under the left axilla where you saw the blood earlier. It is slightly larger than the wound to the sternum and you suspect this may be an exit wound. You place a dressing over this wound as well. The patient is intubated with an 8.0 ETT and placement is confirmed. You note very good compliance with ventilations. Two large bore peripheral IV life lines are placed and the patient receives a bolus of NS. After the fluid you do not note any change in his mental or hemodynamic status other than a very weak pulse of 130. Transport time is 30 minutes.

Take care,

chbare.

AZCEP, it is cold outside , so the patient is in heavy clothing, but the basic crew cut the patients coat and shirt off. You note a small round hole to the center of the sternum. (about 1.5 cm in diameter) There is a scant amount of bleeding oozing from the hole. You also note a small amount of blood just under the left axilla. GCS; E-1, V-1, M-1. You palpate a very weak radial pulse of 128. The EMT-B bagging reports that it is very easy to ventilate, another EMT-B is holding the mask and it looks like he is doing a good job of maintaining an adequate seal.

Take care,

chbare.

You are called to the scene of a shooting. Dispatch informs you that there is a 43 year old male with a GSW to his chest. You arrive on scene and note that police have it secured. There is a BLS crew on scene rendering care to the patient. The patient has just been loaded in the back of their ambulance and it looks like they are bagging him. What else would you like to know?

Take care,

chbare.

Krj00, I do not think that you could say head injury is a contraindication for polyheme use at this point in time. (It is not even approved yet, so I guess you could also argue that there are no indications for using polyheme.) I believe that a patient with a severe head injury is excluded form the study. (exclusion criteria) Additional studies may show polyheme is good for a head injury, who knows. I think the second part of your question may be closer to why severe head injury patients are excluded from the study.

Take care,

chbare.

Dustdevil, that trend seems consistent over in my area as well. We have had 4 paramedics, 1 RT, and 1 LPN try completing nursing school this way. They started about 2 years ago. Everybody with the exception of the LPN dropped out. The LPN is still in the program and expected to finished his "accelerated clinical" in July 2006. We have had 1 other paramedic enroll in a 2 year nursing program. He is expected to graduate in December of 2007. He is gearing up to take the NCLEX PN this summer.

Take care,

chbare.

19.515 seconds, I do not plan on flying F16's for the Air Force anytime soon, so I should be ok.

Take care,

chbare.

Spock, our hospital does not have a protocol for intubating burn patients. We will usually intubate any burn pt suspected of having respiratory injury early. We generally use a 7.0-8.0 on an adult. In addition our docs like to use vec over sux in the burn patients, even prior to the 24 hour fluid shift period. (just to play it safe) Our county only has 2 paramedics that work EMS. (all BLS & ILS) All the other medics work for the hospital or the transport service, so we do not get allot of intubated patients from the field. In addition paramedics cannot RSI in the field without a special skill designation in our area, so we get patients that should be intubated, but the medics opt out of intubation because the patients are awake and have intact gag reflexes. I can only guess that the medic grabbed the wrong tube in the chaos of the situation, or decided to be very conservative because of the airway edema.

Take care,

chbare.

I think I am still in denial about living in a desert.

Take care,

chbare.

Danb, Welcome to the city. There are several threads that discuss the merits of various EMS agencies. You may find it hard to make a career as an EMT-B. (low pay & limited job opportunities) If you have the means, get into college and get a degree in medicine. (Paramedic, Nursing, RT, etc)

Take care,

chbare.

Hammerpcp, I have had a few bad experiences with sycopal episodes and low BGL's, I admit I am a little overzealous about BGL's, but we all cannot be without vices. Did anybody try for an EJ? do we have IO access as an option If she crashes while attempting EJ access? Too bad we could not do a quick US and look for fluid/aneurysm. Sorry, I overlooked the no pulsating masses part of your assessment, typical nurse not listening to the medic.

Take care,

chbare.

Aneurysm until proven otherwise, as of now. Pulsatile abdominal mass? Does her voice sound hoarse? Do the lower extremities appear mottled or cyanotic? BGL? I would want to be very judicious about IV fluids.

Take care,

chbare.

ERDoc, you are not the only doc that thinks this way. Very few of our ER docs would have used lidocaine in this situation. medic53226, I am not a doc but I would have used lidocaine. I have had several patients develop bad reactions to amiadarone. Nothing scientific or research based, but I have had better outcomes with lidocaine. I like the fact that lidocaine has a much shorter half life and it seems like every patient that gets converted with amiadarone becomes a life long user. Just my opinion however.

Take care,

chbare.

here is a link to a diagram describing the clotting cascade. It is a pretty complex process and you can see that several substances are involved. In addition to all of the factors and substances calcium plays a crucial role in clotting. I hope this helps with regard to what factor works where.

http://www.hallym.or.kr/~kdcp/hematol/Coag-cascade.htm

Take care,

chbare.

Fire_911medic, Factor VIII is a naturally produced clotting factor in the clotting cascade. It is needed to complete the clotting process. However, like Dustdevil stated giving it to a trauma patient in the absence of a bleeding disorder could cause serious problems. The most commonly talked about disorder where people receive clotting factor VIII is Hemophilia A. (factor VIII deficiency) Here is a link to some basic information on Hemophilia A, you can also use this site to look up other types of Hemophilia.

http://www.hemophilia.org/NHFWeb/MainPgs/M...ptname=bleeding

Take care,

chbare.

Fire_911medic, if she had a bleeding disorder they may have given her recombinant factor 8 or recombinant factor 9. She may have received vitamin K if there was a coagulopathy that could be reversed with Vit K. She may have also received fresh frozen plasma (contains clotting factors) or cryoprecipitate, depending on her condition and what she would allow. Products such as Hextend (Hetastarch and LR) and Hespan (Hetastarch) are colloids, but do not contain clotting factors and cannot transport oxygen. Hetastarch is a large molecule that exerts allot of osmotic pressure that causes water to shift into the vascular space. The old Rob peter to pay Paul analogy. Unlike crystalloids that will rapidly diffuse out of the vascular space, ( about 2/3 in 1 hour when you talk about NS and LR ) colloids are heavy and tend to stay in the vascular space much longer. However, colloids are not without complications and are not a magic bullet for blood loss.

I hope this helps. Take care,

chbare.