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I think Kate is wanting to go beyond what is traditionally taught. For example, is CO2 it's self a vasodilator? Given that most of the CO2 is transported in the form of bicarbonate ions and Hydronium ions, it's reasonable to ask what are the things that actually cause vasidilation. Is it CO2 by its self, pH changes, release of other substances, an amalgamation of processes or something ill defined?

Not really. In fact, when I first went to college back in the 90's, my ACT scores along with my entrance exams scores were so low that I had to take several credits of remedial or developmental math before I could take the lower level prerequisite classes. Unfortunately, many people who come out of high school are in a similar situation and mathematical illiteracy is something we have to combat at the college. Therefore, I am exposed to quite a bit of math as I try to find easy and intuitive methods to help bring people up to par. Additionally, I have come to realise that only through mathematics can you make any quantitative sense of the world. It is truly a foundational subject if you wish to learn anything about the physical world. Finally, in health care, mathematics is less abstract and actually makes tangible predictions such as with dosage calculations, Oxygen flow duration and so on.

Not really. Wish I could say I am more awesome than I really am. The formula for kinetic energy is pretty simple, plug and chug stuff. However, you have to input the proper units. I think my math is reasonably good because the number I calculated is about an order of magnitude (10 times) the number that is published for the Hiroshima bomb.

Quantifying it is rater interesting: The object had an approximate mass of 7,000 metric tonnes and a velocity of 33,000 miler per hour. Let's crunch the numbers: Kinetic Energy = 1/2[ M(V)2] (M needs to be in kilograms and V needs to be in metres/second) 7,000 tonnes is around 7 million kilograms (short tonnes). 33,000 miles per hour is around 52,800 kilometres/hour. 52,800 kilometres per hour is about 880 kilometres/minute, is about 15 kilometres per second, is about 15,000 metres/second. KE = 1/2 [7 mil * (15,000)2 ] = ~7.9 * (10)14 Joules * A Joule is a derived unit of work and/or energy with the units Kg*(Metre) 2/(Second) 2 or basically simplified to 1 Joule ~ force of 1 Newton applied over the distance of 1 metre. *A Newton is a unit of force where 1 Newton will accelerate a 1 Kg mass to 1m/s/s The Hiroshima bomb by comparison released ~6.3 × 1013 Joules Is my math good?

The physiology is ill defined but a general metabolic theory exists where it appears that cells release vasoactive substances in the presence of metabolic by-products. Clearly, acids are by-products. The exact mechanisms are not well known but if I had to guess, I'd say that it probably begins with conformational changes of proteins and may involve metabotropic or ionotropic (perhaps both) channels/receptors. We also know that changes in protein conformation directly effect physiological processes with conformational changes. Acid levels and the Bohr effect at the tissue level being an example of a normal process based on such changes.

Add a PEEP valve to the BVM and nasal cannula at 15 L/min and you can deliver real CPAP.

http://www.lcsun-news.com/las_cruces-news/ci_22601947/nmsu-expert-weighs-russian-meteoroid-explosion

Your experience will probably benefit you as a RT student. Let me know if you have specific questions. Personally, I rather like respiratory therapy.

I don't know your institution, but where I work, we have to be very careful about academic dishonesty. I basically have to catch somebody in the act or have them confess before I can take direct action. This is probably for the best as everything else is simply hearsay. Unfortunately, you've probably done the worst possible thing. You waited and watched the cheating occur and only now are you going to say something in the form of a letter without any direct communication with the class instructors. The sooner I hear about possible problems, the sooner I can make changes and watch a bit closer. Unfortunately, there is little I can do when I receive a letter after the fact. Do not take this as a personal attack, only as the truth regarding this situation. Sometimes you have to speak up and go out of your comfort zone, otherwise you have your current situation where you have allowed students to cheat through the entire course. This is probably a good lesson to learn and it will apply to clinical practice as well. Many people will simply stand by and watch another person harm a patient because speaking up takes you out of your comfort zone. Instead of preventing a potential patient care disaster you could end up here talking about a situation where you watched somebody do something harmful. Again, take this post in the context I intended. Make this a learning experience.

I think we can often develop a sort of ethnocentric point of view in EMS where we tend to view our way as being superior. From my n=1 experiences working outside of the United States, I've come to realise every country has things I like and things I don't necessarily like. The arguments here often revolve around educational levels, but I've found what people consider a level of education in one country is quite different in another country. For example, when comparing my AAS in nursing with a South African colleague who had a BSN, I found that I had much more experience in mathematics and physical sciences but she had much more clinical experience while in school. Which is better? Going back to my thread on education, I thinks it's difficult to quantify amount of education and provider competency. As I stated earlier, every country has benefits and pitfalls.

An editorial by Dr. Wang, a much loved person by the American EMS community. http://jama.jamanetwork.com/article.aspx?articleid=1557717 Regardless of concerns and potential weaknesses, there is now a significant amount of evidence that does not support traditional endotracheal intubation for patients in cardiac arrest. The literature is now being published by the JAMA, no small player in terms of their representation of the medical community as a whole. All concerns aside, physicians and presumably medical directors may start taking note as contemporary studies continue to illustrate trends of decreased survival and neurological outcomes and their association with traditional airway management techniques. The early evidence from an animal study involving less than a dozen animals is not particularly noteworthy. Evidence from a large and seemingly well designed study is a bit more compelling.

At this point there are many suggestions for studies that can better focus potential causal and effect questions. However, at this point, I also think a good case exists for making traditional intubation in a cardiac arrest patient a potentially unhelpful if not harmful action. Additionally, we are now just starting to gather evidence suggesting supraglottic placement may not be as efficacious as we currently think. The next AHA guidelines announcement in a couple of years will be interesting. Perhaps it's time to let go of the old "gold standard" in certain situations regardless of your personal bias or n=1 anecdotal experiences? Edit: ","

"Tranny" is typically considered a pejorative slang term for either a transgender/transsexual individual or a transvestite.

Is beginning to include supraglottic airways. http://jama.jamanetwork.com/article.aspx?articleid=1557712#qundefined Thoughts?

1) Clearly, a differentiation probably exists; however, I am not qualified or informed enough to say who is dangerous and who is not dangerous. 2) Saying something has no use is a rather subjective and dare I say emotional judgment. For example, I absolutely despise ethanol, "alcohol." I see no use for the substance and believe the world would probably be better off if people did not drink at all. Yet, many people would probably argue that it is important in a social context. The same is probably true with these kinds of guns. What one person says is a useless danger, another probably derives great pleasure and social satisfaction from going to the range and shooting zombie targets, 30 rounds at a time, with their friends. At the end of the day, I cannot say that what I think regarding my world view is better than another person's view. I believe most people are basically good, so their views hold fairly equal weight IMHO. The best I can do is appreciate the views of others and attempt to minimise the hyperbole that is thrown out.

It is not semantics as it can grossly mislead people into believing that these weapons function in ways that are not commonly available to the average citizen of the United States. Not lame at all IMHO. Just trying to reduce the amount of hyperbole that revolves around the topic of gun control in the United States. Again, I ask what type of gun is most often involved in gun crime in the United States? In fact, I have not taken an official stance on this website other than to say that many people in the United States do want something done and that I try to combat hyperbole whenever possible.

Fully automatic? These kinds of guns are used in most gun crimes? How about semiautomatic and how often are sidearms/pistols used in violent crimes? Taking emotion out of the debate and looking at reality requires us to also utilise proper terminology or at least use boundary conditions that allow us to use the terminology within a certain context. For example, "what I really mean by fully automatic is every time I pull the trigger, one round is fired." That is not the common understanding of fully automatic, but at least the term has proper context. It also requires us to look up facts about what types of weapons are most often used in the context of gun crime.

This is becoming an issue in the United States as nurse practitioners who have significantly less education than doctors are throwing out "evidence" that suggests equivalent outcomes with NP's as opposed to MD/DO's in spite of a significant gap in education. Some are suspicious to say the least, but we do not have great quantatitive evidence that points toward an optimal number of hours regarding EMS education IMHO.

Per a prior thread, would anybody care to present good evidence of a clock hour requirement that results in consistently producing a competent entry level provider within the context of the national SOP? I suspect any number thrown out would be rather arbitrary.

I would however caution you not to focus only on registry pass rates. While registry success rates are one indicator of programme quality, many other indicators must also be considered. This is more or less where I was going. I actually agree with removing a strict clock hour requirement. Rather, have programmes develop a curriculum that covers the material outlined in the national SOP but also meets school and student needs. Clearly, checks and balances in the form of accreditation and programme inspection must also occur to ensure programmes are actually producing adequately prepared introductory level providers.

I am not convinced this patient had a true, non-perfusing rhythm however. This is a likely candidate for the pseudo PEA mentioned earlier. This scenario occurred with me some years ago where EMS brought a patient into the ER with chest compressions in progress. The patient would move and groan during compressions, then become unresponsive and apparently "dead" when compressions were stopped. The patient was in a high grade AV block and limited cardiac output was noted with bedside sonography. The patient received a transvenous pacemaker as a bridge to permanent pacemaker and ended up doing well. A good case that illustrates unconventional situations in any event. Thank you for sharing.

Every paced patient that I transferred had us quit for the ER doc to assess then restart using the receiving hospital's equipment.

However, we are now using the national SOP and educational standards models in the United States. If you look at the guidelines, the number of clock hours required is a rather ambiguous concept. http://www.ems.gov/EducationStandards.htm

Actually, the National Scope of Practice model is somewhat ambiguous on the clock hour requirement. I have no experience with "accelerated" EMT/EMT-B courses, but I just started such a class (Advanced EMT) for an agency who worked a deal with the college to do this course. The didactic portion is structured to run 08:00-17:00 three days a week. The students occasionally get what could be called a lunch break. The class runs for about six weeks followed by clinical rotations and national registry prep. Additionally, the students must "attend" a couple of online lectures a week and complete an online exam lasting two hours per week. The students also complete several workbook assignments a week and must write out medication profiles on every medication they can administer. Additionally, they will be doing drug cards and differential diagnosis exercises during clinical rotations in addition to their standard clinical paperwork. I am not sure if another class like this will occur as we are looking to transition to formal prerequisite courses such as anatomy and physiology, English composition and dosage calculations math before being allowed to receive a college certificate of completion.

Cool. I hope your students found the videos helpful.