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I believe the OP is sixteen if I'm not mistaken? I look back and realise that I'm old enough to be this person's father and I've been in healthcare longer than the OP has been alive. I remember being a newly minted EMT/medic and being...rather enthusiastic. Perhaps you guys can call me out with a bunch of "I told you so's," but I'm still inclined to have a bit of patience with prospective and neophyte providers.

NF is another potential life threat to consider.

I thought I'd weigh in on a potential consideration. A possible consideration is mesenteric ischaemia, possibly venous with this patient.

Ronchi is often not really used as there is so much confusion. It is a coarse and sometimes rattling sound often caused by secretions and mucous in the larger airways. If there were no indications of obstructive pathology, then a beta agonist was not indicated until you appreciated the wheezing. I cannot say as I was not there. Do you have the ability to monitor exhaled CO2 using a waveform? Changes in the waveform are often quite reliable at identifying the presence of obstructive pathology.

You don't say. LoL

Congrats!

I tend to agree with ERDoc. Many of us have likely asked apparently "stupid" questions about what other people do. It's often not malicious but out of genuine interest and curiosity. (IMHO) the problem with answering is that many of the most impactful situations for me would be hard to describe because it was the emotional resonance or existential components that made me reevaluate my thoughts and beliefs, not the actual "visual" or "auditory" component of the situation that left its mark. In other words, sometimes the more apparently "mundane" situations had more impact because they resonated with me on a deep emotional or intellectual level. This can be hard to properly describe.

I spent a decade in the military and another year as a contractor that supported some of the military operations going on overseas. What you are proposing is not koser. I was in the military and apparently "I don't get it either." The military has organic medical assets. If you were involved in operational planning, you would know even training missions state side require an operations order (OPORDER). An integral part of the OPORDER is medical support. You are setting yourself up for major liability if you are circumventing official military channels. You received solid advice froma few pros and are choosing to ignore it.

Unless you are actually working for the government in the capacity of an EMT, you are not covered and you are placing your credentials at risk.

Remember, epinephrine attaches to receptors that also use cAMP as a secondary intracellular messenger, therefore it's not unreasonable to question the physiology of other agents that make use of this molecule.

I cannot speak to the authors but glucagon binds to metabotropic receptors and this causes an increase in an intracellular secondary messenger molecule called cAMP. This molecule have cardiovascular effects, so asking theses questions based on the known physiology associated with glucagon administration could be a starting point for researchers as there are documented cardiovascular effects associated with glucagon.

EMS is a rather non-coherent concept. As such, it's very difficult to debate the vocation/occupation/profession issue. Some areas are very different; however, it would be hard to argue that EMS is a well defined profession across the board in the United States. I agree on the Registry. The exam process is pretty robust and validated IMHO. Compared to what I had to do with the NBRC exam process for RRT licensing, the NREMT CBT was simple and much more cost effective. I wish I had a robust appreciation for degrees, but I'm not entirely convinced a higher degree will always advance a profession. My experience in respiratory therapy in my area of the country has enabled me to rethink long held beliefs about degrees, professional licensing and what that can do for things like wages, respect and advancement. Forgive me for making parallel assessments, but my experience in the educational and political arena of respiratory therapy has made a profound impact. Without a robust political machine in place that has significant funding, advancing a profession is difficult and education is not a magic bullet IMHO. Not that I'm opposed to education, but the occupation/profession discussion is far more complex than I knew. If EMS advances in the ways many professions have, we will undoubtably have to navigate these issues. Additionally, the drastically changing healthcare landscape in the United States will likely impact all professions/vocations involved in the greater health care machine of this country.

David: There is probably not going to be a satisfactory answer. First, I'd ask what paralytic was used and were any adjunctive substances such as fentanyl used. There are some reasonably well defined mechanisms for trismus with these agents. Looking at ketamine in a vacuum, the honest answer is we do not have a completely well developed mechanism of action for this agent. The consensus revolves around NMDA (type of glutamate receptor) receptor interaction. However, there are reports of movement disorders and muscle tone alteration (dystonic reactions). This is likely due to some dopaminergic effect. So, a dopaminergic hypothesis is a good starting point. Also remember, people can have a variety of genetic polymorphisms that can increase the risk of uncommon reactions. Start with the "mundane" considerations first however.

Your wife is smart. It is an unpredictable and highly competitive economy we live in. It's hard to predict how things evolve. With your wages and friendly schedule, you should have no issues keeping an active credential. I strongly recommend you do registry and keep it. Think of it as a disaster policy if anything else.

I know one thing. If I make it through grad school, I'm making everybody refer to me as "master." Those who know my last name will understand how much fun I can have. I will make sure that master is used in all settings, clinical or otherwise.

We have a foecal transplant programme where I work. The results have been reassuring. Best wishes for you guys.

Thanks for the reply. I am not sure exactly how to proceed. I only have a week to get through the reading, so I feel as though I need to read as much in it's entirety as possible. The unit exams are only 15 questions long and the entire exam has a 15 minute time limit, and can ask very specific questions from both the reading and our lesson guides. The exams are 75% of our total grade, so if I cannot obtain decent scores on these exams I will not be able to rely on projects and assignments to carry me through. I do highlight major topics and take notes, but I seem to get hammered on small details such as what gene codes for what enzyme and there are literally lists of these things. There are 57 major CYP enzymes alone and their substrates are broad in some cases and some enzymes are more specific to phase I chemical reactions while others are more specific to phase 2 chemical reactions. I could go on, but it's a large body of information and I am trying to find ways to get these small details down.

Thanks man. I plan to see it through regardless of the outcome. I'm not going to have Cheryl post the results of this one on the refrigerator. I am still passing and didn't completely bomb the exam, but I certainly did not do well.

I've never had issues in undergrad with studying, reading or taking exams. Some of this may be that I didn't prepare over the winter break. I saw I was going to do several modules on metals so I dove into coordination chemistry and crystal field theory for a few weeks. Unfortunately, everything has been biochemistry, enzymes and pathways. Aside from being up on ligand coordination with enzymes and all the oxidation state stuff I find myself to be lacking in the relevant material. If this keeps up, it's going to be an incredible struggle. We are moving into pharmacokinetics, compartment modelling and kinetic equations, so hopefully it will be more straight foreword for the next week.

Thanks for the tips all. Unfortunately the exam did not go well for me.

I've know a couple of people who do the retest thing and like you, have overall positive experiences. It probably depends on the exam. I may receive some hate, but after taking the paramedic CBT last year, I have to say it's pretty well developed and I didn't find the questions to be crazy or focused on zebras. Compared to some other board exams that I have had to do, it was pretty straight foreword. In other words, it seemed fairly well written. I know I don't ever plan on taking the respiratory board exams over again, particularly the clinical simulations.

Thanks Dwayne. That is what I've been doing, highlighting major concepts and taking notes the best way I know. It's just a bit overwhelming with a 30 page study guide and a few hundred pages of material followed by an exam. Then, rinse and repeat for next week. Hopefully I'll get into a groove and quit being such a cry baby.

A great idea, thank you!

Yeah, I'm feeling a little overwhelmed and I'm not sure my biochemistry is up to par on many of the concepts. I'm placing post it notes on pages that look important and taking notes on major headings but I'm not really sure how good I'm really doing. I've made my way through general bio transformation and all of the phase I reactions and now I'm working through the cytochrome P450 enzymes, all 57 of the major players in humans. Then onto phase II reactions followed by a test. I'm not feeling like I'm really getting most of it down.

Figured I'd throw this out. I'm in the middle of a few hundred pages of material. The study guide for the material is 30 pages long. I'm trying to find ways of optimising my notes. I started by hitting the big points. For example: biotransformation, then it breaks into phase I and phase II, then under phase one I put hydrolysis, reduction, oxidation. However, under hydrolysis there are seven different processes such as epoxide hydrolases and paroxonases. Then, each sub point has a different pathway associated with it. Reduction has eight points and oxidation has nine, each relating to different pathways. This doesn't include phase II or all of the CYP450 enzymes and their major substrate molecules. I'll be doing this every week followed by an exam and an essay so the tempo will be sustained over the next semester. Anyway, those of you who've had to deal with complex classes that involve large reading assignments with content rich subject matter, I'd love to hear about what helped you out.