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No worries, prior to grad school, I would not have known one of the points that I hope to discuss here, but I want to make sure we discuss something else as well. Therefore, I will move this scenario in very different directions with the intent of covering two very different concepts. First, let's say a few hours into the clinical course of care the patient begins to develop rather sudden onset lethargy. What do you want to do initially? Put the heart rate and blood pressure away for just a moment and just focus on the change in mental status first.

Poison control is unavailable. Let's say he took multiple pills. How long are we going to monitor him? At what point do we let him go if that's what we decide?

Let's say he tolerates PO charcoal. How much do you want to administer? You talk with the patient and indeed he verifies that he ate some of "grandma's candy." This is the only med on board. Patient's overall status remains unchanged. Labs are back and unremarkable. Now what?

You will have to deal with everything relating to the patient and for this scenario, assume no medical evacuation is available. Monitor has been applied and is reading a sinus rhythm at 130 that appears appropriate for the patient's age. Peripheral lines have been placed and labs are cooking.Let's say we contact the grandmothers doctor and we now know that the patient has indeed ingested an unknown amount of her Beta blockers. Additionally, this is the only medication that the patient has ingested. A reassessment of the patient is essentially unchanged at this time. Are we going with activated charcoal? Is a nasogastric tube mandatory? Are there any considerations regarding the use of sedation if we decide to administer charcoal? (Sorry but there is a typo on the age, you have a five year old male not a one year old, everything else is unchanged however).

She does not remember the number of pills and think they are called something on the lines of "Topol or something like that." Time of ingestion was approximately one hour ago.

"I think he swallowed my blood pressure pills?" No health book available. His weight is right in the middle of the range that would be expected for a patient of this age. Skin is pink, war, dry with moist and pink mucous membranes. Respiratory rate is 30 and non-laboured, no signs of respiratory distress, pulse is 130 strong and regular, blood pressure is 90 systolic, temp is normal, SPO2 is 97% on room air, L- this am about 2 hours ago, E-Pill bottle found on floor, grandma did not bring the bottle with her to the clinic. No medical evacuation resources are available and you will have to deal with the patient for an extended period of time, assuming you want to do so. A-NKA, M-None, PmHx- Healthy, thriving carpet commando,

"I think he ate something bad!"

You are a paramedic working in an austere clinic but have limited radiology and laboratory resources. Assume you have a fairly comprehensive assortment of pharmaceuticals and standard equipment that would be found on an ambulance in a country with a reasonably progressive EMS system. The grandmother of a one year old male brings the patient into your triage area. The patient appears to be awake, generally well developed for his age and crying vigorously. Take it from here.

American heart association is a starting point as their journal Circulation is evidence based and free to access. All of the AHA guidelines are published and free to access through their site. Being from Australia, you may want to also look at the European Resuscitation Council (ERC) and the International Liason Committee on Resuscitation (ILCOR).

Was this taken on the job? I suspect as much? Clearly, this is a major violation and the photograph had enough information to allow people to publically identify the patient in question. I do not know much about the civil aspect of this case, but the ex-EMT clearly did something that he should not have done. Victim card discussion aside, we as providers simply should not be posting these kinds of things or we had best be prepared to deal with civil and possible criminal consequences. Patients, regardless of their lifestyle choices should not have to worry about their health care providers posting this kind of stuff on social media sites. Outside of the health care environment, such as what is found in some of the people of WalMart photos, you are probably going to have a good discussion about being in the public and constitution issues, but taking pictures on the job and posting them to social media sites with perjorative statements is not koser.

What is meant by "publishable?" To have something published typically means a significant amount of work followed by peer review and fighting with an editor. I am not sure making you do something that is "publishable" over the period of a week is the most prudent task to assign. Particularly, if you do not have experience writing papers. Often, published material is written using a foot note reference system that contrasts significantly to APA or MLA format.

I'd redo the BGL just to make sure... Supportive care and look at benzodiazepines for seizure control. Try to verify a med list and start working through H's & T's if possible. Have toxicological issues on the list of differentials. Lactate is not so high on my list as I am assuming some degree of cellular hypoperfusion. However, chemistry looking at electrolytes would be quite helpful at this point. We have a laundry list of issues to consider from cardiovascular to neurological to metabolic and toxicological.

Switch out and do two minutes of solid chest compressions then reassess. I can worry about monitor switching later.

There is no specific strap order regarding the KED as long as you secure the torso first. You can download the NREMT seated spinal immobilisation skill sheet from the NREMT and study/practice with it. If you were actually told by the site coordinator exactly what you did wrong, there may have been a breech in protocol in how the test site was conducted. I am assuming this was a NREMT test site. Unfortunately, the KED is part of a larger station known as the random basic skill test, and it is possible that you may end up doing another type of skill such as haemorrhage/shock if you go to another test site.

It looks like distal circulation is preserved in the cadaver model.

Steve, please do not take offence. I tend to be very skeptical of any new claims, even when they turn out to be verified and or validated. However, I absolutely appreciate you coming out and putting your name on this product while directly engaging us as providers. I respect that and I respect the fact that you are providing us with evidence and admitting that the overall evidence base is still limited. I really hope additional studies continue to be positive and I hope your product becomes popular and well recognised for its quality and efficacy. I'm certainly excited and want to see you guys break out. Good luck and thank you for posting on behalf of this product. It was a pretty stand up move IMHO.

Sodium bicarbonate is not a front line medication unless the potential cause of the arrest can be managed with Sodium bicarbonate (TCA overdose for example). There are many potential pitfalls associated with Sodium bicarbonate. One issue has to do with a very important chemical reaction involved in CO2 transport. (H2O + CO2 <-> H2CO3 <-> H3O + HCO3- <-> H2O + CO2) This equation is typically used to explain how the body transports CO2 to the lungs. However, the reaction is known as an equilibrium reaction. Adding products and reactants to the mix can shift it left or right. Adding bicarbonate can shift it to the left and actually create more CO2. This means you are potentially increasing CO2 levels in an arrest patient who may not be able to effectively ventilate in the first place. Additionally, the possible tonicity and pH changes associated with adding bicarbonate to the mix can cause problems. Rockstar, all flattery will get you nowhere. I've seen Dwayne mature into a "senior" medic. He's paid his dues and has earned the right to be called "old." Do not deny him this title, he's an old fart and by God we should acknowledge his...maturity.

Take a look at the link that I posted. It references literature that should answer your question. Bluntly stated, yes.

Putting a "solid" time to it will be nearly impossible because the clinical course of a DVT is altered by a constellation of concepts. You can look through the literature and probably could make the reasonable conclusion that a DVT is associated with significant long term morbidity regardless of the cause. One to get you started: http://www.ncbi.nlm.nih.gov/m/pubmed/9299855/

Okay bro, my bad for misinterpreting.

Dwayne, I am not in the habit of giving online advice, but this is a pretty serious situation. You likely had a DVT months ago and possibly have another one or problems relating to the prior DVT. Additionally, you have some risk factors that could exacerbate the situation. The good news is that many DVT's are conservatively managed with anticoagulation and watchful waiting. However, you are not exactly in a controlled environment. I know you probably do not want to hear this but you need to be evaluated at a place capable of providing "progressive" medicine. I think you should come home as well and be closely followed. It sucks bro, but you have big responsibilities and people who rely on you. Please do not let this one go like the last experience. There certainly is a chance it could follow a similar course, but the stakes are incredibly high. PM me if you want to talk specifics.

My experiences (n=1) have been similar although I bet a bit more limited in scope as the ones you speak of Dwayne. With that said, I also agree that I have worked with EMS providers from Canada, the United States, Australia, Uganda and South Africa. As you stated, I have not noticed that the thought process of these providers deviated significantly from my own. Also, if you look at the literature (somewhat limited, admittedly), you find that EMS provider outside of the United States suffer from some of the same issues we do here. One recurring theme I find is a consistent problem with medical math and dosage calculations. This also crosses barriers into nursing and appears to be a wide spread issue regardless of educational preparation. Never at any time have I found my-self in a position where I felt markedly "outmatched" by any international EMS provider or nurse for that matter. Additionally, the only degree I had was an AAS in nursing. With that said, I have to admit that I did not run into providers who I would call "consistently incompetent." All things considered I found my-self reasonably well matched with these other providers in spite of holding degree that was in most cases "inferior" to the degrees and presumably educational preparation that they held. With that, I am not saying improvements in education are not needed, only that when looking big picture, what makes a "good" provider is probably complex and an "optimal" educational prescription for a given provider is likely going to be difficult to definitively define. I imagine I may end up getting flamed a bit for changing opinions that I may have stated earlier, but I have to remain open to change and challenge prior beliefs when I encounter experiences that challenge said beliefs regardless of how good these beliefs may feel. Dwayne, I have had different experiences regarding XII leads, cardiac patients and pre-hospital interventions. There are providers in other countries using this information to make complex care related decisions. Edit: Added an "Enter."

Will obtaining AEMT credentials help you advance in your job? If you can take it, make a bit more money and gain some experience, I cannot see any significant pitfalls with such a plan.

Regarding EEG monitoring, it's a crap shoot as to who may have it and you can find literature that shows people who do not receive good education and do not routinely use the modality have much higher rates of misinterpretation. With that, I am not necessarily talking about the typical EEG recording, but rather continuous bedside monitoring using something like a four channel setup for seizure identification. Therefore, we are not talking about taking a snapshot and having a physician read it, but rather continuous monitoring looking for seizures. As stated, this likely limits the availability of this modality, particularly during transport. Just to be clear, I see no clear role for traditional EEG monitoring as part of brain death determination in the immediate post arrest interval and I am talking about using the technology for a very specific post arrest issue. This is not an issue of viability at this point but rather an issue of identifying seizure activity.

Levaquin will probably have better coverage. In some hospitals, Cipro is no longer even being used for UTI's due to E. coli resistance.