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donedeal

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    PA Student, EMT-P
  1. Are any of you using Dopamine in your Non-traumatic resuscitated cardiac arrest patients, who DO have a decent BP, specifically for its perfusion effects? At 1-2mcg/kg/min Dopamine stimulates D-receptors dilating not only renal but cerebral and mesenteric vasculature. Combined with fluids to help dilute toxin buildup from a once non-perfusing patient, wouldn't dilation to these organs possibly reduce morbidity in the post arrest patient?
  2. Is anyone aware of any studies that show using the mouthpiece or mask results in a higher concentration of nebulized medication reaching the lungs? At work it was standard to use the mask unless the patient could not tolerate having a mask on their face. But I was told today that by using the mouthpiece you'll make the nebulizer treatment a "more active process", resulting in the patient taking deeper, more controlled breaths. Just wanted to see if there is some factual basis to either approach and what others tend to use and why.
  3. the two are pharmacologically related, acting on prostaglandin inhibition, which could result in cross reactivity. If the adverse effect includes difficulty breathing, then it should not be given. If the allergic reaction occurred 20+ years ago, then its probably safe to give. But yes, additional questions are warranted.
  4. your ACS patient tells you he had a severe allergic reaction to ibuprofen in which he had trouble breathing that occurred a few years ago. Do you withhold aspirin? What if this patient is an AMI?
  5. Ruff-- since I moved away from the area where i was trained, going there is not an option... BUT I wouldnt go back to them anyways. I will be taking a refresher course soon and will ask around for quality programs. Thanks everyone!
  6. Start working in the house. I find some systems there is a rush to get the patient out of the house and into the ambulance. I understand every scenario is different, but some cases call for intervention prior to extrication from a residence. This sounds like it could have been one of them as you had pulses on scene and lost them sometime shortly during or after the extrication process. Most of the time...there is more space in the house, more people can help and there may be clues around you...med bottles, witnesses...ect.
  7. As stated.... can a poorly run training mill put out students that eventually become good medics through experience? I enrolled and completed an accelerated, non-collegiate program that I felt left me well below the curve in terms of paramedic education. It was a poor decision, but it was the one I made. I have a BS elsewhere and have completed some of the hard science curriculum. I've always done very well in the classroom, but feel like i struggle on the streets. My skills are good, but my ability to run through a differential diagnosis in my head during an assessment is often blanking, I miss some things and in general sometimes feel like an idiot. I've been in a busy system full time now for 7 months now. There is a disconnect between my didactic classroom knowledge and recalling that knowledge in my head to put into action. The didactic and skills portion of my paramedic class was okay, but the clinical ride times and hospital time was a joke. We were often let out early and functionally served as nothing more than an observer. I honestly feel like I completed my first patient assessment on the job. Thankfully I have strong partners that are always willing to teach and have my back. I have been re-reading my protocols and offering to tech as much as possible to gain the experience. I'm hoping in time, the experience gained will offset the poor training.
  8. No homework...just reading my protocols again. We call for medical control if we want to tx the seizure in the acute head injury patient. Just want a little more information on why that is....
  9. What is your treatment plan/protocols for grand mal seizure secondary to head injury? What is the physiology behind why benzos may be contraindicated in this scenario?
  10. donedeal

    Where to begin

    From Bunker Hill Community College in Boston, MA Anatomy and Physiology I is the first course in a two-semester sequence that will examine the systems of the human body using an integrated approach. Areas of study will include the structure and function of cells, histology, the physiological and anatomical aspects of support and movement systems and the nervous systems. Laboratory activities will enhance the students comprehension of the structure and function of the human body. Course meets: 3hrs. Lecture:3hrs. Lab Prerequisite: Grade of C or better in Principles of Biology I/Lab (BIO101), Human Biology (BIO108) or general Biology I/Lab (BIO195). From Salem State University in Salem, MA Number BIO 200 Title Anatomy and Physiology I Credits 4.0 Distribution DII Prerequisites BIO105 or an introductory Biology lab sequence; CHE124 or CHE130; or permission of the Department Chairperson Feel free to search the lengths of Harvard Ext School, UMASS, Quincy College and any other Metro Boston college or university and you'll find the same pre-reqs or very similar. I recently went through this sequence Bio I,II, Chem I,II, AP I,II--- it took me 1 full year and I studied and worked my arse off putting in 20+ hours a week (mostly on the chem). I challenge any one interested in becoming an emt-basic to take this sequence and then see if they still want to be an emt-basic making a pittance of a salary when theyre now qualified for entry to some PA schools, almost all nursing schools or 2 courses shy from medical school and the majority of the PA schools. What invasive procedures do emt-basics perform in which they have to understand the mechanisms in microbiology of rna, dna, mitosis, genetics, ect-- all of which are typically covered in great detail during the first semester of gen bio. A macro overview of mammalian anatomy is typically covered in the second semester of bio . Peruse through some syllabi from a general bio and general chem course from within the past 5 years, there's a lot more information being covered now then there was 30 years ago as well and students are being held to higher standards. You'll find most of the people in these classes have aspirations for high level positions in the medical field and some of whom already have their basic card and are moving on. I don't doubt there are some schools that provide a watered down AP course with no pre-requisites required in some parts of the country. In that case, by all means take these courses. In NO WAY whatsoever will it be a bad thing or interfere with your care as a basic provider. I am very pro-education, but as it stands now, becoming an EMT provides someone without a college degree the opportunity to hold a great position out in their community. You start adding all this degree creep and less and less people will be qualified. That's probably not a problem in some parts of the country, but in some parts it will be.
  11. donedeal

    Where to begin

    To enroll in an A&P course at almost any college you need to first have taken general bio and general chemistry as pre-requisites. Traditionally these are all 8 credit two course sequences spanning 2 semesters. These provide the foundation to understand the concepts in A&P and these courses are not to be taken lightly. The amount of time and effort one will put into a general bio and general chem sequence, which also make up some of the pre-reqs required for medical, dental, physician assistant school, blows the length of an emt basic course out of the water. While I certainly see the benefit to having all ems providers take these courses, I don't think the cost outweighs the benefits. The basic provider doesnt need to know the detailed concepts you learn in bio, chem and A&P. Beefing up the general gross anatomy overview provided in an emt basic class is sufficient given the scope of care of an emt. There is no diagnosing, minimal pharmacology or long term care involved at the emt level, but rather immediate intervention based on recognized signs and symptoms. You see blood, you control bleeding, you see short of breath, you provide oxygen...there are no procedures at the basic level that require you to know the breadth of information covered in these courses. We are working at a technician level and receiving pay that accompanies a technician level. That level of education doesnt jive with the pay or scope of care....and then you have an argument of which comes first....but I don't see municipal services already strapped for cash shelling out salaries that coincide with that level of education. Most importantly-- few and far people have the cells and motivation to handle the hard science workload and those that are successful are becoming the higher level providers mentioned above-- not emts making 10 bucks an hour. You can't place that kind of requirement on entry into the ems field or you'll quickly run out of providers.
  12. can someone provide the link for the thread on A&P class requirements for emtb. I dont want to highjack this thread, but i have some thoughts on that...didn't pull anything in a search.
  13. Does anyone carry or would there be benefit in carrying IV anti-biotics? I'm thinking in particular for critical burn patients. Is there benefit to providing prophylactic antibiotics IV en route if there will be a prolonged transport to a burn center versus receiving those anti-biotics on arrival at the ED. Will the 20-30 minutes here or there make a difference?
  14. What does your service use to administer 1:10,000 epi in young pediatric arrests? Can you accurately administer less than 1 ml/.01mg of epi to someone under 10kg using a prefilled 10cc syringe? Do you mix 1:1000 with saline to make 1:10,000 in a 100 units (1ml) syringe?
  15. A vehicle was hit on the drivers side rear quarter panel, activating side impact airbags on the drivers side. The vehicle then struck a tree head on @ approx 40 mph with no airbag deployment from the steering wheel. Is this by design for some reason or a malfunction of the airbag? Also- in cases like this always have FD disengage the airbag mechanism before you assess the patient so you dont take a 220mph shot to the head while assessing.
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