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BEorP last won the day on November 15 2013

BEorP had the most liked content!

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    Medical student, Primary Care Paramedic
  1. ECG for discussion

    Hopefully the attachment works! Sorry that the quality isn't magnificent. I am interested in hearing thoughts on the rhythm since this generated a bit of discussion. Basic clinical details: 67 year old female complaining of chest pain radiating into her back with associated shortness of breath. Reports a history of a previous MI and angina. Thoughts?
  2. COPD and PE

    Thanks. Sorry, yeah "you" meant paramedicmike, PA-C in the ED. I wonder whether the D-dimer could end up leading to more confusion than clarification though given the lack of specificity?
  3. COPD and PE

    Surprised I haven't come across this before. Interesting stuff! Does this have any implications for how you investigate COPD exacerbations, especially when there doesn't seem to be an infection or other obvious cause?
  4. Greetings from Cape Town, South Africa

    Great to have you here! Some of the best paramedics I have met are South African. I have a lot of respect for the particularly challenging job that you do over there.
  5. Great point, Dwayne. Thanks for sharing! Along with that, the other thing we need to consider is how important it is that if the junior crew member has concerns, they need to speak up. All too often it seems that we respect seniority so much that if our more senior partner says it is "just a psych patient" or isn't anything to be concerned about that the senior gets their way even if the junior has a genuine and legitimate concern.
  6. Thank you all for the replies. The list here largely lines up with what I planned on focusing on. A couple points of discussion: Has anyone other than Ruff had any anecdotal experience with strokes presenting with behavioural symptoms? This was suggested to me by someone else who I had spoken with prior to posting but I haven't seen it myself and a quick (but by no means complete) search on the topic didn't reveal much. Secondly, we have a great list here of important things that should not be missed in the patient's overall emergency care. How many of them do you think prehospital providers should actually be identifying specifically rather than just noticing that there is a serious underlying problem and it isn't "just a psych patient"? For example, there might be a hyponatraemic patient presenting with delirium/agitation/anxiety/perception disturbances. We might be able to suspect an electrolyte issue depending on the history, but since we won't have the bloods to confirm that it seems like it would be sufficient for us to simply identify that there is something going on that isn't a strict mental health issue. Hypoglycaemia is obviously the other end of the spectrum where there is a clear treatment that can be provided prehospitally and that should not be delayed. I've rambled a bit, but again my ultimate question now is: Which of these conditions do you think prehospital providers should actually be identifying specifically rather than just noticing that there is a serious underlying problem?
  7. For full disclosure, I will preface this by mentioning that I am working on a lecture for paramedic students about this so this discussion is likely to help with that. Still, I think that it is an interesting topic to have a discussion on. My question is what underlying medical problems that might be interpreted as a mental health/psych/behavioural issue prehospitally should paramedics be sure not to miss. There are obviously many illnesses that could present this way, but I am wondering which you think prehospital providers should be able to identify specifically (rather than just recognising that the patient is sick based on their overall assessment and taking them to the hospital). Hypoglycaemia is obviously the first one that comes to mind, but what else do you think should be high up on the list? I appreciate any thoughts. I will share more of mine later, but I didn't want to risk stifling discussion by sharing my opinion too early.
  8. I know that I am getting in late here, but I disagree with the whole premise of the question. Many "estimates" of GCS that I see done prehospitally get it completely wrong so I go through it properly. As others have pointed out, GCS may not be the best way to assess level of consciousness but if we are using it then we should use it correctly. All too often I see a patient being scored as 3 when they are in fact higher than that but the provider did not bother to actually assess it properly. This may not always have huge implications for patient care, but it could potentially create the impression of improvement when there has been none.
  9. Blood Lancet Devices

    Good call! They may want to look into what happened in this case: The specific details of the potential exposure aren't completely clear from the news article (it refers to a "diabetes testing pen"), but it does say:
  10. Respirations

    I would have to disagree. You might want to take a read of this:
  11. Photo Contest

    oz_paramedic_chick, I love the sunset one. Nice to see QAS represented! Where was that picture taken?
  12. EMS pics

    Thanks guys. It's always interesting to hear different ways of doing things.
  13. EMS pics

    Hey Dwayne... just curious since you and Mike both mentioned it, do you never wear gloves in the cab? Dirty gloves is obviously a no no, but what about on the way to the call? (with gloves that are hopefully new and clean) Or do you guys wait until you get there? Probably seems like a bit of a stupid question, but it seems like how we do it is one of those (many) things in EMS that is very strong in the various organizational cultures.
  14. Hypertonic Saline in TBI

    Yeah, they were using 7.5% and published their results in 2010:
  15. I feel a bit naive now to not have realized that there were so many big names there. Dr. Hamilton's name is one that stuck with me partly because it was on his scrub top but mainly because of how he gave an incredible description of how we were all taught wrong about the pathophysiology of the hypotension in cardiac tamponade and tension pneumo. It would be amazing if he could take a break from being awesome and write up those (and I'm sure many other) examples of physiology that most EMS providers think they know but are wrong about for a publication that front-line providers read. I think that Rob would have enjoyed the station with Dr. Hamilton, but he surely would have appreciated the residents as well. I imagine he would have suddenly forgotten how to intubate and would have needed to spend some extra time at the airway station with Dr. Keville Who was the older doc helping out with the airway station on the second day? He had grey hair, a tie, and seemed like a big deal. (Have I just described all of the senior faculty at the School of Medicine?) He was quite a patient teacher as he helped me to try my hand at intubating the airway mannequins.