BEorP

I would say no, you can't make that diagnosis base only on 2 leads. Personally I would but more stock in your clinical assessment of the patient's presentation, in particular the history to help you make a decision. If you see ST changes in lead II or III it would highly elevate your suspicion but I don't think you can definitively diagnose STEMI.

My question wasn't really about whether or not seeing elevation in two contiguous leads is enough to have a high suspicion of MI since that is what we have been taught. My question was, assuming you can have a high suspicion of MI from elevation in leads II and III when seen on a 12 lead, could you have the same suspicion based on leads II and III from just a 3 lead. I don't mean to say that ST elevation in two leads can definitively diagnose MI though because obviously there are other things that can produce ST elevation.

It seems like AZCEP answered my question by basically saying that it depends on the monitor that you are using since some might actually have a lover quality when only doing a 3 lead... hopefully I've understood this correctly.

Thanks for all the replies.

Hopefully I can make my question make sense... We've recently started learning about 12 leads and were taught that they have "diagnostic quality" if we find ST elevation in two contiguous leads to suspect an MI. What I am wondering is if with just a 3 lead you could conclude that someone is having (at least) an inferior wall infarct if there is elevation in leads II and III? (I'm not saying that this would rule out any other areas of infarct or be a reason not to do a 12 lead if you had the capabilities though.)

I was told by an instructor that you cannot because a 3 lead does not have the "diagnostic quality" of a 12 lead monitor, but that didn't seem to make much sense to me... are leads II and III shown differently (or more clearly) on a 12 lead? If we could say a pt is having an inferior wall infarct from elevation in leads II and III in a 12 lead, why could you not do this with just a 3 lead?

Thanks

Airway Management covers intubations.

I.V, were taught how to put a line in and then up them up on I.V Saline.

As I said this any sort of EMT course is only for workplace first aid and event coverage. They don’t ride on ambulances.

Are you saying that EMT-Bs in Australia are trained in intubation or know what it is?

Advanced airway management and IV therapy?

That’s like me working on a emergency ambulance = SCARY!

I wouldn't argue with that :wink:

EMT-B just a mere "driver"??? Yes, we dont have the training like medic's do but theres just no freaking reason to put us down.

Correct me if I'm wrong, but I thought that the most important treatment modality you could use on a p/t was BLS skills before ALS?

So BLS BEFORE ALS BABY!!!!!!!!

I'm not putting you down because you lack the training of Paramedics... I'm not trying to put anyone down, I don't mean to make it personal... but this is just going back to the much discussed lack of education in some EMS systems. I don't think EMT-Ps have enough education either if that makes it any better.

I wouldn't disagree with BLS before ALS as long as it is educated BLS before ALS.

Were do you draw the line with education? There’s a difference between

paramedicine and medicine. It sounds like we all might as well be doctors to run around in an ambulance.

There's a difference between paramedicine and the first aid or standby medical coverage that you provide, but paramedicine is medicine. I don't mean to be disrespectful to you, but as Dust pointed out, you're not in EMS. Being a first responder or whatever you want to call yourself is not medicine... it's giving out band aids and giving oxygen to the people who are actually sick. I don't mean to bash your organization but I know that being a volunteer "medic" it can be easy to come under the false impression that you have seen and know a lot more than you actually have. For example, it seems that you are big on trauma with your motocross stuff... are you aware that most EMS calls are medical?

What would be the purpose in having a doctor on an ambulance? They are highly skilled and educated but they also know a lot more than they need to (e.g. there is not need to interpret an x-ray in the field right now). There's also EMT-Bs in the US who I would consider no more than ambulance drivers and maybe sometimes give them the credit of being medical technicians. So where do we draw the line? It's hard to say for sure but obviously somewhere in the middle. I think a good start is a four year degree with a large focus on patho to ever be able to call yourself a Paramedic and respond to my family's call for help.

We had 2 textbooks we used in school they are great. 1. ECGs Made Easy 3rd edition- Barbara Aehlert and 2. The 12-Lead ECG In Acute Coronary Syndromes Revised 2nd edition- Tim Phalen and Barbara Aehlert. These are 2 very good textbooks. Hope this helps.

We also use ECGs Made Easy and I've found it to be very helpful... the CD that is included is also great.

There are certain rules that must be followed when cadets go out on duty. There MUST be at least 2 adult members at all events, we discourage younger cadets from attending high risk events, 2400 hrs is cut off time and no body under the age of 18 is allowed trackside at a motor sports event.

Under 18 can't be trackside at motor sports even but you can run onto the track to save the day?

Sixteen year old first aider Tim Ivone was the first medical assistance on the scene.

http://www.emtcity.com/phpBB2/viewtopic.php?t=5974

-Ineffective CPR (not really fancy, but this does kill people)

It just doesn't bring them back, they were already dead

Secondly, I disagree with the fact that the training of EMTs (as one author noted, particularly basics) is insufficient. In my experience both as someone who has spent a year in medical school and is now a National Registry EMT-B/D, when people start complaining about training being insufficient, it is most often not the fault of the training, but the fault of the one being trained. Maybe people should start asking themselves, did I LEARN material and interventions or did I memorize it long enough to get through an exam. I think often, especially with students at the basic level, the latter is the case. As far as clinicals go, my training program required 20 hours of clinical time divided between ambulance and hospital. I completed almost 3 times that many hours, including 24 hour shifts in Level I trauma centers, where I assisted physicians and nurses, administered treatments to patients whose care was placed in my hands and regularly performed neuro exams on patients. Perhaps the best question to ask is not whether the training is sufficient, but whether you took full advantage of the opportunities for training and learning made available to you.

We should worry about education, not training. Look at a PCP program in Ontario and then tell me again that EMTs are sufficiently educated.

Want to know what we do.. read the job description or hey even a read a book about it, or watch t.v,

...like Saved?

I didn't have trouble with the written or the practical, what I said was I failed the STATE written exam.

Sorry I didn't pay enough attention when reading your post but NR or state the advise is still the same for practical stuff.

I don't know what your NR or state or any exams are like, but what I find helps me on EMS tests is to just think of the questions as if it is a scenario you're about to do and decide what your priorities would be before even looking at the options. (Obviously this advise is for questions about a call rather than just "what is the size of a D tank" or stuff like that.) It may seem like an obvious thing to do, but I think it really helps and can increase your confidence when what you thought of is one of the options below and the other three or four are obviously wrong.

I don't know if it is just the written that is causing you problems or the practical too. If it's the practical part then my advise would be to practise a lot (and I mean a lot lot lot). Although ride alongs are good to see how what you're learning will actually be applied, you'll see how things are done in the field rather than how they probably need to be done for testing. If you do enough practice scenarios or skill stations or whatever you will be tested on then you will be able to do it without even thinking and hopefully the nerves won't be much of an issue. (It's like the whole social facilitation thing... you'll be so good at the practical part that it will become an easy task for you so under the stressful condition of testing you will do as good or better than always... hopefully.) If the practical part was not causing you problems hopefully that might help someone else who finds this thread in the future.

I don't have any advise for the NR since I'm not from the US.

Good luck.

What is unclear? Only one person dragged this dead carcass from the grave.

Give him a break... he wanted to give it every possible chance to live. Threads were made to be posted in and now he can leave it up to a mod to lock and and say it's done

Sorry I wasn't able to help...

Zee Medical Products out of Irvine, CA is what Google tells me

I thought this was supposed to be a supportive web site, not a discouraging, rude, self-righteous web site. Or are you just the one bad apple? I don't know why you enjoy tearing people apart, and frankly it worries me that you are the one in the EMS profession.

...

I like making a difference, so damn straight it's my hobby! If you have a problem with that, I suggest you see someone about your childhood issues!

I am just one bad apple... along with many other "one bad apples" on this site who will agree with me. It may worry you that I am in the EMS profession, but at least I am in it as a profession.

Thank you for recommending I see someone about my childhood issues, I will get right on that.

Well, if you put it that way, I guess I volunter for multiple agencies, and only truely "belong" to one. Is there such a thing as a freelance EMT? If so, maybe I'm one of those. My main organization authorized reimbursement for anything I want (bilateral sager splint is on it's way, too), but they don't have the dough to make everyone's personal vehicle into an ambulance (volunteer non-profit S&Rs don't bill insurance companies, so we're poor). I am curious, though... how do true 100% freelance EMTs (for hire as medical stand-by at sporting events, etc.) buy their equipment? I haven't seen any grants that are non-homeland security.

EMS is a profession, not a hobby.

Medical standby at the advanced FA (EMT- level I have no problem with, but there is no reason for you to need a Sager especially since I am guessing you have very little experience responding to true emergencies.

Thanks, Marty! Yeah, for myself when I work rally or buggy races out in the boonies.

Is there a reason that whoever you work for does not provide you with this equipment?

But alas, I must admit... I have a gumball too! :oops:

But it's damn sure not on my personal vehicle!

Goes well with your stars of life...

I know that the points I am about to make have already been pretty much covered, but I am really disappointed to see someone who has their occupation as "Educator" who either doesn't teach CPR classes well (if you are an instructor) or has never seen a good CPR class taught in your time as an EMT-P.

My "we" below refers to where I recently completed my FA/CPR instructor course...

We tell people "come take a CPR class and learn to save a life." We do NOT tell them 85-92% will not make it, but CPR gives them the only chance they have.

We tell them <5% survive. We tell them that CPR only buys time until the pt can be defibed. We tell them that the person will not sit up and thank you and go on with their day even if you do everything right.

We tell people practice and get the compressions right, if you do it wrong you will break bones... we do NOT tell them the sternum was not designed to be pushed down that far and you will may well break cartilage or bones even if you do it right...

We tell them that you can expect to break bones and when you do, just be sure that you are still compressing in the centre of the chest (rather than too much to one side so you are compressing the ribs) and then continue on.

So when their patient, usually a family member, does not make it, my experience is many feel they "killed" their loved one. They forget they were told the person has to be sick or hurt enough to die to qualify for CPR to begin with.

This is probably the part that concerns me most. How can you teach a CPR course without students leaving with a firm understanding that CPR is done on dead people? I know you did not say that they were never taught it, but rather that they forgot what they were taught. Dead people getting CPR is such a key point in teaching CPR that if they forget that within a year then they probably did not have a good instructor or maybe they did but that instructor should not have certified them.

Just as Dust said, any instructor who doesn't cover these points adequately sucks and should not be teaching CPR. And if the instructor is covering these points and students leave the class and have forgotten them all by the time they get out of their chairs then they should never receive a certification. On a side note, any CPR instructor who hasn't failed someone probably sucks too.

But back to the topic... I haven't read enough about CISD to know about how good or bad it is, but I think that if lay rescuers understand that the casualty is dead, the casualty can't get deader, CPR alone will not save the casualty's life, and if everything goes perfectly the casualty will still probably not come back to life then I do not see a need for it.

By me the EMS service is all volly, with no one on in the station, just people coming in when a call goes out. So just about all the EMS workers have lights installed in their cars. Some have "bubble lights" that they stick on their roof when need be; however, those are not as effective and I know of a few people who have gotten into serious car accidents while trying to use "bubble lights" to get to a call.

Could it be that part of the blame on the accident could be for the person driving their personal vehicle in an unsafe manner since they had lights? (rather than blaming the "bubble" light for not attracting enough attention)