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jwiley40

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jwiley40 last won the day on March 4 2016

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About jwiley40

  • Birthday November 20

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  • Gender
    Male
  • Location
    MO
  • Interests
    Family, God, work and Cardinals baseball....order will shift depending on the day/time of year!

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  • Occupation
    NREMT-P, retired Soldier, husband and chef.

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  1. Been away for four long years. For some reason, an email popped up and reminded me of the site. I totally forgot about EMTcity! I'm back and plan on checking in more often.
  2. Morning all, from cold and icy Missouri! The service I work for has shifted in the last year from Broselow to Handtevy for treatment of pediatrics. In a nutshell, it cuts back on the need to do all of the calculations, especially if you're in a very stressful situation. It works more with milliliters than milligrams. Volume over dosage. With the addition of the app for our phones, I can have a pretty good idea of how much of a specific medication I would need to give BEFORE I arrive n scene. If anyone else is using it, how do you feel about it? Has it helped you? I have been off EMTcity for a few years so if it has been addressed, sorry to bring it back up. Thanks!!
  3. jwiley40

    Anaphylaxis

    Diphenhydramine (Benadryl) when given by a medic is in IV form, not a syrup like you find at home. Yup, it'll make you sleepy, but it stops the histamine release. Epinephren 1:1000 given subcutaneously is the first line medication in anaphylaxis, as it relaxes the smooth muscles. The two meds working together will bring relief to the patient.
  4. When I worked as a medic in an ED (US military hospital as a civilian medic), I ran calls and worked in the ED, assisting nurses and doctors. However, we were restricted to performing only within the limits of our licensure. In other words, if we could do it on the trucks, we could do it in the ED. As for meds, if it wasn't on our ambulance, we didn't administer it. Breathing treatments, IV medications such as Cardizem or RSI meds, we gave. We could not perform suturing, even if we were certified to do so. If it wasn't in the scope of practice or on the job description, it wasn't done in the ED.
  5. It's either what they're eating OR how much they eat. There is one thing I have learned in all my time working in rural EMs: farm kids always seem to be much bigger than the city kids I have met. I'm not entirely sure if it's a combination of hard work and good old fashioned home cooking, or if it's simply that they eat more than we did as kids. I took care of a fourteen year old boy that was taller and bigger than I was when I joined the Army in 1982! he was longer than my cot! Arctickat, thank you for the leads! They will be most helpful. You rock!! To all of the members of this page, if I haven't said it before, I will now: Thank you all! You have always been a source that gives me some seriuos guidence. I still pursue the subject I ask about, but you all give me a better direction. That is where I want to be in the very near future. Even after 7 years, I still have much to learn.
  6. Yikes! That's a problem. And that's why I put this out there. I can't seem to find it anywhere, the full study with all the results and data. But I have to agree with the information presented in the paragraph. However, I have to follow the protocols of my service and the new service I'm getting ready to work for. I would like to be able to present the information to my new supervisors.
  7. To all here: I was looking up information on IO infusion for peds and ran across a short paragraph from 2006 that says the Broselow Tape may under-resuscitate children. Here is that paragraph: Registered nurse Carolyn Nieman (In Memoriam) discovered that sometimes motherhood is the mother of invention. Ms. Nieman, who served as an ACNP/flight nurse specialist for Metro Life Flight and faculty at Case's FPB School of Nursing, presented her project “Use of the Broselow Tape May Under Resuscitate Children,” for which she shared credit with seven other researchers at the 2003 Research ShowCASE. While watching her then-thirteen-year-old daughter and ten-year-old son perform at a school concert, she first thought of the idea that she displayed at the showcase. Soon afterward, she began devising a way to improve on the “Broselow Tape” method traditionally used in emergency medical situations involving children requiring resuscitation. The method is used to estimate medication dosing and equipment sizing based on a child’s age and body size. “I always thought my kids were normal size, but that night they seemed so much smaller than everyone else on stage,” she said. “So when I came to work, I started thinking there’s no way that the Broselow Tape can be accurate anymore, and it became more clear to me everywhere I went that kids seemed bigger and bigger.” She enlisted the help of several other flight nurses she worked with to research the current accuracy of the Broselow Tape, which had never been validated in a pediatric population, according to Ms. Nieman. The team worked to correlate the device against a large sample of children. Their research analyzed measurements of about 1,150 children ages 5 to 11 from several Greater Cleveland schools, as well as the database numbers for the MetroHealth System’s measurements of children from birth to age 11 taken during annual well-child visits. The team collected enough height and weight data to conclude that less than fifty percent of pediatric patients today would receive an accurate dosage estimate based on the Broselow system, especially children who are older or heavier. Ms. Nieman’s research group is in the process of completing its research paper and getting it published, which they hope to do this summer. “We want to get the word out to people in emergency medical systems, fire departments, emergency rooms, and so on, so they can determine what they want to do with the information,” she says. Nieman CT, Manacci CF, Super DM, Mancuso C & Fallon WF. (2006). Use of the Broselow tape may result in underresuscitation of children. Academic Emergency Medicine, 13, 1011-1019. I have looked on Google, Bing and in medical search engines trying to find more information. If anyone can point me in the right direction, I would be most appreciative. I would like to think that when I have to resuscitate a pediatric patient, that I use every tool in my tool-kit to do it.
  8. Sometimes the best way to learn!
  9. jwiley40

    Anaphylaxis

    For me, load and go and perform an ALS intercept. At least get the patient moving to definitive care. By the way, I have learned from my last foray into the scenario world: stay heck away from abbreviations!
  10. I'm learning that..... Teaching point for myself.
  11. If you look at the Lead II rhythm at the bottom of the attachment, the inverted P waves are there. I agree though. they are hard to see.
  12. SMR: spinal motion restriction. COA: Conscious, alert, oriented COG: cognitive Wow! I didn't realize I was going to open a can of worms! All I was trying to do was get into the spirit of the thread. I actually enjoy these. Guess I'll need to spell everything out in the next one. I was simply asking all the same questions when I deal with any trauma, no matter how major or minor. I follow that head-to-toe method of assessment. It is something I learned in ITLS (International Trauma Life Support- in case there is any confusion!) So, everyone, can we get back to the thread? I really want to see where this goes. I certainly wasn't trying to derail it.
  13. The P waves look inverted. Tells me it's junctional. It's not a great attachment but I could see the inverted waves. Other than that, regular rhythm
  14. Lets talk ABC's. Does he have a pulse? Or am I working a trauma code? How far did he fall? What was he doing before he fell? Anyone of the bystanders know his past medical hx? I would also start with a rapid trauma assessment: COG: is he COA now or still unconsious/unresponsive? Head: What do I see? PERLA? Normocephalic? Blood and CSF leaking from ears? Neck: JVD? Trachea midline? Back of the neck have injuries? What are they? Bruising/swelling? Chest: Symetrical? Breathing normally or do I have paradoxical movement? Lung sounds equal in all fields? Abd: soft, non-tender or distended and painful? Pel: any bruising, swelling or crepitous noted? Priaprism? EXt: any obvious injuries to extremities x 4? Back: injuries? Bruising/swelling/crepitous? SMR will be initiated. IV, O2 and rapid transport.
  15. Actually, if you are NREMT, you don't have to challenge the state test. I asked about that. My wife and I are looking into possibly moving to Florida so I began to check into it as well. The State Bureau of EMS told me that if you have a current NREMT certification, you can simply apply and pay the $45. If you only have a state license, then you have to pay $75 and challenge the state exam. I'm taking the NREMT in April in St louis because I'm an idiot and let it go. The NREMT cert is good in nearly all 50 states. Hope that helps!
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