Lithium

Excellent analogy ... Sorry, I'll apolgize now if I offend, but are you actually in Paramedic school? If you are, then I would seriously be worried that you aren't familiar with that shortform. I'm just really surprised at the differences between Canada and the USA. Jacob

So, you'll have to excuse my ignorance about this, but aren't monitors standard practice in the USA, even at the BLS level? I realise there is a difference in education and standards, but here, I would say every patient contact gets atleast a 10 second strip printed off of them and usually continuous cardiac monitoring, regardless if the crew is BLS or ALS. Every PCP in Ontario is taught basic cardiology and rhythm interpretation, I guess I was assuming that was typical everywhere ... Jacob

Well, as the first reply mentioned, if purely administered to alleviate hypoxia/hypoxemia, then yes, I believe it would. However, just to be completely technical and anal, if you're delivering oxygen to an apneic patient with a pulse, then no, the oxygen isn't doing the 'saving'. The positive pressure ventilation YOU are providing alongside the supplemental oxygen is what would be the saving. If your patient isn't breathing, then applying a non-rebreather on them is the same as applying one to a donut

Very good point Michael ...

Oooooo, me? What nurse? There's a nurse who wants to date me? what? I completely forgot about this post ...

Please, just use common sense! -Be sure to be on time (which is actually 20 to 30 minutes early) -Be active participant in the vehicle check and morning paperwork -Introduce yourself and shake hands with everyone at your station, greet them warmly then keep quiet -Try not to get too excited when responding to your first call, ask your partner what their pre-call ritual is and what they normally bring in with them based on the call -Think your way through your calls. -This isn't school so please converse with your patients to build rapport, don't solely ask them about their SAMPLE hx and then clam up tight, these are real humans with real problems and called an ambulance for a reason, you'll be amazed at how easy it will put people at ease if you make a comment about their home or family, and that will subconsciously let them know you're not stressed, so why should they be? -Talk to your partner during calls, tell him/her what you're thinking and see what they are thinking -Keep your ambulance neat, tidy and clean, it is your office for the next 12 hours -Treat everyone on your scene with respect. You can delegate and ask people to do things for you, but be sure to do it in a calm tone with a smile on your face. -If you're driving, obey all rules and regulations of the road, and WEAR YOUR SEATBELT, especially if you're sitting in the front cab. -When driving emergency, it is not usually necessary to leave the siren 'on' in a continous wail, give people lots of space, maintain an average speed and be alert for people to suddenly break and swerve in front of you. Don't scowl and get mad at the, realise they probably really didn't see you until just then and were surprised and tried to get out of your way as quickly as possible ( :roll: ) Be aware that people LOVE to 'draft' ambulances, because they think that since you're clearing traffic, it will make a quicker route for them. -Love what you do. If you don't, get out. There's many easier jobs out there that pay much better, but you'll receive a lot of satisfaction and reward if you look at each call as a problem to be solved, not someones life to be saved. There's more, but I can't hog it all ...

Akroeze, remember, you have a two-year, full-time ~1600 hour college diploma in paramedicine, our friends to the south, their entry level only requires around less than 200. Although, I'll admit I prefer to have a line in place before giving ANY drug, just part of my normal regime.

To the above poster ... probably the same way how we got satellite TV ... once you're assigned a station, you can bid into station priviledges, and all management does is pull a few dollars off your paycheque every month. So divide a satellite bill of 100$/month by the 16 regulars, and its 6.25 a month. As for the rest of this post, I know it can be a distraction, but playing the devils advocate, music really helps me relax and get my mind off things. I've never been one to pre-plan and think ahead while travelling to calls (other then quicker/shorter routes) simply because I firmly believe that's where people initially develop tunnel vision. That, plus as we all know, dispatch information is not nearly as abundant (or correct!) as it should be. The only time I will review something pre-arrival is for pediatric arrests, and that's just to keep drug dosages straight. peace

Hello all, Today while my partner was driving code 4 (L&S) down one of our rural roads, we had the FM radio on. All of a sudden, Ram Jams "Black Betty" began playing on the radio. I couldn't help but turn up the volume a bit more on the radio, as this was just too good of a song, especially for driving at higher then posted speeds. What song would you like playing while you or your partner is driving 'hot'? Now don't get me wrong, this is meant for fun, I really do realise the implications of having the radio cranked ... but come on now, we all do it! Jacob

Haha, now I can see why and agree with your decision ALS back-up at all? Did you consider Epi?

Not in the back of a land ambulance, but i have been in a crash while inside a plane. That wasn't fun, and is what determined for me to return to land-based EMS. Just out of curiosity, how bad was the SOB for the patient if you decided to return on a 4? Jacob

Epi? Why not just defibrillate them? It would probably have the same effect but defibrillation would do it a lot quicker :wink: NB, Epinephrine is a sympathomimetic, but it's also 2 forms down the line from Dopamine. Tyrosine --> DOPA --> Dopamine --> NorEpinephrine --> Epinephrine I would be EXTREMELY hesitant to give Epi to someone with a pulse, unless I'm using it for the B2 effects related to something such as anaphylaxis or severe asthma, and even then we don't give anymore then 0.3 mg 1:1000 Jacob

I would first try and consider pharmacological intervention. Pacing hurts, plain and simple, and her BP isn't nearly high enough for me to consider giving her sedation. I'd be hesitant to consider atropine mainly due to the suspected ischemia as is shown on the 12-lead, and agree that Dopamine (or even Dobutamine if you carry it) would most like be best. And, the good thing about it, is if you carry Sodium Bicarbonate, there's a good possibility if you give that, you could deactivate it, same with lasix. Here we would need to patch anyways, as Dopamine for us is only on standing order for a hypotensive patient post-arrest. Talk it over with the doc and see what they think. Jacob

Reading another thread got me to thinking; why is it that EMS providers (specifically ALS) are usually so gung-ho to do procedures and administer medications to patients, instead of for patients? When I took my ALS program, it was told to us over and over and over and over again that simply because we have these added skills, we didn't necessarily need to use them. There was a few scenarios during our lab time where they were designed to be run purely as BLS (monitoring/supportive with no ALS intervention) as the instructors wanted to see if we could defend what we did. Needless to say, this upset a few people as they jumped the gun a few times. The opposite side of the spectrum however, physicians (whether interns, resident or attending) are very hesitant to go ahead with treatment modalities without first consulting with other physicians and nursing staff. Why would that be? Could it be that they're more concerned about whether this treatment is going to help the patient, rather then just give them something to do? So why is it that we like to play with our toys? Where does this mentality develop from? What are your stances? -Jacob

I concur!

Personally, I like the 'bulleted' style of presenting the information. Then again, for me it's always just a recert course ... I'm a huge fan of flow-diagrams for learning material. peace

You touch on some good points Dust ... I for one have always wondered why everyone seems to use the 'yelp' when going through intersections and 'whail' when travelling on straight roads. That's BACKWARDS people! Use your 'whail' when approaching intersections, as the increasing/decreasing levels spreads over a greater area, and the 'yelp' travels in a more straight direction. If you happen to be travelling in a convoy to a call, the lead vehicle should use the tones above, while the rear vehicles should use the 'hi-lo'. peace

Alright, my question for the week ... How in-depth is your knowledge of pharmacology? Is it where you'd like to be, or would you like more, or less? For instance, which one of these statements would apply to you best? A) Nitroglycerin is a drug we give to people experiencing suspected ischemic chest pain and pulmonary edema. Nitroglycerin is a vasodilator, which in turn will reduce preload, which is WHY we give it to persons with suspected ischemic chest pain and probable pulmonary edema. C) Nitroglycerin releases nitric oxide in vascular endothelial cells. Nitric oxide is a gas, which when released in vascular smooth muscle, results in the formation of cyclic guanosine monophosphate (cGMP). cGMP relaxes vascular smooth muscle by inactivating myosin light-chain kinase or by stimulating dephosphorylation of myosin phosphate. (Copyright Rob Theriault, from Drug Guide for Paramedics, 2003) What do you believe should be the minimum amount of knowledge for pharmacology for EMTs and Paramedics? peace edit: spell check

Perhaps the patient mentioned something about the board being comfortable? OOooo, there's something trippy to think about, someone finding a backboard comfortable. Then again, I have heard of people who prefer super hard mattresses for sleeping ... peace

You would be mistaken. :wink: peace

Oh and yes, about the flight stuff... Alright, if you want to get to CCP, go FLIGHT! Pretty simple, you pay for your PCP aeromed course through the Ontario Air Ambulance program. Its around 500$ and is the simplest course in the world. Write your exam, and you're now able to work flight as a PCP. This is where it gets fun. If you're willing to relocate, (and I mean, WAY far away) then apply to the air ambulance services in the province. If you can get on with a ministry funded program, you'll probably be stuck way way way up north in moosonee on a plane. This equates to no scene calls, but, you do get to work (generally) with a CCP doing pretty decent transfers. However, they will now pay for your ACP training. Once you get your ACP training, they will pay for your CCP training. And because they're short staffed right now, generally the wait is only a year (or LESS!) between levels. Once your ACP, it gives you a bit more in mobility, and I would highly recommend trying to transfer to Canadian Helicopters so you can start doing scene calls on the whirlie birds peace

So do I Hammer, so do I. :wink:

BEorP, if I read your post correctly, is it safe to presume you're in the U of T/Centennial program? If so ... could you PM with details about if you liked it, worth it etc etc, I've yet to meet a grad of that program. As far as your question, quite honestly I would say go straight to ACP. Don't cut yourself short. However, you have brought up a valid point. I don't think many services would be comfortable hiring a new ACP graduate who has never worked in ambulance before. That being said, what I can see plausible is to get yourself hired with a service, and while working part time as a PCP, goto ACP school and when it comes time for clinicals/rideouts, associate them with the service you're employed with. Quite honestly, if you're going to be a lousy medic, you'd be weeded out during your probationary period as a PCP anyways, so the thought of a bad PCP becoming a bad ACP is pretty moot there. Northernmedic, I agree whole-heartedly. peace

I dis-agree with your observations. For instance: DURHAM PCP = 2 bars ACP = 3 bars TORONTO PCP = 1 bar ICP = 2 bars ACP = 3 bars CCP = 3 bars with CRITICAL CARE Everywhere else I'm aware of uses the one bar for PCP and 3 bars for ACP (Halton, Ottawa, Muskoka, Simcoe, Parry Sound, Sudbury etc etc). And yes, I know muskoka, simcoe and parry sound are BLS only, but they do have expanded scope in some places, but still PCPs only get one bar. peace

Perhaps I'm a little off here, but, I don't see how less equals more in this instance. Wouldn't this be more of an issue with QA/QI programs instead of HR? If the medics aren't receiving enough calls to keep certain skills current and fresh, then either pull them from the book or offer more frequent refreshers with CMEs. This is where I believe it's up to the service in co-operation with the base hospital/medical director to do some research and tailor the needs of the medical protocols to the community. peace