Mateo_1387

That could be related. I would probably have CP daily if I was an elementary or high school teacher under some of the conditions I hear about. It's bad enough in a classroom of EMT or Paramedic students.

If I was a high school teacher in a classroom today, Nitroglycerin would not be my drug of choice to ease the pain.

I love it when your sense of humor shows !

ATTN:

This bulletin just in...

Do not, I repeat, do not travel to Texas, especially South Texas.

The women are missin' teeth, creatures eat you alive, and oh yea, Spenac is now a paramedic.

I hear Obama was going to declare Texas to be in a State of Emergency, but he did not want Spenac gallivanting all across Texas to treat the injured. (Answering from home, I might add ) (Wakcer)

Aww Hell. I had a hard enough time arguing with you while you were an intermediate...

Oh, and Spenac, Congratulations on a job well done !!!

Charvetta Ford-McGriff (704) 943-6089.

Honestly, you need to call this lady. Charvetta came to speak with my paramedic class last year. She absolutely wants anyone who is interested in MEDIC (Mecklenburg EMS Agency) to contact her. She is more than happy to anwer any questions.

http://news.ncems.org/employment.htm#MEDIC

This is the employment page for NC EMS. There is an add for Mecklenburg EMS Agency.

...And sometimes its fun even when I know I'm wrong to argue a point in order to get more out of people.

Ha !

I knew it

Best of Luck to him. What is his EMT City Screen Name?

Forgive my ignorance please. Is Benadryl a commonly used anti-emetic? I had no idea an anti-histimine would function as such. How much would you give in this case, taking into account the additive effects Benadryl has on alcohol and benzodiazapines?

Just food for thought, Phenergan is a histamine blocker, and is used as an anti-emetic.

Another excellent case that illustrates the value of prehospital 12 lead ECGs for rhythm analysis.

Wide complex tachycardia, rate of 150, with bifascicular morphology (RBBB/LAFB). Atrial complexes clearly visible in several leads (especially aVR, V1 and V2). The trained eye can identify 2:1 atrial flutter in lead III.

Conclusion: 2:1 atrial flutter with bifascicular block (RBBB/LAFB).

Treatment: Assuming the patient is hemodynamically stable, supportive care.

Not to beat a dead horse, but this is another heart rhythm you wouldn't want to treat with antiarrhythmics, especially if the chief complaint was chest pain or syncope.

Tom

I agree with the RBBB and LAFB. Underlying rhythm I believe is sinus in origin. I see clear p-waves in lead V2.

Because with bifascicular block, A-V conduction is limited to a single fascicle (in this case the left posterior fascicle of the left ventricle). If the chief complaint is syncope, you have to consider that the patient is probably having transient episodes of 3AVB. If the chief complaint is chest pain you have to worry about ischemia of the last remaining fascicle. Either way, you don't want to make the situation worse with an antiarrhythmic which could trigger 3AVB (and wipe out any ventricular escape rhythms).

If the patient is stable, that's good! Why mess with a good thing?

Tom

You could always give a little bit of fluid to treat for dehydration...

Nope. With a 2nd degree, type 1 (wenkebach) you have a PR interval that gets longer and longer from beat to beat until you drop a QRS. With a 2nd degree, type 2 you have a constant PR interval with occasional dropped beats. With a 2:1 block you do not have enough sequential beats before the dropped beat to determine if the PR is constant or getting longer.

http://library.med.utah.edu/kw/ecg/ecg_out...x.html#AV_block

Would you be able to tell by the width of the QRS? Type 1 narrow and type 2 wide QRS.

Wow. In reference to the video submitted on May 20th...

Nothing shows love like snorting coke off your baby's stomach while he is breastfeading.....

Unfortunately, by definition you cannot have a left anterior fascicular hemiblock with a left bundle branch block. Remember, we have three fascicles. Two on the left and one on the right. A left bundle branch block can only occur when both fascicles on the left side fail, thus causing a true block of the left bundle branch.

Just to clarify the terminology because it is confusing:

1) A hemiblock refers to the block of a single fascicle on the left side.

2) A bifascicular block refers to the block of the right and the block of one of the left fascicles.

3) A trifascicular block refers to the block of the right, block of one of the left fascicles, and an incomplete or possibly intermittent block of the last remaining fascicle.

Take care,

chbare.

True That !

Thanks chbare for correcting me.

Anyone think this is proof that healthcare can be cheaper than what it is? With Maintenance tools and telephone consults, it probably could be cheaper. Now you can start sweating ERDoc !!

STAY AWAY FROM AV SLOWING AGENTS.

I wouldn't give any drugs to these patients. Shock them! Procainamide is the safest if you have to give drugs. Amiodarone is controversial, but second safest (if you are going to convert them you might as well zap them). C+ Channel blockers or Adenosine will effectively kill them.

Why do you say amiodarone is contraversial? It is the everything channel blocker (in essence) applying the breaks to the whole truck, and not just the front set of breaks...

Also, as for Adenosine, the drug card that comes packaged with Adenosine says that it can be used with WPW. Why do you say it will kill them?

There is complete AV disassociation. This is why the QRS complexes widen with complete heart block.

Wouldn't the QRS width be determined if the AV Node is blocked at the node, or just inferior to the node?

For my interpretation, I am seeing...

3rd Degree heart block

LBBB and LAFB. LBBB is seen with LAD, - deflection S wave in V1, and LAFB with the - deflections of II, III, and aVF.

Thanks so much for the replies guys! You are definitely helping me narrow down my approach. I would like to know more about flight medic and such, but you've been loads of help! Also I'd still like to hear from anyone working in the Chicago area! lol

Thanks again!

And also, another question, do big cities have ambulance services besides private or fire? Specifically Hospital, that's what I'm used to so far and I really like it but I can't find much info on the matter for Chicago.

First off, let me say that I am not a flight medic. What I am going to say though hopefully will make you think about your path to working on a helicopter. (If I am giving out bad advise, someone, please correct me !)

You may want to consider going to nursing school. You already took a 10-hour credit course for EMT-B. I hope this means that you are thinking in terms of getting a good education. If your goal is to be working in a helicopter, then I believe nursing school would be the better way to go. As a nurse working on a helicopter, you will usually have more responsibilities, perform more skills, and get paid more. Also, after being a nurse, getting an EMT-P cert will be a piece of cake. The nursing school and hospital environment will offer you a great education and experience base. I think the same would apply to a Respiratory Therapist, as some HEMS services utilize a combination of RT and RN.

Just something to think about...

G'day

Matt

Lil Wayne - Put Me In The Game ''SONG 2009''

(playing games LOL damn i have a new addiction here the GAMES!)

Where would you like to be right now?

Kokomo- The Beach Boys

Who's your daddy?

For a serious reply though...

A series like this will always be overboard, because they are out for ratings. As a result, it will probably give people the wrong idea about what the EMS profession is about. Showing viewers the world of EMS is not really their job, entertainment is. Some aspect of the series may be good for the EMS, other aspects will not be good. Most of it is just going to be entertainment anyways. Until I see more of the series (which I probably will not watch) I am going with 'Could Be Both'.

G'day

Matt

I do not know if I would enjoy the show, but I would not mind waking up to the blond chick smiling over top of me.

Congratulations to you and Mr. Riblett !

Now I have a friend to stay with when I go to Fl. JK

I have no advise for ya, as you know where I am located. Please, do not be a stranger, and let me know if I can help you any.

Good Luck Ol' Friend ! (and Mr. Riblett too)

RIP

Does NC have just ambulance drivers?... Or was she an EMT?

I know of no places in NC that have just ambulance drivers. Every service I know has a minimum requirement for EMT-B. Reading the article though, if she was working and volunteering at the same agency, that is illegal.

Anyways...I do wish strength for the family and colleagues she leaves behind...This from a neighbor, just down the road.

First of all, your right...haha, I'll shut my mouth before I end up looking too stupid. And second...when did I say that I saved a life? He told me that at 17, I should be living my own life, and not be too worried about the EMS profession. I said that if I lived life, and not cared about EMS, I would basically just let people walk all over me (I already do), and be too generous for my own good (I already am)

Anyways...I don't want to look stupid anymore...so I'm shutting my mouth. Thanks again everyone, for everything. You've opened my eyes to a lot of stuff...not just "small town thinking".

EMS is not going to be a fix to your problems in dealing with other people. Being walked all over (and over generous) is not dependent upon you being an EMT. I fail to see the association. Would you please explain it?

Yeah, I've thought about that before. But honestly....here's me. I'm a 17 year old girl who, if I just lived life, would let other people walk all over her, and be too generous for my own good. I'd rather have a job where I'm able to help people, and not partying. I'm not saying I don't do anything fun....I go to carnivals, go to the movies, hang out with friends, and work as a convience store clerk on the side. Its just that I love to be able to help people. I'm not saying that this will be my only profession...I want to be a nurse.

I just believe its better for me to start at the bottom and work my way up, because if you just go straight to the top, you tend to look down on the less qualified. I've seen that for a fact....RN's looking down on CNA's, and paramedics looking down on Basics. *Not all do, but some tend to have the mindset "I've been in this longer than you have, I have more schooling than you have, so what you think means nothing to me"* I don't want to be like that, so I will always try to appreciate everyone, no matter what level I get to.

It was never said that living and learning means that you will be walked all over. Living life is going to develop your sense of individuality, shape your personality, mold your morals, and understand your personal standards. You are just entering the gray area between teenager and adult. I think this is what people mean when they say you get experience with age. My point is that you should be focusing on this stage of your development with openness to learning and improving upon yourself. EMS, IMO, will drag you away from that important goal/vital time in your development. What I am trying to get across to you is deeper than 'I want to help everyone'. This is about your transition into adulthood. This is not about answering the next adrenaline pumping call. Those calls will always be there. Your time right now, spent doing EMS will not be given back to you.

First, I think you have some great posts. They are so far very easy to read because you possess grammar skills.

Second, my opinion is that you should ditch the EMS thing. At 17 years old, and even at my age of 22, this is not a job for young people. These years should be the times of our lives, learning to enjoy life, think for ourselves, have fun, and soak in as much as we can to improve ourselves. Not spending countless nights at EMS stations, answering calls in a stringent and strict environment that keeps our mentality confined to the attitudes around us. You seem like a very intelligent 17-year-old. I give you that. I have learned though, that even at the age of 22, I do not belong in this business at this point in my life. Quite honestly, my opinion is that others my age do not belong in this line of work. This is time for you to shine, not wipe puke off of some old person who fell on the floor at 3am.

There is so much to learn in this world. EMS will distract you from that. I believed 22 years was old enough for me to be a paramedic. Sure, I can do the job, and I do it well, but I should not be wiping puke off some old person that fell at 3am. This is the time for me to keep exploring my boundaries, build my own life standards, gain life experience, and become the best damn person I can be. I feel at 17, your goals should be similar. You should be focused on your life of a 17 year old, having friends your age, learning to build your own values and standards, and living life to the fullest. There will be plenty of time down the road that you can spend doing EMS.

EMS is not all that bad. I would not trade what has been taught to me, and the experience gained from being a young paramedic. It definitely has shaped my life. The only thing is that I should be doing this at a later point in life. Being young is a special time. Becoming an adult and learning the idiosyncrasies of adulthood is much more important than EMS.

To you, what I posted may seem like a bunch of bullshyte, but I honestly believe you are intelligent enough to comprehend what I am saying. Hopefully, you will take this information and think upon it. I realized it way too late. Please do not make the same mistake. It took a dear friend of mine to point this out to me, and I thank him immensely (you know who you are). There is still much to comprehend and learn about life.

Just one young paramedic’s opinion…

Matt(y)

WOW, that was quite impressive !!!

Thanks for sharing Wendy.

In my opinion, the only reason to leave a student behind is if it DEFINATELY means life or death for the patient.

I disagree. Leave student behind where your patient was shot in a ghetto. Makes good sense eh? Crew before patient, and that includes student, because we have a duty to go home safe.