mobey

Yes any tabs that have the words "hip hop" have african american folk in the pics. Click on the first 4-5 tabs on that same menu though. Not that I really care... the site is freaking hilarious!! I am just poking fun in this thread. I do realize you are not a racist, just bored tonight. BTW: this is a REAL question from a middle-class Canadian Isn't Ghetto a lifestyle?? Like big rims on 80's cars, oversized beer bottles, gawdy big jewlery, houses with ill-maintained exteriors? Economic condition to me signafies income status. Can't a rich "thug" live the Getto life? Eg; Lil' Wayne, 2Pak.

Yes any tabs that have the words "hip hop" have african american folk in the pics. Click on the first 4-5 tabs on that same menu though. Not that I really care... the site is freaking hilarious!! I am just poking fun in this thread. I do realize you are not a racist, just bored tonight.

I realize you were not asking me, but I am in a similar situation. There is not a specific note in the protocols that say "No mainlining", however if I were to "mainline" a drug I could see 3 things happening: 1) Co-workers would poke fun at me for weeks on end 2) Our PCR Audit committee would question my conduct (And if I tried to defend myself) 3) My employer would offer me remedial training on proper I.V. medication administration. Start mainlining drugs and you WILL have a wreck! Only a matter of time before some bonehead tries to do it with D50W or Calcium and does some real damage.

Hilarious reference! Unfortunatly white people outnumber black people in the menu on the left.

SL injections are used in extreme presentations of near death anaphylaxis being attended too by BLS crews in the prairie provinces. BLS can do IM injections but not IV. The theory is, a patient who is shut down peripherally will respond to SL injection as it is more central. I have no idea if it is supported by science, but hey... in that position, I would give it a shot. Tongue in cheek here: Per rectal is actually a well studied and acceptible drug route. I used to use Midaz per rectal in Peds for seizures back in the day. Tubing the rectum with an ET tube though.... That is just stupid. A much smaller tubing is more appropriate eg; Suction, cutoff nasal cannula, foley, etc

Reference?

.....If you have a toilet as a planter.

Why do these shows always fail?

I am continuously training BLS staff that have worked in a BLS service for 10+ years to be competent to work as a team with Paramedics. I am looking for topics or material or delivery ideas anyone may have.

Now we are thinking new onset WPW with A-Fib in a 82 year old with multiple cardiac histories including pacemaker? I can appreciate you wanting to share some knowledge, but scrambling for zebras in this scenario is just too much....

What do you like best about me? Oh.... I thought this was a thread where we post desperate 14y/o girl questions. J/K

We use disposable metal as well. I am confident I can clean them adaquetly. Would I put it in my mouth? Of course not. But it is psycological reasons, not disinfectant reasons. I use silverware at restaurants.... how is that any different?

Huh?

92 y/o male resp distress Mildly hypertensive, HR 112, Sp02 on room air 82%. Temp normal RR44 Pt presented to lodge staff at 0330 with sudden onset difficulty breathing. Pt first sat in a chair, then layed on floor while awaiting EMS. We arrive 20min later to find him with peripheral cyanosis, cold extremeties, no diaphoresis. No peripheral edema. No chest pain, no neuro deficits. History of Htn is all I got. Meds = zylopram, senokot, furosemide, coumadin, vit d3, Apo-Cal. Pt is Alert although clearly tired. Wheezes audible in the room. Apicies are very musical indeed! Bases are near silent, but faint wheese heared at end of expiratory phase. Tx: Immediatly 5mg Ventolin, 500mcg Atrovent. 8mg Dexamethasone. Load into ambulance. I.V. initiated 4 lead = A-Fib. Sidestream EtC02 = 31 Shark fin shaped waveform No change in presentation. Sp02 now 91% on nebulizer. Resps now at 36 Start 2nd neb identicle to above and capture 12 lead. Infuse 2gm MgS04 ASA 160mg Upon arrival at hospital, pt sitting up talking full sentences. Slight tachypnea, mild wheezes in bases, clear apicies. No complaints OK... Check out the 12 lead hope the quality is OK.

I use 2 simple methods myself, since I have trouble remembering all the rules in the heat of the momemt at 3am (Though next time i'm calling bieber). 1) Are all the V leads concordant? (All positive or negative). If so.... prolly V-Tach 2) Is there right axis deviation? If so Prolly V-Tach Consider thier "normal" rythm in this case. If they are a A-Fib look for regularity in your strip. Regular wide strip in a A-Fib patient strongly leans toward V-Tach. If you are really unsure..... just use Amiodarone! Can`t go wrong

It is on the AHS website in one of thier forms. I will see if I can find it and email you a copy.

Baaaa hahahaha.... Is this guy for real? What was that post about Cons on this forum.....

I am with Sys on this one. Legally I can administer a med, continue care for 15min then pass off to a BLS provider. In this scenario there is not 15min to spare so it would not happen. Risk/benefit is huge in this instance, and a little analgesia for anyone is waaay down low on the priority list.

These people get greeted by the RCMP at our destination. Can't remember the name of the law broken.... but there is one.

Rural Medic affiliated with Squint? You are doomed Don't worry our army is getting stronger!

I see your sources, and raise you these: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1014350/pdf/jnnpsyc00500-0049.pdf Instead of another study, I will ask you to re-read your first source, and examine whether it truly indicates a prognosis or not? I do not have a problem with ALS taking Patient #1, as you can see in my later posts. I do have a real problem with you sending him BLS because he has less of a chance of walking out of the hospital. In a way your kind of "writing off" this patient with very limited education of head injuries. Just doing quick google searches we were able to find science that is conflicting on decorticate posturing as a prognostic indicator in TBI. Yet your 1st instinct was to send the guy BLS because..... well, because that was your instinct! That is why we treat with science (Evidence based medicine, where the evidence exists). His vitals are stable. Of course his condition could deteriorate quickly. If the medic could load the meds before transport this could be retarded. “I would consider him the more "stable" at this point since his hemodynamics are conducive with life as compared with our other patient.” MOBEY Not to be taken out of context DFIB. You did not answer the question though Under the suspicion of cerebral edema, if the medic could give him a dextrose solution, osmotic diuretic and corticosteroid like Dex it would in my opinon prolong the stability of the patients vital signs. Ahhh... I see! I can say with confidence that you will not see Cerebral edema treated pre-hospitally in the early phases of head injury. These drugs/solutions used for reducing ICP have some heafty side effects and when used improperly can do irreversible damage. I would be veeeery surprised to hear anyone out there giving mannitol or other such drugs in this setting. As a side note... You would be hard pressed to find a Medic who would swing such a large hammer at the patient, then turn the patient over to the BLS crew. This guy gets the one year medic. In a lot of places where the rig is run by an EMT and a medic. All the EMT does is drive the truck and carry stuff. This would be different from a unit where the EMT is the "in charge on every call" So being an EMT with 14 years experience could mean he is a really good ambulance driver and had 14 years to forget all the stuff he learned in school. I am still going with the medic because empirical experience will not make up for education and extended protocols. Thought we were gonna have to have a discussion on education vs experience..... Glad to see no one has led you down the wrong path.

Initially I was with you on this one, but then got thinking about it further. DD of Patient #2 is high space shock. NaCl bolus may get us to our desired MAP initially, but with a 30min transport, it is a temporary fix. The guy is showing a clinical need for a pressor, and we can be certain that it will only get worse. If Patient #1 is oxygenating/Ventilating on his own with OPA and NRB or BVM, then why does he need ALS at this point? Although he is unCx, I would consider him the more "stable" at this point since his hemodynamics are condusive with life as compared with our other patient. I think I initially leaned towards Patient#1 since Airway is an area we can make a real difference in, however feild intubation in TBI is a controversial subject at best, and without trismus or vomiting, it is pretty hard for me to justify walking away from a critical hypotensive neurogenic shock, to "ALS up" an airway that is being managed by BLS. Great discussion!

I will never understand EMT's recommending when and where to go to Paramedic school..... Everyone here has pretty well spelled it out for ya. The reality is, no matter what you are doing in EMS, it should always be goal directed. Goal Directed therapy (patients) Goal Directed behavior (Professional) Using that logic set some goals to reach prior to starting Paramedic school... not deadlines. Here is an example. Goal: To be comfortable touching patients Goal: To ensure I can stomach blood, vomit, feces Goal: Get proficient at BLS procedures eg. OPA insertion, Nasal cannula application, Driving an ambulance, Using a radio. Goal: Stop calling Ambulances - bus's/taxi's/trucks/cars etc Now, when those BLS goals are met, set a new line of goals for Paramedic school. Then as a Paramedic practioner...... and never stop setting them! So as you can see, it is hard for anyone here to tell you "2 mos" or "2 years", because only you know what your goals are! I can tell you one thing though..... I met all my BLS goals on my EMT practicum, then wasted the next 3 years cheaping my patients out of Paramedic care because I listened to yahoo's who told me I had "Dues to pay" as an EMT before I had the "Right" to enter Paramedic school.

Wish I could give ya'll a run down of what really took place, but the reality is, I was a Paramedic responding with 2 BLS ambulances that day. Little technical/political as to how that happened... but it will never happen again. What I DID do was get 2 fixed wings in the air before we even arrived at hospital. Seems petty, but it was the first time fixed wing has been dispatched from scene in this area. Thought: Does patient #1 or Patient #2 present a clear "need" for ALS intervention? QUOTE DFIB; I would like you guys to help me a little with this. Ask and ye shall recieve My rationale for the BLS transporting the decorticate patient is that his prognosis is poor in survival and quality of life, Time to learn how to learn! Indulge me: Find 2 articles from reliable sources (NOT Wiki!) that patients with head injuries presenting with decorticate posturing, have a poor prognosis and copy the links into this thread. If he is stable the BLS should be able to handle bagging him without a tube and CPR if needed. Is he stable? If the medics protocol allow him to load some meds to help with edema he should have additional advantages. You will have to explain this a little further......?? Patient two on the other hand has the possibility of surviving and having a decent recovery. I would place the most experienced care with him. There is a Paramedic with 1 year experience, and an EMT with 14years experience. So who takes him? Looking forward to your responses

I agree both could go in the ALS unit. Logistically though, it would have been hard to have 2 criticals in one rig. The main concern was that these two were found "spooning" so-to-speak. Immobilization was done one at a time since we had severe neuro deficits with Pt #2. That said, Pt #1 was packaged and ready to go, as Patient #2 was just getting rolled onto his board.