mobey

Hello from a fellow Albertan! I can't help you with NAIT specifically, but overall I can tell you that the passion you have already shown in your first post should go a long way at any interview. If you tell them why you want to be in an EMT program (and you are not a total bumbling idiot), if they refuse to accept you then they suck, and you need to find a new school! There are some really good schools with some great learning opportunities here in Ab. Prior to picking your school, I strongly suggest you decide if you'd like your career to be urban, or rural/remote based. Perhaps then I can point you at some fitting schools. I appreciate your spelling and grammar in your post. It comes off very professional. Take care

This has me reading a little on pneumomediastinum. Thx again dave

I have been a little MIA lately, but i'd be in too.

Been there: please read my post here as it outlines what worked for me. No guarantees it will help you.... but it's all I got. http://www.emtcity.com/topic/21642-longevity-in-ems/

It's funny how much I ASSume based off a single post. I'dlike to withhold my high flow 02 until this question gets answered

What exactly was the surgery? Is he on meds now? Lets sit him up the best we can, start highflow 02 and grab a set of vitals.

I like to go against the grain.... So I'm gonna stick with my plan. I believe the V/Q mismatch at this point is due to PE. I want to attempt the cardioversion prior to RSI. I don't expect it to change the resp status, but I'd feel a lot better about giving anything vasoactive if he was back in his sinus rhythm. I see above where someone states the rhythm will probably convert back.... although I tend to agree, but at this point it is all about scale tipping. I want as much weight on my side as possible for the RSI. If the guy stays in a sinus rhythm for 15min, that is enough time to get him RSI'd, and start an antihypertensive..... though I am not sold we should be doing that.

Better hold off on the Hydralazine: http://www.ncbi.nlm.nih.gov/pubmed/20687078 I am not sure we should be attempting to control the BP without a CT. That right there is how you kill people in the rural/remote setting. Do you know what a rural GP Dr does when hes in over his head? He calls EMS! How about D-Dimer? Would it be specific enough in this acute setting?

There is some literature out there that may be used for or against a provider. http://www.ccjm.org/content/79/11/761.full I suppose if we get this wrong Lee will Su us...... (see original tattoo)

Maybe it is time for one of our computer genius's to track down this guy's school and alert them of this issue.

Good then.... we agree. NSAID use can lead to GI bleeding. Ya I definatly typed the peds dose as I rushed through the last part of my post while making lamb ribs in a dutch oven on my BBQ, thank you all for pointing that out. It is a little sad though that the rest of my post seems to be 'lost' to some sort of frenzy surrounding the med dose. I stand by my original post though. When someone states '9 ibuprophen a day' with no other quantifiers, it alerts me to give a warning about GI bleeds. Although I have been moved to Celebrex, then Arthrotec... I used to take Advil liquid-Gel 800mg tabs daily. 9 of those/day would be 7200mg. Perhaps this is what the dr ordered... perhaps the pills are a lower dose..... I really don't care. The message I was trying to get across is trading narcotic drugs for a high dose of OTC is not always best. I'm not saying that's what happened here. I'm not saying she is trying to do that. I'm not saying the dr didn't prescribe the Ibuprophen. I am saying the impression I got from the OP was she was happy to cut down on prescription Narc's in exchange for Ibuprophen. I simply wanted to leave the impression to all reading as well as the OP, that 'cutting down' on prescription meds and supplementing high doses of OTC is not necessarily a good goal.

No... No you cannot Be careful recommending dosages there Maryb The dose of ibuprophen is 10mg/kg q6hrs. I was less worried about the single dose and more worried about the duration. Taking any NSAID at these doses for extended periods (some will argue more than 3 days) puts patients at risk of internal bleeding.

I am the opposite of a shrink..... I am better at bitch slapping than hugging, but I do have some suggestions for you. First off, clearly you are way too smart to dwell on the things you can't do. So go ahead and cut that crap out. How?? Well, Here's what has worked for me! Advice #1 First off, think about the colour blue. OK, Now, think about the colour red. What just happened to blue? Well.... you chose to stop thinking about it so you could think about red, so it went away. Easy hey! Now apply that theory to all those things that pick at your soul. I know it seems pretty easy to say, but ultimately it is your choice not to let these things fester. Advice #2: Perhaps you need to set some goals, both long & short term. How about starting a blog? A bunch of us will follow I do promise that! Set daily goals, weekly, then long term (no dates on these ones). Short term goals should be both progress and distraction goals. Here are some examples: Learning to crochet Put an ankle weight on the uninjured leg and do 'leg ups', set goals for reps Post 1 scenario on EMTCity per week (13 years on truck and you're not sharing?) Find a physiotherapist (online perhaps) and get advice on how to maintain muscle while laying there Start making jewelry and sell it online Get some bubbles and play with the kids Long term goals could include walking with only a cane, or just 1 crutch. Doing light yoga, Weight lifting goals, etc The ultimate end goal could be passing a fitness test of some sort, then you can decide if you want to go back on ambulance or not, but i'd leave that alone right now. by posting your goals and progress online, not only will you get a 'cheering squad' but you will also have some accountability which helps with motivation. I know first hand it is easy to sit and wallow in sadness, so if your looking for the easy way out - go ahead and do that. If your ready to shake off the dust and get on with life, set some realistic goals and get at 'er As a side note: 9 Ibuprophen every day? What dose? Sounds like a recipe for a bleed to me...... I'd be following Dr.s orders if I were you, I know Narcs aren't fun and addiction is a real concern, but lying in bed bleeding from your stomach ulcer ain't fun either.

Are you just speaking about large cavities like the pelvis or abd? I'm not sure I follow.

By stopping the bleed with the skin you are creating a sealed cavity in which the pressure will build and allow the bodies clotting cascade to take over.

I was speaking with an Edmonton Paramedic yesterday who suspected they were going to see it in the next few weeks. It has been used prehospitally on a patient with a scalp laceration in Hobbema Alberta by a Paramedic and worked like a charm. So.... I guess what i'm sayin is Dwayne was wrong Love ya buddy!

If your grammar in this thread reflects the grammar on your resume, I would say the path may be bleak.

Perhaps your friend was thinking of hypothermia in acute spinal cord injury with deficits. Jury is still out on that one though. http://www.ncbi.nlm.nih.gov/pubmed/21416406

I am going to go at this another way. If I can't get a BP, but I have tachycardia, Im gonna say it's critically low. I'll start up a Dopamine drip and titrate for palpable pulses with warmish extremities if I cant get a BP. Here is where I differ though. I have had 6 ~ patients die in my care, a couple have been in agony, with one of those being a disecting AAA. The reality is, this guy probably isn't going to survive the next 24hrs (Is he even going to be a surgical candidate?). I would be heavy on the narcs.... i'd rather Ketamine..... But if I must, Fentanyl will be just OK. Giving small doses (50mcg) at a time, and not stopping till he is half asleep. It will be like chemistry class... a little Dopamine/fluid, let the pressure come up - A little pain control. Repeat.

Nicely done

I could not disagree more. Your situation is exactly why I do not auto-dispatch If I stop to render aid, I am willing to do only what I am willing to do. It is not all or nothing when i'm off duty. I don't carry an ALS monitor (or even AED) nor do I carry ANY drugs. Where do you draw the line? RSI? Cric? starting I.V.s? Carry spinal equipment? Pacer? Nope, I am offering to open an airway, start chest compression only CPR, stop major bleeding, and call for help. Biggest thing I can do is prevent further injury from bystanders or elements. Besides that.... How big is your car? Carry 02? LP12? Full trauma kit? IV supplies? Spinal gear? Where do you put your passengers?

Sarcasm?

I don't get the reference... What's a 0?

With OLMC – Patients 16 years of age or greater within 3 hours of injury and presenting at any point with HR greater than 110 bpm or systolic BP less than 90 mmHg Dosage Repeat With OLMC - 1 g IV/IO dilute in 250 mL D5W or Normal Saline bag and infuse over 10 minutes Do not repeat dose EMS Contraindications Hypersensitivity to Tranexamic Acid Active thromboembolic disease ( pulmonary embolus, DVT or stroke) Unable to initiate bolus within 3 hrs of injury onset If unable to contact OLMC, do not administer to patients less than 16 years of age Notes Administration of Tranexamic Acid should not delay transport; rapid transport to a trauma facility is still the highest priority. To infuse 250 mL over 10 minutes the drip rate is 4 gtts/sec using a 10 gtt set

I used to carry nothing for fear that Dust would chew me out if he ever found out I carried a kit. Then I came across a rolled over PT cruiser, that the driver was ejected out of. He was bleeding heavily from the leg and was deeply uncx with snoring resps and blood in the airway from epistaxis. I had to wait 20min for an ambulance with nothing ..... I am currently building a kit with basic airway devices, BVM, Abd pads & gloves. Oh and suction........