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/

Any... trouble breathing....?

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:

Some of the adverse effects related to hydralazine that have been reported in the literature include reflex tachycardia,

http://www.ncbi.nlm.nih.gov/pubmed/20687078

I am not sure we should be attempting to control the BP without a CT.

Since he is still under the care of the hospital staff, I would tell them to call back when pt is stable

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!

I'd like to get some labs going NOW. CBC, CMP, Trop, ABG, coags to start.

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.

As a side note, I have seen lower max daily recommended dosing for rheumatoid arthritis in a couple different sources. However, they have also mentioned that some RA patients may respond better to higher doses (but not higher than 3200mg/day).

Yes. Longer duration medication use can potentially lead to GI issues. However, we don't know the dose, we don't know if this is OTC or prescription strength and we don't know if this is the treatment regimen prescribed by her physician.

No drug is without risks. Even OTC medications.

With this in mind there have been studies about ibuprofen induced GI bleeding. This lit review indicates a 2-3 fold increase in the risk of NSAID induced bleeds. Here's another study that saw somewhat increased risk of bleeding. Risks can be diminished by taking the medication with food.

There are more references and studies out there.

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.

You can take 2000 mg of advil a day post surgery for pain. It isn't advised long term but that's what they do to wean you off the narcs

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.

Maybe for skin lacerations, but I'm not convinced it's going to help much for penetrating wounds as they claim. Thinking of a knife wound or other similar injury. Your just closing the surface vessels off.

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!

have an interview coming up, was wodering what advancement opportunities and career paths may look like

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

no it was serious --- nothing like bringing a knife to a gun fight ---- I responded to a GSW in my subdivision (my agency) with nothing on board, just because it was around the corner -- dude blew his entire face off, and I had nothing to deal with airway or his continued efforts to rip the rest of his skin off his skull while he was combative --- a bloody mess; me and my gloved hands were no match.

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?

I would say go big or stay at home. I live in an urban area, so response time is not an issue. But once you get out of your car to render aid, you are committed. Are you ready to do mouth-to-mouth, do you have proper PPE in case of heavy bleeding or vomit ? If you are gonna stop, be prepared for anything and everything.

Sarcasm?

.. From my research it is emphasized that we need to get those 0's moving as quickly as possible.

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

• 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

• 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........