mobey

Link on this one for dropping a different type tube down the throat. I am amazed this woman doesn't gag.

Ahh yes the two things I look for in a woman....A little black dress, and a lack of a gag reflex.

Unfortunately for my pocketbook we still do. We tip for the usual things like good service at a restaurant etc.. I don't really like the concept myself, but I still tip because I don't want to look like a cheap jerk. It's funny how it all works. You don't tip the teller at the grocery store but you are supposed to tip the bellman who packs your luggage. Both people are just doing their job.

Ya that used to pi$$ me off when i was a gas jockey. I freeze my bollucks off pumping your gas in -37 C so you can keep warm inside the store and i get nothing but minimum wage. Then you head down for lunch burning the gas I pumped and tip your nice warm waitor?

Oh well i have never been offered a tip. If i was i would tell them to send a thank you card to the office where the boss can see it, and i can ask where she keeps ALL of hers. Hehehe

Ya I think the original poster is confused about GCS scores.

I rate his GCS as 14

What is the action that causes this to happen?

WOW big question.

It is osmosis. basically it is the movement of fluid from an area of lesser concentration to an area of greater concentration.

Just imagine dropping a tablespoon of salt into a glass of water. Over time the salt becomes equally dispersed throughout the water (this is your hypertonic saline). Now drop a piece of fruit into that saltwater.

The fruit is hypotonic (less salt), through osmosis the water leaves the fruit to get to the higher salt concentrated water. Now the solution becomes isotonic (or equal salt concentration throughout the water.

Now apply that to the human body.

Our tissue is filled with low sodium water. If we fill our vascular system with hypertonic saline (more salt), osmosis will draw the fluid from the tissues into the vascular system in an attempt to become isotonic.

Confusing hey?

HAHAHA, Thanks for the invite.

I would love to see a study on Paramedics vs EMT's. I mean a real scientific study to shut up all these old school wankers (that's right I said wankers), that say stupid $hit like "ALS wastes too much time on scene" and A good BLS crew can be just as effective or better than an ALS crew".

I hear that crap way too often and it makes my BP skyrocket.

and if one is interested B.Bledsoe's website it has a link to "How to do research in EMS"

cheers

Are you meaning the Powerpoint presentation, that's all I can find. (Although I've only had one cup of coffee so far!!

and the first time the call the tod, they ball for four hours.

Is there a Wikipedia entry for "wanker"?

http://en.wikipedia.org/wiki/Wanker

I can't believe it either!!

PS I never suggested that a EMT-B should or could push any drugs, but I will stand behind my statements about advanced airways and diagnostics, IT IS TIME!!

OK lets run with that.

Are we just going to train EMT-B to put stick them in?

Or are we going to educate them on how and when to use them?

Shall thier education include acid - base balance of the respiratory system? I mean after all if they are tubing they better have access to ETCo2. Not to mention the education to understand the numbers. Believe me that is difficult $hit to understand, I don't know how long we spent on the PH of the human ody but I am pretty sure it was a few months!

What about all the anatomy involved with the resiratory system?

So my question to you is how long of a "training course" would it be for Combitubes alone?

Or take a really deep breath.. then bag yourself!!

you gotta be careful with this stuff, ever blown up a balloon till it popped?

What is your story??

Why are you asking this question??

Paramedics may save lives....EMT's may save Paramedics

But Firefighters save dogs!!

I hope he gets a medal of some sort for his heroic efforts. Boy no wonder FF's are paid such substantial salaries.

*End sarcasm*

I created an account for us at photobucket. login name is emtcity and password is password. Post photos if you would like to share. I hope you enjoy.

Or you could click on Resources, scroll down to photos and post them there!

Silent chest usually means not air movement. In Emphysema or disease processes where there is a loss of elasticity and hyperinflation, there may be silence even on a good day. When exacerbated, serious silence.

Thank you VentMedic I was hoping you would chime in on this one. (Thank you also to ERDoc and AZCEP).

Yes this is the sort of thing I was thinking, I thought due to bronchoconstriction, narrowed airways, increase mucus production, the patient was able to suck air through using acc muscles but unable to "Push" it back out. Therefor the air was "Trapped" in the lower airways and aveoli, hyperinflating the lungs till there was basically no gas exchange occuring at all.

Mix up some COPD with Pulmonary HTN causing right ventricle hypertrophy, and an MI 3 weeks ago, I guess it was only a matter of time.

I guess i still wonder if i had of walked in there and slapped on a salbutomol neb if this would have turned out different. but i highly doubt it.

My indications for ventolin is wheezes. That is it. There must be wheezes or I am breaking protocol. I am all for flexing protocol when nessesary, but this happened soo fast there was no time. I was assessing air entry when she quit breathing.

Hey all!

I am wondering if ya'll can shed some light on this. I had a 72 y/o female with CHF and COPD last night that coded about a minute after we arrived at her house. Here is the call:

Called @ 2100 72 y/o female Difficulty breathing

PMHx MI x 3 weeks ago, Hypertension, IDDM, Possible COPD (that's all I got)

Asessment, Patient answers door, slightly overweight, obvious distress. 2-3 word sentences, purse lip breathing, decrease tidal volumes, acc muscle use, you get the picture.

SpO2 68 on room air (no home O2)

BP 184/80 Pulse 112

Denies chest pain, or any other symptoms, Sudden onset approx 10 min ago.

Air entry (here is where I get confused) Inspiration clear in Apex bilateraly. Expiration completly silent and I mean SILENT. I listened in multiple spots front and back with a Littman Master Classic 2. Believe me there was nothing to ausiltate.

Suddenly tidal volumes decrease till there are none.

Setup BVM w/OPA

Check pulse.....Nope begin CPR

Apply pads....Asystole. *Frick*

Off to the hospital (BLS CREW) Drop in a King on the way.

Work her at the hospital for about 20 min and call it.

So I am stuck between Exacerbation of COPD (which she was unsure of in the first place), or some sort of CHF episode (which I have been studying harder and harder to understand).

I know "All that wheezes is not asthma" but what if there are no wheezes??

Sorry if this is confusing been a long week already, let me know any more info you may want.

Well, since HIPAA is an American law, I do not see how you could violate it in Canada.

Did you guys adopt a similar law??

I am known to post things that are completly freeking WRONG!! And yes this may be one of those things. :oops:

I am going to look into this further to find out exactly what I am dealing with, but yes we do have a similar system.

Just wondering if anyone knows the latest on this. Can we transfer 2 patients, unrelated in the same ambulance without breeching HIPAA?

I have researched it and cannot find much info.

We are buying a new ambulance and it "Must" be dual cot for double transfers, but I think that they are highly inapropriate.

OK I will write my assesment and Treatments just because I want them to be ripped apart and spit on so I can learn from my superiors.

As much Hx as possible. How much alcohol?, What kind?, any other drug use?, when last seen normal? Past med history?, current medications?, trauma?, any complaints of headache tonight? Seizures? etc etc.

Head tilt chin lift/OPA, (not too worried about tubing right now)

Pulse Ox, BP, Resp count, Pulse, Responce to pain stimuli, Oxygen 10lpm NRB, BGL(consider D50), , Air entry auciltation, Physical exam. *Take a moment for public education for friends* All done on scene.

Load to unit

I.V, NaCl TKVO (unless hypotensive), Cardiac monitor, Suction as needed.

Reasess

Reasess

Reasess

Bury it with a shovel, then bury the shovel.

But then how will you fill in the second hole??

I could care less,as long as the lights are flashing and the siren is activated,I run like a raped ape! Red lights and stop signs don't mean shiit when seconds count.

How many calls do we actually see where "Seconds count".

I mean really, blowing a red light to save 50-70 seconds? How many patients have you had that coded just outside the hospital door, whereas if you were driving faster the arrest could have happened in the hallway in the hospital?

BTW I hated Recue 911

brock

I have experienced these exact same problems time and time again. I find the only way is persistance. On the way to a call go through the DD's for the dispatch info. Make it a game if you can. challenge him all the time, and ask him to challenge you. I do this all the time with perscription drugs, and definitive treatments.

But there are people who just want the cheq and don't really want to learn.

Does anyone have a link to any studies that have been done on running "Hot"?

I did a search but coulden't find any.

I have had a bad experience one night while running to a call for an out of town MS Pt. who was experiencing lower extremity numness, call came in as an "Alpha" which is the lowest priority our dispatch centre has. Half way there cruising at stupid speeds with lights and sirens (as per local protocol), we came upon an intersection which had the stop sign knocked down. I ended up finding myself in a field with poop in my pants.

I have always wondered what the statistics are. No matter what the dispatch info is we Always respond "Hot" and I hate it!

Push her eyelids shut and call her a three lol

Actually the eye portion is graded on Eye opening from a closed position. Since her eyes are open and fixed that will put her at 1.

Neesie

I can agree with you on the CISD thing, there is NO PROOF that it actually helps at all. I for one support one on one therapy. Time is the only thing that will make this easier to deal with. This was a HUGE call, the one everyone fears.... and it may be a career ender if it is not dealt with appropriatly. This may mean years of therapy or just a few PM's with someone you can trust over the net.

But I believe if you keep it bottled up, it will eat you alive.

feel free to PM me if you like.

"Did you read this whole thread??

First off I cannot obtain my EMT-P because that course is not offered in Canada anymore!"

Uh... yeah, I don't know how you can justify that statement. EMT-P is, of course, offered in Alberta.

Yet when you complete the program the certificate says "Advanced Care Paramedic" not "EMT-P" hmmm But the ACoP calls you an EMT-P.

So what is your credential?? What the plaque says or what the ACoP and instructor calls you?

If you took a course in cooking recognized canada wide as a "Chef" course, but the school and local gov't called you a "cook" so they could keep your wage low, what would your credentials be?

Your school issued cert says Chef but your nametag says Cook.

hmmm I can see how difficult this must be for those who have been fed a load of $hit for so many years by ACoP. I guess they are good at one thing after all!!