mobey

Let me add a twist to the question. The Doc turns to you and says "It's your call do you want to work him?" Ya in rural they ask that kinda stuff! Reminder: 28 minutes down, Pt apneic for 8 min prior to your responce, Pt has layed in hospital bed for approx 2-3 min with no pulse and no compressions prior to return of pulse.

Ok gonna need some american help here!! Perhaps you don't know that an american EMT-B would not even pass first aid in Ontario. (I presume 2 yr PCP means you are from ontario) When I talk about BLS in this thread I am talking about American EMT-B. I put them on the same level as the old canadian EMT course I was talking about when I was bashing Alberta for calling us all EMT's. And for the record I was not praising AB EMT'S in that thread I was commenting on how undereducated the ones were I have had contact with since I have been in AB. I don't care where you work...You will pick up bad habits and take them to class, therefor you will be distracted by trying to break your routine, instead of learning from scratch. And I cannot explain myself further on my previous post about approaching patients differently, but if you took your PCP in ontario I would not expect you to understand. I completly agree a PCP to ACP is not completly different entities. Too bad the poster isn't a PCP, could have saved all the fuss.

hmmm thinking again.... Rate 300 Delta waves Hx of heart problems Digoxin......Has he been on this long? Maybe he should not be! I'd like to change my answer vanna.

My mistake he was extremely skinny, I meant you could see his a pulsating mass in his chest. He was not moving air.

No spontaneous resps, pulse only

Called for 56 y/o male apneic. On arrival Pt found supine on kitchen floor, cyanotic, sliding left arm up and down from head to hip. Eyes open in "death stare", completly apneic, weak carotid @ 46. (you are a canadian BLS crew similar to EMT-I in states I think) Family stated his left arm started shaking as he was walking scross the room then his whole body got involved, and he just collapsed. Your responce time was 6 min, no interventions prior to your arrival. PMHx...3x CABG 6 mos ago, Liver Cancer, Asthma. Your partner puts in OPA and begins ventilation, you attempt IV but fail first attempt. You throw on the monitor and it shows Sinus @ 46 with huge ST elevation. no 12 lead your BLS remember. As you prepare to load onto your longboard you lose the pulse. You start compressions and look over to the monitor to see exactly the same rhythm as before. In the ambulance you throw in a King airway and continue CPR. Only 3 blocks to hospital. Pt has been down now for 18 mins with CPR. On arrival at hospital doc throws 2 rounds of EPI in him with no responce, Rhythm still PEA @ 46 with PVC's every 6 sec or so. Pt has been down now around 25 min and the Doc decides to call it. As you assist nurse to prepare the body for viewing the Doc tells the family. You deflate the cuff on the King and notice his chest moving...NO FREAKING WAY. Yup a pulse. You throw the monitor back on and your PEA now has capture!! So the question is... do you work him?

I am quite sure i am wrong but i will be the first to say V-Tach because I am interested to find out how I can tell it isn't. BLS treatment High flow O2 Call ALS load and go unless ALS will arrive soon in which case i would... Get the best Hx I could Put the Pt. in position of comfort Clear away furniture Have AED handy & set up BVM out of sight Get meds and health card rounded up keep reassessing pulse & BP every 3 min or so Talk about fire trucks with the Firemedic and twiddle my thumbs waiting for ALS! My guess on ALS Tx, Amiodarone (1st choice), or Adenosine (2nd choice)??

I'm with the Doc and Dust on this one. The point I make is that BLS and ALS are two completly different entities. As an ALS provider you will find your approach to patients and EMS is completely different. You stop looking at patients an a human and start looking at them as a series of complicated systems. As BLS when you see a short of breath Pt, you put on oxygen because that's what you were taught. As an ALS provider thoughts run through your mind of the Acid - Base balance and pics of the oxygen dissociation curve come to mind as you apply oxygen. OK bad example... The point I am trying to make is there is nothing in the field that will prepare you for the education you are about to recieve in ALS school. Everyone will tell you to work BLS to learn good assesment before going paramedic but it's a crock! The way a Paramedic assesses is far beyond the mind of an EMT-B. Why do you think Paramedics forget what nmonics stand for all the time. I mean do you really think they ask Provocation because it is in the nmonic OPQRS? A Paramedics assessment is a step in a long treatment algorithm, that's something that is far beyond the realm of a BLS EMT. And in reality what "skills" does BLS have that will take a year or two to perfect? splinting? Oxygen administration? Oral glucose use? come on!!

WOW you guys intubate apes?? Did you go lights & sirens to the vet!! HA HA LMAO I have no idea what APE stands for!

You are absolutly right... I just spent 1/2hr researching this and cannot find any info to support thier claim at all. I even looked at Beta 3 (not important don't confuse yourself), and studied individual B Blockers for a vasodilation effect. None. Who knows where they got thier info from.

So now understanding how the system works you can start to relate some of your medication types, think about how the following classes of meds would affect Pt. presentation: Beta Blockers (Metoprolol is a common one) Sympathomemetics (Epinephrine, Ventolin.) Alpha Blockers (k I don't know any off hand) If the parasympathetic system uses cholinergic neurotransmittors what affect would an anticholinergic drug such as Atrovent do?

Beta 2 has a few actions, the most important to an EMT is Smooth muscle relaxation in the bronchi. Therefore when stimulated by agonists it causes the bronchi to dilate. Alpha 1 & 2 basically cause vasoconstriction (A-1) and decrease motility in the GI system (A-2). The parasymathetic nervous system is in charge of autoregulation at rest (feed or breed). The Parasymathetic system uses Acetycholine as a neurotransmitter. When stimulated by pain, strong emotion, etc, the sympathetic nervous system takes over and you see these affector organs respond (fight of flight). As far as the drugs, I will let someone else tackle them. I have been VERY basic about this topic, however taking an EMT-B course this is probably all you really need to know till your done school and have time to read up on it more in depth.

Anthony give us a little more info such as... What drugs do you give that affect A&B (Epi, Salbutomol, etc) that would help guide the discussion. Ok others may disagree but The 3 most important to BLS are A1, B1, B2, All 3 are Adrenergic receptor sites. That is to say they are the moderator between the nervous system and the affected organ(s). So.... Beta-1 affected organ is the heart. When stimulated by adrenergic agonists such as Norepinephrine, Epinephrine (whether natural from the adrenal gland or injected by an epipen), it causes the heart to speed up (positive chronotropic), Velocity of conduction is increased (positive dromotropic), And causes an increase in contractile force ( positive inotropy). These positive affects are stimulated by the sympathetic nervous system. If this is the kind of answer you are lookig for let us know and we will continue...But I am a slow typer to write out all the others if this is not sufficient.

OK maybe I'm off my rocker Isn't it a bad idea to roll someone with an unstable pelvis??

OK Cx pt, confused, with unstable pelvis, and femur Fx right? I will be interested in how to do this better... But no I would not get a good back assessment. Manual C-Spine w/collar, Scoop onto backboard, swath pelvis with sheet, Fully immobilize, Load and go. Enroute splint femur with whatever splint set is handy. No I will not put a traction splint on a femur with an unstable pelvis, nor on a confused Pt. Splinting this pts leg is not a high priority, He is confused and could be bleeding in so many places I don't have time to name them all. Confusion tells me possible head injury (combined with MOI), Fx pelvis and femur spell S H O C K. I have left out all other treatments, this is just about splinting.

I need a little more info... Did we find a Fx pelvis? Is the pt unCx? If the pt is unCx I would not use a traction splint anyway (contraindicated) It is a load and go, no time for fancy equipment. If a Pelvic Fx was found, I would scoop him onto a backboard with a sheet on it to swath around the unstable pelvis. Then Immobilize the spine, load and go. There is no good way to asses the back using this method but I cannot justify rolling a pt with an unstable pelvis.

Perhaps you should take a deep breath...Re-read your post and try to find the root of your problem. We had a student that was treated much like you were. I can tell you that in "our" defence we did not see him having a future in EMS. He was cocky, snide, dressed inappropriate, talked trash, and thought he knew it all. Not saying that you are, but if EVERYONE around you is treating you that bad, do a quick self assessment and see if you would even be your own co-worker, or friend.

Here is a quick list of stress relief techniques related to EMS -Retaliate against "the man" by filling out your PCR with roman neumerals. -Next time your transporting a frequent flyer, drive to the ER in reverse. -Bill the ER doc your wage for waiting time -While on an emergency run pull up to someone and ask for directions using a fake language barier -Use your mastercard to pay your Visa -Jam 8 tiny marshmallows up your nose and try sneeze them out. -Try to defibrilate your lifepak 12 -Warn your patient you have a rash that may be contagious -Tell your next patient that thier your first "real" patient since you finished remedial EMT school last week! In reality I spend too much time on EMTCity, that helps. I also tinker on old cars as someone else mentioned. I have found it is important to find something unrelated to EMS as a hobby, and make sure I have friends outside of EMS to get away from it sometimes.

Good point!! However I do not believe nurses are fighting to be recognised as professionals. Let me explain my reasoning behind my views of EMT's. I have always worked rural EMS. Coming from Sask us "Newbies" call ourselves PCP's and the EMT's even after finishing "PCP equivelancy" still call themselves EMT's. From my own experiences (about 20 or so agencies I have been involved with) the way those who took the PCP course think and conduct themselves is alot different from those veteran EMT's. I doubt I need to explain this to someone in education. Yes I absolutly agree there are alot of EMT's who have grown with the times and worked hard to meet or exceed the NOCP's, but the thing you have to realise is there are alot who have not. There may be more old school EMT's hiding in rural EMS canada wide than you think. In Sask most companies won't even hire an EMT, minimum requirement is PCP. This is for good reason. The perception I am worried about is ACofP's. I think we (paramedics) earned our titles and I for one would like to wear it with pride. It's not about being "better" or "Smarter", It's just about professional recognition. How do you see EMS in AB progressing over the next 5 years? I can tell you in Sask the EMT's fighting progression are stuck in small hidden towns till retirement. The scope of practice is being increased (for PCP's only). The pay scale for PCP's is greater(than AB's and EMT's). Sask college of Paramedics is creating individual learning modules (in service exams) to ensure each practitioner is competent. By doing these things I believe they are on the right track to making a profession out of EMS. Being new to AB, other than a scope of practice that is completely unjustified by nonexistant continuing education standards, I dont see how AB is so progressive. Lovin the debate bleep

Quote Bleep That's because, in many cases, it is believed that their knowledge is superior to 'the rest of Canada' (not specifically, but the general PCP standard), and thus calling themselves PCPs is actually a step back. Don't shoot the messenger, by the way, these are not my opinions, but the explanations I've been provided over the last 5 years as these changes have been occurring. Soo what is the answer. If the EMT's today are far superior to the EMT's of yesterday, heck even (some) superior to the PCP's what do we call them?? Seems rediculous to keep calling them EMT's right? they are far better than that. I know when I think EMT I think of someone running into the house, slapping on O2, Calling ALS and driving like hell to the hospital, saying things like "scoop and scoot", "because that's what I was taught", and "EMT's save Paramedics". Not the way I want to be portrayed!!

And maybe rethink the paint on the bike.....Maybe Blue?

That about sums it up!! (Oh and add, if we do bitch and whine to the public our employers ban coffee in the rigs )

I would love to see an example of this statement. If AB EMT's have just as extensive knowledge of Ilness, Injury, and A&P as the rest of Canada why would the not want to be called "Paramedics"? I used to work with a semi-retired Paramedic from Edmonton who was blown away by my knowledge when he asked me if i knew what lasix was one night. He stated to me how happy he is that they are teaching BLS some actual Emergency medical related stuff, noting that his EMT course (Back in the day) was 2 weeks long!! No wonder they changed the title.

I will try to hunt it down on the paramedicweb, thanks for your responce however.... In changing the EMT program to the new "Revised" program to meet or exceed the NOCP's are you not just saying you have updated an old narrow program to meet or exceed the PCP level?? I took my ACP exam with over 350 students, and I gotta say I didn't see this "superior" education there. In fact we had a Pt. with a pacemaker and I was the only one of the day to point out there were no pacemaker spikes on the NSR ECG. Even through debates on a few of the questions on the exam the other students got totally lost while talking about fluid shift when utilizing I.V. therapy. I agree the scope of practice is higher in AB but you cannot tell me the EMT program is superior to other provinces. That said I realize there is a difference in alot of schools in this province but that is no excuse. A wider scope of practice does not equal superior education!! I would be more than happy to supply you with some of my Sask PCP literature for comparison if you are not familiar with it. And I would love to see some of Alberta's.

Well I have been in Alberta now for a few months and i can't wrap my head around why we are still calling ourselves EMT's. I took Primary care paramedic the Intermediate care paramedic in Sask, yet when I mention PCP in AB I get stomped on by PCP's who wear a crest that says EMT-A. Yes Yes I realize the college still licences us as EMT's but dammit that's where it should stop. Why are the AB EMT's happy to be put-down by having their education belittled by their peers? This rant stems from the ALS vs BLS procedures by Dust. Dammit I worked hard to get where I am, you cannot tell me some EMT course 10 years ago covered the acid - base balance in respiratory, Sodium - Potassium exchange in cardiology, Neurotransmitters including Synapses, ganglions, and all the patho involved in Neurology, and that is only an example of 3 modules in 13 in the Medical Emergencies portion of my PCP course. I am a PCP (ICP is not recognized in AB) and that is what I call myself, I am proud to be an advanced provider compared to what they had in this community 10 yrs ago. Now who's with me