mobey

I think your thinking is back asswards.

Why should we dumb it down to the lowest common denominator?

Wouldn't a better solution be to require that those rural services upgrade to at least the 20th century standard?

Lowest common denominator?? Did you read my post? You honestly believe that those people who spend 15min with thier patients with a medic "babysitting" them are of a higher quality than us in the rural?

You have to understand some communities cannot afford to staff an ALS car. I may be hours from a hospital but we only have a low call volume, what paramedic is going to sit around in the sticks waiting for his calls when he could be in the cities banging out calls and bossing around some BLS kid? and who's going to foot the bill for him to sit around? The Gov't :roll: like it or not there are some areas of the world where a BLS services make sence.

Hey all thought this could be a interesting topic.

In my Intermediate class the instructor asked "what is the main difference between BLS & ALS? One of the urban PCP's answered "as BLS we don't have direct resoncibility for our pt because we always have a ICP or medic with us. I was very quick to correct his in the box thinking by informing him of this thing we call "rural EMS". I invited him to come take a call in my service where you are paired up with an EMR who considers themselves a driver only, no ALS for 120 miles, no hospital for at least 1.5 hr dry road driving, yada, yada, yada. So this person who claims to be on top of his game because he works for one of the busiest services in this province, has never had full responcibility for a patient!!

I think it should be manditory in the clinical portion of EMS training to do a rotation in a rural service. I would like this kid to pull out of town all alone with a flash pulmonary edema at 3:00am knowing he is at least 1hr away from Ventolin, Lasix, Nitro, or anything else his patient "really" needs :shock: .

So there you go, thats my thought of the hour... What do you all think?

You are getting excellent advice here, and everyone has gone through it.

These 2 steps made the world to me:

When the tones go off take a second, stop moving, take a deep breath and overpower your adrenaline, it is hard but you can do it.

Secondly NEVER EVER EVER RUN. I used to run at some point during almost every call, and I think it forces you to panic. My heart would race when I ran and never slow down during the entire call making it hard to concentrate.

Just what worked for me.

Mobey

In todays worlds there is a ER very close unless you are in the sticks.

I would hate to face a medical director or attorney because I did not have a IV before giving a med. I mean why would you give a med with out a way of treating the possible out comes good or bad.[/quote

Out in the sticks?? Oh you mean 1hr drive to small town hospital with GP on-call. 2.5 hrs from major city hospital with trauma center and cardiologist, 1.5 hrs from ALS intercept if I call them immediatly when I get the tones? YEP thats me!!!

That is why I posed the question. :wink:

Hey all

Just finished an MI call with a paramedic and we sparked a good conversation on the way home, (yeah it's a long drive). He suggested that giving Nitro spray without an IV is too risky and we should not do it. Note: in my province PCP's cannot start IV's but can spray nitro. Now we are not talking protocols here... I would never withold treatment from any pt. based on personal opinion. Just wanted to know your thoughts. How risky is this? I would be interested to hear some war stories about patients having a negative outcome from this sort of situation.

So, what I hear you saying is that it's totally fine to place a substance into the mouth of a person who can't readily maintain his own airway? Do I have that right?

And what's more, you're saying that even after you place it there you suction it out? What good are you doing? It will not absorb fast enough to do any good by the time you're suctioning it out.

Good luck trying to explain why your hypoglycemic patient is now fighting a wicked aspiration pneumonia to your medical director and the patient's family...and your service's attorney, and your attorney et cetera...

Come on! You're smarter than that! Do you really believe what you're doing, as you wrote it above, is working? Or do you stick bite blocks into the mouth of a seizure patient so he doesn't swallow his tongue, too?

Paramedicmike thank you for the alternate perspective... being fresh out of school I still have faith that our protocols are whats always best for the patient. I never considered the aspiration perspective, but it makes perfect sense. Appreciate the eye opening,

Mobey

In my world, sticking a thick gel into an unconscious person's mouth is ALWAYS a bad idea...always;-)

It depends on the circumstances (protocols aside). My ALS intercept is at least 1/2 hr away. Pt lays on their side, I admin glucose onto buccal membrane, massage cheek, suction, repeat. With 1hr transport time I do what makes sense, in my world sticking a thick gel into an uncx patients mouth makes perfect sense.

any reason why with an hour transport time... your service doesnt have 12-leads? Maybe im out of line.. but that seems the same as saying.. my service doesnt carry oxygen or EPI.

Oxygen??

No your not out of line, it is a very confusing system here in Saskatchewan. The reason for the lack of 12 leads is simply education. In my service we have:

2 EMT's - not trained in rythm interp

1 PCP (me) trained in 3 lead - self taught 9 lead

1 RN - not trained in rythm interp

6 EMR's - not trained in rythm interp

1 - Paramedic (formerly of Edmonton x15yrs) - Trained in 12 lead.

So you can see how a community based service could find it hard to make funds available for a 12 lead. Even if we did our paramedic is not always available. We are a BLS service with access to a paramedic on a casual basis. Unless I am on shift the patient probably won't even have a monitor put on. I know this seems insufficient but it is the reality here in rural Sask, we are actually the only service in our health region with Paramedic coverage, casual or otherwise.

And yes I can watch my dog run away for 2 days!

We carry the IM shots and they are excellent for the slightly combative hypoglycemics(when they work). Oral glucose is in our protocol for unCx hypo pts. Squirt it in the buccal membrane and have the suction handy, ya the guy isn't gonna jump out of bed like he just had a dose of D50 but you can only do good with it.

And we work in different countries and maybe there are some SOPs or politics I don't know about, but anyone who repeatedly falls out of bed is getting a full work up from me and the doc.

A-Fib? so I assume you found an irregular pulse - did it match the meds (Digoxin, coumadin etc..) If not that COULD explain some vertigo, or pre syncope, either way off we go!!

You should put some more thought into your first call, I am not calling you wrong but you should make sure you did the right thing chosing not to transport, in case you get the same call @ a different address.

I will probably get lambasted for this but in the end' date=' Grandpa died peacefully, and nice and warm in his own bed. Forget protocols and all the official crap.

Thanks for the recommendation Dust, (You made my wife's life easier for B-Day shopping).

I guess what I'm wondering is does a MCL lead look at the heart the same way as a V lead?

And yes I'll probably buy the book :!:

Limb leads look vertically, the chest leads look horizontally. Moving the limb leads will give you an approximation, but the plane that is viewed doesn't change.

Do you have a simple explination of these planes. I have googled it but can't really get my head around how these leads view the heart. I wish my course would have been more in depth on ECG's, but rhythm interp had most of the class stuck on "hummingbird", so it was hard to get anymore technical.

Hey all

In school my instructor pulled me aside and quickly showed me how to do a 9 lead with a 3 lead monitor ( I loved cardiology and rhythm interp ). I am just wondering how reliable/common they are prehospital. I do not do 12's but with an hour travel time to the nearest hospital I like to use all tools at hand to thier full potential. I have had the discussion before on this site about not diagnosing an STEMI based on 3 lead... however 9 lead?

Certaintly looks like "Short bald man syndrome" to me.

I have to mention however with the number of fire personnel there I am surprised the medic just "abandoned" his patient. Unless that little scuffle got really out of hand I don't think I would have left my patient alone to help 4 firefighters subdue some loudmouth.

This kind behavior is never warranted. I presume the "kicker" is some sort of captain or something (lack of turnout) and is setting an example for some of the younger guys on the crew...

C'mon people try and evolve with the rest of society!

Sounds good to me!!

Remember to get their name after your intro. Also investigate everything thoroughly ex. allergy to Pennicilin... what happends when you take it?

Have you ever had this pain before?... did you see the doc last time?... what did he diagnose you with?... did he give you meds?... did you take them today?

Have you ever had shortness of breath this bad before? Did the doc give you an inhaler? How many sprays have you taken? Have you ever been intubated before?

How long have you felt weak and dizzy? have you been running a temp? any ABD pain? N&V? recent trauma?

And so on. Just never stop asking questions, patients never tell you the pertinant info till you ask. However make sure you are assesing phisicaly @ the same time... kind of a balancing act.

BTW women under 60= Is there a chance you could be pregnant?

(not just for ABD pain.. everone)

NO NO NO I'm east of there...you know the town that kicked YOUR towns ass!!

(and my ambulance could beat your ambulance in a game of pothole dodge any day :!: >

Southcentral Saskatchewan...one of those towns no one's ever heared of. Working as EMR heading to PCP practicum in 2 weeks... accepted into ICP in Feb.

AM I THE ONLY FLATLANDER!!! :?

JPINFV....Calm down, take a valium, have a hot bath whatever you need to do.

My original post was aimed @ the original post about using 3 lead to diagnose. I am not attacking anyone. I am simply stating a PCP student should not diagnose an MI off his 3 lead alone, in the back of an ambulance and start treating off that diagnosis. I realize i am a nobody student to say such a bold statement thats why I put it in a question form. Lets not forget I am also a PCP student (for 6 more days) in canada. Paramedics can come to whatever conclusions they like, thats what they are trained for. Basics need to remember thier scope of training, just because they are told something on a forum doesent mean it applies to them. Again I am speaking to everyone regarding basics only.

At eaze soldier.

Mobey

Accepted standards??

This must be a US/Canada thing.

I double checked with a few instructors and they said (in canada at least) we do not definitively diagnose an MI in a ambulance on a 3 lead. especially when the person asking is a basic. It is a tool for diagnosis but that is all. And really do we want basics to start treating an MI without other symptoms just based on a 3 lead?

The real question is should you be diagnosing an MI on a III lead as a basic? If pt is presenting an MI treat an MI. From what I have been taught ST elevation can be an indication of myocardial ischemia, but not a for sure thing (it could be old infarct for all you know). For the most part you should not need a monitor to tell you if your pt. is ischemic anyway.

Ok so I've asked simmilar questions before, but now it's crunch time.

I am currently completing my PCP and have the oportunity to dive right into ICP part time. That is weekends only. That will enable me to work throughout the week as a PCP while schooling the Intermediate. I am a little too worried about being too "green" for the ICP program.

Thoughts?...I would really like to hear from some ICP students or instructors.

This is geared @ canadian curriculum.

What is the deal on my Obstetrics final?? It was very poorly put together. The focus was on fetal circulation and maternal changes more that the "real" stuff...such as eclampsia, complications during childbirth, ectopic's, and so on. Does it really matter if I know what the forman ovale is... if the child has no pulse I start CPR. How 'bout asking how to deliver a breech baby? I'm a basic da**it not a OBGYN. Any canadian (sask) Instructors out there who can help me understand the direction of this part of the course.

Thanx for listening

Mobey

no other answers this is True/false. How you see it on the original post is how it is written. Stupid hey!!

Thanx for all your imputs!!!

We never find out why this hapeded they are just testing our thought processes, YES this is a stupid question and if I get it wrong the appropriate people will be getting an e-mail. Your probably right the correct answer, and what the instructor wants to hear are 2 different things, but that should not be the case in EMS. There is only 1 answer and thats the right one. The guy gets an EKG - irreg pulse or not.

I think ur contradicting yourself lithium. The question implies you woulden't put on the monitor if not for the irregular pulse. you and me say that's FALSE. MOI is enough for me to put a monitor on. Heck just the age of the pt. is enough for me.

Sighns of a Tamponade on the monitor? you have peaked my interest.

What is a NR exam?