mobey

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

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.

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.

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 :!:

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?

I think we may be agreeing!!! I concur with your statement, it is more reason to include the monitor. However a irregular pulse in this situation is not the ONLY reason for the strip like the question implies. Peace Mobey

The pt.

My argument is whether or not an irregular rythm is present or not, an 81 y/o in an unexplained MVA, with a chest injury is gonna get a monitor @ sometime. We have no idea why this accident occured, hypoglycemia, seizure, syncope episode d/t poor preload... But if I am not sure I want to look at all the systems, Irregular pulse or not. So I unlike some of the other students say FALSE

Hey everyone!! Got a case study question for ya all. It got me arguing with almost the whole class...again. 81 y/o male MVA Truck impacted on drivers door then frontal into tree. Pt. unrestrained lying across front seat, steering wheel is bent. alert to voice..otherwise disoriented, inconsistantly obeys commands. R-22 reg, Breath sounds = faint wheezes in bases, Skin pale, cool, dry, Radial pulse irregular @ 80. BP112/82 no complaints of pain. PMHx Hypertension, and "Heart problems" Lasix, Lanoxin, Slow k, Micronase. Bruise on sternum, pain on left chest wall on palpation. No crepitus. ABD soft non tender, Deformity of ankle. Question reads.."How do Karl's pre-existing problems affect your assesment?" A: Finding the irreg pulse means the cardiac monitor must now be included in the assesment @ some point. TRUE OR FALSE

I am finishing off my PCP (EMT) this nov. and have the opportunity to go into ICP(EMT-A) the next month, part time. Thoughts? should I go for the ALS before working BLS, I do have experience as EMR, not like Ive never done a call. Would I be better off working full time PCP while schooling ICP or would I get too frusterated by knowledge vs scope? anyone who has worked one level while learning another I would appreciate your thoughts.