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Jess

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Posts posted by Jess

  1. Plus 5! I didn't mean to be critical of your post. It's awesome that you found that!

    Oh No I didn't take it that way at all! :lol: I just wanted to post what info I did have because this could take me many hours to find the rest of the info that I'm looking for. I have nothing better to do today since I'm sitting here with gobs of lotion on my feet, feet wrapped in saran wrap with socks on!! lol! Mind you, it works absolutely FANTASTIC if you are prone to over dried out cracked feet :) Okay back to my research!

  2. One of the things I've always wondered about the ComboTubes, and devices like them, but have never heard addressed...though it nearly was in the first video....

    With the cuff inflated in the esophagus, it seems that there are a lot of opportunities for damage if it's vomited against strongly. That seems like a silly risk with dire, long lasting consequences if it goes wrong.

    Once again, this is one of those questions that seem pretty obvious, so as I've not heard it mentioned in the many 'rescue airway' threads, I'm guessing there's something pretty simple that I'm missing.

    This is what I see...The cuff is inflated, a full belly attempts to eject it's contents and the tube is forced out of the esophagus and airway control fails. Or the cuff holds, causing distention, and possible tearing, leading to a whole ream of possible issues.

    I've sometimes thought, "Well, perhaps you don't vomit so violently when obtunded or unresponsive?" But then of course there are the gazillions of stories of crews cleaning the roof of the ambulance after some coronary/head trauma runs....

    So is there some physiological safe guard that I'm failing to see that takes over when unstoppable emeses meets immovable airway device?

    Dwayne

    Dwayne you brought up an excellent point! While there is a valve on the combitube that I lovingly call the "Puke valve" I understand what your saying about the pressure of the vomit meeting the airway device and how it can cause damage. So I researched it because I'm just as curious as you are. This might provide some insight. It might answer your question or it may not but I took a shot at this. Its a study some doctors did to compare seals in supraglottic airway devices.

    A Comparison of Seal in Seven Supraglottic Airway Devices Using a Cadaver Model of Elevated Esophageal Pressure

    Sven Bercker, MD*, Willi Schmidbauer, MD{dagger}, Thomas Volk, MD{ddagger}, Gottfried Bogusch, PhD§, Hans Peter Bubser, MD{dagger}, Mario Hensel, MD{ddagger}, and Thoralf Kerner, MD{ddagger}

    From the *Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Germany; {dagger}Department of Anesthesiology and Intensive Care Medicine, Bundeswehrkrankenhaus, Berlin, Germany; {ddagger}Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, and §Center for Anatomy, Charité-Universitaetsmedizin, Berlin, Germany.

    Address correspondence and reprint requests to Dr. Sven Bercker, Klinik für Anästhesiologie und Intensivtherapie Universitätsklinikum Leipzig, Liebigstr.20, 04103 Leipzig Germany. Address e-mail to sven.bercker@medizin.uni-leipzig.de.

    Abstract

    BACKGROUND: Supraglottic airway devices are increasingly important in clinical anesthesia and prehospital emergency medicine, but there are only few data to assess the risk for aspiration. We designed this study to compare the seal of seven supraglottic airway devices in a cadaver model of elevated esophageal pressure.

    METHODS: The classic laryngeal mask airway, laryngeal mask airway ProSealTM, intubating laryngeal mask airway FastrachTM, laryngeal tubeTM, laryngeal tube LTS IITM, CombitubeTM, and EasytubeTM were inserted into unfixed human cadavers with an exposed esophagus that had been connected to a water column of 130 cm height. Slow and fast increases of esophageal pressure were performed and the water pressure at which leakage appeared was registered.

    RESULTS: The Combitube, Easytube, and intubating laryngeal mask Fastrach withstood the water pressure up to more than 120 cm H2O. The laryngeal mask airway ProSeal, laryngeal tube, and laryngeal tube LTS II were able to block the esophagus until 72–82 cm H2O. The classic laryngeal mask airway showed leakage at 48 cm H2O, but only minor leakage was found in the trachea. Devices with an additional esophageal drain tube drained fluid sufficiently without pulmonary aspiration.

    CONCLUSIONS: Concerning the risk of aspiration, the use of devices with an additional esophageal drainage lumen might be superior for use in patients with an increased risk of aspiration. The Combitube, Easytube, and intubating laryngeal mask Fastrach showed the best capacity to withstand an increase of esophageal pressure.

    http://www.anesthesia-analgesia.org/cgi/co...tract/106/2/445

  3. A Minneapolis couple decided to go to Florida to thaw out during a particularly icy winter. They planned to stay at the same hotel where they spent their honeymoon 20 years earlier. Because of hectic schedules, it was difficult to coordinate their travel schedules.

    So, the husband left Minnesota and flew to Florida on Thursday, with his wife flying down the following day.

    The husband checked into the hotel. There was a computer in his room, so he decided to send an email to his wife.

    However, he accidentally left out one letter in her email address, and without

    realizing his error, sent the email.

    Meanwhile, somewhere in Houston, a widow had just returned home from her husband's funeral. He was a minister who was called home to glory following a heart attack.

    The widow decided to check her email expecting messages from relatives and friends. After reading the first message, she screamed and fainted.

    The widow's son rushed into the room, found his mother on the floor, and saw the computer screen which read:

    To: My Loving Wife

    Subject: I've Arrived

    Date: October 16, 2007

    I know you're surprised to hear from me. They have computers here now and you are allowed to send emails to your loved ones.

    I've just arrived and have been checked in. I see that everything has been prepared for your arrival tomorrow.

    Looking forward to seeing you then! Hope your journey is as uneventful as mine was.

    P.S. Sure is hot down here!

  4. I'm feeling a bit froggy and would like to take a pot shot at this.

    So here lies the question....Can anyone list ways of learning new things WITHOUT asking questions? I can see how this thread could easily go to hell in a hand basket which is why I'm trying to analyze and understand EXACTLY what the original poster is asking. The only way I know to do this, is off my own personal experience.

    Going through EMT-B I never questioned a medics judgment. Instead, after the pt was released to the care of the ED staff, I would ask the paramedic to explain why he did what he did so that I could get a better understanding. I wasn't an "In your face" student that had her book open to page 160 telling the medic that what he did was wrong "Cuz the book said to do it this way" I just simply asked what the difference was between one technique versus the other. I never doubted anyone I did my ride time with. In fact, I gained a lot of respect due to my eagerness to learn. I made an effort that every patient I came across, I learned something from as it goes that every paramedic I rode with, taught me at least one thing I didn't learn in class.

    suzeg487 says: "Is it an EMT's place to question a medic's judgment that seems askew?"

    Jess says: If it seems askew, don't bring it up right then and there in front of the pt. That will just make the patient uneasy about the care they are receiving. I would wait until the pt has been released into the care of the ED, then just explain the concern to the medic. Your not questioning his judgment by explaining something that was going through your head, your just trying to get a better understanding of the situation at hand and perhaps learning something you probably were not taught in basic. How else will you learn if you sit quiet and NEVER ask questions? So no need to babysit anyone :) You never ever stop learning and with the amount of years you've been in this, I hope that each patient and partner may teach you something new!

    I hope I made some sense here. So far I've not had any negative results from my "Learning technique" listed above. I'm open for more ideas and opinions!

  5. Congratulations to you and your partner!! I know its hard at the age you are to realize that your parents mean well. It feels like they're out to get you even though they really are not. I used to feel that way when I was younger. Sometimes it feels like they're trying to live out their own childhood dream through you. That can often be true, but in your case I don't think it is. Your father just wants to see you successful and happy is what it boils down to. I don't think he's really all about the winning aspect of it but rather at the other end of the spectrum of just wanting what is best for you! Like the other folks here have advised, sit down and chat with him to tell him how you are feeling. Chances are, he isn't aware of how you feel. But sit down and have an adult conversation and explain every bit of what you are feeling. Best of luck to you and I hope this helped you some!

  6. Excellent topic! I've learned so much here that I don't even know where to start! I just enthralled by the fact I found this site through a random google search and here it ends up being one of my tools to carry with me through my EMS career! No tool on a whacker pack tops this one :wink:

    When I was younger, I used to be the quiet girl. I know thats a tough image to fathom but its true :lol: The only way I knew how to express myself was through art. I painted, I sketched, I made things out of clay. I didn't have friends so I kept to myself as a kid. I didn't really have any coping skills or communications skills. But i excelled in Reading, writing, and Comprehension. So knowing all that brings me back to the person I am now.

    When I first joined EMT City I was still kind of the quiet girl but was a bit of spit fire. Being on here for the almost 2 years I've been a member has taught me the things I didn't have before. I see how others express themselves here and seeing that brings out my expressions as well. I finally know what kind of person I am!

    I feel more confident at my ability to think things through, find a solution and follow through with that. Sure I could do that before but some of the people that have had the most impact on me through words on a screen are Dwayne, Dustdevil, Ak, Asys, Rid, paramedicmike, Lonestar, NREMT, Jake, Itku2er, and michael. There are many others to list that I have learned from but these are the people from the top of my head right now. There is just so much logic behind each and every thing these people say.

    The quality of post and the fact that in every post it always makes me sit back and think simply because there is always a lesson to be learned. I will never stop being a student. I just got my EMT-basic 2 weeks ago. Physically I'm not in school, but I still consider myself a student. If I could pass anything along to ANYONE its exactly that. There is just so much to learn! I never knew how much more I could learn until I came here! I've noticed a huge difference in my character, my judgment of many different things, including clinical judgment. I feel like now I'm rambling simply because I'm not fully awake. But I saw this post and absolutely could not pass it off.

    Brent, I want to pass on to you how impressed I am with your posts. You have sparked some amazing discussion and have improved so much since the first day you've been here. You've brought out the discussion in me as much as other folks here. Keep it up!

    With all that being said, I thank you all from the bottom of my heart for giving me the tools to sit back and analyze myself as a person, an EMT, daughter, future wife, and future mother. I look forward to posting more through the years and hope that one day I can be an impact on someone the way that you folks have been a impact on me.

    **Edited 1 time to fix a couple spelling errors.

  7. I have to say I'm extremely impressed with the responses of this post and the original post. It's way to easy to misconstrued this post and its responses into saying "fat people are disgusting and you don't belong in this field or society." I've had to read and reread this post over and over again in order to make sure I'm fully understanding what is being asked here.

    Its human nature to form a judgment on someone with first impression. Everyone has done it and it will continue to happen. It's not fair to do nor is it acceptable. But this "I'm fat so what" attitude is not a good one to take. By saying that, you are accepting that your fat as in your going to be like this for life so why do something about it. Not to mention your basically telling everyone else that sees you with this attitude that you done care which gives an open invitation to judge you. Thats not a good attitude. Dwayne said it best though.

    By medical definition, I am overweight. Yes there are times that I used get upset about it, but the last time I got upset with it, I forked over the cash and got a membership to Golds Gym. I have a personal trainer there and a whole lot of motivation to shed the pounds. I must say I'm pleased with the results thus far! Some folks cant afford the membership to a gym nor have the time for it. But there are still things you can do if you are concerned about the publics physical image of you as a provider.

    I am also aware of the fact the some folks are just overweight due to genetics, hormone problems etc. I happen to be one of those people. I refuse to sit here and be upset because people are judging me because I'm fat and then just blame it on xyz medical condition and be content with it. Its perfectly fine to be comfortable with your own body but there is a fine line between you being comfortable with your body and yet being able to perform this job safely.

    The last time I was judged for being overweight was when I was in high school, big whoop, it was high school. This is adulthood and the real world. People will judge regardless of what I look like. I can accept that. But I do know for a fact that I don't have to accept being an overweight individual any longer. I don't huff and puff going up stairs, my bp runs low usually, and I've never had a heart attack. But that doesn't mean that my life will continue to be that peachy if I had continued to neglect my weight problem. DD made that loud and clear when he explained what happened to his friend. He made some very valid points in that post, some of which are some real eye openers.

    So the original question of "Can you look professional and be fat?" Of course you can! Its up to you to prove that though. It comes with self respect, competency, respect to others and appearance. I know lots of MORBIDLY obese folks in this profession that are OUTSTANDING providers!

    People will continue to judge though. Is it fair? Hell no its not but it's life. Which sparks another question, can you still be a functional provider at 5 foot 6in and 92 pounds? (and yes I do know a paramedic that is that height and weight) That can be just as unhealthy as a 350 pound medic. There are many more things that can cause one to appear unprofessional but I don't think weight is one of them.

    ** I know I somewhat rambled in this post but I want to make it perfectly clear that this post is not intended as an attack nor is its contents directed at any one person. Its merely my opinion based off my own personal experience of being an overweight individual. I hope it generates some insight among folks and sparks more well thought out posts from members!**

  8. Little Wonders by Rob Thomas

    This song is amazing. It makes you think of all the things that happen to you in life, forget about the bad ones, and embrace the new ones. It just goes to show that you should keep moving forward. :)

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