usapride2004

ahha, well, clearly, if you did not know that you were supposed to attack, then you must be an ub3r n00b. I love typos

I don't palpate the artery anymore. I have a decent idea where the scope needs to be, so I just give it a go. If I have a problem hearing it, then I'll give it a feel. As for how high to pump the cuff... I usually go to about 200 mmHg, give or take. Why? Psychologically pleasing number, lol.

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Of course you would have suction ready. You ALWAYS have suction ready when managing an airway. And, you just listed all the reasons why I said I try to avoid bagging conscious patients.

Rate alone is not enough to determine the need for a BVM. Look at your patient, is he perfusing? Is he cyanotic? Diaphoretic? Pale? How is he mentating? What are his other vitals? What kind of hx does he have? You have to look at the bigger picture and not get tunnel vision. There is no formula for good patient care. For example, last week I came down with gastroenteritis and a upper respiratory infection (thank you nursing homes!). When I got to the doc I was at 44 bpm. I was short of breath and needed some O2, but I didn't need to be bagged. I had a patient this afternoon, CAOx3/3. Seemed just dandy (he was quite hypertensive--call came from a outpatient surgical center) RR=40 bpm. Did not need a bag. He got 2 LPM via NC and was just fine. In this case... did the pt have a hx of dementia that would account for the mental status? If no, then I would consider that enough to say he is not breathing adequately. I would much rather not bag the patient because based on your scenario, I say he was in failure. I'd rather not lay him down to bag him if I could avoid it. I would sit him up, get him on some O2, continue to ignore the nurse, whose opinion means more or less squat to me, and evaluate my patient. I can't say how I would treat this gentleman specifically, since I don't know all the facts and was not there, but I would not say that just because he was at 36 bpm that he needed to be bagged--he may have--but I don't know. And yes, you absolutely can bag a conscious patient. It's not the most fun you will ever have, but it is sometimes necessary. Just drop an NPA and go to town. If the guys GCS really was 5 (I am betting it was not, since it doesn't really sound like it with the info I have read)... you probably should have been bagging him. It seems this guy really needed BiPAP or CPAP and some pharmacology.

The way I figure it, if they need fluid, I'll give them fluid... if the don't, then why hang a bag? If it's not called for, it's just one more thing to get snagged while t/f the patient. All of my patients are getting a lock attacked to the drip set at a minimum anyway, so it's not even an extra step.

We just got it in RI pretty recently, and my company gives us enough for a one time 300 mg bolus. We have 2- 150 mg vials. We are required to have PVC everything to give it as a drip by protocol, and we need a pump for it as well. We don't have the PVC free stuff, or the pumps... so no drips for us. We can give the bolus through a standard IV line, however. I haven't seen the premixed glass vials thus far, but as I said, it's still pretty new around here, and it's still a med-control option, which is code for everyone is still going to use Lido.

Central lines are wonderful, but since you can place an IO in about 45 seconds, it's a great option for the emergency setting. That doesn't mean you can't also get the central line...

Psych patients need to be closely monitored, that's why they are in an ambulance. We have a lot of "swallowers" that we transport, and you know what happens if you aren't paying attention, they take stuff out of the cabinets and EAT IT. I know, it's happened to a colleague of mine. Guess who is at fault for THAT. My company does an unfortunate number of discharges and boring doctors appointments, just because the patient isn't actively dying, does not mean you should just ignore them. 1.) No patient should ever feel alone in an ambulance (as someone else said), 2.) I've had to divert quite a few patients being transfered for "non-life threatening reasons" to ERs because they developed a life threatening something-or-other. It happens all the time, and you know what, if you're not paying attention, you'll miss it. And there is a big difference between "can" be monitored, and "actually is" monitored. Yelling, "How you doing?" every few minutes is not the same as quality patient care. Regardless of the reason, you are equally responsible for the care of that patient. If someone wants to call me an idiot for caring about ALL the patients I transport, knock your socks off. I bet you can figure out what my opinion of your patient care is as well. As for the article above, if it accurately depicts what it claims to (accurate quotes, etc), than this guy is a tool bag, and has no place in this business. I know people like him, and I can't stand them. Anyone who would jeopardize the life of their patient like he seems to have, has NO PLACE in EMS.

Well, I don't have any sources for you, sorry, but I can tell you that one of the bog reasons for not using it is because it is inconvenient. Having to worry about PVC bags and the like...

You don't need O2 in your car. You can single handedly save the world without it. This is surprisingly common among newbies... if you want a bag... ok. Be reasonable, you just don't need O2.

I'm with you on this one 100%. Of course... it would be nice to have Adult IO access allowed in the first place... It's a paramedic only skill right now, and there aren't a lot of Paramedics running around Rhode Island. The primary ALS provider is the EMT-Cardiac, which I like to describe as "Paramedic Light" less training, most of the scope of practice. IO access could easily be part of the Cardiac scope of practice. I would love that.

It's a basic adjunct in RI, but my company won't buy it. They seem to think that it could cause issues with people using it on scene, and pissing off nurses at SNFs, subsequently causing the company money, because that's what it's really all about, not patient care... that would be silly

This is a very interesting topic. I live in Rhode Island, the smallest, yet second most densely populated state in the country at 1,003.2 people/mi[sup:d65e5f5c7f]2[/sup:d65e5f5c7f]. In out tiny little state (1,545 mi[sup:d65e5f5c7f]2[/sup:d65e5f5c7f]... and 32% of that is water) we have a total of 13 hospitals with emergency departments (not including the 7 other hospitals we have without ERs). Of those 13 ERs, we have one Level 1 Adult Trauma Center, Level 1 Pediatric Trauma Center, one Level 2 Trauma Center (trying to move toward Level 1 status), one Primary Stroke Center (certified by JCAHO), three fully functional Cardiac Catheterization labs (and a bunch more "diagnostic" catheterization labs), two hyperbaric facilities (one 24 hour--not including the U.S. Naval Hospital)... We have a pretty substantial hospital system. Yet, we seem to always have facilities diverting. The way we are set up, no more than 2 facilities in the north or south can be diverting at a time (our Level 1 is considered to be in both the north and south). Once the third facility diverts, it forces everyone open. The most I have waited because of this is about a half an hour... If I were waiting for 4 hours, I would be having a shit fit (on my way to another hospital). Lately, there have been a sharp increase in the number of diversions. I had never been diverted before 2008... it had just never happened. Now, it happens once a week to me... and God help you if you take a patient in when they are diverting... you'd think you just shot their dog, lol. It had better be a code... It goes to show that we need more/bigger ERs to handle to demand... and more staff to move patients faster. When I was doing my clinical time, my very first IV went into a 40's hispanic gentleman who came into the ER with chest pain. Pt was s/p AMI 3 months prior, and states that the pain is similar to what he felt then. Priority patient, right? Wrong. He got some ASA and NTG a couple HOURS later. I had thought that he had gotten it from the RN when I wasn't around... nope. He did get a stat 12-lead... whoopee! Sometimes I wonder if our patients would be better off if we just kept them in our ambulances, instead of bringing them to the damn ER, lol. That ER was diverting. That says to me, clear as a bell, that they are understaffed. Not to mention, only our Level 1 has any triaging procedure. I swear, no one else knows what the word means... So, back to the topic. yes, we have a diversion plan in place, and yes, it sucks being diverted all over the damn place, and waiting in bust ERs, and then watching your patient be ignored by nurses and doctors who are busy with other things.

While the Paramedic may be the ultimate provider in charge of the ambulance, even an EMT-B should know that you NEVER, EVER leave the patient alone, for any reason whatsoever. Especially on an ALS transfer for Heaven sake. She was on a freaking vent... what would make you think that it's OK to sit up front? I get pissed off when my partner sits in the airway seat and does paperwork during routine transports. Anyone can die at any time. That is why they're in a damn ambulance. Plus they obviously lied about the whole thing. Batteries fell out of the monitor MY ASS! This guy is full of crap. They saw you get out of the cab you ass hole! They should both loose their certifications, absolutely, and without a shadow of a doubt. I don't think the state needs to shut down the service, because I hope the family sues the two EMTs and the service, and takes them for every collective penny they are worth. Chapter 11 anyone? And we wonder why EMS is the red-headed step child of public safety/healthcare...

I refuse. I think it's unethical to accept money from patients. Yes, you do tip your taxi driver, but last time I checked, we were trying to get away from that whole, "Ambulance Driver" connotation. That said, I have had people throw money at me, and throw me out the door... and then... well... what are you going to do. If I can, I'll leave it out on a table on my way out or something... but sometimes, you can't. I would much prefer just get a letter in my file for doing a good job. I do appreciate the sentiment when they offer though. I had a doctor once, who was my patients daughter... she gave us like $10 or $20, and was adamant about us taking it. To the point where she stuffed it in my pocket, and told us that we were taking it weather we liked it or not...

Love at First Sight!

Nope, no vested interest at all. I just disagree about the importance of the website. You're right though (both of you) that it should have more information about the instructors and classes.

Accredited by Mass DPH/OEMS Length: 10 months (Mon/Wed 6-10 pm, Sat 9a-5p) plus clinical/ride time Certificate program, inclusive of ACLS and PALS Clinical sites... oy... there's a lot of options there...

Yeah... It's a website. It's not exactly the be-all-end-all in EMS, now is it? You're reading WAY too much into the site. EMS education (at least in this area) is 100% word of mouth. I don't care what the site says, I care about what my colleagues have to say about the programs. The site is just an easy way for me to know what classes are coming up. What certs will the students get? I though that was straightforward enough, EMT-P/NREMT-P/ACLS/PALS. I've never heard of a medic class in this area that doesn't get you NREMT (in RI it's required), so putting it there would be a little unnecessary... Anywhoo... regardless of what you think of their webmasters HTML skills, the instruction is phenomenal. I'd much prefer a great educational experience with a crappy website than the inverse. I would like to see your idea of a good EMS education site though. (for the record, the change in this site was completely coincidental, I didn't get a chance to talk to the big guy about it yet... well... unless one of them read the forum... hey guys! lol)

Speed is not that important. The lights are great to keep you moving, and for getting around traffic. Speed is just dangerous. Want to know when you are going to see me speeding? About 10 minutes before Dunkin' Donuts closes... I need my Kawfee, lol

Check it now. Educational Resource Group

I will pass that along to them

I took their EMT-Cardiac program (it's a RI thing... think of it as Paramedic Light). It was awesome. A lot of my colleagues have taken/are taking their paramedic program. I will probably be jumping into one of those myself in the next few months. The instructors were just great. The facilities are also phenomenal. They just opened a new location this past year (where my class was held), having seen several facilities in the state used for EMS education, I'd say that they have by far the best location around (the East Providence, RI location). Brand new equipment, wireless projector, and the 50" Plasma on the wall is a nice plus too. That of course, is secondary to their prowess as instructors. I know quite a few EMS educators in this area. I will never take a class with anyone but these guys, ever again, after having been through their program. I agree, they should add some instructor bios, and some more info about the programs, but the website is pretty low on my importance list. I've never heard a single bad word about them. And for the record, no, I don't work for them... lol