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fiznat last won the day on July 29 2015

fiznat had the most liked content!

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    In the back
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    Medicine and Motors
  1. fiznat

    PE vs MI

    The epidemiology of VTE is super difficult. The risk of DVT/PE in hospital patients and those recently discharged from the hospital is something like 100-120 times the risk in the general community, and several studies have shown that PE is found in about 10% of all hospital deaths (though it is usually only suspected in about 3%). The are accusations of both under and over-reporting in the literature, so really the picture is pretty cloudy. What's extra weird though is that prophylaxis against VTE is effective in reducing incidence (by about 50%) but not at all effective in improving morta
  2. Paramedic, medical student (just finished 1st year! wooo!). When I do work, it's private service 911 transport.
  3. Hey Dwayne, I don't know too much about those devices specifically, I will have to look it up because you've got me interested in it now too haha. I imagine many of the compensatory mechanisms would still be available, especially the important ones that alter fluid levels or change vascular tension to tune preload to the heart. The same fluid dynamics that make the the heart work better under high preload could possibly apply to any mechanical pump, as well. No doubt the pump would be "dumber" about it though. Our bodies truly are full of amazing dynamic systems that all work in conce
  4. Hi Dwayne! Just learned this a few months ago in school. The body actually works really heard to diminish that pulsing effect. Having peaks and toughs (a diastolic and systolic) in vascular pressure is actually bad for exchange of nutrients at the capillary level. It would actually be completely ideal if the blood flow were slow and constant (like a gently passing stream) rather than the pulsating flow that comes out of the heart. Turns out, this is why arteries are so elastic: because the way they stretch helps to buffer the high and low pressures to even things out. This works so wel
  5. Hey Dwayne, I always did my recerts by challenging the tests. I found it a lot less painful than those 40ish hour medic refresher classes. You've got the basics-- have your medcon/director sign off on skills and CMEs, then you get authorized to take the written exam. Its like $100 and you're done. WAY better than the alternative...
  6. Yeah, I pulled a few shifts with this guy way back when we both used to work at a different company. Seemed like a regular guy then, and all local reports from people who know him now seem to indicate that he was a decent medic who was well liked. I guess you never know. What a terrible thing to happen, and I agree: a horrible black eye for EMS. I know some of my coworkers (who work at a different AMR division in the same state) have been getting occasional flak from patients and other people about it. Really awful.
  7. It isn't that much of a zebra, WPW definitely happens and usually when you aren't looking for it. You only have to miss this once before you start thinking about it on every patient with wide and tachy rhythms. I've missed it before, and I promised myself I wouldn't again. As far as the OP: you really can't tell the difference between VT and SVT with abbarency on a 3 lead. Even with a 12 lead it can be very difficult. I would take extreme caution in diagnosing, and especially treating VT as this is an area where you can definitely do some significant harm with the wrong choice. It's b
  8. Pros- The attitude here in regards to EMS mostly mirrors my own: anti fire-based, anti volunteer (for the most part-- miss you Dusty!), pro education, pro discussion. I think there is something to do with the nature of the place that attracts people interested in discussing what might have gone wrong. That differs quite a bit from the average attitude on the job. I enjoy getting in (professional) arguments about this stuff, and a lot of times these forums have been happy to oblige haha. Cons- The forums are a little slow. Would definitely like to see more activity. Sometimes I
  9. Does your sponsor hospital/medical control require to upkeep your PHTLS card? Ours doesn't-- I let mine lapse a while back....
  10. Cool site, but why not just use Wikipedia? The articles are more complete, and are subject to a more rigorous review process....
  11. Well to be perfectly honest working as a volunteer EMT is not adequate experience, especially for a paramedic. Working as a CNA doesn't cut it either. It is very possible that these agencies aren't willing to take the risk on you because training a new paramedic is a sometimes lengthy and expensive process. There could be some other red flag as well, who knows. I would suggest calling a few places that rejected you and ask how you can improve your application. Find out what the issue was and work on fixing that. You can't do too much about your lack of experience at this point, best
  12. Well, you posted it! haha, actually you are mostly right. When glucose levels are low (or when there is a problem with trapping the glucose in the liver, as is the case here), fatty acids are brought to the liver and transformed into acetyl CoA, which is then fed into the citric acid cycle (TCA/Krebs cycle) for energy. The acetoacitate and beta hydroxybutyrate are the ketone (in KETOacidosis) products of the reaction. The body can use ketones for energy when things get really desperate (starvation state), but what happens in DKA is the ketones start to really build up. Like you mentio
  13. I googled BHSc degree and came up with bachelors programs. Are you saying that what this person should do to prepare for a 12 month paramedic certificate course is complete the material that is sometimes used in a 3 year undergraduate degree? ...And then add chemistry, biochemistry, microbiology, physiology, and other graduate level material? Sometimes I feel like people post stuff like this just to show off what books they (may or may not) have once read. We're not measuring e-peens here.
  14. Absolutely, sedation is in order if the patient is gagging on the tube. That said, I don't think a little gag is necessarily a contraindication for intubation. Gag reflex is not the same thing as consciousness, and it does not mean that the patient is entirely protecting their airway. It is a judgement call of course, which is why you get paid the big bucks to wear that patch haha. What you need to do is balance how well you think this person is protecting their airway against the possibility that you could cause harm with the procedure. High risk for harm or low clinical benefit = do
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