nussy

I'm a paramedic in Israel, their are very few paramedic training programs here, most are not validated in the US, oddly i might add, we usually practice here a wider scope of prehospital medicine. i know that are certification is valid in some countries around the world, not on your side of the globe any how. just like in the US this job doesn't pay much here either, so don't get your hopes to high... and finally, except the military no one pays here for your ems school... good luck...

By my opinion, it's an atrial rhythm with an aberrant conduction. The patient is doing rather swell clinically and by his vitals + the ECG is missing concordance (which usually points V.tach). You can treat it as WCT of unknown origin, and you'll be doing the right thing. Though the patient isn't demonstrating any life threatening situation, administering O2, starting an IV line, and transporting the patient to the hospital, monitored, and not giving any medication is also legitimate, yet I would give him to chow an aspirin 300 mg any way. Treat the patient not the monitor, the monitor is impressive, the patient a bit less.

i've noticed an interesting fact, surprisingly, right before the giudelines where (which most of them make seance) published new chest compresion instruments and chest compresion measuring instruments amerged, this is the same story as amiodorone Vs. lidocaine all over again, like every research, it depends on who wrote the study and why, and of course - what result was pleasable... think about it...

Our rule over here is not "what can we do" at the house, its "what should we do". Though we're technicians we still have judgment, and we have to make the call where to treat - by patient severity (usually our first impression), environmental situation etc. If you're equipped properly it really shouldn’t make any difference. Personally I like doing as much as possible at the scenario and as little as possible in the truck, the conditions in the truck may be of a more controlled environment, yet it’s a suboptimal situation (bumpy driving, noise from the siren, we can only approach the patient from his left side, safety issues seatbelt wise, etc.)

It’s a large company that provides maintenance to different kinds of vehicles. I don’t think the company cares all that much. The countries law requires that if you use cretin substances than you must have a medical team; and it's more costly effective to treat them at work than to send them home to see the doctor…

We've got lots of chemical substances. So there's an MICU and sickbay at all times. nussy

Hello to all, I work at factory that has a sickbay (occupied by RN's and paramedics, and during morning shifts we also have a family doctor), when we have serious calls then we evacuate with our ALS ambulance (MICU). A 56 year old man walks in 5 minutes before the shift ends, his complaint – "a strange feeling in his left upper shoulder", the way he stood and pointed at his shoulder resembled Levin sign. The discomfort started half an hour ago and hasn't changed, he tried to sit and drink some tea waiting for the discomfort to pass, yet the discomfort remained and he decided to come to sick bay "just that he'll feel calm". The feeling appeared suddenly and wasn’t provoked by anything, it doesn't radiate, and it doesn't heart, and doesn't have postural change. Breathing – 16/min, lungs bi-latterly clean, SP02 – 98 RA, HR – 80/min, NSR, LOC – A and oriented, PERLLA, he's not diaphoretic or pale, except his complaint he looks fine, yet he's got that distressed gaze in his eyes, as if something is really wrong. His history – during 1998 he had a PCI which was followed by a CABG, he hasn’t had any problems since then, he takes his aspirin once a day. One month ago he was treated by our MICU and taken to the ER because he started vomiting blood (the aspirin caused a peptic ulcer, he was put on Omepradex). We preformed a 12 lead and this is what we found: I, AVL, V3, V4 – slight ST depression about 0.5-1mm (the T wave was slightly biphasic) II, III, AVF, AVR, V1-2, V5-6- normal. We didn’t have any old ECG to compare it to. Because of his cardiac history we deiced to evacuate him to an ER, he wanted to go to a hospital half an hour away drive. And this is when the argument began; one guy claimed its nothing, lets evacuate just for being on the safe side. I was more worried and wanted to start an IV, MONA and Heparin. The discussion was – should we give him the MI package? (1) The ECG findings and the clinical presentation aren't substantial and even rather ambiguous; (2) he had a recent peptic ulcer, that's a relative contraindication. On the other hand he had that impending doom look in his eyes. What would you have done? How did the case end up? – We started an IV, put him on a non-rebreather mask, gave him 300 mg aspirin PO (chewing) and Heparin 5000 IU IV. We convinced him to be evacuated to a nearer better hospital. During the drive he mentioned the drugs made him feel better (that made us feel better – it indicated something is actually wrong with him). When we arrived to the ED another ECG was preformed, this is what was found: I, AVL –ST depression about 2-4mm and the T wave was biphasic. II, III, AVF – ST elevation 4-5mm. V1-2 – normal. V3-6- ST depression 2-3mm. The door to PTCA time was approximately 30 minutes. The message of this case – sometimes you got to just trust your gut feelings nussy