1EMT-P

If you were going to buy a new stethoscope what kind would you buy & why?

I agree that ETI is the standard of care when it comes to airway management, but what about EMS providers who live and/or work in communities where their call volume is low or where they primarily do transports? There are some places here in the US where providers simply do not have access to an OR. For these folks the ECT, King or LMA maybe the best option available.

The purpose of CERT as I understand it, is to assist in communities in the event of a disaster. CERT members are trained to perform basic first responder functions until EMS, Fire or Police can arrive.

The first thing that I would do if I were you would be to write to the local and/or state office of EMS and ask them. The second thing that I would do would be to ask your agency if their insurance covers ALS providers. The third thing that I would do would be to ask your Medical Director for written authorization to perform advanced skills in an emergency.

PS: Remember to dot all your I's & cross all your T's.

We shouldn't throw the baby ( Phenergan ) out with the bath water just because a few providers did not know how to properly administer the medication, instead we should educate providers on the medication and on the proper administration of the medication.

Zofran is a good medication, but is it going to work at preventing and/or treating motion sickness?

I have been using the Combitube since 1994 and I have not had any problems with it. I think it is a good alternative airway device. The LMA is a good device if your patient has been NPO, but lets face it most of our patients have not been NPO and are at high risk for vomiting.

If I had to rate the alternative airways I would say: 1. King, 2. Combitube, 3. LMA & 4. PTL.

I recently attended an ACLS provider course and to be honest with you I was shocked at just how much content the AHA had left out. The AHA basically deleted the advanced airway and pharmacology sections of the book...

Do any of you work with RRT's who are not EMT's or Medics, but have advanced scopes of practice and who work in the critical care/pre-hospital emergency care environment.

Examples: Flight RRT or Ground CCT RT or Pre-Hopital EMS RT... Not Home Care RT...

Do any of you work with Pre-Hospital Respiratory Care Practitioners/Therapists?

Do any of you know if there any alternatives to AHA ACLS?

The device implies that it reduces the risk of injury, but without research data it's hard to say...

What medications do you use for PAI/RSI in the field? Diazepam & Morphine.

Does your agency offer critical care training? Does your agency offer a stipend for becoming CCT certified?

I agree with your treatment given the patient's history & physical exam. If she had CHF I would expect her to have some edema. Plus given the fact that her sputum is a greenish or yellowish color.

I don't think the nurse was right to question your assessment or treatment... What made her think that it was CHF? Did she do a Basic Metabolic Panel, Chest X-Ray, Ecg or Pro-BNP?

I think it all depends on the patient's condition. If you have a critical patient ( AMI, CVA or Trauma ), then yes lights & siren maybe indicated.

I would have given the patient a 500 ML bolus of NS first and then re-assessed the patient. If the lung sounds were clear after the first bolus then I would have given a second 500 ML bolus.

Sorry about that, but my pc crashed in the middle of my post. The patient's vitals were as follows: BP 140/100, P 78, RR 20, Spo2 94% on RA, SR/Paced 78. The patient states that her Dr. recently increased her Lasix to 80 mg and that her labs showed that her cholesterol and liver function tests were elevated. The pt's Dr. scheduled her to have an echo along with a stress test.

Allergies: Bumex, HCTZ, IVP Contrast, Motrin & Sulfa.

You respond to a 59 y/o female patient complaining of fatigue, swelling of the abdomen & legs & shortness of breath. The patient states that she has not been feeling well and that she has gained 20 plus pounds in the last 10 days.

history of Anxiety, Depresion, Gerd, HTN, Sick Sinus Syndrome & Restrictive Airway Disease. The patient was on ASA, Albuterol, Lasix, Lopressor, Protonix, Xanax & Vitamin E.

I think you did a good job under the circumstances. I probably would have given this patient Cardizem and/or Lopressor instead of the Amio.

Protocols are like maps they are there to help guide your decision making, but keep in mind that there are always alternative routes that you can take.

PS: As a new EMT, I would encourage you to find an experienced EMT mentor to help you learn the ropes.

Dust I was out of town and just got back, but thanks for asking.

Happy Trails,

1EMT-P

The hospital in this case clearly had a duty to act and they failed to do so. When the 911 system was called they also had a duty to act and they failed to do so. The lawyer representing the family is probably going to demand an investigation and also file a civil action against the department of health, the hospital, the hospital employees, the local 911 system, the 911 employees and the local city/county government.

I do not feel comfortable giving Morphine Sulfate to patients with abdominal pain for the following reasons: 1. If a patient has acute pancreatitis Morphine Sulfate may cause constriction and/or spasms in the Sphincter of Oddi increasing the patient's discomfort. 2. You also have to be cautious about giving Morphine to patients with abdominal pain, biliary tract dysfunction, gastrointestinal obstruction and/or renal function. 3. Morphine is contraindicated in patients with known and/or suspected paralytic ileus.

If a patient is under the influence of alcohol or drugs he or she is unable to make informed decisions including signing refusals.

How many of you guys use Propaq monitors?