BushyFromOz

I think not replacing your phone with one that has a working touchscreen so your posts arent all half lettered and muppet looking could be counted up there as one?

could probably help too

Do Nursing first then bridge to Paramedic. It's as simple as that

True that..

you know when you think about things that you should have done and then realise soe istakes made sense at the time, others make no sense and soe of your decision you realise were just retarded.

Not doing the double degree nursing/paramedic and taking the paramedic only one was on of those retarded decisions

Do the nursing bro

Did he get the card back?

There was a cardiac arrest case from Portland, Maine back in the 1990s where the guy was given CPR by a bunch of clowns ....

How is it any different now??

(Note: Australians and New Zealanders need not respond to the question - this thread is not for that fancy evidence-based practice you guys think is so cool.)

modified version of NEXUS

What do you spend all that time doing?

Its the job type that we get around here, non time critical medical calls that dont benefit yourself or the patient by busting your ass to meet a deadline that doesn't need to be there. We generally work as a crew of 2 without assistance so you probably spend 7-10 full minutes asking questions and then another 5-10 on management but the time is lost in moving patients from the house to the truck.

Patients with pain i will happily sit aorund for half an hour getting enough effect from narcotics before i attempt to move them.

Then there are those patients you cant physically move so you wait 20mins for another crew to assist

Time critical patients (STEMIs accepted) i can get out in around 10-15, but theres a few variables in that, and i always have an IV in those before i move them in case they drop their bundle - unless they are particularly difficult, but thats not very often. Complicated trauma patients 20 minutes is about normal if your on your own. 2 Guys providing all the care and extrication from vehicle/house naturally takes a few more minutes than having 4 guys there.

So, my answer is i make the decison on a case by case basis, ill scoop and run when i need to and ill stay and play when i decide its appropriate and all my decision making is based on safety for me and the best care for the patient.

As an aside note, i often find the ability to have a short scene time is not so much a reflection on the guy running the job but the organizational skill of your partner. Theres a lot of good ambos out there who are not good partners and being a good partner is often more dificult than being a good clinician

= If they code something happened that you more than likely failed to catch.

Do you really believe that?

Fascinating but um I haz question *raises hand, what is a proton again?

Crazy little things that roger ramjet sticks thorugh a pill press and eats... better than borocca

thats cos ur a freak

Echo? or is it 1 am again?

my life is a circus

Can you link the article, I'd like to see this new concept as it puts forth a very different hypothesis than our current model.

Ill see if i can find it.... the one i read was in hard copy, just floating around the station so ill have to see if its there when i get back to work

thanks for clearing things up, im not sure how i came up with that blinding question in the first place

thanks for clearing things up, im not sure how i came up with that blinding question in the first place

I always love how people say "we're from the Ambulance" ... like no shit there is a bloody great ambulance parked in the driveway (or at least we TRIED to park it in the driveway if I was driving ...), two or three people with "ambulance" written all over their uniform are standing inside your house with a shit ton of medical equipment and at some point somebody in the immediate surroundings may, just may have called 111 and asked for an ambulance

And yet despite all that, i still get askedevery so often if i have ever had to shoot someone... perhaps i liike a little sketchy, like bryant or knight?

Not for you

*smacks Bushy's hand

You know that reminded me of the last time I got tied up in bed .. hmm, excuse me for a bit, I am going to be over there in that other Chrome tab mmmmk

Yeah, i heard that they stole it and put it in that sherlock holmes movie with Robert Downey Jr in it

Oh look 3am valiums mmm num nums ...

It aint workin, send me something stronger

Hmm, I sounds like you're confusing CO and CO₂ a little bit because CO will bind to Haemoglobin and mess up the SP0₂ Sensor.

God, you know what, it sounded good in my head at 1 am but after some a sleep and a coffee or two i realise the question is just retarded. How embarrassing.

I just read some article about C02 binding to heamoglobin writen by some chemist, basically saying the current model was wrong and that C02 dissolves in the cytosol RBC's and doesn't attach to the proteins on the HB molecule as is the current model. But it doesn't change the fact that C02 won't change the IR frequency of the SPO2 sensor.

Greetings earthlings.

Quick one, C02 binds to heamoglobin but not to the Fe molecule like 02 does. Even so, does this provide false postives when the IR light passes through for SPO2 sensors?

I know the vast majority of C02 is tied up in carbonic acid, with a bit dissolved in plasma and a bit tied to heamoglobin, but could / would it cause false readings in acidotic respiratory compromised patients where PC02 increases from buffering?

random 1 am thought

Thanks for all the replies. Our guidelines outline the use of both IM and IV adrenaline, although IM is generally preferred. We are getting pumps shortly, which will obviously have its benefits.

In a patient that has extremely poor perfusion with brochospasm I would be more inclined to go the IV route, however, then comes the increased likelihood of the adverse B-1 effects, so I suppose a bit of risk vs benefit vs being able to manage the appropriate infusion rate all play into the discussion as well.

And Bushy, for what its worth I had a look at Therapeutic Guidelines (eTG), metaraminol is advocated in anaphylaxis with persistent hypotension. Not to say you guys will ever use it as such, but something worth noting

I saw that too, i havn't looked into weather it stabilises MAST cells, will have to look into that tonight

It shouldn't, im trying to adopt your values.

not like you to be late and repeat what i have said bushy....but you do work for the mexicans....

Better than working for your lot, and they were much better in their HR management - at least im not stuck out at ardlethan or lake cargellico or cobar or some other god forsaken town trying to get back east

And your right, i normally wouldn't repeat whatever your dribbling anyway

since when did he move to new zealand? lol

IM flat out getting to wanaka for the airshow let alone anything else

Simple to mix in that format, yes, but counting drops is in no way, in my opinion, an accurate way to titrate a correct dose. It changes enough on a patient in a non-moving hospital bed... I agree with Chbare that a pump is vital, and it is far preferable to go with the IM route in a moving vehicle.

I'm curious as to what the post-fluid bolus care is... do people end up in fluid overload once the anaphylactic shock has been mitigated? Do we ever see rebound pulmonary edema, especially in those clients already in heart failure? I honestly haven't seen enough anaphylaxis nor the followup care to know... but 4 litres is a LOT of fluid to be positive on!

Wendy

CO EMT-B

RN-ADN Student

I should have been a bit more descript, not all of her circulating gvolume was third spaced, some went down the toilet too

Well there is your motivation to move up to ICP then!

Working on it chief...

I went looking on that other website then realised you meant that other, other website

The ketamine trial from Victoria was sponsored by the MAS so that the MAS could justify having some evidence to introduce ketamine to Intensive Care Paramedics routinely for analgesia as before that time it was used only by the MAS Flight Paramedics

The retarded thing is that the trial was done by both MICA and regular Paramedics so even though i oushed heaps of it under the trial i wont get it when it comes online permenantly.

Don't be jealous. Just because you southern hemisphereers can't get hero status, don't know us up here for being able to do it.

No heroes here, but apparently they trust us more than other other profession so ill take that instead

No heroes here, but apparently they trust us more than other other profession so ill take that instead

Besides, a hero is is some type of weird sandwich

***EDIT***

Ok ok, i know, i should have read page two, craig has already posted this stuff.....

You raise a very interesting point sir. There is no Ambulance Service I know of internationally that is doing this but I think MAS in Victoria (AU) is using aramine in patients with bradyarrhythmia. Isuprel and noradrenaline spring to mind as well.

Metaraminol is used here for poorly perfused SVT's refractory to reversion and hypotensive people arfter some clown mixes viagra and GTN together. Adrenaline infusion at 5mcg/min and then working up, but i dont think the metaraminol stabilises MAST cells like the adrenaline does, but im probably just making that up.

IMI adrenaline is all i have here. Crazy that yours had no bronchospasm, all of my Anaphylactic patients had dynamic hyperinflation and distributive shock which seriously stuffs up their preload, but it doesn't sound like thats the case with yours.

IM with Kiwi, this chick would get agressively fluid loaded from me, and with the exception of the Septic Shock patient i cant think of any other patient you would aggressively load like this. The last anaphylaxis i had took around 4.5 litres to come good - despite the adrenaline and the beta agonists for her bronchospasm she just didn't have anything left to pump..... she had nice puffy limbs though

http://www.semes.org/revista/vol21_3/11_ing.pdf

Pretty much sums up the topic

Same on this side of the ditch, Ambulance Officers have been voted most trusted for the last five or so years running

Sometimes i think the reason they vote for us is because the people voting have never met any of us