stcommodore

Different clinical sites can be just like that. My last programs home hospital was a university so we would have a better chance of getting a tube in the ER then the line for the tube in the OR. We got sent to another hospital that gave us a better chance so its just a matter of getting out there, giving it time, letting them get to know you and if you have to talking to your instructor to figure something else out.

I think when all things are equal it would only be fair for a nursing home nurse to provide a breif report to the EMS crew. I honestly don't care if your busy, have three other patients, etc. Clearly this is supose to be an "emergency" so you can at least provide that report and there paperwork. Everyone has there bad days both NH staff and EMS crew but we are all in it for the patient so for there sake I wish things were better.

I have as much experence as your little toe but during a ER rotation I saw a patient sustain runs of VT. He clearly was unstable, looked like crap, etc etc but it was a learning experence none the less. I believe he was in a SVT they tried to break with Adenosine and when the rate dropped the salvo's of VT would kick in. Oh and feel free to feel special hitting an IV like that, but only a 20?(jk)

How about the push away from ET drugs and IO or IV. I know we rolled out the ez-IO guns to some degree because of that.

I believe we can assist the patient with there nitro and call command for other usage past that for Nitro in my system. ASA seems alot better on the risk vs. benifit side of things at least when I'm looking at it.

If I remeber right from winter quarter the order of the tubes has alot to do with the type of tests that will be done on each. It also covers things like not flushing the extention before drawing from it. Personally I feel that on average a EMS IV and an ER IV probaby care close to similar infection rates. I also understand when rules exsist and many times they just do and really don't have a good basis behind why.

I just got through new ACLS with my medic school and we had the new flip books and old text books like the last poster said. I've had two or three codes in the last few months and the direction I was given as a basic by the medic is to obviously as ACLS teaches is to focus on the compressions. The big note is though that once you have an advanced airway established its not a 30:2 cycle but constant compressions and switch people every two cycles. On a personal note I can't imagine having a good intubation attempt with someone pounding on the chest at the same time. I would think that in the 10-15 seconds it takes you to complete the intubation that would be an acceptable time to hold compressions. edit: While reading over the reason and changes it makes me think that if there is no proven benifit to first aid oxygen and the studies show that ASA early has benifit could we see that in a BLS setting? "here take your nitro, and your asprin" or even "here is our nitro to take and these three asprin" Hmmm.

In the hospital I would hope that someone would examine the patient asap and clear them off the board or at least order a scan so that they could be taken off asap.

It is only reconized as a "rescue airway" and in many places not even allowed pre-hospital. I don't know about how secure the whole mask concept would work on the road and giving advanced airways to BLS providers is a whole different issue in itself.

thanks

I was more then willing to drop it and move on. Obviously I was wrong in what I said before so it really doesn't do any good to stay stuck on the point now does it?

Mabye you need to reread what a lie is. I was incorrect its like not I came out and said "I'm a doctor" that would be a lie. If I made something up to sound cool or appear better then someone else then that to would be lying. But by being wrong on a test does the teacher then say that you were lying?

I saw a sign somewhere along my paramedic hospital rotations that say something like "a patient loses x% of there hearing without there cloths". I had the end of a physical yeasterday for school and had to put on the hospital gown for it. Just sitting there on the table waiting for the PA to come back in and hearing the MA trade comments with the PA before hand was really eye opeaning. It is so easy to forgot what we are saying infront of others, or how this may be our fifth call of the day but to the patient this is there big emergency. I'm obviously in the field and sitting there with the gown on bumped up my pulse, blew my focus, etc. So if you never thought if it before and I'm sure we all probaby did but its worth a reminder that its really different from the otherside.

I don't think its really a respectful thing to go around calling myself or others names. Nor do I think it is fair to make asumptions on why I didn't reply. Did it ever come into your head that I may have a life outside this website and left to go join the real world? Myself and many others haven't been in the field for years and like everyone else we all learn something everyday. I understand the guidlines of my squad and will retract the comment about it being in the protocals. It looks like alot of good reading was posted and hopefully I'll get a chance to go through it all. So for future reference I will never be offended by being corrected on a point but think its really unprofessional to harp on someones error as you did.

I don't recall hearing the term "selective immobilization" before but for what we are trying to refer to that works fine. Following the NEXUS criteria the doctor doesn't have to do xray, ct, or any scan like that to get someone off the board. I have also seen situations where the hospital took the word of EMS and called a level, and cases where they waited, nothing I'm sure we haven't all seen before. It all varies depending on the hospital, and tons of other factors.

If I had it at hand I would post it but why would I make something like that up? In a Trauma situation where you have callled it a Level one or two for example and you have the team working a patient then its obvious the board is going to go, but if the patient is stable and gets put in line in an ER then they may expect to wait awhile to get off the board. Why is this so hard to believe? Do we really believe that every single patient that says they have "neck pain" or whatever needs to be put on a board? I understand many systems protect themselves from the liability of mistake by boarding everyone, but to you as health professionals do the studies show we are doing any good by boarding everyone? Don't use the whole "well this one time ten years ago I had a patient that x" line either, what good are we doing people if we don't look at the bigger picture, do studies, research and change when the evidence says we should have years ago. We are never going to get anywhere as a medical profession if we refuse to act like the rest of the medical world.

Mabye its a county thing because I know we have and use it but Philly does not. Some of the guidlines include exclusion of the very young and very old, etoh, and MOI. But if you have a healthy adult patient that was rear ended at a low speed with no complaints, and overall nothing abnormal why are we going to board him if you are confident of your physical exam? Most of the time the ER doc will do the exact same thing under there NEXUS guidlines. * No posterior midline cervical-spine tenderness. * No evidence of intoxication. * Normal alertness. * No focal neurological deficit. * No painful distracting injuries. can I also say that the trauma team removing the patient from the backboard is critical for there assessment of the patients spine and the collar is the critical aspect in preventing motion by the patient that would cause injury. Hopefully we are all palpating the spine of patients before we place them on a backboard to...

we have the ability to clear C-Spine in my squad and it is listed in the PA BLS protocals. I think following those guidlines you can clear plenty of patients and save them alot of trouble. I heard it but really well at a CE class put on by our medical director. We have to remeber that by putting a pt on a LSB we are putting them in line for Cat Scan when they get to the hospital and an unknown amount of time on that board. If they don't need it it'll be a waste all around, but if you have any doubt board away!

I've worked calls in the parking lot of our local trauma center. Staff can't leave the building to respond to a call because they are not insured to pratice nor trained to work in the "pre-hospital" setting. Hospitals have there in house responce teams and such but somtimes we don't always know all the background to why things happen the way they do.

no doubt bls skills are critical and a good basic foundation is critical to being a medic but with a shortage of everything what do you expect schools, states, etc to do? They need medics out there and if they can pass the tests then medics they will be.

With the current lack of fire-rescue to get jeep people out of the water there probaby going to get black tagged. I would feel odd about leaving someone on scene so if possible everyone on scene outside the Jeep is going with me and we are hauling ass Or we are going to stay and play this one out until someone/anyone shows up

Allow hazmat to secure the hazzards and establish a decon corridor between the bus and triage for mas decon and then secondary decon before treatment and transport.

I know a resident namded Derek Isenberg....