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Ok well I have to jump in here, sorry but your pulse ox is telling you diddly, 48% ??? Best look on the ODC to figure out where your PO2's are at.....maybe around 28 to 32 mmhg, so if your patient is still awake this is telling you more than the machine. Point being your Pulse ox is useless when patients are in Hypotensive states, and look for correlation of pulse ox to pulse. At a BP of 70/30 doubtful that the kidneys are perfused as well so lasix is a waste of time too, one has to support BP with tropes in this situation, position (even the sleeping bat position) will not help you/ your patient. cheers

Argh, second post due to loss of signal so here goes again: Poiseuille's Law In the case of smooth flow (laminar flow), the volume flowrate is given by the pressure difference divided by the viscous resistance. This resistance depends linearly upon the viscosity and the length, but the fourth power dependence upon the radius is dramatically different. Poiseuille's law is found to be in reasonable agreement with experiment for uniform liquids (called Newtonian fluids) in cases where there is no appreciable turbulence. Try this link: http://hyperphysics.phy-astr.gsu.edu/hbase/ppois.html#poi That Said: A point I would like to make is this... MEASURE the Flow rate at the distal end as this is the most accurate way of determining delivery. I use an ERIE LITRE METER "made by Peter"....ok that parts just me. The fact is one CAN calculate the loss of pressure and compensate with flowmeter (s) the Thorpe Tube "the ball and tube deal" does allow for some compensation yet the Burdon (sp) gauge does not, bottom line when adding all this tubing together is the possiblity of LEAKS is far greater than minimal flow loss due tubing length. I was involved in a study, throw in a wash bottle/ humidifier and the risk inaccurate flow delivery increases 50 %. cheers

Dusts first edition was chisled into stone tablets, yes a good buy, but the postage could be rathere excessive. cheers, running in a weaving pattern and ducking for cover.

AH HAA! I knew it, one of those Bow Tie wearing renegades that chased the girls and made them cry. for shame

Dust, did they have BVMs back in those days? I thought that was called an Iron Lung?

قد وإللنق If you use this phrase, and pointing skyward I suspect that you will get an rapid introduction to the Air Marshal, and your airmiles points will be used to visit lovely Guantonimo Bay...ok so my spelling sucks. Good luck.

North: In honour of your B day, I challenge you to a race ..... first wheel chair to the finish line wins free case of beta blockers, economy asa and a jug of stool softener, HEY and no cheating like last time, your bloody cane is STILL stuck in my spokes ........ I have my eye on the prize this year, beware. cheers

I'm tryin', Ringo. I'm tryin' real hard to be a shepherd. I just love that line, thanks Sir Marty ! Thing is sometimes I feel more like a sheep .....opps that was a slip of the tongue.

Some very good teaching points coming out of this thread, I do agree that Intrapartal assessment can introduce bacteria yet this is a very common procedure in the Mat wards, properly done (as clean as possible) the risk is decresed, this would be a note to add. I was very fortunate to work with a MidWife (from the UK) she was a most excellent preceptor and worked directly in a Mat Unit, determining position of the kid is not dificult to learn, engagement of head a biggy. ps Head is hard, Bum is soft.....this in itself can be very vauable information. It is my experiance that reading of ultrasound is fairly accurate, the reason I comment is that I have had a few "stat" transports of Mat patients when a diaphragmatic hernia is observed, this has been lifesaving for the kid as rapid transport to a center capable of ECMO...that is a heart lung bypass preformed at birth to allow surgeons to repair, in the past was 100% death rate, now about ~ 80 % survive....this is directly due to an educated OB or DI imaging and correct Dx. I could be wrong here but once the placenta is implanted, migration would be rather difficult, I would think? If I remember correctly it is about 10 days after fertilization that implantation occures, the blastocyst stage of development if I recall ? Ultra sound here is a bit more routine as possibly the costs are lower? dunno, I think we are comparing apples and grapefruit, usually done routinely upon initial positive "kill the rabbit test" stage, although most likely looking for heart beating, not disgnostic and if for any other reasonable question, unexplained bleeding +++ decreased fetal movement stuff like that. WHAT are you saying....MDs are not Gods? I sure hope ERdoc does not see this ! :shock: Sorry disagree here but 15 minutes transport is not even a consideration when flying in VERY remote areas....(look back at my senario if you wish) it can take up to 5 hours by aircraft to get to definative care center....oh yes indeed. Agreed, again good post. cheers

squint removes sword from belt (ok thats stretching it) removes multitool touching each shoulder with rusty blade: scaramedic of the royal order of the special forces obs/gyn .......... I now dub you sir Night, all rise to welcome a brother into the fold of the "twisted" As for Lord Lone Star my BIG Brother..... thats my line ......LMFAO.

I have seen many of these (lumbar area) tats in Chinese lettering, this may be an old joke but I do ask the young Ladies if they can read Cantonese or Mandarin....short answer, nope. I inform them that unknown to them as I am well versed in these Languages.. the lettering does NOT mean, long life, health and happyness, wealth or love. It's says "WIDE LOAD" te he

This is off of texems list bulletin board bit off topic. Don't know author. It also Fits EMS nicely, well that’s just me, I guess ........ Someone who is equipped to - and at least marginally willing to provide a certain specialized service, Said person is near-universally looked down upon as a lesser form of life, not deserving of common courtesies, referred to with derogatory words, and totally disposable right up to the moment when they're desperately needed. Even then, treatment received generally increases only to the consideration level given to indentured servants. There may be a brief moment of recognition and possibly gratitude at the end, but it's uncommon and altogether fleeting. The completion of one job brings only the beginning of the next job. There's pay or some other quid pro quo involved, but nowhere near enough unless the person in question can and does cater to unusual needs, and even then it might not be enough. Said person may often be trying to get out of this life and typically fails - recidivism rate is high. May be forced into or back into the life by circumstance, or by "just one time and that's it" thinking. Tends to wear clothing styles and/or carry specific items that make their profession obvious. Typically required to work criminally-long shifts and late nights, and associate with undesirable elements of society. Day to day life involves getting screwed over rapidly and frequently. May develop serious health problems as a direct result of the work, even if preventative measures are properly taken, often works in dirty, loud, hazardous environments with notable temperature extremes. Gets a high percentage of work via word-of-mouth, can often be found with a group of people in the same line of work, bitching about the life in general and particular clients in specific. Probably still likes the service being provided to some degree, but probably not in the context of work -maintains a firm line between doing it for personal reasons and doing it on the job: the former is for actual enjoyment. The latter is solely for obtaining money, though pride may be taken in possessing the skills necessary to do the job well. Can only pick-and-choose clients if *exceptionally* skilled and in demand, or has a *very* understanding boss who makes it a point to look out for employees. Usually bills by the engagement, hired by clients with little-to-no regard for lasting consequences, who likely will demand things without actually knowing what they entail, and who don't care about why or how or what is needed, only how fast it can be accomplished. Above was a definition of a prostitute.

If you will allow swaying a bit off topic: Why is FEAR of litigation an excuse in so many situations for EMS providers ? I will never understand this I guess, but when this type of blank senario is used as an example of why we should not explore or prove a need to promote improved education, just blow it off and say I saw/ I heard this once. Not attacking your credibility at all just the concept as far as debate. Just think about the first Paramedic to shoot a tube, start an IV or discharge a defib, in civilian practice.....if He/ She did not push these previously expected norms then we would still be "RUSHING THE PATIENT TO THE HOSPITAL" Just a little sidebar as well if you don't mind, the first time I put in a femoral line the RNs absolutly freaked out .... "you can't do that"!!!!!! your just an Abulance Attendant! The MD checked the line for patency then stated "please hang 2 units of O neg stat, now that patient survived, and she didn't sue me in fact I got cookies and peanut butter too, my fave .... funny thing.

The only tat that I am really concerned about is a 666[/font:83e6486b7c] on the back of some ones head....

Good Grief, sometimes I wonder why I even try, NOT every Paramedic in the world has a hospital just around the freaking corner..... it's not a matter of a "delay of transport" or is it subjecting a patient to a higher risk in means of transport, it IS a matter of using all the tools available and NOT to jepordize the patient(s). The attitude of rushing the patient to the hospital HAS to change first too: Responding quickly to a scene and stabilizing the patient ON Scene. Kapish? That said now don't go off on me about practicing beyond scope as scope does and will change, education, training and proven reliability in making that call will make a big difference. IF and I say again IF "WE" are to progress as a serious entity as a Proffession in the provision of health care one MUST look to all the senarios that one may encounter .... GLOBALLY. SO dare to think OUTSIDE the BOX / or your own backyard, and understand clearly the very serious differences we all must face in logistics. cheers end of rant I hope.

Well Said LONE! You sure your not from Kanukistan?

Interesting PP missed by an OB.... they do routine Ultrasounds. I really have a hard time swallowing that one, C sections are the bread and butter of OB specalists.... SO if the Mom has a low implanted Placenta (unrecognised or undiagnosed)and infringing upon internal oz then during a normal progression of labour. The mom and child are both in a life threatning situation.... any dilation of will result in serious bleeding, AND prior to any rupture of membranes, seriously if one is doing a pelvic with this amount of force.....and lack of knowledge I must agree they should NOT be even attempting to judge station or cervical dilation, bottom line education is the key. Could you explain this statement, I don't think I understand just what you are saying? cheers

In addition: OR very Remote .

If I were an EMT working in a urban environment I must absolutely agree, this is NOT a skill that should even be considered, hot or not....good grief man. But, I think you are missing my point, by taking an appropriate mat history i.e. primagravid vs. multi, prenatal care, socioeconomic status, even race can become serious considerations as well (when considering the above senario). Therefore if a MAT patient is 4 vs. 6 cm dilated this may be very good indicator(s) that you should/or should not transport the individual perhaps just have coffee and wait to deliver in a FAR more controlled environment, with more helping hands, there are RNs in nursing stations .... first off do no harm my friend, do no harm. The major point here is do you rip down the road at high speed and bounce both patients around in the back of a flying cigar tube or truck, just to get that mom to a hospital ? This MAY NOT be the most prudent or intelligent thing to do, after all pregnancy is not a disease..... after all more kids are born in the back of a cab than in the back of an ambo. cheers

I must agree with dust and the researchers comments...well for "todays" snapshot in time, thing is as tat's have become more and more an accepted practice with the younger/ rebelious crowd, now even higher levels of socioeconomical status have embraced this tat culture ..... so could it maybe a that in the furture those that are not tattoed may become the minority ? If so I am in deep ca ca. Quite frequently I have noted that the "tats" have cost more than a well needed visit to a dentist ...OMG just what is with that anyway? a teeth-to-tatto ratio ? Personally my observations of the "run of the mill rebels" you know, the ones with the dolphin, or rose on the calf or the wire around the bicep, somehow this does not now give that individual any more "recognition of individuality" as they are everywhere now. I have decided to stick to the lick and paste variety myself as "micky mouse" makes me appear so fearsome! but that is just me. I do have enough staples, screws and plates as well, so piercings just don't impress me much, either but titanium rocks...er .... holds me together. All that said, I can not wrong anyone that wishes to make a statement of support for a "CAUSE" if it is done with some taste and out of respect for a lost friend or such. cheers

Intrapartal assessment skills were mandated in Alberta as part of Gap Training, this generated MUCH contraversy, the point being that understanding the procedure and practice on plastic "models" was advantagious not a negative, can't see how more education is somehow frowed upon, I have had the good fortune of delivering 8 last count, never really needing this skill as of yet: It can be very dependant on the circumstances surrounding the specific mat call and this may indicate a need for advanced skill sets. For example: a response by air to remote nursing station, maybe a greater that a 2 hour flight to a receiving facility. So does one subject the expectant mother (dilated to 6 cm) to a rather harsh enviroment of a medivac and - 30 C instead of staying in the realative security of a well lighted, warm enviroment. So I believe there should "not" be a hard and fast rule as not all Paramedics have the luxury afforded to them of a 20 minute transport time... cheers

Dear Nessie: Yes I agree with you, on line communications are far more timely, economical and greener to. You can claim theses fees on your taxes, (in association or union fees) initially out of pocket sure enough bites hard, but you do receive credits off the top of your gross...gosh I sure hope an ex bean counter does not see this..... :shock: cheers

Also known as Trousseau's sign, sometimes called "midwife's sign" for the classic presentation as its very similar to the hand position when doing an interpartal assessment, so try googling hypocalcemia, no apostrophe key needed. cheers

Sometimes the best learning experiance, is by making an simple error. Don't think of this as a mistake but a very valuable lesson, I bet you will never forget C spine again....a very good attitude, Beth. cheers

Your quote is edited for brevity. Anthony: Without a shadow of a doubt I must say you are one of the most refreshing individuals that I have had the pleasure to meet in this venue, Your zeal for information is simply astounding, and you call yourself a perpetually EMT, kudos, so many can learn from your in attitude and vigour. You ask difficult questions consistently and this is the true spirit of a professional. I just feel that this must be stated, you are well on your way to becoming an excellent practitioner as a Paramedic... if I ever have the pleasure of a ride along on your truck (and I do intend to visit some day) I would be my honour. Differential DX: Hey don't get caught with your pants down, ever, because I have ! 1- Central Neurological Hyperventilation in a 24 year old female with a sub arachnoids haemorrhage. 2- A 21 year old female with a fractured T 12 transected spinal cord from an unknown cause. DON'T ever hang your hat on a demographic "likelihood" when hyperventilation syndromes present. cheers Google Midwifes sign, if you see this its a really good indication of carpopedal spasm is associated with hyperventilation, but always look for the underlying cause.