tniuqs

Initiation of transvenous pacing?

Oh you have all the kewl toys !

The point that I believe needs to be made (well from my Kanukistanian chair) is this:

Yes I too am quite disappointed with the Provider level books (I drove 100 kms to take a look yesterday) they do not have the same research based data nor references that we as professionals (the grey team) are accustomed to seeing. I too was quite shocked as the Provider level books appear to be so bloody basic, that said: Those that are dedicated and have google and a few subscriptions (for journals) or even the links to the ILCOR research (i.e. the justification based on evidence based medicine.) In fact many threads on this site are self evident of that fact.

If a practioner accepts this new "improved" teaching methodology one must look "just why" is these guides have been "dummied down"...... to teach a huge demographic population,this is a means of delivering educational material, Your individual Licensing body is them to validate your capabilities... it is up to the true professional to chose to excel in this area or just accept the status quo. The Heart foundations world wide have heard the feedback of this I am quite certain things will change once again.

I personally would like to see a new "International Consensus on Science" as in the old publication of Guidelines 2000 for

Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, that had some meat to it, yet there were many of my respected colleague's that never even opened the first page...you get my point, I hope.

ps I don't WANT my General Practice MD to even have ACLS! nor do I want to do prostate examinations or fecal (digital) disimpaction.

cheers

Well:

Its is not very difficult to see the difference in a Professional vs a silly monkey in this thread....I need say no more? ooh but I will, It is quite interesting with the implimentation of new CPR standards that some improvement to ER door is up to 9 % in some areas ?

firefighter523, just polite suggestion, you SIR (a loosely applied term) are in the wrong place and your dedication and attitude is deplorable.

cheers

Well lets look on the positive side for "just a second", the link shows a picture of the Professionals that Rid and myself related to.

Matt Green and Matt Lewis, Tech Rescue Squad members and Virginia Tech students

http://www.philly.com/dailynews/local/2007..._the_shock.html

BLOOD WAS POURING out of her body from three gunshot wounds.Yet the female student was surprisingly calm and alert as paramedics worked to keep her alive."She knew what had happened to her, but her injuries were very serious," said Steve Shelor, captain of Long Shop-McCoy Rescue Squad. "She was probably calmer than I would have been in her situation." In a makeshift triage clinic outside Norris Hall, Shelor and dozens of other emergency medical workers on Monday had tended to the wounded as best they could. In some cases, no doubt, their doctoring meant the difference between life and death. The young woman, whom Shelor declined to identify, would make it. But there were moments when Shelor wasn't so sure. She had lost so much blood that paramedics feared she'd go into shock. They ran intravenous lines into both her arms. They pumped her body full of saline. As they gingerly lifted her into the back of the ambulance, she looked into Shelor's eyes and asked for comfort."She asked me to tell her a story," Shelor said. "That kind of worried me. That kind of made me think that she was going to go downhill kind of quick. It seemed like a weird thing to ask."Shelor said he wanted to fulfill her request, but there was too little time and too much to do. During the three-minute ride to the hospital, Shelor worked at a frenetic pace, checking her blood pressure, pulse and oxygen levels."I wish I could tell you that I told her some big, long tale, but time passes quickly," Shelor said. "I told her to hang in there. I told her she was going to be OK."Once at Montgomery County (Md.) Regional Hospital, the young woman was rushed into surgery. She is now recovering.

Like so many other EMS workers on the scene that day, Shelor said he tried not to think about the unspeakable carnage before him."Obviously you think about your own child when you are working on someone pretty close to their age," said Shelor, 52, the father of a 14-year-old son. Dozens of EMS workers gathered last night at St. Mary's Catholic Church in Blacksburg to comfort one another. The private assembly allowed EMS workers to reflect and grieve.None could remember an event so singularly tragic."There are some things you never forget," said Buford Belcher, captain of the Newport Volunteer Rescue Squad, one of a dozen squads called to Virginia Tech. "You learn to live with it and you learn to tolerate it, but you never forget. You never forget."Belcher, 63, who did not attend last night's gathering, said the campus shootings brought back memories of when he responded to the murders of two hikers on the Appalachian Trail in the 1980s. Other EMS workers recalled when 16 people were hurt in a 1996 balcony collapse at a Blacksburg apartment complex. And a 2001 natural-gas explosion in Radford City, 20 miles from Blacksburg, that killed three people. But Blacksburg is not a place associated with killings. In its 2005-2006 annual report, the Blacksburg Police Department reported zero murders for the third straight year.

Virginia Tech Rescue Squad members Matthew Lewis and Matthew Green, both 21, said they're typically called to respond to alcohol-related accidents and illnesses on campus. "It just didn't seem real," Lewis said. On Monday afternoon, Belcher and two other Newport volunteers waited inside Norris Hall with a stretcher as police officers brought bodies down from classrooms. Their ambulance served as a hearse. They transported two of the 33 dead, including shooter Cho Seung-Hui, to the medical examiner's office in Roanoke, Belcher said."You do the job you're trained to do," Belcher said. "Then after it's over with, you sit down and reflect on everything and that's when it starts to get to you. It gets to you - I reckon I have to say it that way." *

It is not very often we send out a note a of a job well done in our business. Although, I am sure there were many mistakes and errors during this MCI, as all MCI"s have, Yet, I have been very impressed by the representation of the Rescue/EMS as per interviews on national network television.

Like nearly everyone else I am not aware on how well the MCI was handled, but I have to say that I have watched two EMT's (Both first names are Matt. ?last names?) on several networks. It appears these gentleman did a smart thing and prepared a well thought out statement. I am very impressed with the way they have handled the press, they way they have spoke and in their personal & professional demeanor.

If their actions and treatment is any reflection of the way they described and handled a difficult situation such as national press, and interviews, I am sure they performed their jobs as well.

Again, my personal thoughts as many are with all of those involved in this horrible event, but was glad to see in this dark moment that our profession was well represented by these gentlemen, which is not always the given in such situations.

R/r 911

Yes Rid, I saw this too, a most excellent and intelligent commentary by Dedicated Professionals this makes me with very mixed feelings somehow PROUD....... in the face of absolute tragic event.

As I write this I am watching an Interview on CTV TV, the Media is "typically" is pounding the subject...in Virginia one can purchase a semi automatic or handgun without a background check, even without ID....that's just a little bit scary to me. One interviewer suggested that the Professors be armed....OMG! Stand away from that crack pipe! This is NOT even a viable suggestion!

This individual was know as a Loner, anti social, bizarre writings, stalking (known to the police) and death threats.....maybe we should pass legislation "For the Teachers" to report this pattern of behavior to the authorities and give the Police the POWER to actually do something. Oh yes, someone will scream a humans rights issue.. but a simple room search ? (if you have nothing to hide) is just not a problem for someone who is innocent.... just to my way of thinking.

But the good part of this "if there can be": is "The EMS Workers" were commended for their very Professional Response, describing that through training on "weekends" and "days off" they practice for MCIs and situations like this.

The (CTV) interviewed EMTs and Paramedics were called "prepared" and "well trained" "very professional" and they stated when the interviewer goes to the personal part (they always do?) that the EMS workers grieve AFTER the patients receive appropriatle Medical Care and are Safely in Hospital.

If one could find "a silver lining" perhaps these PROs have accomplished this....KUDOs to my southern brothers and sisters, they put themselves at risk once again.

ps they were "not" wearing body armour, as were the police.

cheers

So what exactly do you hope to accomplish by complaining to HIM? Do you think a bunch of angry emails are going to make him resign on his own accord? Doubtful. Also, looking into this further I see that I was mistaken and that Forrest is President of the Winnipeg Firefighter Association and that the joint Paramedic/Firefighter union has not formed. Meaning Forrest has no incentive nor power to have paramedics recognized in a memorial. Where is the EMS side of the Winnipeg Fire/Paramedic service in all of this? This may be something for them to bring up at the Manitoba Labour Board hearings beginning on April 26. Clearly some lobbying needs to be done on their part. I'll submit a letter to the editor to CBC and the Winnipeg Free Press, that will do a lot more good than engaging in a private battle with Mr. Forrest I think.

I believe you are missing the entire point here, going to the media will not accomplish the goal of convincing this individual to do the right thing, that of cooperation and respect for all emergency workers. Bring it to the attention of the media and it will become a public battle. Besides the point that its "not" the Labour Board, as they have been successful in there lobbing, this concept has achieved first reading in the Manitoba Legislature....it is in the initial quote.

Thanks for your opinion and assistance.

MEDIA NO, my letter of complaint and request for his immediate resignation was sent 1 days ago: Sent: Sunday, April 15, 2007 8:46 AM

[align=center:b54dc45442]pres867@aol.com [/align:b54dc45442]

This does not show up as a link, and it is the e-mail address for Mr. Forest ...... so send him your perspective.

Bethadone:

This is totally unacceptable and paramedics accross the country should be rallying to support our brothers and sisters in Winnipeg.

EXACTLY.

Thanks there Deano:

"Its not how these people died that we remember them, but how they lived."

I will not dispute this point, but is not the topic, really, the government is looking at passing a Bill in the legislature.

I could use more intelligent ammunition, so to speak. I have received correspondence in reply, unfortunately diversionary tactics and off topic information ...even a denial, that those were his words...oddly enough a reporter quoting someone out of context is liable....... in Canada.

His reply:

For one thing, that was the reporter who said that. The memorial is not a firefighter paramedic memorial it is a firefighter memorial. The paramedic profession will be honored in putting the paramedic profession with the workers memorial.

REALLY?

This only adds evidence to the fact that the initial comments were from himself, and feels that somehow (as you put it) Paramedics somehow should be lumped with with teachers and construction workers, cause if it wern't for janitors we would all be in ****!

cheers

Preamble:

Memorials to honour fallen police, firefighters, workers

CALGARY (CBC) - Manitoba's provincial government has introduced legislation that will result in the erection of memorials to peace officers, firefighters and other workers who die on the job.

The new act sets out the parameters for three non-profit foundations to raise money and erect monuments on or near the grounds of the legislative building in Winnipeg.

One monument will honour all workers who have lost their lives on the job.

"This is the first legislation of its type - giving the recognition that's due to workers that have died on the job - anywhere in this country," said Darlene Dziewit with the Manitoba Federation of Labour.

Insp. Dave Thorne of the Winnipeg Police Service said Friday a second monument to peace officers would include police, corrections and natural resources officers.

"For the memory of those who have lost their lives protecting society, and to their families who are left behind, this monument will be something tangible to remind them that their losses were not in vain," he said.

Alex Forrest, the president of the Winnipeg Firefighter Association, said the third memorial would mark the deaths of more than 70 firefighters who died in the line of duty.

But although it will be called the Winnipeg Fire-Paramedic Service, and paramedics share some of the same duties as firefighters, Forrest says paramedics would not be honoured on the firefighters' memorial.

"Why would the media assume that the paramedics would be with the firefighters?" he responded Friday to members of the media who inquired. "I think paramedics should be recognized. I am sure that there has to be some paramedics within the province of Manitoba who have died. But unfortunately if you look at the numbers, it only makes sense to put them with the rest of labour."

Firefighters and paramedics in Winnipeg have been involved for years in a bitter dispute over the amalgamation of the formerly separate services and sharing of some duties. The city wants the workers in the same union, a move that both groups have vowed to fight. Manitoba Labour Board hearings into the matter begin on April 26. The legislation creating the foundations has been given first reading. The foundations can begin raising money once it has been passed. There was no word on when the monuments would be erected.

mia.rabson@freepress.mb.ca

My letter of complaint:

To: pres867@aol.com

Sent: Sunday, April 15, 2007 8:46 AM

Subject: APPALLED by your recent commentary!

Sirs:

I am simply APPALLED by your recent commentary in CALGARY (CBC) News.

RE: Manitoba's provincial government has introduced legislation that will result in the erection of memorials to peace officers, firefighters and other workers who die on the job.

Quoting "Alex Forrest, the president of the Winnipeg Firefighter Association, said the third memorial would mark the deaths of more than 70 firefighters who died in the line of duty. But although it will be called the Winnipeg Fire-Paramedic Service, and paramedics share some of the same duties as firefighters, Forrest says paramedics would not be honoured on the firefighters' memorial.

"Why would the media assume that the paramedics would be with the firefighters?" he responded Friday to members of the media who inquired. "I think paramedics should be recognized. I am sure that there has to be some paramedics within the province of Manitoba who have died. But unfortunately if you look at the numbers, it only makes sense to put them with the rest of labour."

For your clarification and education I include the "Definition of a Labourer": a social class comprising those who do manual labour or work for wages; My personal view is that a firefighter job description clearly fit's into this category and far before a Paramedic (and just my personal "non public" opinion) please review the requirements and length of training programs for those that you believe you represent. If I were ever in your position I would NEVER voice my personal opinion in public to a poor attempt to bring disrespect to another group. As a Paramedic I am allowed by law to use devices and medications that are highly restricted, if I make a error this could result in an immediate death. I read 12 lead ECGs and give thrombolytic drugs exactly the same as an MD....and I am a "Labourer" by your contorted opinion, I am personally offended as well.

Your commentary reflects your ignorance of the facts, but is so inflammatory as to be obvious to myself and many members of the EMS community WORLD WIDE ( many who work BOTH sides Fire and EMS) that you should step down from your position in true disgrace. How do you believe that you could be a representative for those that voted for you to represent "ALL" workers? So please look at yourself in the mirror this morning and tell yourself that you are doing a good job to advance good working relationships within Combined Emergency services. You, I believe were voicing a personal very biased opinion that has absolutely no business in the public forum, again respectfully..... please step down, many other letters have been written to those that may have "intelligent input" as to your future.

Please feel free to respond:

Just a suggestion, perhaps your union will fund some sensitivity training or the education in the history of EMS in Canada is in order "before you speak" publicly again, well, unless it is a heartfelt apology.

FYI: EMS across Canada has lost sadly 17 dedicated members since 1995 in LODD.........cancers not included.

signed **** ******

aka squint

[align=center:d01c5125f9]pres867@aol.com[/align:d01c5125f9]

This is the public domain of the Figher Fighter Paramedic Union that Mr. Alex Forest represents and speaks for both groups "at this time" The sad part about this commentary by Mr. Forrest... if the Paramedics of Manitoba came out and belittled the Fire Services LODD the way he did.

We "EMS workers" ... it would be stuping to a level we have never done publically before and a road I hope we as professionals don't follow them down.

If anyone wishes to assist myself in an electronic letter writing campain to have this individual removed from his position....PLEASE FEEL FREE TO CONTACT THE ABOVE ADDRESS. This would be a good message in my humble view, my only request is that no "disrespect" be implimented, and please no "Toban's" respond, let the rest of us make a statement on your behalf, cheers and thanks all in advance.

"PLEASE STEP ASIDE and ALLOW A UNBIASED PROFESSIONAL TO SPEAK FOR ALL or PUT FORWARD A PROPOSAL THAT A MEMORIAL FOR "ALL EMERGENCY PROFESSIONALS" AS THIS WOULD BE MOST "POSITIVE" MOVE FOR SOLIDARITY FOR COMBINED SERVICES.....PLEASE DO THE RIGHT THING "

cheers and squinting

ambman142

Eloquent.

cheers

Ipratropium (Atrovent)

Rats a day late and a dollar short!

Yes in the COPDer the studies are very signifigant that FEV1/FVC improves without the side effects of B2....AZCEP is quite correct (like he needs my ego boosting... .)

There is a tremendous over usage of B2s ! and the profolactic use of Roids needs far more work in education.

Sure Doesn't leave the EMS practitioner many options when the patient has had 37 MDI treatments prior to arrival.

cheers

Good point, add to the fact that just how do we evaluate "better ventilation/oxygenation" could we be talking ABG machines in the rig as well? An EMS study is frought with issues absolutely agreed.

Why would you want an ABG? Waiting the requisite time for the equipment to give you a reading that should be accomplished by observing the patient is near negligent. Use your pulse oximetry/ECG/EtCO2/hands & eyes. Listen for changes in breath sounds. Feel for changes in skin condition. These are not difficult concepts.

Ok we are really getting off topic here, but I will answer your queries as best as I can: Many longer distance transport teams use them in Canada...why not in the back of a rig?

An ABG is positive factual data "not negligent" thats nonsense dude, are you saying that ABGs done in a Hospital setting are? Its still the "golden standard" and prior threads disputing bedside the use of Peak flows (by Rid) so just how do we quantify FEV1 in the ER ? Or are you just attempting to start a argument here.

EYES EARS and Listening are JUST clinical observations and highly subjective especially when doing studies, in fact when the introduction of pulse oximetry the observations (a blind study with experiance flight guys "in your very own US of A") noted that cyanosis was not "observed until SaO2 was noted at less than 77%............hence the serious "world wide" introduction of this now accepted new vital sign.

cheers

tniuqs wrote:

4- That said: the discovery that Salbutamol was effective for use in smooth muscle relaxation was FIRST noted in the investigation of "slowing of premature delivery". (the patient was also an ashmatic) ps Ventolin IV, in the gravida patient has not been used for years, and disproven to be effective for that condition, just to big of a "hammer" no pun intended.

So you are saying the use of IV Ventolin is ineffective for relaxing uterine smooth muscle? This proves what exactly? There are many beta agonists that do work for relaxing the gravid uterus that aren't especially helpful for other reasons. Terbutaline anyone? I suppose I just need what you are trying to say here clarified.

tniuqs wrote

Yea was poorly written, I am trying to explain the History in the use of Ventolin, it was good observation on the researches part to not just focus on the labour but all the systems affected..... any beta will affect "smooth muscle" its a physiological fact jack...lol. Berotec is another that has lost favour as well as Terbutaline, (yes, I know you southern guys still get it prescribed by GPs for Asthmatic cases)

The reason that this Ventolin IV or (even S/S neb trialed in one ancient study) this has lost favour with the NeoNatal crowd is there are more effective medications with less serous side effects for the kid in utreo....( will not get into those really not applicable on this board) Pemature Labour and NICU transport Teams are the WAY to go with these gerbils and uncooperative Mothers.

The placental barrier could be just "theoretical" we are very aware that narcotics are not affected by this suspected barrier.

6- The use of "early" use of nebulised steroids has far more promising with current studies...google it out, especially paeds.

The problem comes with the definition of early. Steroids help reduce morbidity/mortality in these patients, but they do not help to rescue the affected airways.

Are YOU positive ?.....My southern brother ?......So just how much change do you have in your pocket? I do take CC as well. :twisted:

Frankly we know that Roids work but the exact mechanism is still NOT explained other than the fact that Roids stabilize cell membranes....hey when in ICU, and nothing else is working ....LOADING with ROIDs is a very common practice.

Unless we are doing a randomized examination of the individual treatments, why would we not administer the first line treatment and progress to an adjunctive modality? Discussing one over the other as definitive is a bit problematic, but the end result of better ventilation/oxygenation is where our concern lies.

Good point, add to the fact that just how do we evaluate "better ventilation/oxygenation" could we be talking ABG machines in the rig as well? An EMS study is frought with issues absolutely agreed.

[hr:9a18f9b802]

akflightmedic Posted:

Squint, I have no studies, only personal experience.

The times I used it and it worked was during my Alaska days, you know what I am talking about...where I had a 2.5 hour MINIMUM flight by plane to get anywhere near definitive care. I had exhausted all resources and yes, plenty of time had gone by for the other meds to kick in if they were going to work, but they didnt. Once MS was given, there was immediate relief and turnaround. I think it should be considered more often and earlier in status asthmaticus.

OH I hear you man, when your down to there! I too have no problem in giving it a shot....have never said I haven't used myself, justification is what I need when I walk into the ICUs and get quizzed.

[hr:9a18f9b802]

Ok who mentioned CPAP or BIPAP.....now this is thinking outside the box a bit! Instead of using a "medical approach" and it fits on CHFer, COPDers, and Athmatics......now if we could just find a Ventilator, that was multi-roled, Invasive and non-Invasive... that didn't cost more than Hammers tuition fees for 2 years.

So just my 2 cents (and I know its off topic) but this would be where I would put all the cash "from all my winnings" !

ps, Oh yea that Gauntlet.... is more like a used Nitrile Glove.... :twisted:

Interesting points all:

I believe in the PHTLS they are refering to non visualized airways, I have observed a few "Gas Passers" do this.

But a moving target is going to reduce first attempt sucess, I suspect ?

I like the SLOPE acronym and first time I have heard of it.....must be an eastern coast thing?

LOL.

"ERDoc"

I agree with all of your points. However, aspiration pneumonia most commonly occurs in the RLL. The reason being is that the left mainstem has a sharper angle off the trachea than the right, so it is a more direct path to the RLL. This is also why most inhaled objects end up in the RLL. Then again, those north of the border may have a different anatomy.

Oh sure, pick on the dumb Kanukistanian challenged by snow, ice and trying to find a doorbell on those damn igloos! :oops: Yes in this case (from the commentary and reported ascultation) more likely a LLL aspiration, but your point well presented the Right Mainstem is far more a favourite route for "peas and carrots".

VentMedic enlightens us with the "chronic, bed-ridden" patient and most excellent comentary, yes, the BLS approach of suctioning with an Trumpet tube would (most likely) have been my first option as well, yet again, well stated the armchair quarter back is always correct post play!

BUT the thing in VentMedics World "rumoured" is that when he flushes the Toilet Bowl it circles the OTHER WAY ?....

I have no problems playing Monday morning quarterback for any call that someone has a question about, but, as tnuiqs stated, be honest with what you are thinking and hoping to accomplish. Say straight out, "I had this call and got a major attitude from the nurse. I think I'm right, but let me know what you think." Just be prepared to hear that you might be wrong. If you are looking for opinions on what happened and what the diagnosis is, you've come to the right place. If you are looking for someone to make you feel better and tell you that you were right when you might have been wrong, you have come to the wrong place.

This point is also well made ( I failed political sensitivity training 101) far more diplomatic, so in conclusion, patient presentation a systematic approach and the possibilitys that one can not be 100% correct all the time was attempted by Overactive Brain, so + 5 on the Dust devil scale as this was a great teaching post, it refreshed my under active brain as well!

Overactive Brain does post some great stuff and a very valued member on EMT city, hope I wasn't TOO harsh.

OveractiveBrain:

Talking to my partner who said a pulmonologist Doc told him that a paramedic in the field will be unable to differentiate a pneumonia from edema due to resonance and a generally untrained ear. While early pneumonia may be localized and audible in one field, the chances are slim. Now i think thats crap, because pneumonia should sound different, but its still something I consider.

This point: I must whole heartedly agree ! and it clearly demonstrates your willingness to learn and not accept a pre-concieved status quo notions.....I think its crap too.....perhaps "that" MD.... as specialists do thrive on this elitism idea. Perhaps this pulmonologist should get off his opinionated ass and do more teaching as well..... :twisted:

Gosh darn good thing WE have the very respected ERDoc and his daily (almost) comitment to this board.

ps Just in passing Overactive Brain...if the opportunity ever presents itself again, ask to review the CXRay this is a great learning experiance even though it can be most humbling at times, (I have been!) The difference between a Good medic and a Great one is never let bedside personality differences cloud your learning, my personal experiance has been that one recieves way more brownie points from ER staff when one is open minded.

cheers

Trust hammer to show up out of the blue, and forward an interesting controversy;

So a pleasant dream or nightmare?

Sorry DOC and the rest of you:

Mag sulfate is a trace element (elecrtolye as we know) it is used on spec. with those that may have nutritional or ETOH abuse PMHX in our CCUs. Poor nutrition has been linked with some of the population of asthmatic/ obese children.

Fact of the matter is one needs a whole heck of a lot of Mag. Sulf. to see loss of DEEP TENDON reflexes. Mag Sulfate was used for years to slow premature delivery, but we loaded 4 times the standard dosage that one presently carries on car these days, for torsades.

You know....... I can not believe that EMS and some ERs have jumped on this "BANDWAGON"... now..... for those evidence based medicine dudes and duddettes, I challenge you and throw down this gauntlet.

1- I bet $$$$ that for every anecdotal remark that Ventolin and Atrovent (concomitantly) is already on board as with "standard of care" in patient treatment and usually (MS) started within 15 minutes. So the question is: Just what are the peak effects/vs time with Ventolin.....hmmmmm....your going to tell me M. S. this is definitive conclustion to patient improvement?......please think again, cough, splutter, wheeze.

2-Your comparing 2 drug modalities at the very the same time and drawing the a concusion......NONSENSE! Your beating the horse with 2 whips, this so NOT science.

3- SHOW ME THE STUDIES! for every one you show me I will show you a study that disproves it, The first (study?) was a young asthmatic female that was weaned from a ventilator....this study is totally a shame and has absolutly no EMS application.

4- That said: the discovery that Salbutamol was effective for use in smooth muscle relaxation was FIRST noted in the investigation of "slowing of premature delivery". (the patient was also an ashmatic) ps Ventolin IV, in the gravida patient has not been used for years, and disproven to be effective for that condition, just to big of a "hammer" no pun intended. :shock:

5- For hammer...could it be that the uterus and smooth mucle (in the male airways) makes us more in touch with our female side ?...I digress.

6- The use of "early" use of nebulised steroids has far more promising with current studies...google it out, especially paeds.

Ok: For the research crowd in EMS...a very rare breed....put together a study to actually study this supposed phenomenon in EMS....but medical legal ethical questions will get in the way....this I put $$$ on too.

Off to soak my feet in Epsom Salts!

cheers

This is a PCR format that I use, not that its the best, I have lots to learn myself, but a logical case presentation should be followed:

C/F- Dispatch info Code's

O/A- scene/mech/RN/MD

Pmhx- SAMPLE bgl

C/C- PQRST& assco.c/o

CNS- APVU-A+O M+S function losses?

CVS- perfusion, pressures, central /perf.- Heart sounds.

ENT eyes edema reflex+consentual .neck

CVS B/P perf.pulse cap refill

PULM o/a, a/e , adventica

ABDO tender/non-masses/rebound

G/I G/U lbm / output urine bowel sounds.

DERM -temp. color' moisture, edema. petechiae

ORDERS M.D.

RX prior/ RX HX

Noted changes enroute.

CXR,ABDO,CT,LABs,U/S

TX V/S Urine output monitor,Sa02,ETCO2,ABG,12- lead

Totals ins/outs-drains

VENT-settings, IV rate/RX/totals # Bags I Vs & Type of fluids.

Papers,belongings,

INCIDENTs

Police #

Follow up findings.

Differential Diagnosis ?

Ok, now don't take this as a personal attack, just constructive criticism is all.

The case presentations I have seen lately on this board smacks of "did I do the right thing" and I believe attempts for others to empathize this its getting silly....Your asking for Diff Dx... when your not using a presentation that is logical. PERIOD.

I will quote your own words.....which scare me a bit frankly:

Right off the bat im thinking CHF.

Your jumping to conclusions.....not Physical examinations and findings. Listen to the PMHX (when you hear the HOOF BEATS think horses not Zebras!) What leads you to believe that Pulmonary Oedeama is present when the pathophysiology of this disease (and your knowledge base) needs some serious reading, Excacerbations with Neuro Muscular disorders and Aspiration Pneumonias are not only "common" but the factual "top of the Hit Parade" statistically.

but i went for more benign treatment since at this point she was awake and aware.

Seriously flawed thinking, Lasix is NOT benign! You may have complicated electrolye balance "Nutrition for the MS patient is always a concern" for what reason would you diurese a patient with your stated BP findings?

dropped her pressure from 132/p to 114/p,

while the lasix helped her,

AFTER the lasix, it sounded wet,

Am I just confused here or is your presentation?

Ok justify why you think this helped her? PLEASE.

she has no cardiac history other than HTN and she takes no diuertic nor rate control medication

132 systolic is NOT HTN.....@ 50 years of age! So why no Diastolic.....this is very important and palp is notoriously 10 mmhg lower than auscultated?

You have not included what meds this patient is on...BGL would be an idea too, perhaps a TEMPERATURE?

OXYGENATION

SpO2 98 on 15LPM NRB..

GREAT but what were SATs prior? Was there an O2 deficit, you state Laboured Breathing what was the rate?

(i imagine some medication that focuses on injured nerves of the face, deadening sensation and also the ability to speak)

If you don't know your assuming? What medications again?

she has no cardiac history other than HTN and she takes no diuertic nor rate control medication

LOC...? You state GCS of 15, with aphasia...very confusing.

LUNG SOUNDS

right side clear, left side still junky, all throughout.

Pulmonary Edema, and the ER nurse hinted that i was wrong for doing so. Talking to my partner who said a pulmonologist onc told him that a paramedic in the field will be unable to differentiate a pneumonia from edema due to resonance and a generally untrained ear. While early pneumonia may be localized and audible in one field, the chances are slim. Now i think thats crap, because pneumonia should sound different, but its still something I consider.

Lasix diuresed her well and cleared the right the side, but the LEFT side still had full-on fluid sounds.

HUH?

The most common aspiration problems are (LLL) when supine or the infirm patient.

She sleeps laying down, one or two pillows, and its not because of diff breathing, its because of pain in her neck

You would think, if a person were in pulmonary edema, there would be a problem that led to it. For example, ventricular failure, rate for filling time, an infarct, a hx of, something.

I would! But you have no positive findings......sooo:

Im just going to assume I was right in what I did.

Ok, that was long, but heres the question:

Was it CHF or pneumonia?

ED Nurse says "Aspiration Pneumonia" no doubt.

and the ER nurse hinted that i was wrong for doing so.

AGREED TOTALLY...... based on this presentation you should LISTEN TO THE RN she/he is telling you something here.

[align=center:e47ff87a50]Oh I am SO happy for you AK!

I had no idea that one could legally marry a Camel.

But your Elk is going to be so so Sad![/align:e47ff87a50]

So I will volunteer to assist the Elk to deal with the rejection.....cheers.

I say Sux and a large dose of Niacin to cause the hot flash. paralyze them, breath for them but make em feel the flash.

Rats: just re read this, I do like the way you think....

but off topic a touch sorry, no tube hmmm and thats Murder not theft, gottcha. :twisted:

cheers

ps Its not the RNs that steal my Pens....its the DOCS! :shock:

I'd love to comment on this, but I'd just get too pissed off and spend too much of my valuable R&R ranting about it. Plus 10 to Wild-atheart for recognising the shortcomings of this programme and for aspiring to greater heights.

Agreed +10

Holy crapola, how the heck did they get away with an entire cath lab. Didn't someone notice or was it done in one night?

If it happened over a period of time then serves em right for not putting a camera or something in the lab to catch those creeps. I say Sux and a large dose of Niacin to cause the hot flash. paralyze them, breath for them but make em feel the flash.

Oh yea an over night job, they put in a cam after but all they caught was an MD and an RN....er... being very "frendly" after hours, but that is another story...ever see the Sharon Stone thing in the parking lot with Micheal Douglas....opps outside voice again.

cheers

Funny thing you ask! I leave the sheets at the hospital..... eeeewww! And if it ain't bolted to the ground and has a sticker on it is..... MINE!

[align=center:1fce6c2060]"HONEST SQUINTS SLIGHTLY USED HOSPITAL EQUIPMENT"

Looking for franchise distributers.

Well I have to retire some day don't I?[/align:1fce6c2060]

j/k

Seriously in a past facility where I worked some one "and most likely an inside job" ripped off a complete Cardiac Cath Lab...including monitors, computers +++, If I would have caught them it would have been rounds of SUX for all ....and no ETT. I hate thieves, just imagine if your Mother had been waiting for 3 months to get her pipes checked?

cheers

I do have one scrub shirt... and it is older than most of the members on EMT city.

I think a large part of being a good provider is being able to meet the total needs of the patient. Sometimes the often forgotten spiritual need is as great as the medical need.

Absolutely + 5 for this comment.

Simple Respect.....for your patients needs ..... whatever their beliefs not yours.

Muslum, Buddist, Shinto, Judaism, United, Baptist, Petacostal,(sp), Catholic, Navaho or Cree.

Riddle me this:

What religion does not believe in a higher power?

BUT Quoting Dust:

As for what is appropriate, I would concur that it is probably only appropriate when asked directly by the patient, without prompting. However, if it is your nature to pray for your patient, then it is appropriate to do so silently, without making a Broadway production out of it. Religion is between you and Allah.

You do not have to speak aloud to be heard.[/

cheers

wow what an incredible post. I've always thought that by doing what you said, keeping someone from smoking or everything else you said that I was doing something right but never thought about it in terms of a Save.

That's food for thought and also great thinking outside the box.

Vent, if you are interested in writing pm me and I'll talk to you about a proposition.

Oh yea, pick Vent guy....3 minutes late and one time zone away plus my 'hunt and peck' tecknique.

I don't a proposal to get run naked and drunk through the field of dreams...... foiled again!

Its that Canadian thing isnt it...LOL... Ruffems.

cheers

Well interesting comments by all, but I have a bit of a different perspective, can you call a save doing monkey skills as in CPR, shoot a tube, bang a line in, push a preloaded drug according to a cook book ? Can not any Paramedic can do these things what is it that makes a Save to me means much more, perhaps a bit harsher view than most on this board.

So I submit this perspective for your review;

Preemptive treatment with a patient that ultimately WILL arrest, Yes the that BiPap (asthmatic or COPDer) applied and coached cheating that tube and vent, the Lasix for that Pulmonary Oedema, that RSI in the 13 y/o head injured patient that siezes and posture's on take off (and discharged to go back and play hockey the next season) and on to all your specific calls not just the V-Fib patient or CPR on arrival.

Vent Medic and I share a different point of view...yes the Vent farms, I bet my bottom dollar that because one single RT that decided that "This" one patient would NOT be allowed to give up and 5 months later decannulates that Trach...was it the Paramedic that saved that patient...maybe partly. We forget all of the others that make a huge difference to those potential patient's and their discharge to door, sometimes this proffession gets a very narrow view, we are just part of the team NOT the whole Team.

These as are many other situations could be considered saves (if there really is such a thing in the first place) I am of the opinion that the choices that were made at that critical time because it was Me that made that choice, to run with it or stay and make that difference. Now, my experiance in the "early days" was single Paramedic, single Pilot and NOT short distances and even sometimes with 2 patients, one trying to deliver and one with a real funky rhythm, these were the times (with no other support) that I made a postive diffence to an outcome...or the proverbial save. After all there really is no hard and fast line in the sand.....really is there?

cheers just my 2 cents CND.