tniuqs

Its really good to see you drop in Kevkie .. just wish it was under better circumstances .. yes I do remember very clearly and Rob laughed at the ass whooping I received .

Count me in.

FYI I gave Chopper Copper the intel on EMTcity and link and Happi maybe this thread will be printed out for Rob's Mum and Family is my hope, but if you wish to add more ..just cant see an issue in slightest. I unfortunately may not get there (depends on final sent dates) as I have a Education seminar planned, re: Health & Wellness Clinic “expanded scope” of practise training. I know Rob would understand if I am absent physically, I will be there in spirit (s) Hoo Hoo Hoo and a bottle of Rhum.

I received this note after a phone call as a follow up, it is self explanatory ...

Hey Asy PM me .. I have a way better place to ski than Peru better bars too as AK can attest and did you get registry in AB yet ? This Winter is going to be really busy and am looking for a few good men / women. cheers

Yeah LS but in a Samuel Jackson voice my 'verse' is way cooler <grin>

hmm a thread that should be discussed again ?

AK I am so embarrassed by my fellow countryman's past comment so if you would be so kind to allow me ...... Dear a noob Canadian Paramedic DOOGs firstly a welcome, I believe "we" have perhaps met from CPW ? This very out of character for you and stepping into an area of honour after just 4 posts on this site, to the my band of my brothers is serious folly at this juncture. I have held my brother Rob in my arms, as, I was one of the privileged few that knew from initial dx what the final outcome would be, the memories of those few days and end of life discussions are mine and Robs alone. Never to be discussed, except that I am most proud that Rob chose the path he did .. he climbed a Mount Everest every day. I too as the many others am seriously fucked up / messed up by this announcement, its been many, many years waiting for Bledsoe's dreaded notification. I know that my brother AK too was aware, but HE deals with lifes challenges in his "own way" as he is his own man and I am honoured to call HIM my friend. BUT I am soooo displeased with your post, Doog, yet a thank you as my deep sorrow has changed to serious teeth clenching anger, so thank your <insert your great spirit> that I am not anywhere close to you this minute as my Scottish heritage coping mechanism's are not any where near as refined as AKflightmedic. I am most pleased to bring to you one of my most favourite biblical quote's so you may pick up what I am laying down, well, that is if you are a religious man. Ezekiel 25:17 (eh). (somewhat amended) The path of the righteous man is beset on all sides by the inequities of the selfish and the tyranny of evil men. Blessed is he who, in the name of charity and good will, shepherds the weak minded through the valley of the darkness. For he is truly his brother's keeper (or in this case, the village idiots helper) and the finder of lost children. And I will strike down upon thee with great vengeance and furious anger those who attempt to poison, disrespect and dis my brothers opinions out of unadulterated ignorance .... And you will know I am the Squinter when I lay my vengeance upon YOU! cheers

As per Lone Stars request http://paramedictv.ems1.com/Media/603-The-Future-of-EMS-as-a-Profession/

My most sincere thank you to Dr. Bryan Bledsoe, yes Brian as we age we are subject to more and more eulogy's they are getting far to frequent as we discussed in your pool that day but stir the shyte ? isn't that somewhat to a pot calling the kettle black ? Although a bit of a negative connotation but both Rob and Blesoe force us to look at ourselves in the mirror professionally and ask the truly hard questions and ask "just where are we going ?" as without shadow of Rob was dedicated to advancement . I am at a most serious loss for any intelligent words right now, except that I feel like I lost my brother today. Most Honestly this news has has farked me up (a dust devilism). I felt so highly of Rob, I respected him for his passion and his commitment to the future of our Profession, in todays day and age this is rarely equalled. Rob's his support behind the scenes of his friends was true blue, I am indebted to Rob for helping me with some personal monsters, nuff said. Rob would tell us its time to support those that lost. SoI called his family to send my sinserest condolences, damn it was hard to choke those words out of my throat I will admit it took me a couple of tries .. now, Robs wishes were not to have a funeral but as you know from AKs start of a tribute / photo montage that Rob he enjoyed setting up rendezvous' perhaps we should do this in his honour. Robs step father is answering Robs phone right now and is astounded / astounded at the calls from all over the world that are coming in, and when, I gather some composure I will network with Robs family I will advance on this thread. So RUFF keep a part of that bottle full. I asked that Robs Step Father to please give Robs Mother a great big heartfelt hug from all of us on EMT City so that she knows that even though we are on the inter net, Robs extended family could hold her tightly ... and with no shame she could give us some comfort as well. Rob you are gone from this dimension but you will NEVER BE FORGOTTEN.

Ok I did like the Dengue fever idea, WHO is indicating an increase in incidents with world travellers ... but a bit more common would marine stingy things like Iracongi, Box Jelly Fish and Portuguese Man O War ?

What a great start ... NOT ! I wonder how @ 17 y/o the criminal fraud charges will be dealt with .. our PC laws here for Juvies suck, he would most likely get a slap on the wrist never be put in the crowbar hotel AND because he is a minor, media would not be allowed to name him in the papers .. which IMHO is total bull shit.

Yup the CRASH2 study .... I believe a link was provided earlier and a you tube of Dr. Ian Roberts for that. Hey zilla .. what ever happened to Hypertonic Saline in TBI ? ... I know that one study was stopped in the poly trauma due to efficacy "not proven". I will say I was a bit sceptical from the onset as after doing ABGs and STAT lytes (up the ying yang) and sodium going it critical ranges with large doses of N/S alone and pitiful coags (making kool-aid but at least it didn't clot in the abg syringe, dark humour there.) so question is are there any other positive findings coming out of the sandbox in that reguard ? My reason for asking is my next deployment is kinda remote (no blood) and any advice appreciated. https://secure.muhealth.org/~ed/students/articles/JAMA_291_p1350.pdf

And his excuse in court is "I played a P.A. on TV once" ?

www.rcsw.org/.../Presentation%202005%20Aero%20WashState05.ppt Slide #15 ... Rubilar L, et al. Pediatr Pulmonol 200;29:264-269 ED based, 123 patients presenting with moderate-severe wheezing Most < 12 months age NEB - .25mg/kg salbutamol Q13 min x 3 MDI+VHC- 2 puffs salbutamol Q10 min x 5 Successful clinical response After 60 mins: 91% MDI , 71 % NEB After 120 mins: 100% MDI, 94% NEB cheers edit for smiley

Yup the CRASH2 study .... I believe a link was provided earlier and a you tube of Dr. Ian Roberts for ......

http://www.jppt.org/archive/v8n1/JPPTv8n1ms7.pdf Seeing as this thread is morphing into treating asthma, can you explain the actions of mag sulfate, especially in the paediatric population. I will bet after chbare's query, that someone is madly using Google to explain (exactly how oxygen shut's down the respiratory drive in acute, severe respiratory distress) I have always wondered why EMS has jumped onto this mag sulfate band wagon with such vigour, as in most ER (that I have worked) we rarely used mag sulfate. Studies and because of the multiple pharmacological interventions of beta agonist and anticholinergics plus mag sulf, its very difficult to make any real conclusions, although I have heard from a few paramedics that swear that suddenly, after 15 minutes post administration of the triple treatment their patient rapidly improved ? My following question is what is peak efficacy of beta agonist ... then that deer in the headlights stare. That said; It could be that that the risks are so low as a trace element at the 40 mg/kg suggested dosage and very little documented negative effects, then again this could be yet another EMS myth soon to be busted by Bledsoe ? Do I use it in the field ..sure why not as it (mag sulf) is so benign but really is it making any difference in outcome's or admission rates ? I say nope. What's odd in my guidelines in EMS that CPAP is not advised (in the field) yet in ER its used very frequently, more than curious really. I can say that when committing an asthmatic to life support (ventilator) or even a flow diverter and spring valve PEEP gauge on a BVM when titrating PEEP up, use a stethoscope as well as watching all other 'notable' parameters like BP, SpO2, ETCO2, ABGs if you have them as one will at (qualifier) some point will note a decrease in bronchospam. best look to your protocols if so driven/ restricted. Still waiting to hear about how humidity (estimated @ 2% increase in relative humidity from the typical wash bottle) which is highly prone to leaks (decreasing accuracy of delivery of O2) and then the infection rate with tap water (far more common than most would believe) may complicate ? Which leads to another question in anyone's service, do any have an IDC guideline for noting when the "fluid" is changed ? As I reflect on what I just wrote (off the top of balding head).. I believe if in the OP scenario and I was in a court room to defend my actions and why I "allowed a bystander" to share an MDI to a patient. I feel quite confident that I would be able to justify my actions under our "reasonable man" basis of law ... just saying your mileage may differ but I could NEVER stand back, deny or turn away any beta agonist volunteered to treat a child in distress, ps besides Pirate Hunters are known to be renegades. cheers

OMG I have just realized ..... I AM A LESBIAN ! Thanks AK

http://www.rchemerg.com/EMS/Protocols/BCAS-Adult-Treatment-Protocols http://www.rchemerg.com/EMS/Protocols/BCAS-Pediatric-Treatment-Protocols The exam is wrote memory work .. chronological order and sequence is important to BCAS . Got a query .. if you are registered / licensed in any jurisdiction in Canada as an ACP, you should have only have had only need to write the jurisprudence exam. Way fewer regulations and acts to study than in Alberta .. good luck.

Good advice .. but so very sad to hear of this, no words that will help, except that we love you Kaisu for your heart, your spirit and what you teach us.

Is that the Penn of Penn & Teller ?

Hear in Kanukistan (AB) we have a deal called the Health Professions Emergency Aid Act, as long as there is no negligence and one provides care within the defined scope (even if a death occurred) this legislation covers us as we have no Good Samaritian Act that pertains to Professional Health Care Providers, if after a fatalities inquiry and then proceeds to hearing we are judged by our peer group NOT the general public at large. Thank You. If a "tort" lawsuit were to ensue, (damages) if one was not charged for gross negligence then that court would not stand a snowballs chance of any "conviction" we are defined by our registration NOT the job we are being paid to do. On the other hand if we "withheld" treatment one could be charged. In an known Asthmatic and not permitting the use of someone's else's MDI ... well that would not be me I will sleep well at night knowing it was the RIGHT thing to do. The different countries laws aside .. I will do what is best for my patient FIRST then deal with the possible repercussions, that said to make changes towards independent practice one may have to break a few old eggheads. I would suggest you review the nebuliser vs MDI with spacer controversy as far as efficacy in delivery, although my personal view differs than the studies done by Galaxo based on decades of care, perhaps a topic for discussion at a later date. I can tell you that this is a daily occurrence for admission to the ER and if folks actually took more responsibilities for their personal care .. well Health Care Costs would go down, although sometimes it falls onto ones pocketbook and not being able to afford their own ... ps I have a few spare MDI I carry just in case of this event its happened to me a couple of times).. its just the way I roll. cheers Hey Kiwi ... grow a pair ... LMAO !

That is what my ex always claimed as well.

Whew what a relief ... Yes a post I made was eaten by the server gods during admin's change over, (a couple in other forums too) although I did look for thunderstorms in my area.

In closing has anyone anywhere ever been convicted or legal precedent set of <gasp> allowing a bystander to volunteer medication in this situation .. ps stop living in fear of litigation, do the right thing.