tniuqs

"chbare"I think you took my comment out of context. Hitting somebody with a 3rd gen cephalosporin is shotgunning. Broad spectrum activity. I did not disagree with ABO coverage in the presence of delayed evac. In fact, I had to cover patients with ABO therapy because of a similar situation when I was deployed following Katrina.

Sorry but "good old shotgun approach" sounded demeaning, no offence taken or intended.

Yes: I do see your point but this IS common practice in the OR or ER, I don't have C+S capabilities or gram staining where I am and no incubator, besides the fact I have no background in bugs to even know what I was even looking at!

I know it could be hit and miss but something should be done or at least attemped to promote remote Paramedical Practice.

If you have an opinion on what would be the best broad spectrum you should know that my major demographic group of "possible patients" is aboriginal north americans, with many penicillin and sulfa "allergies" I am totally open to suggestions.

The receiving surgeon was the one that ripped me a new orifice..... nothing like getting between a GP and a Surgeon... I felt like monkey in the middle!

Does your service have aggressive wound management guidelines for such situations?

Sorry no and not certain what you mean, a surgical scrub with betadine on board a chopper?

Not trying to be a smart ass... I am all ears though, your input is really appreciated.

cheers

AZCEP

Benzodiazepines are extremely safe for use. In the ventilated patient, it is near impossible to have any toxic effects from them. Switching to Ativan seems reasonable, but once you have given 20 mg of a BZD, the flavor really becomes immaterial.

LMAO @ flavour!

Ok;

1- Takes one hell of a lot of benzos to actually kill you, and attempting to reverse a mixed OD with Fluazamils could be a fatal error (just in passing).

Need some more info here...V/S would be a good start.

Reversed the Opiates....Did LOC change?

Then tubed? Then Chemical Paralysis... to keep the tube in? with no narcs to cover...it my be premature, but it sounds like this MD is just a meany.

Vecs normal loading dosage is 0.08 to 0.1 mgs per kg ideal body wt.

Maint is 0.01 to 0.015 mgs per kg ideal..

Whats the pt's wieght er ideal body mass, a more poltically correct term!

cheers

ps any ETCO2 or ABGS when intubated, or was a Ventilator not used, any Bicarb hung?

That is quite the unique situation.

I am having a major conflict with my Topside Medical Director, frankly I wish to choke him slowly.

Senario:

Remote postings with transport times in excess of 3 hours with workers in VERY remote areas and access by helo only, with crappy comunications a wait time for me to reach them could be in excess of an additional hour, and if weather craps out or nightfall times could be even more excessive, like overnight.........!

BTW my MD is a GP......argh!

So any penetrating injuries to abdomen, compound fractures, or animal bites (ie Grizzly Bears and Cougars) should these patients NOT recieve broad spectrum bug juice? My pick would be ROCEPHIN (CEFTRIAXONE) 1gm IV.

Comments SVP ?

cheers

PS SnowFlight.....where is your Flag ? Show the colors Man!

I thought so.....good god not another Kanukistanian !

Greetings and Salutations.

ERDOC, Asys or Rid you have anything to add?

Ok and squint is chopped liver! snif snif....

Propofol = Mothers Milk!

Isn't it time to introduce this into EMS, ie Facilitated Intubation as opposed to RSI, (perhaps with an ephedrine chaser) it certianly simplifies the process.

I have some real concerns with the RSI sequence.....it really should be called SSI, "Slow Sequence of Intubation" just pull up Lydo, or Etomidate, Fentanyl, Versed, Succs, and then Pav. or Vec. or Trac......tell me again this is "RAPID" hmmm?

cheers

PS SnowFlight.....where is your Flag ? Show the colors Man!

I suppose you believe in the tooth fairy too?

Are you trying to say there's no tooth fairy......??????

DAMN! :shock:

Whatever:

So the question still remains what is the "BEST" way to deliver warmed fluids to your patient, instead of shocking them? or getting ice cubes forming in the lines and infusing abnoxiously cold fluids... remembering "DO NO HARM"!

Well.... this is what I came up with....why in fact heat the IV bags at all?

The heat loss "from the bag to the patient is my biggest headache" .....in -25 C and a lovely breeze out of the north west! I just can't do this in my present deployment, as not many helos have a microwave as an option, let alone a proper IV hook.

I digress.

So I use an approved "disposable heat pack" (lots of different types on the market that have been approved as to not burn when applied directly to skin) test them so you get a consistent heat range, just drip the fluid onto a thermometer to see what temp. your delivering at the patient site. I coil the "extra long med set line" in an "S" shape, then tape it securely in the heat pack using 2 like a sanwich and closer to the patient the better, about 6 inches was found to be acceptable for temps in the 36 to 41 C range (I use the real cheap carbon/oxygen activated ones the hand/foot warmers as they last up to 8 hours) about a buck and a half too, thats the scottish heritage speaking there! :wink:

Any other thoughts on this or other suggestions I am all ears.

cheers

Late entry: we have played around with the "heaters" for MREs as well, the water activated type for the IV bags themselves....be very, very careful with is method as they get damn hot really fast, we melted a 1000 cc bag cause we got talking, it is quick and dirty trick when you miles/kms from a warm enviroment....but don't look away for more than 1 minute, this method of heating IV bags is great if you are using then "JUST" as heat packs to groin or axuilla areas, but wrap them and pad them in towels PLEASE! before applying. Your Mileage may vary, and I am not suggesting any use this untill you get it approved by your medical director, mine volunteered to be the gueani pig, and was nice and toasty in the SKED.

oops another cheers.

:shock:

Just so happens that this one is right up my alley er igloo..... sorry, it is so long but was compiling a Hypothermia Guidelines for backcountry treatment and this may help out, for whatever its worth, and there is that word "NEVER" again :oops:

Classic IV warming is not an efficient strategy of rewarming per say It is merely a good strategy in preventing/stabilizing hypothermia

Emerg Med (Fremantle). 2001 Jun;13(2):181-5.

Reliability of modern microwave ovens to safely heat intravenous fluids for resuscitation.

Delaney A. Emergency Department, Gosford Hospital, New South Wales, Australia.

OBJECTIVE: To determine if intravenous fluid heated in modern microwave ovens is warmed to a consistently safe temperature, as has been advocated in a number of texts and journals.

METHODS: Five, 1L bags of normal saline in Viaflex (Baxter Healthcare, Old Toongabie, NSW, Australia) containers were heated for 2 min on high setting in 16 different microwave ovens. The output power ranged from 650 to 1,000 W. All microwave ovens were equipped with electronic timers and turntables. Initial and final temperatures were recorded with a TestoTerm 1100 electronic thermometer (Dade Behring, Lane Cove, NSW, Australia), accessing the centre of the fluid via the injection port. The average and standard deviation for each measurement was determined for each microwave oven.

RESULTS: In nine out of the 16 microwaves (56%) tested, the fluid had reached an average final temperature greater than 42 degrees C and thus was greater than the recommended maximum temperature for the heating of intravenous fluids. All microwave ovens with an output power of greater than 900 W overheated the fluids. However 13/16 microwaves (81%) had a temperature range less than 3 degrees C, thus if correctly calibrated could be appropriate for heating intravenous fluid for resuscitation.

CONCLUSIONS: The increased output power of modern microwave ovens can lead to overheating of resuscitation fluids, if the simple algorithm currently recommended is followed, leading to potentially serious complications. Microwave heating of intravenous fluid could be a safe, simple, cheap and effective means of heating intravenous fluids for resuscitation, but care needs to be taken to calibrate individual machines to ensure a safe temperature is reached.

[hr:9d2083d79b]

Acad Emerg Med. 2000 Oct;7(10):1169.

Shaken. Not stirred-temperature change and heat loss during delivery of IV fluids

Fields E, Hsu C.

Beth Israel Medical Center, New York, NY.

Microwave-heated intravenous fluids are used in the rewarming of hypothermic patients.

OBJECTIVES: To study the effect of both shaking of the microwaved bag and heat loss during delivery.

METHODS: Twenty 1-liter normal saline bags were heated individually in a commercial microwave, immediately randomized into a "shaken" or a "non-shaken" group. The temperature of the fluid was recorded initially out of the bag and then at one minute intervals by a blinded observer as the fluid ran "wideopen" through ambient temperature tubing.

RESULTS: No statistically significant temperature difference occurred in any of the measured time intervals between the shaken and the non-shaken bags. Seventy percent of the overall temperature losses occurred in the first three minutes out of the microwave for both groups.

CONCLUSIONS: Absence of shaking of the microwaved fluids does not produce "hot spots." Higher initial temperatures out of the bag should be considered as well as warming of the IV tubing.

[hr:9d2083d79b]

Ann Emerg Med. 1985 Sep;14(9):876-9.

Microwave warming of resuscitation fluids.

Leaman PL, Martyak GG.

Hypothermia is a common complication in fluid resuscitation of the hypovolemic patient. Warm intravenous (IV) fluids have been shown to be a valuable adjunct in volume replacement to prevent this complication. A rapid method of warming IV fluids is the microwave oven. Heating time for liter bags of crystalloid to 39 C was determined to be two minutes at high power, 600 W. Fresh frozen plasma was thawed with five 30-second exposures to microwave radiation. Microwave warming of packed red blood cells (PRBC), 4 C to 37 C, resulted in a 17-fold increase in plasma hemoglobin over that of water bath controls, (P greater than .01). Heating on a warm cycle to room temperature, 21 C, caused an average 26% increase in plasma hemoglobin. Therefore, we do not advocate microwave warming of PRBC because of the possible danger of local overheating, which causes hemolysis. We warm PRBC secondarily by diluting with microwave-warmed, calcium-free crystalloid.

[hr:9d2083d79b]

Am J Emerg Med. 1985 Jul;3(4):316-9.

Microwave heating of intravenous fluids.

Anshus JS, Endahl GL, Mottley JL.

Microwave heating of intravenous (IV) fluids is a viable alternative to heating by conventional means, such as by blood warmer(s) or an on-site warming oven, for administration to hypothermic patients and trauma victims. Three 1-l bags each of lactated Ringer's solution, normal saline solution, 1/2 normal saline solution, and 5% dextrose in water were packaged in parenteral containers and heated in a microwave oven from room temperature (21 degrees C) to 40-42 degrees C in 3 minutes. Little difference between temperatures of the four solutions was detected at each of five intervals up to two hours after heating for 3 minutes. Samples were taken before and after heating to assess any potential alterations in sodium, potassium, chloride, calcium, glucose, and lactate levels; differences were within the range of variation of the methods used. Though the plasticizer in the polyvinyl chloride containers is stable to microwave heating, data on other components is incomplete.

[hr:9d2083d79b]

J Emerg Med. 1985;3(6):435-42.

Preventing hypothermia in trauma patients by microwave warming of i.v. fluids.

Aldrete JA.

Warming plastic bags containing intravenous solutions in a microwave oven (MWO) raised the temperature from 18 degrees C to an average of 34.1 degrees, 40.2 degrees, and 42.8 degrees C when treated for 120, 150, and 160 seconds, respectively. Fluids at 18 degrees C, when passed through a blood warmer, resulted in temperatures at the distal end (DE) of about 27 degrees C; but if the bags were priorly warmed to 42 degrees C, fluids arrived at the DE at a temperature of about 30 degrees C. Fluids heated by MWO to 42 degrees C through a single short tubing 180 cm long arrived at the DE at a temperature of 33.7 degrees C. Fluids administered at operating room ambient temperature of 18 degrees C arrived to the DE with a temperature of about 19 degrees C, thus most likely contributing to lowering the body temperature of traumatized patients treated with large volumes given at rapid flows. One group of 19 patients undergoing repair of injuries to extremities received infusions warmed by MWO to 42 degrees, while other groups received them at about 20 degrees. After an initial fall, average temperature in the former tended toward normal levels while in the latter, body temperature declined. The simple expedience of MWO warming of the bags to 42 degrees C, and flowing through shorter administration tubing, appears to ameliorate this complication and in some cases prevents it.

[hr:9d2083d79b]

Am Surg. 1984 Dec;50(12):656-9.

Microwave ovens. A safe new method of warming crystalloids.

Werwath DL, Schwab CW, Scholten JR, Robinett W.

The multiple trauma patient often presents hypothermic. The infusion of warmed parenteral fluids is one of the least invasive methods of core rewarming the hypothermic patient. This study discusses and describes a safe, efficient method of warming normal saline and lactated Ringer's solution by microwave radiation. A 650-watt microwave oven was used to warm single liters of nondextrose containing crystalloid from room temperature (70 F) to 101 F. Total heating time required was 120 seconds. The technique involved midcycle (60 seconds) interruption with agitation and end-cycle agitation. Intra- and extrabag temperatures were confirmed with three separate thermometers. It was concluded that by following the recommended protocol, hospital personnel could be taught this safe method of rapidly warming nondextrose containing crystalloid.

[hr:9d2083d79b]

Anaesthesia. 2000 Mar;55(3):251-4.

An assessment of the thermal safety of microwave warming of crystalloid fluids.

Lindhoff GA, MacG Palmer JH.

Department of Anaesthesia, Dumfries and Galloway Royal Infirmary, UK.

We performed an in vitro study to determine the thermal safety of a domestic microwave to warm intravenous crystalloid solutions. Five-hundred-millilitre bags of crystalloid, randomly allocated to groups which differed in power setting, timer setting and whether or not agitation was performed after warming, were heated in a microwave oven to a calculated temperature of 39 degrees C. Timer accuracy was checked by stopwatch. Bag temperature was measured using an infrared tympanic temperature probe and fluid temperature was measured with an in-line thermocouple. Mean times measured by stopwatch were higher than set. No in-line temperatures reached 40 degrees C. Wider overall ranges and a higher mean were found with the tympanic probe compared with in-line temperature measurement. There were significant differences between the in-line temperatures of shaken and unshaken bags at each power setting, but not when groups were added together. There was no change in colour or odour of bags or fluid. One bag developed a pinhole leak when the packaging was removed.

[hr:9d2083d79b]

Perit Dial Int. 1994;14(2):163-7.

Control of microwave heating of peritoneal dialysis solutions.

Deutschendorf AF, Wenk RE, Lustgarten J, Mason P.

OBJECTIVE: To determine if microwave heating of dialysis solutions to 37 degrees C produced focal overheating (hot spots) and caramelization of dextrose.

DESIGN: In vitro determination of conditions for controlling time, temperature, and procedures. Bags had been stored at ambient room temperature.

MAIN OUTCOME MEASURES: Solution and external bag surface temperature determinations. Dextrose degradation products

determined spectrophotometrically. Microscopy for potential caramel precipitates.

RESULTS: A microwave oven with no rotation tray produced uneven heating of bags of two commercially available concentrations of dialysis solutions. The greatest hot spots were evident in spike ports. External bag surface temperatures were within 0.20 degrees C of reservoir temperatures. Initial solution temperatures correlated with temperatures of the solutions after microwave heating (r = 0.895). No statistically significant differences were found between dextrose degradation product concentrations of unheated and heated solutions, including hot spots. No precipitates were observed microscopically.

CONCLUSIONS: Despite the presence of solution hot spots in bag infusion ports, 37 degrees C temperatures were achievable in the bag reservoirs with no evidence of increased glucose degradation. This outcome is assured if the initial temperature and the microwave conditions (procedure, time, mixing of solution) are held constant, and the external bag temperatures are measured after heating.

[hr:9d2083d79b]

J Trauma. 2000 Jun;48(6):1052-6; discussion 1056-7.

Hyperthermic resuscitation is safe and effective after hemorrhagic shock in dogs.

Wiley D, Sheaff C, Nagy K, Reiman H Jr, Leslie C, Barrett

J.

Department of Surgery, Mt. Sinai Hospital, Chicago,

Illinois, USA.

OBJECTIVE: To show that resuscitation from hypothermic, hemorrhagic shock using 65 degrees C intravenous fluid results in a more rapid return to euthermia compared with 40 degrees C intravenous fluid, without significant endothelial or hemolytic injury.

DESIGN: Fourteen anesthetized beagles (10-12 kg) were cooled to a core temperature of 30 degrees C and hemorrhaged to a mean arterial pressure of 40 to 45 mm Hg for 30 minutes. The animals were randomized to receive either 65 degrees C or 40 degrees C intravenous fluid through a specially designed catheter at a rate of 80% of their blood volume per hour until euthermic (37 degrees C) or for 2 hours.

MATERIALS AND METHODS: Blood pressure, pulmonary artery pressure, heart rate, and core temperature were continuously monitored. Blood samples were collected at baseline, after hemorrhage, 2 hours of resuscitation, and at postmortem examination after 7 days of survival. Laboratory measurements included complete blood count, plasma-free hemoglobin, and osmotic fragility. Values were compared using the Student's paired or unpaired t test with p approximately 0.05 indicating significance. Postmortem examination included light microscopy of the proximal superior vena cava or right atrium.

RESULTS: Animals receiving 65 degrees C intravenous fluid warmed 3.6 degrees C/hour, significantly faster than the 40 degrees C animals (1.9 degrees C/hour). There were no significant differences in plasma-free hemoglobin or osmotic fragility. Endothelial injuries were found in two animals in each group. These defects occurred along the path of catheter insertion and not at the infusion site.

CONCLUSIONS: Central intravenous fluid at 65 degrees C is a more rapid means of treating hypothermia than standard 40 degrees C intravenous fluid. It is safe even in hypovolemic animals.

[hr:9d2083d79b]

J Emerg Nurs. 1991 Apr;17(2):68-9.

Comment on: . J Emerg Nurs. 1989 Sep-Oct;15(5):416-20.

Questions about hypothermia: speed of rewarming and use of microwave ovens to rewarm i.v. fluids.

Berman WL.

Ann Emerg Med. 1986 Feb;15(2):228-30.

Warming nondextrose crystalloid in a microwave oven.

Werwath DL, Schwab CW, Scholten JR, Robinett W.

[hr:9d2083d79b]

Aust Nurs J. 2001 Oct;9(4):35.

I.V. fluids and microwaves oven safety.

[No authors listed]

[hr:9d2083d79b]

Surg Gynecol Obstet. 1985 May;160(5):400-2.

Rapid warming of infusion solution.

Yamada Y, Yasoshima A.

A useful method was developed to warm solutions rapidly used for infusion and peritoneal irrigation, frozen plasma and blood for transfusion. It takes only two minutes to warm 1 liter of saline solution from a room temperature (24.5 degrees C.) to a body temperature (37.0 degrees C.) with the 600 w electronic range. The time necessary to warm a solution to any temperature can be simply determined. With an infrared sensor, the time setting is not necessary.

A large volume of a solution can be rapidly warmed. The time necessary to warm any solution can be shortened with higher wattage. Whole blood did not suffer any change from the rapid warming. A living fish was also not damaged by the electronic range, which directly vibrates and heats water molecules with high frequency electromagnetic waves. With the present method, troublesome warming procedures which have been done in many hospitals, even at midnight, are not necessary anymore.

[hr:9d2083d79b]

Migration testing of plastics and microwave-active materials for high-temperature food-use applications.

Castle L, Jickells SM, Gilbert J, Harrison N.

Ministry of Agriculture, Fisheries and Food, Norwich, UK.

Temperatures have been measured using a fluoro-optic probe at the food/container or food/packaging interfaces as appropriate, for a range of foods heated in either a microwave or a conventional oven. Reheating ready-prepared foods packaged in plastics pouches, trays or dishes in the microwave oven, according to the manufacturers' instructions, resulted in temperatures in the range 61-121 degrees C. Microwave-active materials (susceptors) in contact with ready-prepared foods frequently reached local spot temperatures above 200 degrees C. For foods cooked in a microwave oven according to published recipes, temperatures from 91 degrees C to 200 degrees C were recorded, whilst similar temperatures (92-194 degrees C) were attained in a conventional oven, but over longer periods of time. These measurements form the basis for examining compliance with specific and overall migration limits for plastics materials. The testing conditions proposed depend on the intended use of the plastic for microwave oven use for aqueous foods, for all lidding materials, and for reheating of foods, testing would only be required with aqueous simulants for 1 h at 100 degrees C; for unspecified microwave oven use, testing with olive oil would be required for 30 min at 150 degrees C; and for unspecified use in a conventional oven testing with olive oil would be required for 2 h at 175 degrees C. For microwave-active materials, it is proposed that testing is carried out in the microwave oven using a novel semi-solid simulant comprising olive oil and water absorbed onto an inert support of diatomaceous earth. The testing in this instance is carried out with the simulant instead of food in a package and heating in the microwave oven at 600 W for 4 min for every 100 g of simulant employed. There is an option in every case to test for migration using real foods rather than simulants if it can be demonstrated that results using simulants are unrepresentative of those for foods. The proposed testing conditions were validated as being realistic by measurement of the specific migration of

various components from different plastics into foods under actual conditions of use and comparing with migration into

simulants. Migration of plasticizers from PVC and VC/VDC copolymer films was monitored for both microwave reheating and cooking of foods. Total oligomer concentrations were measured from poly(ethylene terephthalate) (PET) trays, and volatile aromatics from thermoset polyester trays, using both types of container in microwave and conventional

ovens.

(ABSTRACT TRUNCATED AT 400 WORDS)

You get half price at Dairy Queen?

Lucky you! :shock:

Just put a stupid post so that I can follow this thread is all I believe that We your friends to the North have VERY similar issues.

Dustdevil:

There is only one thing more maddening than being unable to solve a problem. That is being able to solve it, but not being allowed to. Being on my eighth month in Iraq, I can tell you that most of the insurgents and terrorists fighting here are fighting for much less justification than we have to improve our profession. And I am rapidly coming to believe that the obstructionists in EMS should meet the same demise as those terrorists.

Very Unfortunately Apathy appears to be the problem here so guys and gals support the troops in there respective battles.

http://www.emtcity.com/phpBB2/viewtopic.php?p=100759#100759

cheers

Growing up in Vermont, where we actually had legitimate snowfall, I can say on your car splurge and buy studded snow tires. My recommendation is if they are compatible, buy Nokian Hakkapelitta snow tires. http://www.nokiantyres.com

All seasons are for the guy in -20 below weather stuck in the snow bank.

Positively, hands down Nokian are the way to go!

I use them on my Truck and one Industrial Operator I work for in Oilpatch has put them on all their trucks.

ps All season radials are not Snow Rated either, this does make a huge difference in the go part, but improved Braking distance is by far more important to me.

Would it be possible to get back on topic at this juncture?

Apologies all for my boring rant, but I do not think that this "hijacking" of this thread should be continued as professionals.

I was hoping that insight "on topic" would be provided by OZmedic this topic is dear to himself as in other Forums his research is stellar, damn it I just can't find it in my searches.

cheers

zippyRN:

and this can't be achieved without creating another Health Profession?

The creation of the RRT discipline stemmed from an identifiable need here in Canada as it did in the US, the bottom line was that there was a lack of the so called RN specialist in "inhalation therapy" attempting to teach pulmonary mechanics and applications, ad hoc at bedside this was neither not cost effective nor a productive means of delivering appropriate care at that time. Seriously RRTs are now entrenched have been around longer than the caps and gowns "lost" era in the UK and oddly enough the history of Inhalation Therapy originated from ex Korean British RNs. (I am under the impression that they wished to be an independent group as they were frustrated with the dogmatic dominance of the RN umbrella)

Contrary to the picture painted by some on US -centric boards the NHS is very much into optimising the use of it's beds, firstly to keep an eye on costs and secondly to reduce the average stay to sensible minima ( i.e. having people in the lowest safe acuity of bed )

I find this statement rather odd, the cost delivery and reduce the average stay portion? I don't believe you have actually researched the data (could this be why UK MDs are looking across the pond?) as in fact the cost effectiveness of the RRT in the ICU in regards to average stay on a Ventilated patient or any factual studies or sensible minima that you refer to is without real proof it is an based on what again? Conjecture?

Also in passing are the studies that Ventmedic so astutely refers these are beyong highly suggestive and do compare the senior RRT's to the Junior RRT's (we challenge all aspects) their experience in prioritizing and to continue with weaning of Chronic patients when the unit gets busy, a proven cost saving to boot, daily statistic are mandatory in my old department and prove conclusively the statistically value this "new field" of expertise as you would call it. On the other hand RNs have failed to apply this statistical proof of worth, I look into my crystal ball and suspect that this will bite them in the ass not far down the road.

Fortunately here in the colonies, patient care comes first and then a cost effective delivery is the philosophy, we RRT (s) are streamlined in administrative positions as well as RRTs act more independently, the ratio of Administrator to Bedside provider is vastly superior in that regard but then again my experience is only in the frozen northern part of america, I can't speak for my southern allies.

Ventmedic:

Relatively new professions such as EMT/Paramedic and Respiratory Therapy have made their impressive mark in the health care realm. They are still evolving and will continue to grow.

I would certianly hope so, by putting these cross trained members on the front lines of health care may be very refreshing and insightful for the mulitdisipline care perspective dare I say a holistic approach as well, besides the fact that one seat is used in that rig, or onboard that aircraft, a very cost effective to my way of thinking.

I too can start IVs, hang meds, and manage just about any technology in the ICU. But, I prefer a team approach and am willing to work with anyone who can help improve the outcome of the pt. That is what healthcare is supposed to be about. Egos need to be checked outside of the health care environment. Too much wasted energy on how to get one up on the other.

Yea yea, tis very unfortunate that "Paramedics" in a Hospital setting hired as an RT under a "different set of rules" separated only by a piece of glass in a window, we are not allowed in my "hood" to practice to full scope of Paramedicine inside the hospital property this is limited by what philosopy, frankly and I seriously doubt that any "medics" on this site would disagree, as my candid observations have been that RNs are somehow threatened by any other recognized well organized entity. My opinion would be that the dominate Nursing profession is very Territorial like a big dog in fact protecting its turf and growling at any passersby. Could it be that Old School Nursing Practices cannot progress with the times, gosh I hope not!

The question has to be asked - why create another professional role instead of addressing the preparation for practice of others ?

Perhaps administrators are very concerned with the grip that the RN profession has with Unions and Associations and the like that are in areas that seriously impact health care but are NOT cost effective nor best for the system at all. ps I don't know how your System is operated in the UK, but I suspect that just one dominate Union and one may find this is NOT a superior way to manage the System nor the best way to represent ALL the health care workers.

It quite often seems the US way is to create a new role rather than address the preparation for practice of other roles and each role likes to carve out it's niche of exclusivity and require others to be registered in that professional group as well if they dare to cross the line in the sand. UK health professional development is much more about common standards for skills regardless of who undertakes them and there is little exclusivity or ring fencing of roles

ring fencing

Could you please explain this term, I really do not understand this slang, while you are at it, please and thank you in advance explain the the term "POM" that the OZ use to identify the Brits is a bit of a mystery as well, if you would be so kind.

Further, please look at my flag I am so not an American no offence intended: So just how will one accomplish this "meaning acute care medicine" in the future, a 6 year degree level program for Nursing? This would impact negatively on the numbers of registered RNs and fail to provide adequate numbers of the much needed Generalist Health Care Providers for the public at large. Here in Canada and looking down the road the demographic breakdown in regards to the average age of the bedside RN is around 48 years old, so how will your system "with the aging population" be able to provide for this eventuality? Just my opinion again but frankly I would rather work beside a Diploma level RN (with experience) than a degree level RN, they seam to have portions of their anatomy like there "heads" in areas of Exit only.

Quoting Zippy:

Identifiable need for what? another person to bill for?

Well an excellent point in "fact" RRTs are paid just slightly less than their RN counterparts here, so bill for a few cents less and your argument becomes...... well just simply hopeless accomplishing the "required work" for a lowered cost with a specialist trained in that area.

Quoting Zippy:

I'm not quite sure what you mean here ,

Sorry that comment does not make sense to me now as well, I guess it boiled down this :

squint:Tis a pity that the UK has not followed this and dogmatically sticks to it's traditions for traditions sake alone.

Quoting Zippy:

The competencies are more important than the collection of certificates and badges - the UK has a open scope of practice for all health Professional groups where expansion and extension of role in the most part is not reliant on gaining a further registerable qualification, and standardso f practice are profession and settign independent

Have you looked at your offshore programs for the north sea or remote practice in the UK? Frankly and not intending to sound flippant but please look at all the badges, certs, and collections mandated by your boards your pointing the finger the wrong way.

In closing I was taught in school by a Proper British Eductor, so I hope you don't mind that I capitalized your comments, perhaps your having technical difficulty with the SHIFT key I suspect.

cheers and ps: I call myself a Paramedic FIRST, btw.

no , we manage quite well without a further dilution of patient care to yet another 'single function professional' , also don't forget the UK is very much anti ringfencing roles at present , and most descriptions i have seen of the RT role are tasks undertaken by nursing staff and/or physios in the uk context

Yes I see, we have tried the "generalist approach" to medicine here in the colonies as well but as modern medicine progresses and advancement in the area of pulmonary medicine there has been an identifiable need. Factually many others, such as as OT and combined lab/diagnostic imagery as well. It has become abundantly clear that these discipline (s) are quite essential, tis a pity that the UK has not followed this and dogmatically sticks to it's traditions for traditions sake alone or an anti ring fencing philosophy. I dare to say that job descriptions vary widely from in function to the application of degree level programs specializing in these areas. Physio and RNs here are not permitted in most cases to touch any thing other than the 100% key or silence key unless inadvertent alarms sound on "state of the art ventilators" in fact we as RRTs have generally gained the respect of the vast majority of RNs in the ICU and ER settings, unfortunately there are some old hold outs.

The idea of "cross training" individuals is rapidly gaining popularity here as given a chance it usually enriches both "lateral professions" Hence we do have regulations against the "standard RN" in the back of Ambulances as well as they must actively gain the EMT status, unless they are specialists in transport teams.

RRTs also do a very admiral job in the home care settings as well, quite independent of Nursing, why would an RN be in care of an individual dependant on a Home Ventilator? or the trached BPD patient or the COPD patient this simply baffles me.

Query:

Do nursing sisters still wear the traditional Cap and white smock over there?

ZippyRN:

Are you sill using Venturi Masks in the UK?

Are there no RRTs in the UK?

Have you seen this new device?

I personally cannot endorse this product I have not seen enough research as of yet.

http://www.oxyarm.com/ourProducts_oxypubs.shtml

http://www.oxyarm.com/ourProducts_oxymask.shtml

I suspect if Ventmedic, basemedic or OZmedic see this post they may have some interesting input as well?

cheers

Ventmedic:

I SOO hear you!

I got sick myself was on BIPAP for 3 days in 94 in my own IC, P02sa of 48, on 10 of PEEP, and Fio2 of 1.0 for 36 hours.

NOT fun times, a mycoplasma pneumonia (maybe?) so I wonder where I picked that up....fishing?

I couldn't work for 2 months. Let me tell you that just trying to get even short term disability was a freaken nightmare, no compensation at all, the MDs said it was pointless even applying for Workmans Comp. So many times the RTs are the forgotten as the very "Hi risk exposed" health providers (s) SARs was another example too.

But, I think you forgot one situation....CT Scan. NO mr. RT, the radiation is low level.....like 3 times a shift?

Ok then, why are you (mr/ms Xray) dude standing behind leaded glass, 4 inches forking thick!

I always asked where is my Lead Hat? but the Xray folks thought I was joking...sheesh. In case you ask it took 3 years to get a transport Vent in ER, and most RTs (at that time) said it was not worth the time in set up, TILL one died of a Brain Tumor!

sorry off topic Dean, but please heed Ventmedics cautions ALL, RTs are NOT just Oxygen boys.

cheers

scratrat:

Amiodarone (long term usage) can lead to PF complications, the PFTs that Ventmedic is refering are called DLCO (diffusion limited carbon monoxide testing) always wondered how good that test was for the patient?

TALC Lung a completly different story, IV drug abusers with bad "cuts" from those concerned "dealers" that use talcum (sp) powder is used and with devistating results, as the lungs are an excellent "filters" The CXRays are "signature" as they look like a freakin snowstorm. I doubt in this 90 year old patient that this was tangible possibility.......that said.... I have come to the conclusion that one should "expect the unexpected".

cheers

What's his logic for this? Low flow O2 works just as well? Got anything else? details?

http://www.emtcity.com/phpBB2/viewtopic.ph...p;highlight=chf

Note Oz medics comments, a interesting thread to be sure, lots of controversy in the research phsiology as of late there is other threads an MD researcher posted in EMT City about CHF and poor outcomes with Hi and lower levels of O2 administration, but this was very small study group to my way of thinking frankly (soory cant find the link) as my connection sucks right now.....or..... I am just lazy too, you pick lol.

If you go to the "CHEST Magazine" website you may find more info in this regard as well.

If I ever reached end stage with a breathing disorder; high flow nasal cannula (Vapotherm) so I can have my martini with some vodka on the side to nebulize if pulmonary edema happens and nebulized morphine with matching IV doses.

cheers

Hey thats my line...damn RTs anyways....

Late entry, we are seeing a new population of PF ers rearing its ugly head lately, I did not see mentioned in this discuss "TALC LUNG" another mixed disorder, I doubt your patient would fall into this etiology but for just for completeness. The long term use of amiodarone is often over looked an excellent inclusion Ventmedic for those gathering good med history (s)

CHEERS

:roll: thats about all i have to say about that

Ok Forrest, what kind of Chocolate did you get? :shock:

Yes must agree with everthing Ventmedic stated, my preference would be BIPAP over CPAP as CPAP can increase Work of Breathing, but watch the BP to be sure.

In most cases in PF these are mixed restrictive and obstuctive disorder's so bronchcdilation may not be a bad idea.

In some cases severe Dyspnea can be relieved with nebulized morphine, and if this patient is end stage I can't see why this would not be another option as well.

cheers

I am still working thirty years later. Don't sweat it.

******** You mean 50 don't you Dust?**********

:twisted: :twisted: :twisted: :twisted:

thbarnes :

Dump these turkeys like a hot potato, they are NOT worthy of your dedication and it sounds to me that they just used you anyway, good thing that you did not have an "incident" of some sort or another, as I bet my bottom dollar they would not have backed you at all......so you are actually quite lucky I would say, so spread your wings.

cheers

Who are you and what did you do with somedic?!?

I've been watching your last several post (actually I see them all, it's just the last several that caught my attention)...they have been kind, insightful, insult free, and not a single hint that a person should simply kill themselves if they are not in the military...I'm becoming a little worried about you...

Agreed DwayneEMTB !

Very seriously and back on topic an EMT that can't lift, your OFF my truck in a heart beat.

You are danger to yourself and other workers, or just like that 90 lbs RN that wrote her Paramedics exam with 94%.... nice.

Quote: if I can't lift I will just call the handsome Fire Fighters to help me.

Nice talking with you, find another partner NOT me.

EMT or EMT-P = Eds Moving and Transportation...period no exceptions.....think dispatcher.

NEVER EVER------Hmmm ? The old "Never" comment.

Granted there has been recent changes "perspective wise" in some research that indicate that Oxygen therapy may be more detrimental that previously thought, Hi flow O2 therapy can be controversial to say the least: absorbtion atelectasis, toxicity to type 2 cells, and some outcome studies are suggestive that hi levels of O2 are detrimental in CHF......(a very small study) or higer incidents of post op complications of Pneumonia with low levels of O2 in the recovery room.

He wants the paramedics and emts to show him with medical documentation, that why high flow O2 is needed.

I personally applaud this "attitude" it does make one think does it not? BUT perhaps ask this astute MD if one was to withhold Hi flow O2, is he willing to put his licence on the line in a court of law that uses " accepted standards of care" as guidelines ? I think he maybe is just challenging you to use that thing called a brain, conversely my query to your system MD would you put your his suggested Protocol on paper... thanks.

Let us remember in the "old days" we gave BiCarb to a non-perfusing heart, we gave Hi dosage Epi, we hyperventilated head injuries, we used 10 to 15 mls/kg for tidal volumes, we did some crazy stuff that we now know was most likely not to the benefit of the patients...... time and research will tell.