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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.

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

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

******** 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

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. 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. 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.

YOU said inches.....te he he!

Well said.

I like the term "Gut Wagon" its so charming. Dispatch: Unit 666 respond to the trailer park. See the man with bubbles, trouble unkown. That is all.

DVD in a leg, man you guys have everything down there, we just got color TV last year..... :roll: j/k. Hey ERDoc, can you pass me a syringe, I need to loose this Foley....bad..... :twisted: just woke up in that kind of mood, sorry tmi? cheers

Well, don't I look the turnip! An EMS Stud, a Rapper, Texan and a Fisherman. DCMed124: (I think you left out that he drives a beat up Toyota Truck too, hey, he can't be all bad) cheers and salutations. :twisted:

Its an LED..... and dont you just love those new hi- teck toys? :oops:

Sorry to get in way too late on this thread... Inspiratory wheeze = possible Intrathorasic Airway Obstuction. PFT and Chest XRay is the way to go for definitive Dx. cheers

Would that be your Bus? :shock:

Well mute point now, as somehow an avatar has popped up, is that significant for some reason a Star of Peace for EMS I am hoping ? I digress. Perhaps we should get back on topic before "the Dean" (thats an inside joke) violate's us for going "off topic". ER Doc has some very good questions. Oops, as I type I hear incoming mail, thanks Doc. cheers Late Entry: If we EMS personnel are part of the problem then how can we tangibly effect change ? Just a suggestion, perhaps a review with Topside Medical Directors reevaluating current criteria of the use of rotary? Query: I suspect a difficult question to answer, when the bird flies does the ground EMS operator reimbursed at the same level? Perhaps the funding "formula" could be reevaluated as well, I know in my "hood" that if the bird flies then a different goverment agency pays and as result of that the Ground service(s) usually billing a private insurance in most cases, this loss of valuable and funding essential in maintaining the ALS operations at a rural level, this has caused much controversy as one might expect. Granted the Vast majority of the medevacs in my country are accomplished by Fixed a completely different ball of wax er vegetable, thoughts from a turnip.

It sounds as if your contradicting yourself a touch? but agreed some good intel, thanks. I have never seen a study comparing the 2 methods in the acute asthmatics and in the EMS setting it is unlikely you would find a compresser onboard many rigs. In fact check local protocols as there has benn a case where compressed air was used instead of O2 resulting in a court actions. ok yea can't say "pet peeve" here! cheers

Hey just trying to help out a Noobie is all :shock: Maybe this Bryan fellow could stop by D. Barns place and get a REAL Avatar. Why do I sense incoming ? :twisted:

Yes a bit off topic but I think some valuable information... and don't PM the DEAN aka ASY or we are all going to get the strap... I think IV "salbutamol" is out of scope of practice for most here, we did have it in some services here but wthout a pump your shooting CRAPS, the one round dose lost favour cause Pts get a wooge, drop pressures and get really pale in color! "ROIDS" yuppers early vs late, they work on everything...but I was no them in 1994...no wonder I am still LOOPY, sucks to come off big time, ACS. Quoting VentMedic: I am way too lazy for that. Good point ! cheers

Firstly welcome to the City VentMedic. Yes, have seen the AeroEclipes unfortunatly those in "Extremus" have some may difficuly in triggering and the mouthpiece delivery is not the "most optimal" in my opinion for those patients in an EMS setting, as the patient has to make a seal. What I have used is a device made @ Bedside with 2 extention tubes inserted into the holes of the normal SVN mask, (STAR WARS) is what we called it also increases FiO2 (in theory and proven @ bedside) by increasing the reservoir size of the mask ~ 100 mls per breath, I have mentioned this in prior posts, there has got to be a better mousetrap out there ? For delivery with MDI the areochamber is mandatory, (again bedside testing) that I have been involved indicated that with MDI only just ~ 20% of patients were actually recieving a dose, no radioactive isotopes were used in testing as with initial trials this just clinical observation by experianced practioners. My question was when the primary findings for MDI the efficacy, deposition and isotope tracing (by Galaxo, if memory serves me correctly for the MDI) was that the SVN delivery method in the studies never did "clearly identify" whether mask, mouthpiece or other means was used. In ancient times a "T" or "Y' was placed on the O2 line downstream from the SVN and pt.s were instructed to use this thumb control to optimize delivery (only during inspiration) old idea but cost effective. cheers ps j/k there akroeze, more Mars for me.

:shock: "Shootouts" :shock: Only if the Ozzies loose North.

Hey man not trying to say you did not putting words in your mouth at all, just friendly exchange of ideas is all. I just find that this option "is still an option" with many services as per local protocol (s) is all and risk vs benefit, should be weighed cautiously. cheers ps But I am still pissed that akroeze had peanuts taken out of my Mars Bars! :twisted:

Well learn something every day! thanks AZCEP. I guess Glacoma should be mentioned in passing for completeness, and Fluids for increased insensitive water losses. cheers

Firstly edited for your reading enjoyment, please google on. 1EMT-P: This use of EPI really concerns me, if one had a Cardiac PMHX (with or without Beta Blockers) then add EPI to an already stressed heart your asking for trouble, this has lost favour in Kanukistan for the most case with Respirologists. OzMedic mate: Ok I have my camera ready smile :shock: Kevkie: You said "Albuterol" LMFAO......... are you ok man? Your right about Mag Sulfate, the studies are anywhere but conclusive, but, just on spec if ones PMHX of poor diet or alcholism go for it, as there has really been no lifethreatning side affects have been reported, that I have come across. I can't really understand why EMS has jumped on that Bandwagon. Note: Current "trends" may indicate that inhaled steroids are acting faster than previously thought, and early implimentation of BIPAP is gaining popularity...ps this is where I would put my money, and why can't anyone make an improved Nebulizer one that increases the Volume of "Salbutamol or Atrovent" inhaled per breath? is is believed that only 10 to 15% is actually delivered to the terminole bronchus. as for the term bronchospasm....this is not plural ! :roll: Agreed.......EMT = Ed's Moving and Transport. Rid: Can we get these guys a s/s ETCO2, it can't hurt, I don't know if it will make any difference to outcome but maybe some education in the use of this diagnostic tool. akroeze: Peanut propellant? in MDI I don't think so, hell they stopped putting Peanuts in MARS bars thanks to you! But go with the neb till you find out for sure and touch my Snikers bar and there will be a WAR east vs west! :shock: EMSBrian: Last but not least......did that Lecturer ever have a patient with breast ROT, I think NOT, use your PPE. :twisted:

Good: Just as an outsider here but I have some experience in your system (got in late to Katrina) was frankly blown away that a single pilot, single medic team (don't get me going on that either) night operations to boot, in a BK 105 would dare to land at a stadium for a suspected spinal at a high school football game...good grief batman. My thoughts where " when he hits the wire how many injuries would I have to deal with now? It certianly took a long time for these fact to gain any attention, I have stacks of info on accident rates. It appears that FINALLY a evidence based view has been utilized, not a potential profit margin. IFR why the delay on implementation of this factor as if weather has not been in a vast majority of cases, duh? Pushing the envelope is not good, and now proven in spades. What about Mission informed vs Non-mission informed pilots as well a good start. Nothing get's the fly boys blood boiling like going like a sick kid vs well you fill in the blank. Physical Separation of Pt. vs Pilots and birds that could accommodate are vastly more expensive, I suspect the smaller can I say fly by night operations may not survive this implementation of this strategic "criteria". There is one thing that studies do suggest and that is Skill vs Speed the Flight medics / RNs / RRTs are better educated, allowed more latitude in scope of practice my god take one tenth of the aviation costs and funding and relocate those monies into an improved education system. Oops say this way to late, apologies svp, I do like the way you think, but further: Frankly speaking the myth of the "Golden Hour of Trauma" needs to dashed to bloody bits in my opinion, this as been the impetus for far too many flight operations in the US. Who is to blame? -1 for not us as opposed to we Doctors I know this is you first post and all.... Yes and No, who is to say what the end diagnosis may be, a due diligence factor must be weighted and good ER Doc (s) are a very valuable asset, I wonder sometimes how many have been lost to frivolus lawsuits looking for a scapegoat? That would be a rhetorical statement I suspect, ever here about Sildenafil and determining signs of death? I digress. YES :The EMS Adrenalin Syndrome. Cold load vs Hot this could be a idea for new criteria. I know that could blow the on-scene times out of the water but safe is safe period. ROTOR BREAKS may be another idea. COST: Here is a suggestion, maybe on the TLC Channel they should include this proviso: NO the Patient Died, and He didn't have insurance, so his Wife and Kids lost their house and now are living in a CAR! Ashamed not really, without statistics how can one prove any argument, just a damn shame we have lost so many good people. Doczilla's always right :wink: Bryan Who? Not bad for a first post, have you ever thought of publishing some of this information, you may be on to something here. cheers from a turnip.