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Hey great site. Thanks for the link!

Agreed: In addition on a ventilated patient with an acceptable blood pressure and dependant on Patho one "can" make changes to numerous ventilator settings and improve ventilation and oxygenation. Got any studies there would love to see any "sharks fin" research. So just what is "Normal" for a "COPDer" an Asthmatic or a healthy patient? Can you explain how and why this may alter treatment, specfically what treatment, If you would be so kind. Bit confused here, are you saying a good assessment is not possible without ETCO2, I don't think that is what your implying but please correct me (not trying to put words in your mouth) Has anyone heard or read of" Volumetric ETC02 monitoring" in present applications for EMS, it maybe the future of ETCO2 ? This tread could turn ito a great teaching post if given half chance. cheers

Hey in real life I am a Turnip! To answer this threads query: When onboard aircraft...if I knew I could get free drinks I would... er .... will in future, thanks for that advice all. But then if "I was impaired" I would be forced "ethically" to stand back and watch the fictious Air Marshall or some medic earn his wages. I am beginning to wonder just whom would be the "poser" in here.... obviously not "akroeze" even though he does look like an escape from "HULL" ? Personally getting "put out" by some that would profess to be professional, slamming those with nothing but honorable intentions and despite the fact that proctologists, RN, and EMTs would be of any value in an onboard medical emergency ... sheesh, lord give me strength, and admin give me latitude, to speak my mind, please. cheers and squinting.

I commend you, I just wish that the time that I spent in ICU that more MDs would have made that very difficult choice, I bet It was not easy. Agreed: Never in the back "of a rig" with seat belt on in the front well unless your on board aircraft. Now that gets Me concerned as I have a unwritten rule "No family escorts allowed to fly" :shock: Yes, totally. My opinion too, just brought the topic up for clearity, understanding this has made me more "comfortable" Did I say comfortable? OMG! cheers

Thats because you used the Correct Password! Shnaps!

Really..... Man o Man I just have to get out more!

LOOK NORTH. Try contacting Canadian the consulate, then pick a major service then contact it. Try Ontario or Alberta or god forbid Nova Scotia...lol. :twisted: ps bring shnaps!

ERDOC: I seldom disagree with anything you state, I find I must disagree here just a touch: There was a study undertaken "somewhere" the risk to proceed with a lawsuit or any other actions in the case of a sudden death was markedly diminished to "nodda" when the family was present at an arrest. The Family (in the field) is not asked to leave the room, in fact I leave that desicion up to them now in fact, they observe all the procedures and efforts and this confirms to them that everything humanly possible WAS done to help their loved one, I frankly found this to be a shock. This was explained to me by a most excellent R.N. a George Gow (a female) who put my mind at ease and did change my perspective for transporting critical patients with escorts...... "never the less" I thank god, for not being employed in the state of NY! lol. Oddly enough in my career I have received 2 thank you letters from family's that have had a family member pass on while in my care (one on board aircraft on final "an end stage cardiomyopathy") and (one dissecting AAA that I got to the table but later died) in both cases families had observed first hand what exactly what was involved and understood completely and later both wrote me letters of thanks ........ much to my amazement. [hr:eeb3db5e61] On to dgmedic: The tread and question posed IS: Would YOU do this procedure given the senario presented? Your sounding a bit like a politician ..... "directed v/s asked" this is semantics', dude. Cute big boys? wtf, I do agree with the majority of your statements but we are big boys and big girls, some a "bit cuter" than others granted. But we DO practice medicine, period. What do you call it last aid? please forgive me but a bit off topic. Just what is your definition of not practicing medicine: 1- we make surgical incisions, (some suture skin, lines and tubes.) 2- we do invasive procedures. 3- we give drugs IV that could kill instead of (I hate the word save) 4- we prescribe and deliver drugs (in the majority of instances without direct medical contact) 5- use enough electricity to start a small jet. . ill witted ER docs?.... huh? ......I haven't met too many of those in my career! If I were to put myself in ERDocs shoes or any in fact, I would be VERY concerned about the capabilities, observations and competency of that field medic too....! Must take a lot of balls to make that type of call, my hair would be white in one week. Just whom IS (again the word) "comfortable" sticking a COOKs needle or any thing else handy and long enough, so close to a heart anyway? and btw I would suggest you stop the gut wagon if you are going to do ANY procedure similar, hit a bump in the road...ee gads man thats an excuse as opposed to a possible complication from an invasive procedure, but I think you were trying to make a joke...I would hope. cheers "Edited and minus 2 for rambling off topic"

HELL YES! I love my job thank you and I don't do this job to feel politically "comfortable" and so many folks hide behind this excuse. In a new york heartbeat I would follow this M.D.s advice as the picture is painted so clearly, and in theory I have provided the "facts" to lead him to make this diagnosis..... can you imagine just what HE/SHE is thinking, can I trust this medic? He did, so its a no brainer, period........but......... is that the end of the story? You have medical backing and this is a very simple procedure, (it is taught here in theory but no formal practice) In fact in every ACLS course I have attended in the last 20 years this is an option to be "considered'.......isn't yours? Besides the fact that I truely hate "THE WOLF" and could this very patient be the one that makes the difference in how we treat this ugly disease and you failed to do your part? I would be even "more comfortable" in preforming this procedure in a trauma call, it is Christmas and I bet my bottom dollar that some childs Mother or Father would be VERY pleased that "I would dare to make a difference in an outcome" so that they would have another Christmas with their Family or at least give that patient every chance. I in fact joined this board to give Kevkie a rough time and vehemetly opposed his views in a very similar thread. How can we advance the profession by sitting on our humps and quote some paper regulations, they can be changed. WE are the forefathers of the future.....so just how does one think we got here in the first place ? Advancement of medical practice everywhere has always been by individuals that have been willing to take some risks. BTW: Kevkie was morally correct, I was wrong! A recent ruling in my "hood" stated that this procedure (Emergency Pericardioscentisis) is "inconsistent" with the on paper regulations for ACP level, the HDA also stated that PCP can't deliver Ventolin or shoot a Combi-tube either....sheesh! This may be the exact scenario to open up that door and dialog....or perhaps kick the damn door down! The overly conservative legal/legislative crowd really needs to put these concepts into personal perspective as we are dealing with life and death situations here and not a around a table discussion. In fact could criminal charges could "in theory be laid" ???? That in regard: NOT PREFORMING TO THE LEVEL OF ONES TRAINING..... this could be a very viable argument in a court of law, if I am looking at flipping burgers for my retirement package I would rather consider that, than looking into some childs eyes and lying that I did my best for their Mother/Father. When I did not because I felt "uncomfortable" or explain to that child that I could have made a difference but some words on a useless piece of paper stopped me. That I could NOT do! The Law can be an ass, (to quote my OZ friends), but we do live in democratic societies don't we? So call me renegade, call me **** disturber, call me anything you wish but you can never call me "afraid" to try to make a difference in a life, fear of not doing the right thing this is my greatest fear. I do love my job, thank you. cheers

Question pops into my head, would there be any widening of the QRS complex to give us a hint of IHSS?

Well from your detailed summary looks like you were very diligent to be sure. I would add that besides the differencial diagnosis that have been provided, perhaps you should include Costalchondritis as this is quite a favorite complaint with my current "wards" with a "seasonal virus" cough leading too......when you hear the "sound hoof beats" think horses not zebras..... cheers

All 3 meds are carried and used on Alberta Air Ambulance and on Ground in "most services" Gravol = Dimenhydrinate it is what you ate I learned this in school and it stuck with me, perhaps useful for the newer EMS crowd. This is my first option and frequently used as pre flight as the side effects of sedation are handy added bonus, remember to dilute in 10 mls at least if your pushing IV, it is corrosive, nasty stuff to veins. Phenergan aka Promethazine = 2nd option dependant on patient history, used with maternity types and "generally acceptable" Benadryl aka Diphenhydramine as an anti-emetic is an American "Thang" (as in Cali's Dramamine Drive) but a good option too. If one is aircrew and is prone to motion sickness, best think of another line of EMS, unless a Weight loss program is in your plans. cheers

This all boils down to the Canadian Shotgun Rule of "Engaugement" Amendment 43201217849 section 9, subsection 2 : :roll: If a passenger actually has a shotgun "whatever gauge" in his/her possesion regardless of a legal "FAC" aka a Firearms Accusition Certificate. The holder gets to DRIVE! :shock:

Confusious Say: Boy who put hands in pockets feels dinky all day? Yes, I too have seen a "tannic acid in leather" transfer but from green deck shoes, I found a friend one day singing "In the vally of the Ho Ho Green Giant! " Alcohol was prescribed "per ora" as a treatment, it was ineffect for the physical complains but very effective psycologically (around the campfire). Needless to say I had no reason to do a P/E for "the little green sprout" it was my understanding that a female medic did in fact investigate at a later time but evidence was not reported. LOL. cheers ps if this was Raynoulds and the accepted norm of using Pulse OX on the fingers... as perfusion to hands may be decreased. Due to this Sats "I suspect" would not have been 100% on room air as provided information from ERDoc a DGA of "Dead Give Away".

Amendment: Or your ex-wife decides that it is HER House, and your not getting any of "IT"

Most Don't. te he.

Intermission time.....lmao @ (more cultural imperialism). :roll: 4 "Downs" is for poofters.... :twisted: Now back to your regular sheduled "Boy with the Blue Hands" senario.

When I whent through "IV school" it was in ER. The student RNs were not allowed to do starts in the area, Paramedics students did them ALL. So feeling a bit guilty, so I let the RN students practice on this "dummy"........ not the best choice I have ever made....but did get a date out of it! cheers

Right then, so here is my next query..... does a female "troglodyte" (wtf) dressed up in a boy scouts uniform and using a call sign of a 4 legged rodent, (ok in even my dreams) does this constitute a breach of any law in the state of NY? ...... One can always hope. So just which catagory would I click on to register in this thought provoking thread/poll. ps rat115 there is NO "women" in the oilpatch (well at least one that I would allow to be picked up by)....... and for good reason, ever hear of a gal with the nickname "Roughneck Sue" ...... NOT that hard up just yet thanks. cheers all..... back to da bush!

Do animals count?

You can call me turnip.....! TWTG "the way to go" TITRATION" Oxygen IS a drug! With pulse oximetry this is entirely possible, but it would be bloody brilliant to have a means of detemining Hemoglobin levels in the gut wagon as well, one can only hope its in the future. With Head injuries, don't forget the 30 degree head up and +5 of PEEP if intubated, Lydocaine and Fentanyl pre noxious stimuli, PLEASE..... this has been proven, I would post studies but my internet connect is not optimal (I know a poor excuse) but we did get television just last week "in Canada" so I can't complain. te he. Post your heart out, a good read to be certian. AGREED IN SPADES! During a recient conference that I attended, a researcher proposed that: HI levels of O2 admin in the post operative patient may actually contribute to post op pnemonia (s) as a direct result due to absorbtion atelectasis. Could this be true in other demographic groups that we are treating? hmmm matbe not too far feched at all?

Hello....I am over here. Ok well out in the Bush anyway and providing care to an "very important demographic group" as a publicly funded but privately owned entity, providing services to government employed workers and in remote practice to boot! As much as I hate to agree with the Past Dictator of the this Province there can be "a turd way"! A fellow by the name of Preson Manning convinced me of this idea in a presentation about 1 month ago, its not too extreme to believe that Public administered Delivery of Health Care "could" be the end of social health care as we know it, as the rapidly soaring costs and means of delivery must be reevaluated. The Idealistic "Public vs Private Argument" is simply POLITICAL EXTREMISM as health care has always been blended here in the great white north. One can make a difference if one is determined to provide "improved services"... Dust I take a bit of exception here to your comment of "just adding a drug" #$@^%$! You do want a Canadian Pasport dont you...te he! For example I have just reciently added a "drug" to my inventory AND with the my medical overhead approving, that being tetracaine (fluorescein is next) not only in adding "this drug" I did accomplish additional education for Paramedics in an operation that is providing advanced remote care. BUT the previso is that one must have additional training, and be examined in house... what a concept "checks and balances" extending scope of practice within current guidelines. (My convincing argument was to decrease the possible use of systemic Narcotics for "pain control" and forcing a 6 hour transport (or medivac) then waiting 4 hours in ER when a non-fixed foriegn body or arc flash cojuntivitis can be safely and comfortably be removed on my site) Yikes I think I am growing up but PLEASE dont tell anyone as it will destroy a perfectly good reputation of renegadism... Yikes I think I am growing up! Now as Paramedics are already "approved to administer the drug called lydocaine", is it far reached that this drug does can be used in variety of applications like suturing......te he. Hey and don't let on that this could be precident setting to boot..... if the Health Proffessions Act ever gets through the legislative mumbo jumbo it may release some of the strict control, and just whom is opposing this HPA anyway ? Please don't tell me that College of P+S will let go of any control of the reins in this traditional territorial wars, well without a good fight anyway. They are lossing some minor battles to the Pharmacists.... and good for them, not a 5 hour wait in the Pharmasave lineup just yet. If one can PROVE cost effectiveness and decreased lost time injuries THIS could become the new critria and not extreme idealism.....$$$$ does talk. "If a foot can be put in the door" so to speak, perhaps we can deliver improved services through Paramedicine. The fact of the matter is that our health care system "is sick" just may be an incentive in itself as the facts are that in some provinces may go broke very shortly. Alternative means of delivery MUST be reviewed, to that debate I ask this question: What MD in this country does not bill the health care system as a non-busniess manner? Hint: You know of any strictly salaried MDs in your "hood"...... NOPE "fee for service" is the bottom line. cheers ok enough rambling/ babble.

Back to the regular sheduled thread........ Then best buy CANADIAN ? LMFAO......and we practice playing Doctor in Alberta @ about 8 years of age! As for other meds that require serious monitoring add Bleomycin to the "almost absolute" contraindications.