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Firstly: Lone Star .. couldn't find a "turnip reference" pity ... LMAO good one made my morning. I must concur, what chbare said only far more eloquent that myself. Dear Dwayne: I do enjoy your input but most seriously if one wishes to change, educated without "cost" and improve communication across ALL borders in any system, for the better. Does it really matter who is given credit ? I have learned one thing in my years: That working EMS is like urinating in ones BDUs, one gets a warm all over feeling, but hope no one notices. cheers (edit for contextual change and tenor and dang quote things again>

Firstly what's "job status" employed, non employed, air, ground, rural, urban, suburban, turban, remote, sandbox ??? We have many countries in here, varied levels of education / training should we be talking down to "I am just an EMT" (I hate that personally) ... I think not, posts should be judged on merit. For example the "Country" of British Columbia where everyone is a called "Paramedic" even the P1 P2 P3 ? Then OZ and who the hell knows what that's called, well besides tossers. Then the Germans a rechesstalage ? WTF over, it sure sounds that these guys are advanced practioners no doubt in my mind. Even this AAS title used on your tagline Dwayne and for the life or goggle of me I have no idea what it means. Shouldn't the context / content of the post be judged on that alone ? We have so many "variations" of titles is not realistic in my view, so I will remain a lazy band aid, if I put all my crap letters up any anonymity would be lost. cheers

Your asking many questions .. in one sentence. 1- Ok so just how in an arrest with no forward blood flow could blood glucose levels be raised ? Prior to an arrest in CVA MI or trauma the human body will in compensate for the increased physiological requirements, (cortisol and gluconeogenesis) but is that measurable in the field on the dip stick ...hmmm, not likely. 2- If it were a respiratory failure and typically extremely high metabolic demands due to WOB "work of breathing" and depleted glucose stores the reading would be lower, this makes logical sense, does it not ? 3- 30 mmol/L (that's 545.454 mg/ dl would be rather high, did the supervisors patient arrest due to a Hyperosmolar Hyperglycemia and buddy supervisor is basing his "observation" on that anecdotal finding alone ? Here is some links for your reading pleasure and further educational needs: http://emedicine.med...914705-overview http://en.wikipedia....aboratory_tests <edit spelling again>

10 months of winter and 2 months of "poor" skiing ... but hey come on up lots to do lots to see in the National Parks.

I came across this while reading news article about a record breaking rescue ... http://www.edmontonj...8966/story.html LOL in the vid no spine board was used ... due to terrian .. no shit batman, and puts a new spin on giving report on the FLY ! Ah the good old days, I sure miss em.

Well just me but when working in a remote clinic setting, the couple minutes of extra time spent to evaluate is very positive for patient contact, in fact I did it yesterday on a "I have a HA, dizzy" and a resultant negative finding ... the worker was bragging to the bosses how great a paramedic they had, the treatment plan was 500 ml of H2O and a tylenol, it was a magical fix and no lost time on the job. Not that he was wrong mind you about the great part LOL ... Would a positive finding of orthostatic hypotension result in a different treatment plan, in a non acute patient, well not really, but I would have a tendency to "flip" to a higher level of care to investigate in far more depth just to be on the safe side for the patient. The skin turger or tenting can be a bit misleading as well, and in a geriatric with PMHX of HTN and on meds I look more towards end organ perfusion LOC and urine output, if in an acute care setting. Yes ERDoc those dang snot spewing, toddling virus packing alien life forms called children never follow the rule books ! cheers

NOT if it was your nipple ! OUCH !

http://www.youtube.com/watch?v=z0rt9BB0FoU&feature=related You be the judge .

here is another pic.

And summer T storms are not expected in North America ? Absolutely no excuse for poor engineering, it wasn't tornadoes or hurricanes that brought these down .. like I said my tent stood up to it in you know were.

DFIB ... as you wish. Mass and Temperature (remaining constant) the volume of a gas is directly proportional. That stated: with the pressure decreases there is also shift of the ODC, (the oxygen dissociation curve) which in this case presentation, So if the curve shifts with a decrease .. what happens to the affinity of the haemoglobin for oxygen ? Hence my question for pressurised vs non pressurized, you can be in a typical helo at just 5000 ft agl but in fixed wing you can have a cabin pressure of 3000 ft agl and actually be at 25,000 ft agl and "over the weather in calm air" ... now look back at the patient picture, is the musculoskeletal injury life threatening or is something else you may wish to make note in clinical observation ???? must have been one hell of a high impact to bust buddy's arm this bad, any other concerns for going flying ? Ah Bushy, just wake up mate ? Agreed. Im tired of seeing people jam 15 L/min on everybody, even when they know the patient isn't aneamic! Twisted ankle = 02, paper cut = 02, boggles the mind (and the 02 cylinder rental costs im told ) I am not a fan of the toxic effects of O2 ... te he, (a high potential for ARDS) but my reasoning was, with the rather liberal amounts of analgesia that I was using to control pain, was that oximetry changes could indicate a hypoventilation state (late).. but was relying on ETCO2 as primary tool for hypoventilation, for a near conscious sedation. I really did not want to push Narcan or have to ETI on board but with the "yet to be identified" life threatening issue, sorry no AP CXR available. (hint with the good clinical observation skills applied) and no pneumo but we are getting closer close (ps) vascular lines to periphery was the hint that no pneumo present initially although that can change when Boyle puts his physics to work , a small closed pneumo becomes a lot bigger with increase in altitude. Probably myoglobin, i dont know the normal values though. That is one .. myglobinuria better, any others ? Its "poikilothermia" a failure to thermoregulate. Ah the presenter becomes the student .. you sheep shagger ! Ill see if i can find it, but there was retrospective analysis done here on tension pneumo's that were missed in the field, led to an education pack coming out where they got us to be more aggressive in identifying and manageing, there was a good stretch in it about trending ETCo2 and the missed pneumo. Ah send it to me svp, that svp is french btw and good thing you don't have to deal with those spy talkers like we do. Let me get back to you boke, i dont understand ETCo2 or fully remember treatment for hyperkalaemia due to my lazyness (i used to). I went to some joint once and learned some stuff then got a job and forgot most of the stuff that i learn't I wasn't concerned about hi K+, could give ventolin while on board, but not going the glucagon and insulin because we don't carry insulin and this was a stable no CP distress, no big ass T waves and K excelate was out definatly of the question, but we are getting a bit off topic direction. rhabdo treatment was where I was headed ... any ideas ? hint TVI flight time was 1.5 hours, then add 40 mins for ground transport both ends. I was curious about the 30 to 32 ETCO2 although .. I think I can explain it but one can not be 100% why he was hyperventilating just a tad any comments ? cheers

You really spiked my interest in this area ERDoc ... it will be my "safety talk topic" early dark wake up on a project I am deployed, Its really hot here and the workers are not conditioned to this heat nor are the providers for EMS in evaluation. btw I peeked at the american journal of nursing, no link provided to their suggestion's, just to keep this excellent teaching tread going. cheers

Dear Members: Well with now another G Damn stage has happened now in Indiana, count 5 dead 40 injured .. One in Ottawa this year and one near Edmonton 2009...one dead, 23 injured. I am pretty certain why that one went down, I have pictures of the failure of I beam where a reinforced gusset would have "likely" at least helped prevent a catastrophic failure and I am no rocket surgeon, note balliest block placement ... a boy scout knows better ! Fact remains that until the engineers to "get it right". Stop the shows, I will be writing a letter to my government officials that my fn'ing tent is bloody stronger that and these so called Stages, the engineers responsible should be in jail waiting for results of the investigation as these are no longer rare fluke events. I would like to encourage all of you to do the same, as we are the ones that end up dealing with these very "preventable" wrecks, deaths and subject we the EMS and Fire Rescue in serious jeopardy crawling around in the mud, debris and crushed bodies. EMS across borders for safer communities. the end

Well we do not have any volly EMS in AB that I am aware ..and thank you very much for that.

LOL Richard... or maybe Kelly Grayson .. he is known to have a few knee slappers "his own self' that (self acclaimed coon ass Louisiana good ole boy. ER doc I woulds say an increase of 10 % in pulse rate and changes of 20/10 ... time would be more of a consern if pulse did not return to base line (say 5 minutes) .. i know this is controversial. Personally a one beer infusion makes me dizzy when standing up too quickly, that when I realize its empty and need another, its sounds like a good justification to me re: "orthostatic hypotension" so I am going with that, as an answer for door number one.

Not exactly certain of what your asking for pulse, resps , BP, colouration, skin turger. I would expect, say if I observe a relative tachcardia and change in BP correspondingly (sp) that dehydration or a low volume may be a culprit but if I observe no response in pulse rate or borderline brady I would be asking if patient is beta blocked, doing any labs in field for say hypothyroidism is not available or in the case of a "blue hair" my favourite demographic actually, ask for the chart .. but maybe I should stand down and let someone further up the Darwinian ladder have a crack at the answer. before I completely make a fool of myself in reading comprehension.

Thanks .. We too have "laws" permitting running of red lights and over the posted speed limits, the previso being only when safe to do so ... one wreck and the legal domino's fall squarely in the operators lap. Kind of a hollow promise really.

Got a link to a pic or do want all readers to goggle of what you speak ? OR are you selling something ?

In Alberta Canada : Green for vollie FF was allowed here but under very serious legislative review now as a Volly FF smoked a family and killed 2 in an intersection when he was responding to the fire hall, for a grass fire. BLUE here is strictly verbotten POLICE ONLY. I so wish that when on scene at say major MVC with extraction that ALL emergency viehles could have a "select" switch for just protect a scene from behind or in "front" all these flashing things make me blind when your working on a patient that is trapped, most times these lights are way overkill. ps Edit .. whats a VAC ?

ER doc ... are you asking about orthostatic hypotension ? As Kate is suggesting as a positive finding, as in a change in 10 to 20 mmHg from lying to sitting position ? OR is this just another EMS myth ? I am sensing an ass kicking here is forthcoming LOL ----- > Unabashedly I "have" been under the impression that this is an indication the "tank" may be low, due dehydration or a hypovolemic component (dependant on underlying pathology) although I believe in some endocrine disorders its a more than common finding .. argh back to goggle and studies AGAIN ! Good topic

LS ... I spit coffee on me screen Damn YOU ! ROFLMFAO ! Here I thought packing a magnetic cheezy $30.00 ... so I don't get smoked on the Highway when I come across a wreck was whackerism ? Isn't their any LAW about this in the USA ? My baby rotating red beacon is stretching the law here to the very limit, even on an industrial ECALUBMA . I have never been charged for "impersonating" an ambulance a hose monkeys school bus or LEO vehicle, in fact thanked for protecting a scene but this Christmas tree stuff would NEVER be tolerated .. SD would have his nisson towed to impound yard if he ever switched them on even parked at the side of the road .. if moving he would likely be arrested. Dear ADMIN: PLEASE change forum to "Funny Stuff"