tniuqs

As a passing comment, receiving lots of Paramedic handoffs in ER and ICU ... the vast majority of cuff pressures are WAY TOO HIGH guys and girls . cheers

. The new Health Care Minister Fred Horns response .... back away from the benzos Fred your a thrilling speaker LOL and best lose some weight or you will be holding down a Ferno/Stryker in a hallway . So: Build 2 new sub stations ... for what ? I don't know, if your sitting in ER what good is am empty hall ? Strike a committee, ok who's going to speak out when the hidden faces and voice over was used in the interviews ? Remember the signed STFU agreement ! I just cant wait for an election to be announced Period !

Looking forward to Fred Horn's release tomorrow twisting his way out of this one part 2 of a global EDM TV investigative reporting.

Hey Bro .. got the scope +++ just now ... and all the gack .. WOW and Nice Patch too ... lol. Sure wish I had that ETCO2 sampler on a call back in Sept .. sure would have made my life easier. cheers

After digesting some of the posts: Lets discuss this NON INVASIVE part first .. any positive pressure ventilation is invasive to a degree, invasive your reversing all pulmonary mechanics and can affect Right Ventricular Output, just think of a dam in the lungs between the right and left side of the heart .. hence one can drop LV output and drop BP like a stone with higher levels of CPAP / PEEP, in fact in ACLS PEA or relative hypovolemic states can directly be attributed to Dynamic Hyper Inflation. Point being monitor BP as you increase CPAP always.. and look to ETCO2 and Sats . (ps some patients have not read the pulmonary mechanics books ) 1- A most excellent slide presentation BUT I would STRONGLY disagree with the European study, CPAP does increase WOB i.e. forced expiration and increased assessory muscle usage .. try one on for yourself in fact. 2- Yes BI LEVEL support does increase mean airway pressure but not WOB it decreases it with upper level support augmenting / supporting the inspiratory flow, but that's entirely the point (oxygenation is dependant on mean airway pressure) Dr. Neal Finer. 3- CPAP and BILEVEL, NIPPV are used in any modern day ER .. asthma, COPD, CHF, TALC LUNG +++ to stray off the tube. The problem exists that it can be very clinician dependent in success rate and early application as opposed to late decreases "chewing on the ETT" and as a sidebar "cost efficacy" in ICU and decreased mortality morbidity. OMG I said PEEP "splint's" terminal airways open mechanically in ICU once in front my Respirologist and 4 residents and got a new one ripped .. apparently the real definition: CPAP / PEEP matches intrinsic PEEP, some COPDers / CHFers (of which its a 50/50 deal as most COPD/CHF are the same critters, its not a matter one is a dog and one is a cat. 4- A big fat fail for AHS in choice of devices on 4 counts, a- the Boussniac is not approved for in-hospital use, b- It uses a huge amount of O2 (controversy in high vs low O2 delivery). c- inconsistent Fi02 this dependant on the Minute Volume of the Patient, d- serious lack of education during inception of a completely new therapy. 5-The one that a friend @ AAA allowed me to bench test does not deliver what it claimed to do .. goggle that POS and look at the Israeli studies a mixed bag of justifications ... you just cant replace a Visions CPAP, PB 840 or an LTV with 50 dollar device. 6- Curiously the ACoP did not have "in attendance a representative" at the AHS meeting of regulatory bodies when the topic of transport ventilation and CPAP was discussed ... WTF over ? 7- The Booooosniac it doest work like a jet turbine engine LMFAO its called the venturi effect, ok enough slamming AHS for their bean counter purchasing department follys. 8- Real CPAPok, better yet BI Level Support IMHO which is an available mode(s) on many new transport ventilators, (and education, sorry dust, my bad ?) this should be the choice for any EMS if they actually wanted to improve the system overall, then you get a bigger bang for the buck OR "buy once, cry once"

http://www.ffwdweekly.com/article/news-views/news/health-crisis-hits-albertas-ems-workers-8653/ Transition to perfection ... do you recall anyone predicting this outcome ? cheers

WORD !

Let us know ... wasn't Phil from NSW ? I miss that twisted MOFO pervert .. I bet he knows Mike or of him. Got your 6 ... craig ... let us know if we can support in any way, Mikes kids should know what this global EMS community is all about. Medic's beyond all borders, its a brotherhood and sisterhood and those children are welcome in my home any time for a Kanukistanian adventure (pick summer best advice) cheers mate.

Yup Comrade Morgan and Comrade Clapton a great mix. Sorry 2c4 im going to use the 2c4 cm anal probe ... just to be certain you know. ROFLMFAO ... I slay me. Just a "bit of pressure" my ICU RNs would say . cheers

Nothing to add excellent advice from a pro ..

Try this sound bite Dwayne: Apparently this guy came from the "hood" too and overcame the oppression.

Ok great points but your missing the question posed .. Dwayne do you use hand moisturiser ? Damn that heathen pirate grog called egg nog <ahem> and somewhat fortified, I would love to retort but this pirate training is making me eyes blurry ..... and 2c4 "the gear head" and "vampire killer" of all time ... link to temporal scanner svp. cheers

cheers

Your a good man Herbie1

After reflecting on the multitude of posts that flaming has made, I believe he is in need of some help from a forensic analysis's point of view, from his anger to delusions of grandeur and strong yet misplaced concerns that he will never be realistically be able to effect in the slightest. This has nothing to do with his preferred sexual preference, as I look to other balanced EMS providers (one on this site that is a truly dedicated professional FIRST and highly respected !) It appears he has pent up and misplaced anger on a multitude of issues .. perhaps this is just his way to vent and very jaded sometimes, I can only guess about that, but that's acceptable to myself. I myself and tongue in cheek have had an opportunity myself to take a few pot shots at the ignorance in his posts (My Bad ? ) It is more than apparent to myself that his goal as an advocate for Gays Rights in EMS that he is defeating himself with own goal(s), as the tenor of the vast majority of posts is very negative, and cant therow rocks if you live in a glass house but without a global open respectful perspective of others he shoots himself in his foot. Personally I could give a rats ass what my partners sexuality is AS LONG AS THEY ARE DEDICATED to the PROFESSION FIRST. It is my hope that today he has "someone" to hold and love, this is my true wish for him on this day, i certainly sounds likes he needs as this the very basic of human needs, that being human touch and compassion. As is AK I am not a practising Christian (or anything else for that matter) but in the spirit of this day, I sincerely hope ONLY for the best for flamingemt, and the hope that all adults can change, no one what their childhood horrors may have been. I would like to refer him to http://www.tema.ca/ that would not hurt either. cheers

HERBIE1 ... sorry mate I don't see arrogance at all but I do see some humour in in his post, 9orange is making a good point .. perhaps we all should be using a real thermometer(s) it is a vital sign. <cough> There are those that do use antibiotics AND antipyretics IV as well as inducing hypothermia OR treating it in the field. ps Don't set your sights so LOW ...... Please. It is essential when treating hypothermia to have a rectal probe up the chute as "cold and waxy" to the touch on a patch to an MD 600 kms away on a sat phone just doest cut the mustard. cheers

http://www.heraldsun.com.au/news/more-news/paramedic-dies-during-rescue-operation/story-fn7x8me2-1226230346541 http://news.google.ca/news/story?q=australian+search+and+rescue&um=1&ie=UTF-8&ncl=do1XaM-pU0QFCMMeWQNoLmhH6vSzM&hl=en&ei=NlP3TomjK-iRiAL5i42UDQ&sa=X&oi=news_result&ct=more-results&resnum=5&ved=0CEwQqgIwBA For those that have experience in this area, the line is cut ONLY when the there is threat to the life of the entire crew and the bird, its something all crew chiefs understand and accept as a risk. After reading all the 81 on line posts concerning this event, a rational man is lead to believe that this sacrifice was unavoidable. I feel so deeply sorry for all those involved and it is my hope that they do not blame themselves as all these hoist rescue's come with huge risk. "We do this so others may live" PRSAR, RDSAR, WSAR (member) Closing note: Craig if you could be so kind as provide a link to a memorial on line page link, I am quite positive that others would be pleased to send our condolences to family and friends .

http://www.rollingst...canada-20110114 Quote from Rolling Stones article : "Mark tells me that due to the ban, he has now substituted the word faggot for 'fudger'...for Canada."

Ah political correctness at it finest banning music .. this song was banned 2010 by the Canadian Regulator for Telecoms, Radio and Television because one individual complained that it had the word "faggot" buried in the lyrics somewhere. It has been a hit for more that 20 years. OMG I just realized Clapton is wearing a PINK suit ... gasp !

More gross generalizations without facts . FAIL .

This type of evaluation of temperature is all folly (not that I don't touch my patients as an indicator but moisture level is of key clinical revalance ) when a patient presents beet red and one can fry eggs on a forehead its time to get a bit more invasive. In a primary delivery of health care education day with a present employer this topic was discussed even more depth the tympanic type thermometers can be up to + or - 4 C .. the only reliable ways of determining core temp is 10 cm probe up the chute and even oral can be affected by ambient temperatures although a less challenging method with the adult evaluation for bacterial vs viral URTI of which I see 3 to 4 patients a day. Oh the why didn't you get the Fluviral that the clinic was offering for free and then the subsequent lecture and finger waving. PS I would really like to bitch slap that Jenny McCarthy myself. I have personally purchased a Infrared Probe (ps not cheap) Have bench tested the oral "mercury" tip of the thermometer (yes that's what the purchaser went to <sheesh> ) My personal evaluation is in comparison to the tip of the mercury immediately after the 3 minutes (oral) and the Infrared focused on peritonsillar area is dang close + or - . 3 C as not a lot of "takers" in the oilpatch are willing to comply with request of rectal temp probe, but your mileage may differ. My study was a matter of do I transport a rig pig or observe for 24 hours ? This makes a big difference in where I practice. http://www.cps.ca/english/statements/cp/cp00-01.htm http://welchallyn.dk/documents/Thermometry/Ear%20Thermometry/Temp_Measure_in_Crit_Ill_Adults_OLC.pdf http://ajcc.aacnjournals.org/content/9/4/254.abstract

Ok the CPAP device, what type was it ? Second question .. so what PEEP level and did you put a flow diverter with PEEP on the BVM post intubation ?