emsbrian

his is if you are strapping it to a backboard which is wrong anyway

NO

strapping it to a bed is even more wrong

YES- Not even an option, if I caught this at my service their would be some serious problems.

The reason I post in such an extreme manners is that you advocate vacuum mattress as the ONLY form of immobilization. FOR NEWBIES do no take this to mean don't do it. Obviously alot of services run with only backboards there. BACKBOARDS ARE THE STANDARD OF CARE. It is cavalier to claim they are either useless or affective. One hundred times more studies show positive outcome increase do to immobilization over no spinal precautions.

THE IMPORTANT PART: Muscle twitches are cause by unsupported parts (mind you our body normally twitches muscles in the same manner the study I read stated as a problem on a daily basis even sitting on a couch.) Padding the voids and proper webbing MUST be done. If you don't, then you haven't back boarded your patient. Spider straps and duck tape are crap, use them only for dangerous rescues where you need a high speed extrication because of further harm to Patient your you. But in every case possible you should web them. If you pad the voids you SIGNIFICANTLY reduce spinal movement and twitching. As far as the head. I like disposable cardboard blocks and tape, this prevents as much movement as possible. As a note from a NREMT examiner, most people pass backboarding, but they do it wrong. PAD THE VOIDS. If it was up to me their would be a lot more voids across the wall in NR, SKILL UP people, do it right its not hard I never failed ONE)

Summed up: Backboard, BUT DO IT RIGHT!!!

On that note......... Vacuums better all around, splints and mattresses, they conform to injury and provide the best rigidity for a conforming splint.

PFC can be used to breath, yest they carry so much oxygen that we can handle them in there lungs, As we speak there are patients with it in liquid form in there lungs to enhance oxygen carrying while on vents (research from what I understand, it was a WHILE back that I was reading about that) But yes the whole abyss thing was sweet, and may be possible. I cant remember much about the article except that the patients had some problem, they flooded there lungs with PFC and had them on vents (this was before my medic times)

Talking about that 80% transfusion, thats a LONG way off. The problem is not oxygen transport, but everything else. Obviously (and we all know this but gotta say it) There is more then RBS's in blood. An major PFC transfusion would have no problem transporting oxygen, but there would be no clotting agents, no WBC's ph balance ablity would change, and etc. etc. etc. I personally see PFC's as a oxygen carrying drug, the only reason it would be in a transfusion form would be the fact that it would also normally need to be give with a volume expander.

The day I have to breathe liquid is the day I stop diving.

Well thought I would spawn a new thread about oxygen therapy, as appose to using oxygen as a a drug, using drugs for oxygen. The future of trauma, we have now, the first and truly only medicine designed to treat trauma. (okay a little over dramatic but I got high hopes on this one)

The future is here. A milky white substance will soon hang in the mini-fridge (next to the sodas) on our ambulances. (forgive me my science journal is at home on the toilet so namesake will come later) Artificial bloods are improving. While they will still not replace whole blood for its ablitity to carry waste products and other biological agents it is 50 TIMES better at carrying oxygen. This new artificial blood is also so small that that one single 50x loaded molecule can squeeze 6 side by side through a single RBC capillary. Whats this mean to us? Not only does it last longer on the truck then blood, but it carries oxygen so much better, through such smaller parts that it can bypass injured sites, including Spinal, Brain and cardiac injuries. Mouse studies have shown a 90% decrease in traumatic is chemic tissue damage with its use.

How does this apply to Oxygen discussion? The whole point is getting more oxygen to the patient by giving him more to absorb, but the underlying problem is the transport system. By giving this new form of artificial blood were looking at making super blood, we both increase oxygen carrying ability and the delivery of it. In theory a near complete blockage of a coronary artery would allow MORE oxygen through with this drug in a persons system, then if it was fully open?!?! Imagine the possibilities of this new line.

Perfluorocarbon based

* Oxygent, by Alliance Pharmaceutical. Status: U.S. phase II trials, European phase III trials

Oxygent is a solution used as an intravascular oxygen carrier to temporarily augment oxygen delivery to tissues and is currently being developed by Alliance Pharmaceutical Corp. Right now, the goal of the development of Oxygent is simply to reduce the need for donor blood during surgery, but this product clearly has the potential for additional future uses. Perfluorocarbons surrounded by a surfactant called lecithin and suspended in a water based solution give Oxygent its oxygen carrying capacity. The Oxygent particles are removed from the bloodstream within 48 hours by the body's normal clearance procedure for particles in the blood. Namely, the lecithin is digested intracellularly and the PFC's are exhaled through the lungs. The fact that this blood substitute is completely man-made gives it certain distinct advantages over blood substitutes that rely on modified hemoglobin, such as unlimited manufacturing capabilities, ability to be heat-sterilized, and the PFCs’ efficient oxygen delivery. Oxygent has done well in most clinical trials, but recently ran into some trouble, with participants in a cardiac surgery study slightly more likely to suffer a stroke if treated with Oxygent rather than the standard care.

* Oxycyte, by Synthetic Blood International. Status: U.S. phase II trials

* PHER-02, by Sanguine Corp. Status: In research

* Perftoran (Russian). Status: approved for Russian clinical trials in 1996

Bows to AZCEP, way to slap that one down, good job.

He was saying that since we can't diagnose, that confusion was reason enough...

Well theres your problem... AMS... run down the list, ruled out stroke its off it no probs there buddy. As long as you cya'd with hypoxia, spo2, hypothermia, blood glucose, ETC...

You did the right thing by realizing he was altered, this was your problem looked for the cause.

I think were boiling down to the same thing really, I just ask why work the >8 minute code and stop. Either we call it obvious death at some point or not. I teach ACLS for a major medical school here and we make a point to teach to call the code when needed, but I still feel in hospital and out of hospital are two things. Work it 15 minutes and call in a hospital sure, 15 minutes into a code on the truck and I'm five from the hospital, so why stop?

P.S. Love this thread, right up my line of thoughts.

Stroke - high flow O2 may decrease your Pt's respiratory drive.

True, but if we have an oxygenation problem to begin with it needs to be resolved, try O2 by NC if this doesn't resolve it then Hi-flow if your worried. In most protocols around here stroke is still instant High-flow, the possible benefits FAR out weigh problems, so it is in no way a contraindication. The reason we feel this way (beyond the whole more O to the brain thing) is that on top of numerous benefits, decreased respiratory drive is easily fixed by bagging. While I in no way recommend taking away respiratory drive (watch the morphine guys) I dont mind if the oxygen needs to get there.

CPAP with MI - This may worsen the MI.

A second excellent point but again we look at the underlying problem. If we are dealing with immediate tissue death then we need to oxygenate. But you do make to very valid points in LONG TERM consideration, I feel the immediate salvage to prevent tissue necrosis is important.

[spoil:75400b39ad]The future is here. A milky white substance will soon hang in the mini-fridge (next to the sodas) on our ambulances. (forgive me my science journal is at home on the toilet so namesake will come later) Artificial bloods are improving. While they will still not replace whole blood for its ablitity to carry waste products and other biological agents it is 50 TIMES better at carrying oxygen. This new artificial blood is also so small that that one single 50x loaded molecule can squeeze 6 side by side through a single RBC capillary. Whats this mean to us? Not only does it last longer on the truck then blood, but it carries oxygen so much better, through such smaller parts that it can bypass injured sites, including Spinal, Brain and cardiac injuries. Mouse studies have shown a 90% decrease in traumatic is chemic tissue damage with its use.

How does this apply to Oxygen discussion? The whole point is getting more oxygen to the patient by giving him more to absorb, but the underlying problem is the transport system. By giving this new form of artificial blood were looking at making super blood, we both increase oxygen carrying ability and the delivery of it. In theory a near complete blockage of a coronary artery would allow MORE oxygen through with this drug in a persons system, then if it was fully open?!?! Imagine the possibilities of this new line.[/spoil:75400b39ad]

I agree with akflightmedic I don't teach EVOC but my partner at my company does, and as as an over all matter we need to be more professional in EMS. Using your lights or siren any time other then when crucial is unsafe and dangerous. A polite wave is good, anything you think a woo-woo might do, should be avoided.

I dont care either way. If a patient dies or not I did my job. But I feel that its for the hospital and the doc to decide. If we go telling people to cancel codes were gonna loose what little good there is. When I'm in the hospital I can know a lot more about my resources the patients chances the viability of organ donation ETC... I think we need to way in the field decisions alot differently. Even if in all actuality we are hauling a body to the hospital for the freezer, resources aren't wasted if there is any chance it can go to good. And to be clear, I have cared for a patient in the ICU we had 2 years ago a fucked up miracle resuscitation (the nurse checked pulse after the doc called it and found one). He went on to the ICU for 3 days (i followed the case for an article i was writing, and the family asked i was involved with care since they saw me around ( i was very nice to them as i am with all people, and they took a liking and i spent alot of time at the hospital.) And while they eventually pulled the plug and i feel the nurse should have never checked after it was called (it was MASSIVE amounts of epi from a escalation trial pushing the pulse.) My feelings were not bothered either way. Why would you ever stop working someone once you begin, Ive rolled many into the hospital to have the doc call it, in my en route I let him know. I can agree with never starting, and I can agree with letting the doc stop it as soon as I get there, but I would never stop en-route. How my TX isn't that long if I started I had a reason and might as well work it.

YES to BLS. I have no problem with BLS no initiating a code with obvious signs of death (assuming proper training). As far as canceling a code, nope unless there are other circumstances why would ANYONE cancel a code. And by other I mean mass casualty or serious system resource problems. No level should ever cancel working a code and call it. We are here to up the chance of survival, no matter how little. Now if there are three people and you can up two significantly by lowring or calling it for another thats one thing. But on a normal call to a normal code with no obvious signs then ANYONE should work it. If there is any doubt work it. I'm well versed with ACLS studies and CPR studies, and with new AHA bullshit they perhaps are below what a standard should be, but still we have to try. The medications used in ACLS have shown no signicant variation in the outcome of a standard code, and no change in a traumatic code, yet we still do it because it may have a improved chance. WORK EVERY CODE. As far as safety, good driving means you never exceed a posted speed limit even when hot, change tones, slow and honk at intersections etc... But for codes we get police to clear to the hospital so we can expidite code 3 and ignore normal rules, this way we dont create the increased risk to others to save the one. I hate to hear that any of you would not work a code simply because of the likely hood of outcome. Our protocols call for 2 obvious signs of death before we decide not to work it to be clear TWO guarantees that there is no hope. One guarantee there is no hope and were still working it. There are few circumstances where working a code would require system resources that could be better used elsewhere. Next thing your going to tell me that my grandfather who has had 2 heart attacks and a stroke (with NO problems acquired from them, amazing eh?) should not be resuscitated because his chances are crap?!?! Is a baby more important??? What if the guy is a monk meditating and is just out of it but fine and we have no idea?

WORK THE CODE.

Give me a ride to LA and I'm in. Always up for a ride along anywhere. Just as a fact there are set rules for using a stretcher for a reason. We ALWAYS count, I don't care how long you've worked with a partner. This is for patient safety. As a rule the person in the back pushes the person in the front steers. I don't care if the person I'm working with thinks I wanna get to into communication or codes. We count every time "Up on three... One Two Three" People loose there newbie skills (those that newbies have right) such as that. Mainly due to long term habits, but in some cases (and apparently in yours) because they see others not doing them and think they are lame or whatever. As far as codes, if you are hauling ass so fast that you need to stop and end up hitting something your going to fast. At any time ONE medic should be able to stop the stretcher, this is a safety issue. There is a lot more to patient care then medicine. WE ARE IN THE BUSINESS OF COMFORT!!!!!!!! We teach comfort as part of the class. We teach lifting the streacher smooth, rolling smooth. We teach smooth breaking and cornering. Comfort is in fact a major part of my care. Unless we are working a code there is very little to do while ground pounding. I dont know what your Tx times are but here they can run pretty good during rush hour (a actual total of 5 hours out of each day.) During that time in the ambulance comfort is key. (More on comfort in another rant, stopping now).

I hate to be harsh but I have a rule, if your gonna complain do something about it. I started as a basic newbie at this company made friends but worked my way to the top. While people would get pissed when I called them out they respected the fact that I worked hard and cared. I personally understand the want to keep it from the supervisor, so then your left with confronting him. While you may piss him off for a while its better in the long run. If you can't resolve partner problems your gonna have a lot more problems soon. Take advantage of when your in-charge. If its your patient your the boss. Everything that happens is your responsibility. I now own a company (training and consulting) with a man who has been in EMS for 35 years. We can but head big times, were great friends. But when we make calls if I'm in-charge he respects the fact that it all comes back to me. This is life saving, not about making friends. While we spend up to 72 hours living with these people, we spend 30 minutes working with them to save a life.

I stress again ITS ABOUT PATIENT CARE AND YOUR SAFETY.

Again I say EMS is not as professional as it should be (a post for another thread) So your right if you go up about this, other will worry. In truth though there is NOTHING wrong with it, it is the right thing to do if patient care is compromised. I had a partner who had bad stretcher habits, easy to confront him about, even though it took many times talking to him, which got him mad at me for months. But if care and safety is compromised and it cant be resolved, DONT run from it. You need to fix it not just leave him to cause harm. You say you worked with PD then being bossy shouldn't be a problem. Ive been pissed off by many people and ive pissed off many people, but it comes down to care.

I'm long winded, and as the above shows perhaps confusing, so I will try to make myself clear, but I fear I may simplify my point to much.

Memorize the cook book. Know the ingredients. Then LEARN HOW TO USE THEM. This is the missing step. I'm a big fan of easy mac, never would order the restaurant stuff. (Okay am I talking about medicine or food here?) "most do not think enough" IS my argument (all be it cryptic perhaps in my rant) We do diagnose, we do perform (who practices) medicine.

"What I hope you mean, and what I suspect you do, is that a simple answer is often best. Give them a firm foundation and teach THEM to research and always encourage them to question, make sure they know that while you have to memorize much of the cookbook, most of their patients will not have read the script and my throw extra ingredients at you...so be ready for it and if you are not be ready for it the next time!"

---> NAILED IT MY FRIEND

In medicine we rule out the simple before the rare. STRIKE THAT We rule out the COMMON before the rare. (At this point I just deleted 9 lines of ranting)

TEACH THEM TO THINK. This conversation stemmed for O's and a funny comment made was if pt is on fire O's is contraindicated. (Yes i know its a joke but i can make a point with it) If the patient is on fire A: Who cares about O's, B: How would you get O's on them. My point is the cook book may say put it on them, and god knows that some cook book medic would try to put it on him because his protocols said so!

At this point the conversation has perhaps moved to EMS education but that goes back to the original question. LEARN TO LEARN< LEARN TO THINK

Alright so you got a lot of problems to deal with there. The company I used to work for had a rotating partners policy. Of course I've had static partners to. Both offer difficulty, but I always feel patient first. The number one issue to deal with is quality of care. If anything your partner does effects quality of care the you have a real problem. I agree, who puts two newbies together? This first problem was created by your employer. As far as dealing with problems bite the bullet and talk to your partner. Sit down lay out the problems. While your friends with him your also partners. Depending on the outcome of this, you may have to go to your supervisor. Old school thinking is that in EMS/FD you shouldn't nark. This is a more professional job then that. If there is a true problem its your responsibility to bring it up with your superior. An FTO will have an immense amount of influence on new medics and should be professional, intelligent, hard working, and good at the job. When I went supervisor I appointed a guy I hated to work with as FTO. He was anal, weird and nit picked ever detail. But he was a good medic. While I as a super, was anal about alot, he was anal about everthing. So those who trained with him learned only good things. One of my good friends wanted to be FTO and had seniority over the other, but he had a bad habits (simular to your case.) As a supervisor new employees has a sort of fear for me, so it was hard for me to get a hold on where people were. Rearly would partners come to me with there problems (the previous supervisor felt they should work it out.) Many times these problems could be worked out. Personally I would think that y'all simply need to change partners. While we rotated partners, there were pairings we avoided. Just ask, I know EMS is still back asswards, but if your lucky youll get a profesional listining to your problems. Hoped this helped.

First off, SAM splints are more then useful for a number of things, along with vacuum spints. As the others have said!! Remember the c-collar is very limited in its helpfulness, so the lack of the ability to apply one is minimally a problem if you can secure with head blocks (rolled, towels etc...) properly once the rest of the body has been immobilized, as this is the only true final cervical immobilization. A KED is good if you have posterior surface mutilation (not just abrasions or lacerations) preventing normal immobilization, but remember most people will get over the pain. While I'm not going to torture a patient, if a little pain is for there better its the way to go. I find a lot of patients begin to ignore the fact or deal with the pain of damaged tissue on there back when facing spinal injury. If the patient has numbness or pain you really have no choice. As far as body plates and clothing, and helmets. Everything but the helmet comes off, I don't care how much it costs. I don't deal with Mx'ers sept on rear occasion when the local track ties up both its standbys. But I do deal with ALOT of pro soccer and football players. Don't pussy foot around, you have to do a head to toe with one exception. HEAD. Cut off everything to check it. There is never an excuse to miss any injury, you have to be able to see and feel. I wont go into that any more assuming you can make a good head to toe. The reason the head is an exception is the helmet. Helmets are the only piece of protective equipment that can support/splint and injury that may be made worse. If the patient does not have a major bleed and has a patent airway leave the helmet on. Let them remove it in the controlled environment of the ED. There is no reason to risk more injury from removing it. Unless they have the water bladder designed to remove the helmet without risk to the spine. If the helmet has a need to be removed though, such as airway control, bleeding etc. do it carefully, but I stress leaving it. Your description of a standing takedown is the best way to immoblize them, no probs there. If you can make your question a little more precise (had a lot of different topics there) maybe could help a little better. Hope the advice helps.

I agree greatly with that. As I said I feel research and knowledge is important and while I would NEVER tell a student "its not important" more likely it would lead to a discussion of decision making. I believe that teaching people to think, especially at a paramedic level, is underdone. Just as we have to teach them that the more likely cause of a problem should be treated we have to teach them that the more likely knowledge should be used. If you have a woman in a high speed MVA expect abdominal trauma not ectopic pregnancy for the abdominal pain. But wait, it is still very important to know about ectopic pregnancies. As much as people hate it I believe we in EMS have lost focus and want to play doctor to much. There is a fine balance between transport and treatment. I worked a Major League Soccer game where a woman was shot, the stadium less then a minute hot to the hospital, yet by the time the basic called me they had been with the patient over 10 minutes trying to figure out a treatment plan. The woman was completely stable, light penetration of a small caliber apx. 2.5cm inferior of the subclavian. When I arrived I questioned why they called ALS, they lacked the knowledge to correctly ID a bullet wound (fired from over a mile away so no sound in this case). Which is a problem with knowledge, but they also lacked the thought. It was Obvious there was a penetration, with something in it. Treatement took me 2 minutes, I explained to the Pt. the situation, and that in truth we could not be sure if it was a bullet or not, but there was something. (While in most cases I know a shot when I see one, I make no assumptions). I slinged her arm and immobilized it against her body to prevent the bullet from causing further damage, told the on scenes to transport and do a lock and draw in Tx to save time at the hospital. The point is both of these two were paramedics, fresh out of big city fire academy. But had neither the experience or the knowledge, many people say we cant teach experience but we can knowledge. THING IS WRONG we can teach the ability to apply knowledge. This is our greatest problem in EMS. In all length of comment, I agree with the above statments by others and would just like to stress that point.

I'm a fan of the simple answer. I think and EMS we think to much. While knowledge is by far our most powerful resource (as I can attest, I constantly study the strangest things as I have used what I thought the most useless information to save a life before) we tend to over think. While there may be an O's contraindication the main thing to concentrate on is that fact that the chances of running into someone using it is SOOOO low its almost pointless. On top of that the average AND the advanced stokers will not know what particular addative or pesticide was used in the developement of there stash. My associate used to come to me daily to ask me questions when her students would ask questions simular to this. I feel while it is important to inform students many lack the experience to make the decisions we need to teach the decision making skills. As you said hypoxic drive is not a contra, because again its hard to know, they need more os anyways. If it does deminish there respriatory drive then we just breath for them and get them the oxygen they need.

Im 21 and i have constant chest pain, mine is from a new addition to my sleep, CPAP. It is making all included muscles work harder to breath in my sleep, so bad that i woke up this morning almost convincing myself to call my buddy at the station to give me a 12 lead, but i recovered fast. While I personally have seen an AMI in a 8y/o male and in your case the fact that she is on BIRTH CONTROL automatically rules an age independent indicator for worry. If you follow your protocols for SOB and Chest pain then your fine anyways, Alway remember, the arrival at the hospital is the most important part of your care.