snakemedic

You can get about a gazillion index cards for 5 bucks or so...a lot of the learning is in the making...don't cheat yourself out of it. Dwayne I think this says it all. After 15 years I'm still learning and relearning. Snake

contrary to popular opinion, even ontario shops out calls turned down to weather. Medics need to stand up for themselves and "refuse to be abused". Still, very saddened by this tragic news. Snake

I'm glad I'm not the only one that caught that, shameful act of "heroism". I don't know what was worse, the poor history on the anaphylaxis which apparently needed the use of a BVM after the administration of epi? I guess she was in extremes, what ever I began getting turned off quickly at that point, then let's walk the cardiac patient out to the ambulance....did they not bring the cardiac monitor to the back for the "short of breatch" patient but the above quote put me over the edge too. I don't think this promotes the profession and actually does a lot to take away from a lot of time and effort many paramedics have put into becoming very highly trained.....perhaps this is an anamoly of all paramedics and only reflects San Fran's medics or at least how they wish to be portrayed. I will not watch this ever again....two thumbs down. Jake

We pray the Lord brings people around you to strengthen you in your weak times and to walk with you in your struggles. You and your family are in our thoughts and prayers . Snake

I am sorry that you had such a crappy shift, I think the hardest thing to do is not take it out on those we love or those who call us for help. You did well reaching out and you received a lot of great support. All the best, Snake

I have noticed over the past 8 years that intubations have continued to go down and I think the numbers also go down because we become a little more mature and confident in managing the airway with other adjuncts first, however mine have dwindled to: 3 facilitated 2 of which were accomplished on second attempt 2 RSI accomplished on 1st attempt. An adjunct I've noticed that made a big difference for me was the Bougie, never had one until I went to the air environment, love it. and 6 intubations in the OR during CME 1st attempts each but all patients stable and healthy elective surgery. Snake

To answer your question of giving NTG without IV, I would say if that is the road you are persuing then yes, I would be comfortable giving NTG without IV. Her sysstolic is 110 and her map acceptable to give nitro. How did she respond to her own ntg, did she fall on the floor? Her chest is clear so if you need to lay her down because she drops her pressure you can do that. This stuff is not etched in stone, you need to think about what your trying to accomplish, take the workload off the heart, but , don't increase the MVO2 by dropping the pressure to far (risk/benefit). If it was her first time ever with NTG I would be more concerned with a possible pressure dump but....that's what they pay you to do, think. I would stay away from the MSO4 until having a line the concurrent histamine release might be more deleterious than uselful. In the end try to do the best you can for the patient like they were your own family. Out of curiosity, did you ask the Dr what they think about the NTG without a line? Snake

Hey there, this is very basic and I will add a file here in the next two days of a good diagram you can use as a visual learner. It takes some time to grasp the concept. remember whats in the cell and outside the cell in a normal homeostatic state. Na+: Sodium is outside K+: Potassium inside Ca++: outside think of a concentration gradient as a slide, so "things" slide down the concentration gradient from positive to negative. Phase 0: Na+ slides in Phase 1: Na+ lets Ca++ slide in Phase 2: K+ slides out Phase 3: K+ slides out (remember at about -70 mV the cell hits the relative refractory period where some cells will depolarize (VF?) Phase 4: Na+/K+ ATPase pump is very strong when supplied with energy (a body building dad) so it pushes his children Na+ and K+ up the slide ( Na+ now pushed outside cell, K+ pushed inside the cell...but he favors one kid, look up which one.) Sorry it's rudimentary I'll send a little better in a few days, this covers the basics for you. Keep this infront of you when your looking at your cardiac drugs and it will give you a good idea of why Lidocaine and Amio are used in ACLS. make the cell more positive, it has the tendancy to depolarize easily make the cell more negative, it has the tendancy not to depolarize as easily Let me know if this helps. If your more interested in pharmacology, I would suggest investing in Lippincott's it has helped me through all my education needs thus far. Best of luck Snake

I read someone spoke of ORNGE....don't hold your breath about the takeover and grand plans just yet....wait and see how it all plays out first. pay your pilots a salary not by mile or call and just ask them to do a weather check. Keep it safe.

Have fun, take a little time each day to study and realize none of us have all the answers. Good luck and congrats. Jake