Cardiac Arrest

[medic001918]

...most of them our the Ca Ca...

It might be poorly written but I can use the word weather in its proper context

That's nice that you can use weather it's proper context. Look up "our" and "are" in the dictionary, as the two words are grossly dissimlar. Looks like we're even, doesn't it?

Shane

NREMT-P

[whit72]

touche

[Punisher]

That's nice that you can use weather it's proper context. Look up "our" and "are" in the dictionary, as the two words are grossly dissimlar. Looks like we're even, doesn't it?

Shane

NREMT-P

Also learning a better way to express that someone is an outstanding medic than "most of them our the s--t" might be helpful, especially given the fact that you seem hellbent on rejecting evidence based medicine and any other opinion other than your own ideals, you should be on the mark with your posts- or to use language you might be familiar with "bring your A game, yo."

[Punisher]

Well, for one, yes, some it does have to do with lack of skill. But also, the fact that most intubations are done in a well lit operating room or even emergency room, and we medics get to do it in the ditch. Ever tried auscultation lung sounds in an ambulance with the sirens going? It isn't easy, sometimes mistakes are made.

But to use that to justify giving people a lower level of care is really just asinine.

Actually if that is a perfectly good reason to either overhaul the approach used to deliver a higher level of care- especially given that there is no concrete evidence that ALS provides any significant benefit to the patients, and there is some evidence indicating exactly the opposite in the case of advanced airway and ACLS pharmacology- or reduce the scope of practice. The former approach is likely more beneficial to all involved.

[whit72]

I am not rejecting evidence based medicine. I am just stating dont assume that everyone is competent to make decesions above their level of training. If you dont believe that you have your head in the sand. Maybe you havent been in EMS long enough to have witnessed some of the mistakes that EMS proffesional make. Whatever the reason is.

[Asysin2leads]

Actually if that is a perfectly good reason to either overhaul the approach used to deliver a higher level of care- especially given that there is no concrete evidence that ALS provides any significant benefit to the patients, and there is some evidence indicating exactly the opposite in the case of advanced airway and ACLS pharmacology- or reduce the scope of practice. The former approach is likely more beneficial to all involved.

Sorry, but I hold up the bullshit card. I agree that many of the practices in ALS need to be reviewed and backed up with concrete evidence, but the whole notion that ALS doesn't do anything and may even make matters worse is a myth, a myth backed up by frustrated EMT's hellbent on trying to explain why having a lower level of training helps the patient, really.

Give me a report that says advanced airway management in the field produces a lower patient survival outcome, and I won't doubt it. I'd like to see the methodology and the way the study was conducted, and think there are other things in play (i.e., ALS providers have a lower patient survival rate. Is this because the ALS doesn't help, or is it that paramedics work on sicker people who will have a higher death rate to begin with?)

Give me what EMS deals with, the 300 pound guy at the bottom of a 6 flight staircase who has a severe head injury with seizure activity, and tell me exactly how ALS pharmacology and advanced airway management is not going to be beneficial to this patient. Better yet, tell me exactly how you're going to ventilate him through clenched teeth without it.

[PRPGfirerescuetech]

Sorry, but I hold up the bullshit card. I agree that many of the practices in ALS need to be reviewed and backed up with concrete evidence, but the whole notion that ALS doesn't do anything and may even make matters worse is a myth, a myth backed up by frustrated EMT's hellbent on trying to explain why having a lower level of training helps the patient, really.

Give me a report that says advanced airway management in the field produces a lower patient survival outcome, and I won't doubt it. I'd like to see the methodology and the way the study was conducted, and think there are other things in play (i.e., ALS providers have a lower patient survival rate. Is this because the ALS doesn't help, or is it that paramedics work on sicker people who will have a higher death rate to begin with?)

Give me what EMS deals with, the 300 pound guy at the bottom of a 6 flight staircase who has a severe head injury with seizure activity, and tell me exactly how ALS pharmacology and advanced airway management is not going to be beneficial to this patient. Better yet, tell me exactly how you're going to ventilate him through clenched teeth without it.

So....you acknowledge that studies exist suggesting ALS airway management lowers patient survival outcomes, but you blame the theory on ALS makes matters worse on EMT's who are hellbent on jusdtifying lower levels of training?

Just playing devils advocate here, but it sounds like your blame is going in a poor direction...

ALS efficency - Literature review

ALS airway review

Heres a bit of research to start....concentrate on the latter study, good read and a rather reliable source...

[chbare]

Asysin2leads, good point. I will agree that anything other than 1mg/kg of divine intervention IVP will probably not help the person who has been in arrest r/t a massive MI or trauma, or the guy who has been in asystole with no correctable causes for 20 minutes. However, in critical patients that are on their way to code land, ALS and meds may very well be life saving. The head injured obese guy with a bad airway is a good example. Other examples could be that bad CHF guy with a long transport or somebody in a third degree AVB who is circling the drain. In addition, what about an often underlooked and undertreated problem? What about pain control?

Take care,

chbare.

[Ace844]

"PRPG,"

I hope you are also not discounting the evidence which shows paramedic/pre-hospital ETI-RSI is a much needed resource...Here's the study.

[web:9f20ecd849]http://www.naemsp.org/Position%20Papers/prehospitalintubation.pdf[/web:9f20ecd849]

[web:9f20ecd849]http://phtls.org/datafiles/GregChapman%20EndoIntoPro%202004Mar03.pdf[/web:9f20ecd849]

Hope this helps,

ACE844

[PRPGfirerescuetech]

"PRPG,"

I hope you are also not discounting the evidence which shows paramedic/pre-hospital ETI-RSI is a much needed resource...Here's the study.

[web:4e89829363]http://www.naemsp.org/Position%20Papers/prehospitalintubation.pdf[/web:4e89829363]

Hope this helps,

ACE844

Not at all, I dont really have an opinion on this.

There is quite a bit of evidence in both directions on this. Too many to form an opinion.

My thought is this. If prehospital ETI is being performed so poorly, and delaying door to door times, blah blah.....

....then why not increase requisite education exponentially to accomidate for the deficiencies?

Seems like every study performed that shows a skill being lacking doesnt turn out to require further education being needed, they just want to take the skill away. Seems silly.

Just like everyone thinks BLS education sucks, so they want to do away with BLS. Instead of increasing education exponentially to accomidate for the deficiencies....but thats for another thread....