Leaderboard

Ah the fledgling RRT ... Oxygen absorption micro atelectasis, EXPLAINED, nicely done. Funny we (EMSers) throw everyone on O2 then only to start weaning them off as soon as we introduce ourselves as RTs or as Vent medic states "titrate", got to love it and with newer studies in regard to treatment of CHF maybe down the road this will become a household EMS concept ...one can only hope.... Oxygenation can be far more complex than just looking at a pulse ox and with the now introduction of A/a Gradients ... hey don't hurt anyone Vent ... Oh in passing wtf in the reputation department ... I only warrent a 2 ...sniff

It's on again... http://med.wright.edu/em/caplab/ Dayton OH at Wright State University. It is our 4th annual Cadaver, Anatomy, and Procedure Lab for EMS (CAP Lab). It is an all-day (one day) seminar on cadavers, live tissue, and simulators covering a variety of topics, held on Dec 9 and 10. We are offering it for $35 to EMS providers of all levels, and it's good for 6.5 Cat 1 CEUs. The Lab starts with a 45 minute lecture and anatomical review. The students (usually about 100 per day) are divided into groups of 10 to rotate through several stations, which are all taught by residents and faculty from the Dept. of EM as well as PAs from the EM PA Fellowship at WPAFB. Students get to practice procedures as well as get hands-on with the cadavers for close instruction. Stations include: Surgical airways Rescue airways Field amputation Tactical/battlefield medicine Neuro, with cadaver brains Cardiac, with cadaver hearts and EKG review Cadaver airway, chest decompression Vascular access Chest and abdomen anatomy Musculoskeletal anatomy Website: http://www.med.wright.edu/em/caplab/ When you register, put EMTCity and your username in the "comments" area. Registration is not open yet, and I will post here when it is. Attendees must register to receive directions and important info, including disclaimer forms. Email address is on the website if you have any questions. Slots are open until they are filled. No, you can't stay at my house. With any luck I'll be teaching it again if they let me out of Iraq in time. From last year: http://www.emtcity.com/index.php/topic/13528-cadaver-anatomy-procedure-lab-for-ems-dec-3-and-4/page__st__140 'zilla

We will sometimes do O2 by SpO2 and titrate from there unless there are other immediately obvious factors. Short term O2 should not present a problem. Quite often that STAT ABG upon arrival to the ED will reset the breathing or be enough push them over the edge. Either way it gets "results". I just make sure they are on the stretcher when I poke them. The presenting SpO2 and symptoms did warrant oxygen. A 24 y/o with the initial SpO2 of 89% would deserve a closer look regardless of what emotional issues were going on. The drama is important information but the onset, length and presentation should be emphasized more than the nitty gritty details. Too many distractions can skew an assessment which is why I do fault the RN here for assuming without at least a closer look. O2 can be titrated as the symptoms and vitals stabilize. However, allowing a patient to remain with a low SpO2 could be worse. I have also seen patients with an SpO2 of 100% on a NRBM come back with an A-a gradient of 300+ mmHg and get intubated. Hence, the reference to the flu and the PNA associated with it.

Yes and no. If you are unsure, I see no problem with a cautious approach and supplemantal oxygen. However, sustained exposure to high fractions of inspired oxygen can lead to problems. You can have nitrogen washout and collapse of the alveoli, you can have damage to type I and type II alveolar cells, and even free radical concerns. Therefore, I can see your point; however, health care does nor stop at the door to the ER. Therefore trying to look at the big picture is helpful. Take care, chbare.

Hey guys, we also need to appreciate the difference between oxygenation and ventilation. Putting somebody on a non-rebreather is not going to change their carbon dioxide. Talking about chemoreceptors and respiratory center activation, we need to realize acids typically tell us to breath. When you hold your breath, the urge to breath is due to carbon dioxide levels increasing. Therefore, I cannot see any harm in the short term by placing a person who is breathing rapidly on a NRB if we are unsure of the cause. However, assuming hyperventilation syndrome is a dangerous mistake without solid evidence to back it up. I have seen many anxious diabetics in DKA breathing rapidly to compensate. You assume a rather benign condition and have them breath in a bag, you just opened a big can of fail. Many other pathological causes can cause "hyperventilation" and must be ruled out. ( overdose, pulmonary embolism, trauma, metabolic acidosis to name a few) Take care, chbare.

I know this is against my typical posts to this thread however, out of fairness to the actors I'm going here. They can't change the character they're given. If that's what NBC what's, that's what they'll get. Money talks much more to the actors than a bunch of rioting EMS workers. This is how they make their living, just as patient care is how we make ours. I'm not saying that makes the characters right, nor does it make them accurate. It just makes them what they are. It's kind of like the medic that works for two services. One service allows them to be very liberal in their treatment, the other is very restrictive. When with the restrictive service, they have to work to work according to what the script reads (ie protocols) even though they may want to do something different that is outside the protocols. The same applies to actors, they have a director to answer to as we do our med director. If they don't perform to expectations, they quickly find themselves looking for another job. I do have pity on the actors in a way as they have been given these scripts and told they are accurate or that's what they want. They are probably like much of the public and didn't know any different. I don't believe either of the female actors said "oh, oh make me barbie medic or the porno pilot". If they did, well that's an entirely different issue. However, I'm hoping to believe that's simply the plate they were served and expected to eat. If they didn't, they wouldn't scrap it, they'd just serve it to someone else. I wouldn't be suprised should NBC pull it from their line up to relocate it to one of the cable channels as they have a few other shows. One can only hope the characters are developed more than a damaged medic, a barbie medic, and a pilot that to me seems confused as to what she is. Has the potential to be a good show if allowed to be, otherwise I see it joining the ranks of Saved in the scrap bin. You don't have to have everything perfect, but people expect more in a show that just blowing up lots of stuff and sex every show. That gets old quick and won't survive. Give your characters more of a personal story and interaction, couple tweaks here and there, and you could have a respectable show. Good luck NBC

I am down a perky point - where's my corner I can go cry in? Somebody didn't like me, what did I do? Maybe if I went into my next shift with my uniform down to my navel my points would improve. You think?

I, at first, was influenced greatly by my big EMS siblings. The common consensus, in a nutshell, was that suicide attempts got what they deserve and that it is only the great intangable governing body Ethics that causes one to set their opinions aside and treat the attempt. As I have gained my own experiences I feel I have earned an opinion of my very own. Excluding the B/S suicide attempts, you know the chicken scratches on the arm or the threat over the phone to mom, girlfriend etc.... the 3rd party call to EMS that don't amount to any distress what-so-ever. Those burn a person out I agree. I mean the guy you find that is really dying and doesn't want you to stop it. There must be something big going on there. Think about all of the impending doom expressions you have seen. That is a fear like no other. In general, humans have the same drive to survive when it comes down to the wire that all other animals do. Mice don't give up when the cat has obviously won. Yet, in a small percent of people a drive stronger that sex, stronger than pain is bypassed, or overridden. How does one lose the will to survive? Its a bigger picture than sad, pain, or weakness. How many cancer patients have you seen hold on to the very end? What a horrible why to die. So pain isn't it. Long before the the life experiences that EMS has bestowed, my dad attempted suicide. It didn't work and he recovered to return to his existence as a very depressed alcoholic. Their was the opinion proposed to me that it was for attention. Maybe. I'll never know. He had passed about 10 years ago from ETOH abuse. I was taught that having a parent that committed suicide increases the risk in that person. A long time ago I too had to be treated for ideations. No attempt, I was close, but it was real to me. I have made great strides in treating depression, I even gave up alcohol before it was a problem. To this day I cannot fully understand what was happening in my head. I can give you a first hand account of what its like, but answers I don't have. I know that attention was the last thing I wanted. I don't recall any behaviors that could be considered a "a cry for help". I was obviously depressed, but not obviously social. I had a counselor at the time, I knew how to avoid a 72 hour hold, and I did. I went to the hospital on my own accord. But what if there was some hang up about going to the hospital. I know I had a lot more excuses to not go than to go. I'm not sure how that day went but I ended up treated. The point is, its old and out dated to say one has right to kill themselves. I am telling you from experience that, if you have a patient that is a serious case there is something as wrong as an MI. Psychology has progressed far enough to show as that it is possible to have a mind so disrupted that one can kill themselves despite will to live. At that the moment just before they end their life there is no "impending doom" no fear. I reconsidered but was not afraid. I don't know why. I challenge every EMS provider to ask themselves if they haven't "what if I'm looking at this wrong". Illness can be psychological as well as physiological. There is something that I can not explain that goes beyond selfish or weak.

With the upcoming flu season I've been thinking about things we do that become high risk when dealing with droplet transmission illnesses. The preferred method for Ventolin (Albuterol, Salbutamol, pick your favourite name/brand) administration is via nebulizer in most services I'm aware of. This becomes problematic when dealing with a suspected H1N1 patient due to the nature of how it's spread. This doesn't mean that we should fail to treat these patients however. All that said, I began to think about the possibility of IV Ventolin administration. Thus far the downsides found in my recent searches include greater risk of tachycardia, hypokalemia, cardiac dysrythmias, and elevation of BGL. Does anyone use IV Ventolin in their service? If so how effective has it been? What has the prevalence of adverse affects been like? Any links to relevant research and studies are welcome.

Hey all, One of the guys I work with is a fire medic and we got into an argument this morning concerning Fire and EMS. My argument was that most of the times that EMS has attempted to make a run at creating an entry level AAS for paramedic medicine that Fire has consistently opposed it. He claims that this is nonsense, that the fire unions are pro education and responsible for many increases in EMS education. I'm looking for articles, as I know I've seen a lot of them, to support my argument that Fire consistently stands in the way of increased education in EMS. I have no doubt that both arguments can be supported, but I am looking for support for mine only. Though I would be interested in seeing another thread to support the opposite if possible. It is not my intention to start a flame war here. I have many, many friends that also happen to be infected by the Firebug. This is a good natured argument between a medic I respect and myself and I simply want to smite him in a good natured way. I simply don't have the time, or the mad Google skills to do so on my own in short order. I'm asking as a favor that we avoid having this thread locked by keeping it in that spirit. Thanks for any help you can provide. Dwayne

What a great thread! Can you expound on this more, especially the iatrogenic PEEP? Wouldn't alveoli collapse from N2 displacement followed by a return to indadequate TV or at least high deadspace? Alveolar cell damage? Can you explain this further, especially the A-a gradient?

There ya go buddy! Cheers! Take care, chbare.

Agreed, I like how you explained that and laughing .. the old paper bag kill them trick MAJOR RN FAIL. Carpal spasm more correctly (just showing off is all) The OP presented/ painted the picture in Technicolor and with SpO2 of 89% on FiO2 of .21 then O2 admin is required asap, no questions asked, it certainly sounds as if Hyperventilation Syndrome (er increased deadspace ventilation due anxiety) was the underlying patho here .. but these days we should not ever rule out recreational drug use(cocaine or meth) or even excited delirium to this presentation, yet another differential dx could be Central Neurological Hyperventilation Syndrome from the early onset of an inter cranial bleed, and with DOA ie drugs of abuse on board then having an MI associated, yes even at this age this should NEVER be ruled out. Late edit Ventmedic/ chbare "tachypnea" more susintly, dang always a day late and a dollar short with you guys .... YES the RN should be treated for cranio rectal inversion, she knows zip (bitch slapping sounds overheard)so use the info provided to open a dialog and discuss all presented here. Now on to my bro LS ... JPINFV is quite correct there are 4 factors that affect any mask or N/C delivery, the concepts they teach about the concentration and flow in differing delivery devices are JUST optimal and just in the books, Unless one exceeds the patients minute volume by 4 times your kidding yourself that a NRB is actually delivering what the books say, or by definition NRM is a high flow delivery system ... I am going to make a RT out of you guys if it kills me ! The major drive is NOT hypoxia its CO2(argh as already stated) ... unless documented with ABGS and that is only 5% of KNOWN COPD ers....in this case the drive was higher up like frontal lobes anxiety or drug assisted. Criteria for optimal delivery for Masks or N/C. 1-RR less than 28 2-properly fitting mask (as if the reservoir bag ever collapses with one size fits all) 3- RR is regular. 4- Ok I forgot but I know there is another criteria. ps in passing did you know that 15 liters per minute on a BVM can actually cause iatrogenic PEEP, and lead to Dynamic Hyperinflation and dump a intubated patients BP ... ok enough of that, but the point being you want to deliver 1.0 Fio2 ...use a BVM, talk to your patients and watch the reservoir bag ...if its not deflating a bit your wasting O2 bottom line and could be causing some more issues. cheers

As far as the chest pain is concerned, I personally, in my own mind, felt as if this chest pain was secondary to the tachypneic state this pt had been in for nearly 15 min. Pt wife states that he has no med hx, w/nkda, and does not take any prescription medications. Sounds kinda lame I know, but he has no medical problems. Throughout the day though, the wife states she started accusing him of cheating on her with someone who works at the hospital. She states that he was getting angry throughout the day, and that he did have an earlier episode of this rapid breathing, however it lasted appx 2-3 minutes, and he was crying and very emotional when this happened prior to. She was able to calm his breathing verbally. She states that he walked outside after she suggested that if he wanted to get angry with her, that he should leave and go talk to his "girlfriend". Once he was walking outside he started breathing heavy and it turned into what was present when we got on scene. Vent, I was anxious to hear your response to this, for no other reason than I like the way your responses are worded. I had read those articles prior to posting on here as I was trying to find this out through my own research. However they dont state how the admin of o2 is bad in strictly a hyperventilating pt. As far as the other etiologies of tachypnea, one would think from an EMS point of view, that they all deserve o2 admin correct?

Umm ..... OUCH .... I guess when your standing in the sunshine your bound to get burned a bit. You make some good points: I too believe that any PR is good PR ... I have spoken with others in the medical community and because generally speaking because of the "hype" generated this has increased the viewers just to see for themselves. cheers

Too bad I can't point you there terror. Hmm go to work naked? That is an not a viable idea. However, unless one of my coworkers is running around on here in hiding I don't believe any of them would be entertained enough to give me any points - you never know though....and as for the gun - these boys know I can shoot. I was taught by a good one and went shooting with them before and well, let's just say I have good aim for a particular area I do believe they are aware don't mess with this southern girl !

I am beginning to believe this show did such an overboard production with the first episode just to get attention. The second was not as ridiculous with some things toned down but enough over dramatization to keep people talking. This may be just part of their strategy to get viewers. How many have viewed the links for the show just to see what all the fuss was about? Who would have cared if the show stunk or not if a few big organizations hadn't got involved and all the forums hadn't been discussing it? How many bad EMS shows or shows with an EMS character (The Listener) have come and gone? Rescue Me got some of the same reaction when it debuted. The first few episodes really upset quite a few viewers, both FFs and the general public, who had placed FFs on a pedestal after 9/11. However, the characters and story lines are now strong enough to stand on their own with the fire station just being a place they happen to work and the show is not about fighting fires. If Tommy left the fire department his life's drama is still a decent story for a soap. In fact, those who want to see fire fighting are probably disappointed as that is no longer the emphasis. Those who get hooked on soaps do love this show. The title, Rescue Me, is also appropriate as it can imply FD and it can apply to the emotional turmoil or roller coaster each character is on. Will Trauma and its characters be able to pull it off? I personally don't think the actors in this show are strong enough to pull it off. As far the blonde, if a woman is going to do justice to the role of slut, she should have the beauty, class and some acting ability to do so. Rachel Welch managed to do that nicely in Mother, Juggs and Speed. Even if her acting ability was not always the best, her class made up for it. The blonde on Trauma has neither the class nor the acting ability to represent even the women in EMS who might be on the low side of professionalism.

I use a spray/cleaner on the stretcher and any other equipment I used, even my scope. If there are fluids, then they get a more thorough cleaning then a simple few sprays and a wipe. The floors get mopped with a cleaner and other surfaces are cleaned with cleaner. Once a month or so, this is done as well. I like my ambulance to have that hospital smell. I work back there, my coworkers work back there, I treat patients back there. My safety means a lot, and I like a clean area.

I watched House a few times, it was mildly entertaining. Every episode was the same. Same structure in the plots, same type of scenario. Every rare disease comes into this hospital, and he figures it out at the last minute every time.. *yawn* Never watched Greys Anatomy, or that other medical show that I can't remember the name of. But seriously people... IT'S TELEVISION, and it's entertainment. You can't really expect everything to be factual and realistic. Given, terminology should be correct, and basic operations should be as well. But for the most part, you need to kick it up a notch and create action, drama, and conflict for ENTERTAINMENT. It's not a learning show.

Was she hot?

I wasn't sure if there was a market for PT flight RN's/medics. I got on at Fairfax at age 32. I'm currently 33. Normal service retirement is at either 25 years of service at 2.8% (approx 72% of average three highest earning years minus OY), or age 55, whichever comes first. One can work in excess of 25 years to increase the multiplier, resulting in a near 100% yearly payout. I plan to work a total of 23 years, which will occur when I'm 55, and then do three more years in the DROP, to maximize my retirement. I'm currently living in Garrisonville in Stafford County, just below Quantico. I'm going to meet with the FRD's career development/education coordinator next week and see what we have set up with regional universities/colleges. I'll check out your leads as well, of course. Thanks for that. I worked FT + an OT shift each week on average while going through my 13 month medic program, which was two 8 hour days per week with 16-24 hours of clinicals, flexible. The material wasn't anything as intensive as the RN or RT curriculum, I'm sure. The FFM job + OT will keep us comfortable, so completing the Fire Science dergree first may be the best career wise, especially if you're only meeting once a month. Tackling an RT or RN program head on should be easier on a Tech or Lt salary, along with an ample amount of leave available. The RN or RRT licenses interest me greatly, but can be deferred if the curriculum creates too much with my current schedule and relative lack of leave in the bank. If it works out I'll do RN or RT first, but at least I know that I can do the Fire Science degree in a much more career friendly fashion at first. I also want a fallback with RN or RT if I go out on permanent injury, or to segue into FT post retirement. 20 credits is a full plate, I'm sure. Keep up the good work! FRD is the Fire rescue Dept, Fairfax County to be specific. NSLIJ is the North Shore Long Island Jewish Health System. I worked for their Center for EMS, which does both NYC 911 and IFT. The DROP is the Deferred Retirement Option Plan http://benefitsattorney.com/modules.php?name=Content&pa=showpage&pid=17 WOWOWOOOO is my work rotation. Each character represents a 24 hour block. W=work, O=off. Everything clear as mud? Thanks again. It would have been way easier if I was still working at NSLIJ, where they are willing to accomodate a FT school schedule with a workable shift change, as long as your intended degree would benefit the Health System. I had to go with the FFM position over staying in NY to pursue a degree (or several). This made the most financial sense for my family and I, and I can still fufill my degree aspirations. It'll just be a little more taxing. If I decide to go RT, I'll go all the way. Money won't be a motivating factor in this anyway, so why not take the time to attain the highest level possible? I suspected as much.

I always wipe up anything that's obvious, maybe every surface gets wiped down twice a week, at least once. Now if the patient has flu or respirator symptoms, I wipe it down before we even leave the hospital. Doesn't take that long. We're not that busy. Biozide concentrate mixed into smaller bottles, is my preferred fluid. The cot, scope, cuffs, I wipe off with SaniDex after every patient. The ceiling bars, door bars, etc. We have one of those hand held steam cleaner things like you see Billy Mays advertise at 3am. But instead of just water, I pour in the Biozide too. So, it's like a bunch of birds, with one really big stone. The floor gets cleaned with Spray Nine because I like it's pleasing odor.

I'm a little disappointed that I didn't get the lead role though.

I've been wanting to make one for a long time, but am too computer challenged to do so. Props to NickD, because this was absolutely the perfect timing to make one!

OMFG! That's awesome!

Sorry guys, had to do it . . .

Sometimes you are merely checking for the presence of breath sounds. In such cases, sometimes (depending on the patient), environmental factors may make it preferential to auscultate through clothes if you can (you can do the real auscultations in the ambulance). EMT-B's especially are rarely well trained in identifying breath sounds anyways. Overall, yes. Big problem in EMS. (especially failure to expose for trauma... I've seen chest trauma treated as an AMI when a simple shirt lift would have showed massive contusions.

Urban EMS Medic here! Busiest 14hr shift-Halloween 08/Baseball team world series parade party...I think 26 or 28 runs Busiest 12hr shift (sch change)-around labor day weekend 20 runs 50 ALS/BLS AM 35 ALS/BLS PM Average "incidents" per day including 20% FD 700-900 My unit was 7th busiest last year and did 6,400 runs and were probaby going to break 7,000 this year.

Not being harsh here, but once you realize it's no good get the heck out. Sometimes you don't know what you're going into. Sometimes you do. If you go stupidly into something with no cops that has a real chance of getting you hurt, then no. If you end up in a scene that goes bad, get out. I've had two friends of mine (same call) that started off routine and went downhill quick. One was shot and killed trying to run to behind a tree for safety. My other friend and former partner was shot in the head - lucky it just grazed him hard. Perhaps that's why I feel a bit differently than you Dust, perhaps you've had similar and still feel that way, I'm not sure. Maybe this is one we just have to agree to disagree. No one said they weren't athletic. Heck there are pole dancing classes for workouts and they're challenging (not like I would know). And I have known a few that used it to get through law/medical school as well so no one is calling them ignorant. What I am saying is they have no place coming to work like that. The two former pole dancers that I knew - you would never know unless they told you or you were privy to their "off" time. At work, they were very respectable, classy, ladies. These two bimbos on the show could do well to learn from that. Leave the stripping for the stage or the bedroom.

The first inclination of the kinder, gentler Dustdevil was to leave this alone. But then I noticed our friend lurked here for over four years just to make that first post. Seriously? That is what finally brought you out of lurking?

Florida and a few other states do have separate licenses with some differences in scope. CRTs don't always get to work the ICUs or do any of the "fun things" nor are they accepted to transport or ECMO programs. Rumor has it that California might finally do the right thing and only license RRTs. That would be great since CA was well known for its RT mills in the 80s and early 90s. If the legislation is passed that the AARC has been working on, the Bachelors program will become more prominent. The RT profession didn't wait for a mandate that they had to get a college degree in their profession. The RTs and employers just starting accepting it as the norm long before the legislation was passed for the 2 year degree. It was sorta common sense to see where a "cert" was not enough in the ICU just like the LVN. Now the 4 year degree is going the same route as more people are getting it to stay qualified in this job market.

My nursing clinical experience was not flexible. We had practicum on Tuesday and Wednesday. We had 16 hours of practicum a week and another 4-8 hours of pre-clinical work per week. The exception was labor and delivery where we were on call and had to continue the rotation until we did a delivery. My RT clinical experience will not be flexible either. We have practicum on Monday and Wednesday, with the exception of the summer session which is about 10 hours a day for five days a week from what I have been told. Vent pretty much nailed the other concepts and would be a better resource if you consider the RRT route. I would not suggest settling for CRT if somebody tries to persuade you to take the shorter route. With increased competition and focus on critical and special care, the role of the CRT in many places is going away. Go RN or RRT and if you have a BS program close by and get accepted take the opportunity. I wish there was a BS program in my area. Take care, chbare.

FDNY EMS Command, with the hospital based additions, and the subcontracted ambulance providers working for some of the hospitals as a part of the NYC 9-1-1 system, handle roughly one point three Million calls a year. I suspect that when the year 2009 ends, the new total will probably be closer to point four. I still believe for "Braggin' Rights", NYC may still be the busiest 9-1-1 EMS response area in the US. I yield that London, England, might be busier, on the international side. When I first started in municipal EMS in NYC in 1985, I signed on at 3 PM. If there were more than roughly 1,500 calls in the Computer Assisted Dispatch system, we'd had a busy day. Nowadays, by 3 PM, we're already past 2,000 calls. I am unsure of the figures, but I believe we handle about 3,000 to 4,000 calls each 24 hours, with exceptional events, like the blackout, spiking the numbers upwards of these numbers. I am of mixed thoughts of newbies coming into the FDNY EMS Command, talking of their home agencies being "busy", with 10 to 20 calls a week, as I don't know to pity them being eaten alive by the NYC call volume, or envy them their down time between calls back home.

I would keep an eye out at Montgomery College's website over the next few years as they are doing a lot in the way of a paramedic program and since they have a pretty good nursing program they might offer a bridge. The nursing school is located in Takoma Park, Maryland, which can be a little bit of a hike from Fairfax (not sure where you live). I'll shoot an e-mail to the program directors over there and see what they are thinking in ways of a bridge course. Montgomery College does however have a great Fire Science degree with one of the classes taught (last I heard) by our Chief Richard Bowers. The fire science course I took through there, equivalent to Officer I, met about once a month and almost all of the work was online. We had a career MCFRS member go through the course. Something to look into. I can not speak much to RN vs RT but I am a full time nursing student and just school alone (20 credits) is really kicking my butt some days. I just pulled an all nighter and I wish I could say it was my first of the semester. We have one woman in our class who works full time as an ED tech and she is barely scraping by with passing grades. It may just be the program I am in, but something to consider. A full time schedule anywhere is the equivalent to a full time job in my opinion and depending on your social life, may be hard to keep up and still do well. Best of luck to you and don't hesitate to PM me if you have any questions about MC's programs. I know both of their department heads and they are fantastic people and paramedic volunteers in Montgomery County.

40 minutes until strike two.

Strange, I just sent one in before I put the link here. Maybe I made them cry with my comments...

That 5 week ventilator course just introduces you to what a ventilator is. The following semesters apply what you learned from that course to the courses for introduction to critical medicine and bring it all together later. You will also get a semester of specialty ventilation/critical care theory for Peds and a semester for neonatal. As well some programs may have electives in HBO, Cath Lab and ECHO. I did all three because I just couldn't get enough. I also repeated Cath Lab later when I did my B.S. in CardioPulmonary just to see how another center known for caths did it with technology. The first was in the 80s were we still did all the calculations and manual drawings. It is difficult to have a flexible schedule because the clinicals may actually be monitored by physicians along with the clinical educators. Most of my classes, especially ath the B.S. level, were taught by physicians. Nursing of course can have more opportunities but the RRT can have many also. I can travel on short or long assignments in any state I care to get a license in. I have also worked PRN as an RRT most of my career as a FT Paramedic. For specialty programs such as Neonatal, they did require a serious commitment especially if you wanted to work at a higher level of competency and be on transport. RT is a very active profession politically when it comes to lobbying for benefits for the patient and the therapists. The benefits for the patient includes home care payments from medicare for extended services. By that, whatever benefits the patient gets it helps the RRTs' future. But, the patient is always emphasized first which the profession took notes from NPs, PTs and PAs in that areas. They didn't use the "me, me, me" approach and have managed to make great strides in the past 20+ years. The biggest thing against the Excelsior program is the clinicals. You really need to know basic nursing skills and time management. Few RNs precepting you will want to talk you through gait management and the various lines when there are so many other things to learn about the facility. The clinicals also allow you to network for a decent job.

You could definately do the PRN gig in nursing in almost any specialty, however I cannot speak intelligently of the RRT field. All of the RRT's I work with on the neo team are full-time, but Vent would be a great resource for that particular question. the problem isn't so much of working when convenient, but more getting to that level. As chbare states, the education is a full time one, regardless of the field. Excelsior will not prepare you for the field clinically, they expect you to come prepared. Nor does their program adequately provide the delineation from medicine and a strong foundation of the nursing process. That is the reason why many State's are thinking twice about licensing their graduates and why a good number of Paramedic's fail the CPNE. Even in an articulating students or transition program, you have to dedicate the time for class, skills, and clinicals. Can you get creative with your schedule? Sure! Will it take its toll after a while? Probably! I'm working fulltime at two jobs plus taking a 12 semester hour load. Quite honestly, it is kicking my a$$. But I have the determination to see it through this time. Having communicated with you in multiple threads elsewhere, I could see you getting it done as you have a passion and motivation to succeed. I'd say do it! In reference to working in the flight environment, I would strongly recommend becoming familiar with the height / weight restrictions of the agencies you are interested in. Many have a 220 - 225# weight restriction wet, meaning with suit / equipment / helmet / etc. Many also have height limitations as some of the smaller single engine airframes are not so accomodating to you taller types! I know I was tight in a Bell 206 and I'm only 5'7"!

Just for being spenac. Good point, conisdering I got one point for my -5 to spenac and you got -1 for your above post. I guess I shouldn't say anything else about spenac, since he has more points than me.

I've got to agree. By getting the sugar up you've won the battle but not the war. The important thing here is, why are they hypoglycemic. Most pts don't require much more of a workup but there are those that do. I feel it is completely inappropriate/malpractice to make someone sign the form. If they don't want to go, that is a different situation.

Post of the year. Too bad that way too few will get it.

I think the obese partner puts me more at risk than a person using meds to control depression. If the meds do not make the person drowsy or otherwise adversely affect them there is no reason they should not be at work. As with any med you need to be extremely cautious when you first start it. So many conditions can and do affect people. Some are short term, some life long. If any changes occur with any partner pay attention, if a danger to you and your patient have them leave. Give them the option to leave on their own and if they refuse then have them removed.

I like the system as long as it is for good posts not just people we like.. Maybe there could be some sort of reward for if you reach 100 positive points? Like a t-shirt or a month of premium membership? An incentive for people to post quality posts. On another note... Thank you for changing the way the status messages show on the forum threads. It is a lot easier to read

If you have to use an IO, you have poor IV skills.

What is with all the over inflated ego's and people walking around high on there degrees that have yet to realize it's just TV! Dustdevil I have no idea what 9/11 has to do with my comment or this show, but I'm not surprised some type of silly comment would come from you.

Straight out of Compton . . . "First In" A mix of fire and EMS. What's an ambulance operator? Full Episodes here: First In NickD

Umm... how bout using a new neb each time? What's the problem here? IV ventolin? For respiratory? Sounds less effective and more dangerous...

I'm thinking the only way to make it through watching this CRIPE is to turn it into a drinking game. Every FAIL met with just a sip. But be careful. Don't get ETOH poison.

how should I start this? hum.. I wish it was really that exciting as depicted by the screen writers. Real EMTs' don't let their cleavage hangout, the unisex uniforms don't look that good on anyone! They didn't even break a sweat while doing FAKE CPR. Whats up with "I wanna try the atropine, to see if it will work"? And I didn't know flight crews were allowed to transport family members and enlist their assistance. Where'd the 3rd crew member go of the flight crew? Illegal sedation of the flight patient, who was A/O? Well we could go on and on, but as professional EMTs, my partner and myself could hardly stomach the extreme load of BS. We've never seen flight crews behave unprofessionally. What's up with the giant gray headsets worn by the street medics? And where in the heavens did BLS and the FD go in the tanker scene? The staging was completely WRONG. They were never there. Maybe NBC should hire some REAL EMTs to help out the ignorant writers of the show. They portray our profession very badly, and make it look like a big action movie. Where are all the obese people at that we lift out of the 2nd and 3rd flrs. of the houses? I'm talking over 300lbs. plus. I guess the "San Fransisco" area don't have obese people. Honestly, how many EMTs and Medics do you know that are physical fit and in shape that do this job full time for over 10 years? That don't have any health issues or surgeries for weight loss? Bringing Out The Dead's, John Goodman and Nicholas Cage, did a hell of a job!!!!!!!! Why don't NBC bring them on the script? too much $$$$$$$? That's it. For my rant. Thank you all. Gotta getta frequent flyer. Have a quiet night!!!! 10-7 on time. reposted from video page by me

Rectal D50 is appropriate,you do not need a protocol in my opinion, but if you feel you do, by all means do so. The IO is to IV skills what the EGTA or Combitube is to Intubation skills. And I did not make any statements about literature, I believe that quote was attributed to me by mistake chbare