Leaderboard

Dust forwarded this video. IT IS SHEER GENIUS. What a great way to vent frustration and identify an issue. I have told everybody to boycott the trauma show and A.J at JEMS is doing the same. I have emailed the link to everybody I know and they love it. I could not resist the chance to send the link to Randolph Mantooth. He'll laugh his ass off. I'll let you know what he says (he loves this kind of stuff). Again, sheer genius lurks somewhere in the confines of this list. Thanks for letting me in on it. Bryan Bledsoe, DO, FACEP P.S. There is an "E" at the end of "Bledsoe" (e.g., Drew Bledsoe). But, it's all good.

HERE YA GO! EMD flip cards (50 of em)! http://www.state.nj.us/health/ems/documents/guidecard.pdf

Recently I sat down and was looking at the amount of unity that is had between the vast majority of EMS personnel over trauma and how we are complaining about it. It made me wonder - why do we think it is so important to unite and picket a show that in reality probably won't change much of the public's perspective about us. However, when it comes to an important issue that will affect the future of EMS we become so divided as everyone goes my way is best. We wonder why we are not taken seriously, and I think this in itself proves why. We come together to bicker and complain like little children, but when it comes to important matters we divide. Perhaps if the reverse were true or we learned to all come together as a profession to push for better recognition and to be seen as professionals then it might happen. If we can get NAEMT and JEMS and the other professional organizations to stand up against NBC for inaccuracies in a show, why can we not get them to stand to help us progress the profession? Just some thing to think about.

I've said this in several different threads, on multiple topics- there is no universal answer to the problems in EMS, so a "compromise" is really not possible. Look at the attitudes here- volunteer vs paid. Fire based EMS vs 3rd service, single role vs cross trained- everyone has their particular niche they want to protect or one they pick on. What is a huge issue in NYC may be irrelevant in Chicago, or SF, so it's not even an urban vs rural problem. Pay scales vary widely, depending on who you work for and where you provide care. Some folks live barely above the poverty line while others are making quite a comfortable living. In other words, there is no single issue that we can rally around, which makes things like political action difficult. I don't know what the answer is, but I think we are at a crossroads in EMS. The push seems to be for fire to absorb EMS, and too many times, the group that loses out is EMS- as well as the patients. I think that single role providers are being pushed out in many areas because of budget issues. From an economic standpoint (from a management perspective) anyone who can perform multiple tasks is the wave of the future. It is more cost effective, less complicated from a manpower standpoint (one person can perform multiple roles, depending on the needs of the day). The bottom line for municipalities is $$, and anything that costs less will be embraced. One of the favorite buzzwords of planners in recent years is "interoperability", which essentially means multiple diverse agencies need to play well with others. It also means we have turf wars and power grabs- nobody wants to be seen as irrelevant or nonessential, and groups like the IAFF have millions of dollars to play with. They can promote their service- even while fires are down, and because they have established assets and manpower, it's easier for them to crank out a few EMT's or medics from an EMT mill to keep their manning and justify jobs. Fire understands the need to tap into something that generates revenue to stay relevant and keep staffing, so the logical solution is to go after EMS. EMS does not have the numbers, organization, national recognition or power structure to absorb fire departments. Notice nowhere did I mention what is best for the patient- that is the least of a city manager's concerns. As long as SOMEONE shows up, they are happy. "Hey look- we have 5 people and a fire engine here to provide care for you!" They never explain the level of training or skills of those 5 people- it's all for show.

If two sides are diametrically opposed, compromise is difficult, no?

I didn't say anything about a pulse ox. I personally avoid it's use, b/c I don't think it works properly. If it does.. Even at rest and perfectly calm, I'm tachy. Maybe the end is near? Oh well. Anyhoo, Dog in a car, is what I say when I tell noob responders to open and sit next to the curb window, for air.. when they're getting motion sickness. Kinda of like a dog sticking their head out the window of a car. We were taught to use a plain SCBA bottle, with no fittings, just an open valve, to ward off nasty dogs to get at patients. Blowing in a dogs face, either pisses them off - or they run away, but sticking their head out the window of a car apparently makes them feel good. As fresh air seems to cure ride induced nausea, since sea bands clearly don't work. Dog In A Car, Theory. I didn't mean hot day suffocation. I'd have said head out the window theory, but then you'd be blaming me when your partner got decapitated by a road sign.

Praise from Dr. Bledsoe is praise indeed . . . I just came home from my first day of Paramedic Prep at Daniel Freeman (UCLA). And of course the two textbooks I received both have Dr. Bledsoe's name on them. It's been a big day for me! Thanks, Dust, for sending him the link. And thinking about Johnny Gage from "Emergency" looking at something I did, and maybe having a laugh, is the absolute cherry on the cake! NickD

Agreed, although parody is a required taste. I am a huge Monty Python fan as some here can attest to. Not everyone gets it though. Personally, I laughed my ass off at Nicks video! Thanks for offering your perspective Dr. Bledsoe, as always it is greatly appreciated.

I had a 4th year student from COMP in the ER last week doing his EM elective and was quite impressed with him. The students from that school in California seem quite good (at least in the ED at UMC). It's called parody. Month Python made their fortune doing it.

I have never seen Gray's Anatomy (but my daughter loves it). Some of the medicine in House is pretty good (although everybody gets a brain biopsy). First, Princeton does not have a hospital and a team of diagnosticians sitting around waiting for zebra cases would be quickly unemployed. But, the diagnostic decision-making in house can be OK (most internists could not do the microscopic work that occurs on that show). But, in the real world, despite House's apparent genius he would be run off. Such behavior (although attractive to some of us in medicine) would not be tolerated.T I watched the first episode of Irauma where ever I was that week (Laughlin I think) and it was atrocious. There is no way it will last. I know Seb Wong at San Francisco Fire has tried to guide them in the right direction but it has been all for naught. Any of these television shows (even Mother, Jugs and Speed) have some reality--but very little. I only watched one episode of ER and thought the medicine was OK. I don't have to watch television to see weird things--I work a Level I ED in Las Vegas. There are levels of weird in that city heretofore unseen.

A-a is Alveolar to arterial What you expect for PAO2 at the alveolar level minus the measured PaO2 or arterial level. A-a gradient = PAO2 - PaO2 The normal difference should be about 10 mmHg. Alveolar equation: PAO2 = ( FiO2 * (760 - 47)) - (PaCO2 / 0.8) Now you can also relate the value for the PaO2 and SpO2 (or SaO2) via the Oxyhemoglobin Dissociation Curve. http://www.ventworld.com/resources/oxydisso/dissoc.html The SpO2 or SaO2 can still be near 100% but the A-a gradient might be very wide which could be the result of impaired diffusion or ventilation-perfusion inequality or mismatching (V/Q) or shunting. Of course, once removed from the NRBM the SpO2 will probably drop quickly.

Take care, chbare.

6 LPM/NRB is what our medical director suggests, for hyperventilating patients that can't be easily coached into slowing their breathing. As for regular administration of oxygen, I use the "To Keep The Bag Full" theory.. On NRB's 10 or 12.. NC gets 2 or 3.. Nebs get 6 or 8. People that are getting road sickness, but are otherwise okay; I use the "dog in a car" theory. 2 by NC, tell them it may keep them from getting sick. I hope my white lie distracts them, and like a sugar pill, they feel better. Or just don't vomit.

The 1968 Ambulance Attendants Manual suggest only giving 10 LPM by plastic mask to victims requiring oxygen therapy. The 1971 AAOS Emergency Care book doesn't mention flow rates, nor does it mention the use of a Nasal Cannula. The 1978 Brady, Second Edition, suggests flowing oxygen at a rate of 6 to 8 LPM, via nasal cannula. The Brady Fourth Edition suggests 4 to 6 LPM, via nasal cannula. The Brady Eighth Edition suggests 1 to 6 LPM, via nasal cannula.

You are all going to like this one. Critics: H1N1 bill gives too much power Updated: Thursday, 08 Oct 2009, 4:40 PM EDT Published : Thursday, 08 Oct 2009, 4:40 PM EDT * Veronica Cintron * Matt Caron CHICOPEE, Mass. (WWLP) - A bill that would give the state the power to isolate those infected by the H1N1 virus passed the House on Thursday. Public health officials would also be able to set up quarantines to contain an outbreak. In addition, the Massachusetts Department of Public Health would have the power to evacuate public buildings and even close access to contaminated areas. We caught up with House Speaker Robert DeLeo in Chicopee on Wednesday to ask him what the bill entails. "In terms of requirements for quarantine and what role hospitals and medical centers will play." Critics of the bill say it gives government too much power. The Senate approved an earlier version of the bill in April. Now, the bill heads to the Governors desk. Run for the hills.... Oh wait I'm already there.

Great info and a great link... sometimes I really think I should go RRT instead of RN...

Look at the oxyhemoglobin dissociation curve to see the correlation between mmHg and SaO2. One might expect the PAO2 to be at 450 mmHg and the PaO2 to be 440 mgHg on a healthy patient on a NRBM. If the PaO2 is at 90 mmHg, that is what one might expect on a healthy person on room air and would give you an SpO2 in the high 90s. However, if the patient is on a NRBM with an FiO2 of 0.90, that gives you an A-a gradient of 350 mmHg which is very significant. Intubating may not immediately fix the problem. The patient may even die because of the oxygenation problems such as what we are seeing with the Influenza A patients and ARDS. This is part of the discussion Tnuigs and I were having on the Ventolin/H1N1 thread. It may take the serious RT technology such as High Frequency Ventilation, Nitric Oxide or ECMO to oxygenate a patient. But, we would hope that the direct route to the lungs with a closed circuit, PEEP can do its job to improve oxygenation. Check out the Respiratory Failure link here: http://www.ccmtutorials.com/ In the All about Oxygen section, you'll find some information on absorption atelectasis and that will explain about nitrogen. Read about ARDS under Acute Lung Injury and you will learn about damage to the various cells. There is also the O2 toxicity concern from high concentrations of O2 for a long period of time. Usually we try to lower the FiO2 within 24 hours to below at least 0.60 with 0.50 being preferred. However, we must also look at other factors that may still require significant O2 to maintain adequate PaO2 or SvO2 which is venous saturation. Patients with sepsis and some TBIs are monitored closely and may need more ventilatory support, pressors or fluids to maintain an adequate range. For some patients such as those with PNA from Influenza A, they may be on special ventilators for several days or even weeks until the lungs heal well enough to have the FiO2 at a reasonable number. The same for patients that develop ARDS due to trauma or sepsis.

Since someone asked, my little example is a summary of exactly what happened in a county near me. Crazy but true!

This has nothing to do with you being an EMT if you are working as a teacher in Florida. This falls under the guidelines of the position you hold in the school system. Unless you are specifically hired to be an EMT with the school system and that is the title you are working under, don't confuse that cert with the job you are hired to do and the responsibilities that accompany it. If you are uncertain about your job description and responsibilities to the children, you can contact the education board in your county or FLDOE. You can also review the P&P for your school and that medication with the School RN. I also know it is unfortunate that the School RN is often covering several schools at one time and is not immediately available. http://www.fldoe.org/default.asp?flsh=false Example of Manatee county: Manatee County Good article this month in Pediatrics: http://pediatrics.aappublications.org/cgi/reprint/124/4/1244

Probably because we can't get agreement on what progress would be.

As an EMT I see where you are coming from but you realize they have to keep the show interesting to the layperson. I know for a fact there are EMTs who have been like nancy and her boyfriend, it detests me but it happens, I only hope they get caught and lose their license. What bothered me more is the way the flight crew and copter were portrayed. We know the crew is the crew and not some medic they take along for the ride and the copter is set up so there is no room to move. Several things were portrayed in ways we would never do things but at the end of the day it does show our dedication and neccesity to do our job. It also shows people we have feelings, we're not just cold people who carry out our lives not caring if someone dies or not.

Funny stuff. I have yet to watch this show, and I honestly don't know if I ever will. Based on the responses here, it would seem I'm not missing much. As for realism- well, unless it's a documentary, I don't expect anyone to realistically portray EMS. Think about all the early shows based on law enforcement. ADAM-12, CHiPPs, Hooker,- some were downright comical, and cartoonish, and certainly not accurate. Did LEO's boycott these shows or pitch a bitch to the studio heads? If they did, the studios did not care, and it certainly didn't matter because the public loved them, and if they generate $$$, that's all that matters to them. Being accurate is the least of their worries. The daily grind of real EMS is not action packed or glamorous enough to make viewers tune in every week, but a fictionalized TV show may just stir interest in the profession and get people to look deeper, and maybe generate some interest. I look at it like "Backdraft". I loved the movie, but... to the uninformed, they think that every time a fire engine pulls out it's a multiple alarm fire with people hanging from windows. We know that is not the case, but it makes for great drama, and it did provide an upswing in interest for firefighting. Same for Top Gun and Navy pilots. Sadly, "Bringing out the Dead" with Nicholas Cage had more truth in it to me than most of these silly TV shows. I knew a couple guys who could have played lead in that movie, but thankfully they are out of the business now. Is it frustrating to see a lack of realism, which does nothing to help promote our cause, but I think we need to keep plugging along and remaining professional. Push for higher standards, push for parity in funding and respect, and take shows like Trauma for what they are: FICTION. WE know they are silly, and I think most of the public does as well. For those who think this is what EMS is all about- well, let's just say those folks probably also think a show like "Reno 911 is a documentary- meaning- you can't fix stupid.

Zactly ... I never bash free gak.

Paramedics from TLC had to be cancelled due to HIPPA act. Because of HIPPA, the reality of it is simple, in order to keep it as much of a reality show vs. a drauma or etc. the people in it are real paramedics,the procedures are real and done in real time. They're running realistic calls (becuase every show has a glorious MCI, and in my 5 yrs with EMS there has only been two from my county, which is close to a million people). Now, an idea, that can incorprate both portaying EMS in real terms and keeping people happy would be a first person reality. Every week you follow three "recruits" or probies from different agecnies. The probies have been recently hired and have to complete a "FTO" phases and while doing so they run real calls and function as a 3rd persons to "credential" up. The probie after 10 or 12 episodes "credentials" and becomes a released paramedic and deals with the ascpets of life after FTOing. They're not competeing for anything,but can and will be able to show the various different lifestyles, morals, and feeings that make every paramedic unique. Thus, giving Hoollywood its ratings for being "reality", giving the professional EMS community something to be proud of, and protrays the REAL side of EMS to the nations.

You mean to tell me what the book says, isn't what really happens? Do I need to start learning EMS from tv shows now?

Interesting all these Oxygen queries as of late ... as Ventmedic mentioned there are devices like the Optimizer type N/C that can be set at much higher levels than some "protocol" these include concepts like the Venturi effect (flared tips) and some have diaphragms that upon inspiration allow an increased reservoir flow upon inspiration, of this I know well because I had the extreme pleasure of wearing one for 2 weeks ... that said. Generally speaking the reservoir in the standard anatomy the naso and oro pharynx is flooded with flows equal to 6 lpm (some books say about .40 for FiO2)higher flows over 4 are generally quite uncomfortable, although longer term the "over the ear" tubes are far more uncomfortable and can lead to skin breakdown (just in passing personal commentary) Now using common sense if a patient does not tolerate a mask ... and many patients feel they are being suffocated, besides they smell like chemicals ... so if a patient does not tolerate a mask and they require and tolerate 8 liters per minute well who's going to quote "some book" if it works. Use a pragmatic approach in respiratory care is my humble opinion. cheers

say what you will about the Nazi's but thier fashin designer was just FAB-U-LUS! best dressed Blitzkrieg in history

Did you expect med school to be a cake walk? I used traction splint 2 times on real calls. Used them numerous times in training. Also used one for a Halloween costume, and MAST pants...

I tried to download on my iPhone coming back from Boston today and couldn't. I finally downloaded it at home and laugh every time I watch it. I don't know who Nick is but he has won my respect. What a great video. It is screaming across the internet in EMS and emergency medicine circles. A physician friend from Oregon sent me the link a few minutes ago. BTW, I got pictures of Dust's latest girlfriend. Like him, she loves those helicopters.

Boycott? But it's just such a REAL depicition of EMS!!! (That was sarcasm, love.) It's so much fun to make fun of it, but I don't think boycotting it will do much, it seems destined to crash and burn on it's own. Hopefully it's DNR is valid and properly filled out. P.S- What video? No link!

would you really expect anything less from hollywood, terri emtdumbass

so at one point the max was 8 lpm. wow. thank you.

Now, now... The A-a gradient thing is more likely to be an issue with a NRBM. I had thought the "dog in car" theory was like my "cat in carrier" theory when I lie to them. However dogs will believe anything their humans tell them and cats want evidence based proof.

Whoo Hoo thanks Lord chbare, back at you and one for medicv83 for just starting the thread, good learning post from all, and its hard to keep up with the other oxygen pple. As for 4c6 .... I think a negative rep just to piss him off wtf is the "dog in a car" theory ? Do you talk to dogs or watch to many episodes of the Dog Whisperer ? .... cheers ps the rule of thumb(s) or now referred too as the 4cmk6 Protocol/ Guidelines aint a bad way to go using a Pulse Ox, but I sense a repremand with the A/a gradient vent introduced ... oh well live and learn.

Here you can run into some problems with "interpretation". The NRBM manufacturers have provided recommendations for safe liter flow when using their product. Many publications and protocols have published their recommendations for the usage of O2 devices and liter flow. Do you have the medical director's suggestions in writing? If not, when an adverse incident occurs, the MD might say in the depo "that's not what I said and especially not in that circumstance". Your charting and that of the rec'g ED will have the documentation to which you may have to defend your actions.

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

Assuming they have a community water source. However, we have a well, there's no municipal water in the town which the station is located. I don't like to use bleach products anyway, unless I'm cleaning up a large volume of body fluids. I've used those Clorox wipes, but it discolors the stainless steel counter tops. Though, our water is sulfur scented.

Wear one of these!

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.

No, you have to wear your full uniform, badge, batbelt with all your gadgets, and portable radio.

Nasal Cannula is supposed to be used any where from 1-6LPM. If you exceed this, it can cause discomfort to the patient, dry out the membranes and even cause nose bleeds. Oxygen is very dry. This is what is recommended on the national standard. You are best to check your local protocols though to see what they say. They may say different as to not exceed 4 or even 5lpm.

bummer.. can't make it. I have an adult film industry conference to be at that weekend..

Absolutly not. On the average blue hair run, we simply wipe down cot, bench, contact points with disenfectant wipes. On trauma's or infectious disease calls however, we fill a pail with disenfectant and go to town. We have a low call volume, but once a month we do a "deep clean". Pull everything out of the cabinets, fully extend all seatbelts, remove cot mount, etc etc, and do a real good disenfect.

Unfortunately it's already proving to be a popularity, not productivity contest... If we can now just get folks to vote based on post content instead of warm fuzzies, life will be good. Or at least better. Dwayne

Exactly now you know my train of thought.

That is exactly what I mean they don't know how many are the regular flu and how many are the actual H1N1. I just can't stand them all saying that there is an estimate of so many people having the swine flu yet they are not actually sure. There is no facts to these statements they are sending out. Just to show you what I mean I will copy a article from the past week. Mass. estimates 20,000 swine flu cases First vaccine shipment set to arrive next week Updated: Thursday, 01 Oct 2009, 10:05 AM EDT Published : Thursday, 01 Oct 2009, 10:05 AM EDT WORCESTER, Mass. (AP) - An estimated 20,000 Massachusetts residents have already contracted the swine flu and the number is likely to rise in coming months. Gov. Deval Patrick said during a swine flu conference held in Worcester on Wednesday that the state has already taken steps to help curb the spread, including ordering its first vaccine shipment, set to arrive next week. The initial number of vaccinations is small -- up to 50,000 doses meant for health care workers -- but additional batches should continue arriving weekly through the flu season. Public health officials say the 20,000 number is based on the fact that the federal Centers for Disease Control and Prevention has estimated 1 million cases in the U.S. and Massachusetts is 2 percent of the national population. The state has stopped testing for the disease. and just so no one says anything here is the link wwlp Now don't get me wrong I am not disagreeing with you in anyway. I do see it as a waste of resources to test everyone with flu like symptoms. I just don't like that they are playing this out to be a huge pandemic yet they don't have the numbers to support such a finding. They are riding the numbers of the normal flu cases we have every year all year and making them all out to be what they want them to.

You know what would be great but will never happen? If they actually tested the sick to find out if they had H1N1 and not just the flu. But like I said its not happening this state has stopped testing all flu like symptoms (except for the deadly ill) for the dreaded swine flu. So now everyone with flu like symptoms are being classified as having the horrid swine flu even when they don't. Welcome to the pandemic of the normal flu season. How many people knew that some states like Massachusetts and New Hampshire have stopped testing 99% of the suspected cases? Don't worry I am sure there are a hell of a lot more states out there that have also stopped testing and are just lumping everyone into the same category of sickness.

Dave Barry's colonoscopy journal: ====================== I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy. A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis . Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner. I nodded thoughtfully, but I didn't really hear anything he said, because my brain was shrieking, quote, 'HE'S GOING TO STICK A TUBE 17,000 FEET UP YOUR BEHIND!' I left Andy' s office with some written instructions, and a prescription for a product called 'MoviPrep,' which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America 's enemies. I spent the next several days productively sitting around being nervous. Then, on the day before my colonoscopy, I began mypreparation. In accordance with my instructions, I didn't eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor. Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-literplastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons). Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes - and here I am being kind - like a mixture of goat spit and urinal cleanser, with just a hint of lemon. The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, 'a loose, watery bowel movement may result.' This is kind of like saying that after you jump off your roof, you may experience contact with the ground. MoviPrep is a nuclear laxative. I don't want to be too graphic, here, but: have you ever seen a space-shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet. After an action-packed evening, I finally got to sleep. The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, 'What if I spurt on Andy?' How do you apologize to a friend for something like that? Flowers would not be enough. At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the heck the forms said.. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked. Then a nurse named Eddie put a little needle in a vein in my left hand.. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep. At first I was ticked off that I hadn't thought of this is, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house. When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point. Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand. There was music playing in the room, and I realized that the song was 'Dancing Queen' by ABBA. I remarked to Andy that, of all the songs that could be playing during this particular procedure, 'Dancing Queen' had to be the least appropriate.. 'You want me to turn it up?' said Andy, from somewhere behind me. 'Ha ha,' I said. And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like. I have no idea. Really. I slept through it. One moment, ABBA was yelling 'Dancing Queen, feel the beat of the tambourine,' and the next moment, I was back in the other room, waking up in a very mellow mood. Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that It was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ. ABOUT THE WRITER Dave Barry is a Pulitzer Prize-winning humor columnist for the Miami Herald. On the subject of Colonoscopies... Colonoscopies are no joke, but these comments during the exam were quite humorous..... A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies: 1. 'Take it easy, Doc. You're boldly going where no man has gone before! 2. 'Find Amelia Earhart yet?' 3. 'Can you hear me NOW?' 4. 'Are we there yet? Are we there yet? Are we there yet?' 5. 'You know, in Arkansas, we're now legally married.' 6. 'Any sign of the trapped miners, Chief?' 7. 'You put your left hand in, you take your left hand out...' 8. 'Hey! Now I know how a Muppet feels!' 9. 'If your hand doesn't fit, you must quit! 10. 'Hey Doc, let me know if you find my dignity.' 11. 'You used to be an executive at Enron, didn't you?' 12. 'Now I know why I am not gay.' And the best one of all. 13. 'Could you write a note for my wife saying that my head is not up there?' No virus found in this incoming message. Checked by AVG - www.avg.com Version: 8.5.392 / Virus Database: 270.13.50/2296 - Release Date: 08/11/09 06:10:00

Its hard to justify that without looking at all the other factors. I work with a couple people who are taking their ACP with distance learning just because they cant afford to take the 2ish years off and second, the only ACP school in Saskatchewan is in Regina, I work over an hour out of saskatoon in the wrong direction. So yes choosing a better school is a good idea, just not always a possible one. Besides generally if your going to ITT tech and spending 3 times what you would have at a real university, theres probably a reason (like not being able to get into a real university)

Where is the video link?