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WOW.......Where to even start this reply..... First, Where in Detroit are you working? As this is my old stomping grounds as well.... Second, I truly hope you don't seriously rely on ANY of the above information you just gave to the masses..... Here are a few lessons you should probably learn quickly.... 1.Pulses Clinicians frequently try to palpate arterial pulses during chest compressions to assess the effectiveness of compressions. No studies have shown the validity or clinical utility of checking pulses during ongoing CPR. Because there are no valves in the inferior vena cava, retrograde blood flow into the venous system produce femoral vein pulsations.8 Thus palpation of a pulse in the femoral triangle may indicate venous rather than arterial blood flow. Carotid pulsations during CPR do not indicate the efficacy of coronary blood flow or myocardial or cerebral perfusion during CPR. 2.Oximetry During cardiac arrest, pulse oximetry will not function because pulsatile blood flow is inadequate in peripheral tissue beds. But pulse oximetry is commonly used in emergency departments and critical care units for monitoring patients who are not in arrest because it provides a simple, continuous method of tracking oxyhemoglobin saturation. Normal pulse oximetry saturation, however, does not ensure adequate systemic oxygen delivery because it does not calculate the total oxygen content (O2 bound to hemoglobin + dissolved O2) and adequacy of blood flow (cardiac output). Tissue oxygen tension is not commonly evaluated during CPR, but it may provide a mechanism to assess tissue perfusion because transconjunctival oxygen tension falls rapidly with cardiac arrest and returns to baseline when spontaneous circulation is restored. 3.End-Tidal CO2 Monitoring End-tidal CO2 monitoring is a safe and effective noninvasive indicator of cardiac output during CPR and may be an early indicator of ROSC in intubated patients. During cardiac arrest CO2 continues to be generated throughout the body. The major determinant of CO2 excretion is its rate of delivery from the peripheral production sites to the lungs. In the low-flow state during CPR, ventilation is relatively high compared with blood flow, so that the end-tidal CO2 concentration is low. If ventilation is reasonably constant, then changes in end-tidal CO2 concentration reflect changes in cardiac output. Eight case series have shown that patients who were successfully resuscitated from cardiac arrest had significantly higher end-tidal CO2 levels than patients who could not be resuscitated (LOE 5).2,22–28 Capnometry can also be used as an early indicator of ROSC (LOE 529,30; 4. I would really study up on the Dissociation Curve...... 5. Relying on a Pulse OX is the worst thing you could be doing for your patient....Before you go losing your mind about what you were taught in Paramedic school, there is a saying, You don't know, what you don't know. This is what separates the Critical Care providers from the population mean. You might want to read through ALL of VENTMEDIC's posts and learn. Respectfully, JW

From Site Rules that all claimed to have read and agreed to upon signing up for EMTCity. "Give reasonable attention to your grammar. Although we want to maintain a casual atmosphere here, this is ultimately a PROFESSIONAL forum where members of the public are free to read and draw conclusions about us as a profession. There is an automatic spell checker provided on this forum. Please use it. Do not post messages that appear as if they were taken from a 13 year old girl's AOL chat. "You" is spelled YOU, not "u." "Whatever" is spelled WHATEVER, not "w/e." And punctuation is extremely important to those trying to understand your statements. If you are too pressed for time to type legibly and using punctuation and capitalization, then please come back later when you have more time. AND NEVER POST IN ALL CAPITAL LETTERS!" It seems to me that this is all that Doc is talking about.... What is so friggin' hard to understand? SA, I'm thinking you've been here much longer than necessary to know that we are not laying in wait to attack those from a different country that make spelling or grammatical errors. Are you really saying that because of the cultural gap you don't understand the paragraph above? We're not asking any to be perfect, only to make a reasonable effort to use adult, high school level spelling and punctuation, right? Many here that preach education are unwilling to do so, so I think this was an awesome topic. Dwayne

In my country we believe a man convicted of outragous offences of criminal activity or lewd acts of sexual or moral perversity must suffer the consequences until the day he dies. A man who is a criminal or murderer or fornicator must be punished and allowed no respite from persecution. Only in the next life is he free to persue a career in emt . His past sins will only then be absolved.

Hey City senior thanks for the effort! Every day I learn how much I still dont know. I'll follow up with Physio. "MEME" great though process but remember you can have a O2 sat reading of >90 for several minutes in a patient with no pulse. I think the most intuitive thing you said and often most ovelooked is pt color.

The fire department brought in a CPR ... you mean they brought in a code??? Ok, I can't really say much more than Jwade because he said everything so perfectly (+1 for that one, I'd give more if I could). Here are a few very simple and non-technical things I'd like to point out. How many codes have you actually been on and participated in? Have you NEVER seen a head turn purply/bluey from prolonged CPR? What about the veins in the forehead and temporal areas popping out? Would you also assume someone with cherry red skin complaining of nausea, headache, dizziness, maybe some altered LOC was fine because their sats were 99% on room air? Maybe just a little out of sorts hey? Or not ... I can't top what Jwade said quite honestly because I'm sure he's got more on me than 4 years, and I'm a little too tired to go browsing through my resources. What does meme think about all this?

To the best of my knowledge my partner has not been swabbed. He’s usually a good partner but every so often he’s too much of a stubborn Russian for his own good. He has yet to return to work and frankly I don’t want to see him there until he’s back in good health. The patient in question was transferred out to a higher level facility the same night requiring further respiratory focused care (Kamloops being the closest facility with RT’s available). The transferring crew took full precautions and suffered no ill effects post transfer. Just PM me with any further details you need regarding this case and I’ll fill you in as best I can (sans any information that could be used to identify someone as per usual). The only thing I’ve seen government do successfully so far is scare the crap out of people. So we have people’s attention. Great. How about using this as an opportunity teach people how to mitigate risk? Nah. That would actually make sense. I’m not sure how I feel about this one. It’s great they are putting a valuable resource to use, but using a resource without taking the steps to protect it is just plain stupid. Hopefully we can send Falcon to the same special place in hell while we’re at it. The BC legislature just went through first reading of a bill to impose a contract here in BC. Back to work legislation? We never left you ignorant #%#$. At least someone does. Now that we have some leadership in the right direction, let’s get organized already. I know you’re trying Squint. If there’s anything I can do to help put together some kind of proposal/presentation let me know.

Actually, he stated "seems" in his first post prior to saying "Point is." Additionally, he clarified his statement in a third post where he stated "seems" for a second time. I have to disagree with the notion that his statement was anything other than anecdotal observation. Take care, chbare.

Please explain to the masses how you are qualifying and quantifying this statement of fact? As a long time Flight Paramedic and Pilot, I have seen things from both spectrums. Coming from Michigan where you do NOT call a helicopter unless true life or limb, to my current state of Arizona, where you cannot spit without hitting a HEMS aircraft, the HEMS Industry is broken.....A few good programs doing things right here and there, but the majority are pathetic.. Before business school, I, too was probably a bit naive in thinking that we all can get along, etc.......Now, having EXTENSIVELY studied HEMS statistics and business models, I can promise you one thing....It is about MONEY, plain and simple......Safety, patient care, employee morale, is all secondary to flight volumes, and keeping the competition in check...... This lawsuit is nothing more than keeping their pockets lined with cash! JW

ROFL I have a spelling checker It came with my PC. It plane lee marks four my revue Miss steaks aye can knot see. Eye ran this poem threw it. Your sure real glad two no. Its very polished in its weigh, My checker tolled me sew. A checker is a blessing. It freeze yew lodes of thyme. It helps me right awl stiles two reed, And aides me when aye rime. Each frays comes posed up on my screen Eye trussed too bee a joule. The checker pours o'er every word To cheque sum spelling rule. Bee fore a veiling checkers Hour spelling mite decline, And if we're laks oar have a laps, We wood bee maid too wine. Butt now bee cause my spelling Is checked with such grate flare, There are know faults with in my cite, Of nun eye am a wear. Now spelling does not phase me, It does knot bring a tier. My pay purrs awl due glad den With wrapped words fare as hear. To rite with care is quite a feet Of witch won should be proud, And wee mussed dew the best wee can, Sew flaws are knot aloud. Sow ewe can sea why aye dew prays Such soft wear four pea seas, And why eye brake in two averse Buy righting want too please. Edit: Author Unknown....to me at least

http://www.emtcity.com/index.php/topic/16768-nbc-cancels-trauma/page__hl__Trauma%20cancelled__fromsearch__1

I agree. I am not an English professor, and most likely no one else here is either. We ALL make mistakes, big deal! This is a discussion forum, not a legal document. Although it annoys me when people use improper English/grammar, that is quite blatantly WRONG (ie using your instead of you're or there and their), mistakes will be made. It IS very childish to bash on someone for not being perfect in their SECOND language. You should be grateful and HELPFUL, to your fellow provider. Especially someone with a wealth of knowledge who can teach many of us here a few things. Bashing on them over crap like that only shows how immature and conceited you can be. Not to mention discouraging people from replying to your posts just out of spite for you being dbags. Furthermore, I think his spelling and grammar is pretty darn good for English being his second language! Grow up people!

We have no inoculation system in place here and treat patients on a case by case basis as they are reported and tested positive. As it is, we are having to import the treatment as there's not enough available. Ah the joys of Africa, only the strong survive here....

AS a PALS instructor, The Pediatric AED pads have essentially a " Voltage Regulator" that will dial down the joules from 360 - 50 joules....If they are in VFIB / Pulseless Vtach and the 6H's and 5T's have been ruled out, you NEED to be shocking the patient....End of story, regardless of age.....The bottom line after all the BS and anecdotal crap, is you still have a lethal rhythm that is potentially reversible..... Not quite sure why so many people are afraid of the NEO / PEDI population, Dead is Dead, they will continue to remain DEAD if you do nothing....... Respectfully, JW

Basic immunology. The first time it your body is exposed to a specific antigen (note: antigens may change as an organism mutates. This is why the flu shot doesn't always work to prevent the flu) for your body to switch from the innate immune response (macrophages, natural killer cells, etc) to the adaptive immune response (B cells, T cells, antibodies). During this time, the receptors are undergoing somatic hypermutation to find the exact fit for the receptors and the antigen and the cells are undergoing clonal expansion to essentially gear up for battle. While the innate immunity is doing it's best to control an infection, the adaptive immunity is able to target specifically the antigens on the invading organism and bring heavier weapons to bear. It is this process that produces memory B cells. Once the memory B cells are produced, they tend to stick around for an extremely long time. Additionally, since they are able to recognize the antigen, your body is able to kick in an adaptive response in a day or two (no need for somatic hypermutation. Able to release some antibodies immediately as the cells start clonal expansion. Earlier response means the infection has less time to grow) instead of the week timeline. On a side note, this is why you don't have an allergic reaction to the first exposure, but do to the second. During your first exposure to, say, bee venom, you're body doesn't immediately recognize it as bad and overreact. The second time, it knows that the venom is bad and already has cells that can respond to it.

One of my mentors in EMS made a point once about "bringing care to the patient." At the ALS level if we are not doing that in situations that permit it then we need to readjust our thinking.

This is a chat site, not a legal document. MOST people here have semi-reasonable spelling and grammar, and don't in fact type like teenagers. When it comes to a PCR however, that IS a legal document and a very good command of the language it is to be written in is required. Thatz awl I hav to say aboot thayat.

Can't spell can't either.

I was speaking in general

I work for a for a public utility model and as such, we are separate from the fire department. I ran a call the other day that angered me so much I was ready to walk off my job, so here is what happened. I was dispatched to a medical alarm for an 85 year old lady that had fallen. It was out of my district, so we had a longer response time by about 4-5 minutes. When we were approaching the corner of the street I saw the engine company sitting there, waiting for us. When they saw us, they started their truck up and went down the street ahead of us, arriving at the same time we did. On arrival we see this elderly lady standing at the door. She states she was moving and fell and that she is fine now. The fire department enters the home with me (I have no idea why) and start to interview the lady without giving me a chance to even talk to her. Clearly they were not needed and since they projected no interest in running the call by delaying their response for us, they should have left. I looked at them and told them that they could go. The one guy says they would leave but they had to get the patients name first. They have to justify their value by getting some patient information, even though they didn't want to be there and did NOTHING for the patient. By the way, she was fine. Here's what pisses me off. There is no one I can complain to within my company. They have suspended medics over issues they've had with the fire department when clearly the fire department was wrong. And, yes, I was a victim of a suspension because I tore into in with a fire captain when he refused to relinquish medical command to me on a call. I was told that in theory medical calls are my responsibility however the fire department has ultimate command of any calls. Here is the second part that pisses me off. They are funded by tax-payer money, yet they pull this crap. That woman pays their salary and she could have been seriously injured, bleeding, or dying. There are many more of them then there are of us, but if they're not first responding, what purpose do they serve? We are not funded by tax-payers in that area, yet we are held to response times, and would never dream of pulling a stunt like that. I realize this fire department thing is a racket. There are too many fire stations and fire fighters and not nearly enough ambulances and medics. They are just not needed as much as they were 25 or 50 years ago before improved building codes, sprinkler systems, etc. I understand they don't want to lose their jobs and will try to do what little they can to prove they are still needed in great numbers within the community. Bottom line, there wasn't anyone I could turn to. Over the past year I've come to realize that I don't hate being a paramedic, as I once thought I did. I hate being a paramedic where I work. I hope that I love this job like I used to once I move next month. I don't know if I ever will. EMS seems like such a loss cause to me anymore. Thanks for reading my rant.

The entire thread is directed at me. Thanks for chiming in. I'll give you the reason why a seasoned practitioner with steady hands that did pull it off without damage in a pinch had to try it... Necessity. I was in a situation with nothing else at hand at a complicated delivery with multiple equipment failures. I absolutely had to suction meconium, which requires intubation, and I had two successive blade failures, one a bulb and the other broken by an overly anxious EMT. Scooby didn't get the entire story before she began to flame me and call me a baby killer. You can Monday-morning quarterback all you want, but when you're knee deep in a big pile of suck, you make do and improvise. I might be stupid, but that kid is alive.

And your source of information would be ???? Not being a smart ass, lets talk evidence based medicine too many myths not enough tangible information ....

Respectfully, That is NOT what you stated.....You stated specifically " Point is that it is working in my area"......Now you say it " SEEMS" to work..... There is a HUGE disconnect between those two statements..... I asked you how you are qualifying and quantifying the first statement.......Anecdotal hypotheses don't support the statistical facts of the HEMS industry as a whole.... Again, I will agree, there are a few companies and areas doing it right......I simply asked you to prove your premise through facts..I have studied pretty much the entire US HEMS in MBA school, I have a good idea as to what is going on in any part of the country...Because you made such an initial blanket statement of fact, I assumed you had your own statistics to back up your assertion.... Respectfully, JW

can a person become a emt if the crime happened over 20 yrs ago

I ran a call last night in which a bicyclist and a car collided at an intersection at a low rate of speed. By low, I mean the car had traveled three feet from a dead stop before coming in contact with the bicyclist. The speed would have likely been well below 5 mph. The patient was alert, oriented, and had a complaint of "a tired feeling" in his lower thoracic spine area. He had some minor redness to this area that resembled his mesh undershirt. He was ambulatory at the scene and initially wanted to refuse treatment and transport. He had no distracting injuries, no c-spine tenderness, no neurological deficits, no loss of consciousness, and was wearing a helmet as well as a few layers of protective clothing. He states he more or less tipped onto the hood of the car landing on his back. He was NOT thrown into the air, and had contact with the car that probably had less impact than if he would have fallen to the ground from a standing position. No damage to the car or the bike. His vital signs remained well within his normal limits throughout transport. We did not immobilize the patient. My third rider felt the patient didn't require spinal precautions and I agreed based on all the information I gathered. When we got to the ER and gave report to one of the residents, he ordered spinal precautions on the patient. The nurse also decided to give my third rider a hard time over not taking precautions. I'm telling this story because I started researching c-spine clearance criteria when I got home this morning in an attempt to figure out if I had mis-managed my patient. I'm familiar with the NEXUS criteria, and honestly, that his the criteria I cited in my rational for not taking precautions. This morning I came across a few abstracts about the Canadian c-spine rule and how it is superior to NEXUS criteria. In turn, I researched the Canadian c-spine rule and reclassified my patient based on that criteria while doing a little call review with myself. After all of that, here is my question (finally ): Would this particular case be consistent with the "bicycle struck or collision" part of the dangerous mechanism? I understand it technically was a bicycle collision, but this man probably would have hurt himself more falling to the ground. The car hood likely broke his fall from the bike and probably kept him from more significant injuries. Secondly, how many of you would or would not have immobilized the above patient and why? I know the outcome of the patient, and I'll post it after some feedback. Thank you all for your help.

Just to parrot Wendy, Dwayne you are wrong. Admit your error and move forward.

im glad god dont feel as u do god forgives anything people deserve second chances

I dint sea the problim with haw we wrate on hear as lung as we get the pointe acress