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So many of you have come to my defense with words of encouragement, offers of GOOD advice and general support that I am feeling overwhelmed. I didn't really believe in an internet community before but you have made such a difference to me that I don't have the words to express it. Thank you from the bottom of my tiny black heart.

Well, I didn't offer any advice. It's easy for me to do when it's a patient's life at risk. Not so much when it's your career at stake. But I think you know that I do care, and I hope this situation resolves itself painlessly and positively. You are absolutely a credit to this profession, and anyone who doesn't recognise that is an idiot.

Holy shit...He only has two posts, took the time to get involved, and Really? The only thing the next page of posters could think to comment on is his caps lock and formatting? C'mon folk. Some of us have done way more foolish things, I do them on a regular basis, perhaps we could show a new poster the courtesy of at least commenting on his content at the same time as bitching about his presentation?? Capt Stern, a few things, as I'm going to assume you might be new to forums. First and foremost, welcome to the City!! Thanks for taking the time to participate. Presentation sucked..But that's not terminal, as I think your post content was really good! All caps is bad form. We're strong believers here, many of us anyway, that the way you present your ideas in text tells much about your intelligence and personality. Spelling, punctuation, capitalization, and paragraphs go a long way towards making your post easier to read and respond to. Also any 'lingo' that may be specific to your location, cert levels/radio codes, etc should be defined when used so that others are not confused by them. Not sniping brother, just trying to give you a heads up. I absolutely agree that much more information was necessary, including your ideas on confirming that this was actually a CVA, is necessary before being able to determine whether or not fluid was appropriate. Though it's not uncommon here for folks to create a 'what if' scenario off of an actual call to help them ask a specidic question. I found a lot of food for thought in your post, I'm grateful you took the time to create and it and had the courage to post it. I'm also confident given the information you need, if you haven't been discouraged by your first time out, that your presentation will be much different in the future. And last, and possibly least, if most or all of that information came out of your head as opposed to being Googled, as I have a feeling it did, I have much to learn from you...I hope you'll stick around. Have a great day all... Dwayne

I dont know that phils mind is so far behind as it is so far in the gutter sometimes that well he has interesting thoughts....

In some cases, yes. The thread was looking like it could go into nursing erotica land, and I wanted to emphasize the fact that the profession of nursing is far from sorted. While this does not excuse EMS, I also wanted to point out some of the major issues facing my profession. Take care, chbare.

Its funny how many ads from the community college I see for RN's to make extra money teaching part time. Seems nursing has some of the same issues as EMS and Tom, Dick, or Harry can teach.

I applaud nursing for having high educational standards for the educators. I personally feel that EMS is lagging because it has not set the bar higher for its instructors to become educators. Once education becomes more visible to the students, an example is set rather than "look at the cool things Bubba has done and he only had 4 months of trainin'". For RT, I am really impressed at the support for education but then after having all the other health professions looking down their noses at the RTs in the 80s when the tech mills tried to ruin the profession, it is nice to see this profession emerge stronger than the weakest link. Unfortunately, EMS is still catering to the weakest links. RT combines the best of two worlds; technology and health care. For those who love gadgets and taking the human body to extremes with technology, it is a fascinating career. However, Physical Therapy ranks up there in gadgets and a fascinating profession with many different opportunities as well as being one of the better paid with sign-on bonuses that make even the RNs drool.

First thing to note is that a catalyst only decreases the energy of activation (think energy needed to start a car vs energy needed to keep a car running. The energy needed to start a car is the energy of activation of the car). It can't make reactions happen that wouldn't happen otherwise. Granted, some reactions are so unfavorable that you wouldn't see it occur without the use of a catalyst, however "unlikely" and "unfavorable" are different than "won't." Acids, in it's most basic form, are something that can donate a hydrogen ion (H+, proton). There are other definitions of acids, however things like Lewis acids and bases give me a headache. What allows the hydrogen ion to come loose from an acid is movement of electrons away from the hydrogen. Essentially (there are some caveats with electron pairing and all) all atoms want their outer most electron orbits to be completely full and this can be accomplished by either taking or donating electrons from other molecules (ionic bonding) or sharing electrons (covalent bonding). Donating works because if you can empty out all of the electrons from the outermost orbit, then it essentially ceases to become an orbit. The second to last orbit (which is, by definition, full) becomes the outermost orbit. This brings us to the periodic table of the elements. For the purpose of this, ignore the dark blue middle area. The far right column (He (hydrogen), Ne (neon), etc) contains the Noble Gasses. All of these gasses have their orbits completely full of electrons making them nonreactive. The molecules on the right all need electrons to fill their orbits, so they attempt to take electrons from other molecules. On the other side, the molecules on the left all want to get rid of their electrons so that they can empty out their outermost orbit. This comprises the concept of electronegativity. The larger the difference between the electronegativity of two atoms, the more likely one is going to give up their electron to the other. When this happens, the atom giving up the electron becomes positively charged while the one receiving an electron becomes negatively charged. Positive and negative charges attract and we have an ionic bond. Also, since the is a negative and positive ions are bounded to each other, the net charge is zero. Partial charges is what causes molecules to be polar as well as causes phenomenons like hydrogen bonding. This is important for acids because a molecule can be like a big game of tug-of-war. Let's say we have molecules A, B, and C. A is the most electronegative and C is the least electronegative. Let's further say that A bonds to B and B bonds to C (A-B-C). A can be pulling so hard on the electrons of around B that it can end up pulling on the electrons around C. Now instead of having the electrons somewhat centrally located, there are more electrons around A and less electrons around C. This gives A a partial negative charge and C a partial[b/] positive charge. If C donated electrons making the atom itself a positive ion, this can allow C to leave (dissociate) from the molecule, such as when a hydrogen ion leaves an acid. So we combine H2O and CO2 to form carbonic acid. Oxygen is only 2 spaces away from the noble gas column, so it's pretty electronegative. Hydrogen is on the furthest left column, so it wants to give away it's electrons. However, if you look towards the middle, there's another hydrogen atom that's double bonded to a carbon atom. It really wants those electrons too. So that middle oxygen pulls on the electrons on carbon, which results on carbon pulling electrons away from oxygen because carbon hates losing it's electrons (it's somewhere in the middle, so while it doesn't want to take from other atoms, it isn't going to give up electrons either without a fight). So the outer oxygens pull electrons even further from the hydrogen. This gives the hydrogen a partial positive charge and the oxygen a partial negative charge. The hydrogen ion is already positive, and now that it's bond is also a partial positive it decides to take off. The hydrogen enters the solution causing the pH to go down as the concentration of hydrogen (and H3O since hydrogen can readily leave H30) Le Chantelier's principal. The basics of it's relatively simple. Let's say you have a balloon sitting on a table. The balloon is at equilibrium. Now imagine that you have a camera with a resolution high enough and frame rate high enough that you can see molecules moving around inside. Now you pick up the balloon and squeeze just one side of it. In real time, the part of the balloon not inside your hand bulges because the pressure inside the balloon increases (the pressure in the balloon inside your hand also increases, but the force on excreted by the pressure on the inside of your hand is transmitted through the balloon wall and into your hand). For all intents and purposes, this is instantaneous in real time. It's kinda of like turning on a light. We all know that light has a speed, however the speed is so great that turning on a light in a room makes it look like the light travels instantaneously through out the room. So you have this camera and you're filming the molecules inside the balloon as you squeeze on a part of it. The instant that you squeeze you increase the pressure in that part of the balloon putting the air inside the balloon out of equilibrium. The air molecules start bumping up against each other and over time (instantly in real time, but we are looking in super duper slow motion) even the molecules the furthest away from your hand are now moving at the same increased speed. Equilibrium is restored until you move your hand. So if you change the conditions in one part of the balloon, you end up with a change in the entire balloon. To transfer this to chemistry, if A+B<->E+F, if you "squeeze" the E+F side (e.g. add more of E, F, or both), the equation bulges at the A+B side as the reaction reverses until you reach equilibrium again. Now you can "squeeze" an equation by adding more of a product or reactant OR if a specific environment is preferential to one side (say A+B likes a positively charged solution) changing it to or away from that environment.

This episode will pass , as many others in your life have before. Stay strong and don't let the Basturds get to you girl! :-} :thumbsup: we old folks need to stick together.

I am trying to learn here, quit yelling.. lol

Little birdie in the tree, why did you do that to me? Little birdie in the sky, why'd you drop that in my eye? I'm no baby, I won't cry, I'm just glad that Elephants don't fly! (Anonymous) (Sorry, fireflymedic, I felt challenged by your comment.)

So so so very true Phil! BTW Love your posts!

That's uhhh... Sexist. and wrong.

The aussie wins again I am just waiting to see what dust says about (or aboot for our canadian friends) this one

lETAS LOOK AT THE PATHOPHSIOLOGY OF A CVA. YOU HAVE A THROMBUS, EMBOLUS, LUCANA, ANYERUSIM,PONTINE HEMMEROGAE IN ANY CASE THEY ARE ALL CLOSED HEAD INTERVENTIONS. I HAVE NEVER SEEN A PERSON WITH HPOTENSION GET A STROKE , MAYBE HYPOTHERMIA WITH A RECIRCULATION DISPBRITUTION BUT FOR ALL INTENTS AND IMPRESSIONS HER BP WNL WHICH BASICALLY RULES OUT LUCANA AND WITH HER EYES PERRLE R/O PONTINE AND DID YOU SEEK ANY ADDITIONAL HISTORY PERTINENT LIKE EAR INFECTIONS SINUS INFECTIONS OR ANY OTHER TYPE OF BRAIN DISORDER LOU GERIG, MYASTHINIA GRAVIS ETC. THIS WILL HELP YOU IN YOUR QUEST HER ECG WAS NSR AND NO POSSIBILITY OF STOKES ADAM. IT SEEMS LIKE A STOKES ADAM WITH A UNDERLYING POSS MI DIN'T SAY ANYTHING ABOUT DIABETES. GERIATRIC MEDICINCE IS A BRANCH ALL IN ITS OWN AND REPEAT EXPOSURE AND GOING OVER YOUR ALS REPORT WITH YOUR MD WILL HELP IN HONING YOUR SKILLS. a FLUID CHALLENGE TO R/O SOMETHING IS NOT PRUDENT IN THIS SITUATION. CAPT MITCHELL STERN, AS, MPH, EMT-4, NCEMT-4 (RET)

All Kangaroo's look good in the cross hairs....... But, they got nothing on the drop bears