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Tell him that the Pathology Bible (Robbins and Cotrans Pathological Basis of Disease) only recognizes 5 types of shock (neuro, anaphylactic, septic, hypovolemic, and cardiogenic). If he wants to argue with a text book used in medical schools throughout the country, well... it's his funeral. Of course there's Google, WebMD, EMedicine, and plenty of other online resources available. In closing, do your own homework!

I wrote a big thing but firefox crapped out on me. Here's the reader's digest version... 1. Make EMT a one-year CS or move it to a first responder role and replace it with AEMT or EMT-I as a one year CS 2. Make paramedic a minimum of an AAS 3. Do away with PHRNs and instead create a REAL critical care paramedic level (a bachelor's) 4. Make bachelor's the minimum for paramedic/supervisor. 5. Get EMS away from fire departments 6. Drop "EMT" from EMT-Paramedic 7. Do away with volunteers 8. More anatomy, more physiology, more pathophysiology, and more clinical time 9. Rigorous QA/QI 10. Adhere to the national standard

So? Maybe someone else has the same question and now has an answer. Maybe something will click this time through.

That was what I was getting at. Shock, by it's definition is a state of hypoprofusion. Regardless of etiology, the vital signs are going to be similar. As shock progresses from compensated to uncompensated (non-progressive to irreversible), the vital signs are going to be the pulse increasing and the blood pressure decreasing. What's going to differentiate between the different types of shock isn't vital sign ranges, but the history of the present illness and the signs and symptoms associated with it.

I politely disagree, well about EMS being "young" anyway. It's been around for four decades and in that time has failed to really intergrate itself into the public minds as a profession worthy of true respect. Why? Education and professional standards is your answer. Now this is not true in all parts of the world; in Australia ambo's enjoy a very high reputation both from the public and other health professionals, same here (although to a slightly lesser degree) and in the UK. These are nations with by-and-large very high education and professional standards which run Ambulance as a core activity of the health system generally at a state level; Australia is by state and the UK well, don't ask me how the NHS works! While in times gone by it was possible to get away with "weeks" or "hours" of training, many nations now require a Bachelors Degree or higher which basically excludes all the whackers, firefighters and volunteers thus raising the standard in terms of provider and the care they provide. By comparison New Zealand requires a Diploma (Associates Degree) if you want to be a volunteer and at least Bachelors Degree if you want to be a Paramedic or higher (read: get paid, start IVs and give drugs). While I quibble about some of the Diploma content it will only do good things for the service and it's image. Lets see, what doesn't do do good things for the image of Ambulance Officers (no, no, me excluded) .... - 120 hours of training minimum - No requirement to get any higher education or even take an anatomy class to get certified - Vastly different standards; 600 hours in Texas vs. 3,000 hours in Seattle (try taking a TX cert to Mike Copass in Seattle) - People who drive round with lights, sirens, air horns and decals all over thier personal cars - A plethora of different titles and levels - No real interest in moving beyond the "emergency" sphere of jobs - Fire services trying to justify tax dollar sucking budgets aimed to keeping things on the downlow so it's patch factory won't close - Lack of industrial and political leadership and representation .... and once again, we seem to have centred on .... the United States Where is EMS heading? In the US, nowhere, never has, never will, rest of the world .... somewhere interesting and for the better.

I feel that the standard of education needs to be higher. Some of the programs I've seen in my area are so focused on just pushing people through because it's their buddy rather than stating " Hey you didn't make it." that people who are truly not qualified are being certified. I also think that the public needs to be educated on what our capabilities are. They need to be reminded of what truly is an emergency and what isnt. We are not a taxi service and I agree with previous statements that some patients can be left at home. Just because someone calls 911 doesnt mean they need our services and therefor we should be allowed to leave them at home. Time after time after time our services get abused and our resources drained because there is no cure for stupidity. I also feel that if it is a medical call that fire needs to stay at their station and let us do our jobs. More time is spent on scene than needed because fire feels they have some obligation to do something rather than turn over care and allow us to be on our way with the patient. EMS will never truly get the respect it deserves or the recognition as long as fire continues to accompany us on calls.

Seems to me that EMS is painfully but rapidly growing as a profession. (been a paramedic for five + years). I look at the two professions that we are most related to and I see that we seem to be growing at a faster pace than they did. One: The fire department is more structured and looked at as more of a profession than EMS, but fire has had more than a hundred years to establish itself as a field and to become what it is today. EMS has been "organized" in the USA as far as I know only since the 70's. Two: Nursing has been around even longer and has established itself as a strong well paid profession. Nursing has evolved a lot in the hundreds of years it has been needed. Key point.......lots of time.... My point: EMS is still so young as a proffesion and just like fire and nursing when they were young, EMS has to establish itself in the minds of the public as a needed, profesional, organized feild. I think that we have come a long way in the mere 30-40 years that the feild has been around. We have gone from driving as fast as we can to the funeral home to treating anything from medical to trauma with hopes of actually improving the person. Im looking forward to seeing what EMS will become in the next 30-40 years. As someone else mentioned in a previous post, we (the people in the feild now) will decide where this feild goes as a profesion. OK OK the rambling is done.

The wide awake drunk as someone already said. Anyone ever had a Jagerbomb? Or several? Terrible feeling the next morning ...

Before I start, I'm going to be using the words IF and MAY quite a bit. I'm not disputing Ms. Pearlman's claims! IF in fact her statements are true about FDNY sending out an 'all call' for anyone with medical training to assist, then she should be taken care of. It appears that she's already proven that her son was affiliated with an ambulance company, and his body and personal effects were found at ground zero. Whether or not the responders were 'full time', 'volunteer' or just some joe schmoe who jumped in to help because they've got medical training/education. I could see rejecting her case and assertions, regardless of the documentation if Ms Pearlman was the second cousin by marriage three times removed. But jeez, its the guys MOTHER! I'm sure there were a boatload (or more) of false claims, but this one has the ring of authenticity to it. I say give the woman what she's got coming and just be done with it!

I'm afraid you might be out of luck my friend. In terms of working on the streets for sure. And in Ontario every working Paramedic is required to have a valid "F"-Class DL, even the flight guys. I had an idiopathic seizure (more likely situational syncope, but that original ED diagnosis was seizure) two years ago that almost killed my career before it started. It was a long battle of testing and review boards to keep my DL and allow me to finish school and get a job. That being said, you're 18 and you haven't started yet. Give yourself the better career option and pursue a career as an RN. You can then work in emerg, ICU and one day if you're still interested in the CCT or Flight world and along the way have a better education that still leaves you with multiple job options when your back or knees check out. I love EMS and here in Ontario we get paid comparably to RN's, but I still consider going back to get my RN, for the added education and as a fallback for my knees and burnout. Good luck!

ahahahahahahahaha

The story reported on in the link I posted was a fatality of "one of our own". I made a simple comment that the situation was a little more serious than tonsils, which I *hope* most would agree with. Nowhere in that post did I make mention of sincerity. So, what I am saying is that I will not apologize for your misinterpretation of my comment. It certainly is unfortunate with several lives being turned upside down. I hope none of us ever have to find out what it's like to be in that situation. Yeah, a lot of unrelated stuff ... seems to be the norm for these forums though.

Honestly, are people even trying anymore? What was your first call? I am wondering, what was your first call? This doesn't include ride-alongs. Seriously people, at least try...I am not grammatically correct all the time. At least I try and CAPITALIZE things or form some type of understandable sentence structure. My first call? Honestly I don't recall.

i get the concept of shock this is what my instructor is asking diffrent shocks can have diffrent vitals

It wasn't the title ... it was the fact that you actually came across as being a dickhead in your subsequent replies.

I do a lot of digging on here to try and find different things to learn about. As a newbie, I thought this was a fun string to read. I would have never thought about trying to find this specifically, so it was a nice surprise.

Although it sound like one of those bullshit hero stories... My first call as a paid medic on my own truck (in the U.S.) was an "Unresponsive 3 month old, CPR in progress." Can't go into it further without taking a chance on following CrapMagnet down that bumpy road... Dwayne

Ambos need to stand up and take the bull (EMS) by the horns rather than let the bull continue to have the upper hand over the ambos. Broadly .... the following need to be addressed 1. Funding 2. Professional identity and leadership 3. Intergration with the wider health sector- no longer just call and haul/de-emphasis on emergency role 4. Standard education and levels of practice with common cross-jurisdictional titles 5. Industrial representation/pay 6. Fire service 7. QA/CQI

When someone sneezed, I offered a box of Kleenex, and said, "Tissue?" She responded, "Tissue? I don't even know you!" ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ A year ago, I was in a Texas bar, when a drunk cowboy pulled his revolver, and shot a dog in the foot. At the same bar a year later, the door suddenly slammed open, and the same dog limped back into the room. He pulled his own revolver, and spoke to the room in general, "I'm looking for the man that shot my paw!"(Pa) (Sounds a bit better if read sounding like Clint Eastwood.)

this is so you people dont think im nuts!

Assignment: Report on the 8 distinct types of shock im in dire need of help i need to find specific vital signs i may observe and any treatments we as basic providers may give to effect patient outcome in both the national and Rhode island protocols anything i can get help on will be hugely appreciated.

What are you saying Syphilis? That Lisa's appreciation of the people who cared for her is not so sincere as that of Cst. Czapnik because her medical emergency wasn't quite as severe? That is how I interpret your comment. All she is stating is that she appreciated the efforts of the paramedics who treated her and can empathize with the appreciation that this officer felt. There are enough medics out there who bitch and moan that ours is a thankless job, it doesn't help matters when our peers belittle those who express their appreciation for a job well done.