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EPIC WIN!!! What a bunch of whiney, fear-mongering drama queens in the FD. Get over it and go back to your recliner chair.

There is more to the removal of furosemide than purely the risks involved in misdagnosing pneumonia. Patients with acute cardiogenic pulmonary edema (ACPE) have traditionally been treated for having too much fluid - after all, there is fluid in the lungs, so they must have too much fluid everywhere. Hence the use of diuretics in the acute setting. However we know that this is not actually the case. ACPE occurs not because there is too much fluid, but because there is fluid in the wrong place. It is at it's heart a problem with pressure - innappropriate systemic vascular resistance leads to a redistribution in fluid and the subsequent vicious circle of decreased oxygenation, increased sympathetic response aggravating SVR, decreased contractility aggravating back-flow, leading to further decreased oxygenation. Eventually the right heart gets in on the action too, with a RV afterload mismatch caused by hypoxic shunt from increased pulmonary cascular resistance. Bad news. Most ACPE patients are not in fact fluid overloaded, but euvolemic and in many cases they are actually dry, so diuresis is not going to provide anything beneficial. Whilst some may argue that there is a degree of vasodilation that occurs due to furosemide administration (and this is true) the degree of dilation and the time it takes to happen is extremely variable and not clinically relevant when superior agents such as nitrates are available to achieve the same ends. THere may be some call for furosemide in certain cohorts of patients, such as those with a history of fluid overload, however it should be used with caution if at all. Now, on top of all of that, there may actually be a place for the use of furosemide in the setting of a patient with pulmonary edema, just not in the acute or pre-hospital setting. It seems that patients who recieve positive pressure ventilation for more than about 24s have a subsequent inappropriate production of anti-diuretic hormone and their fluid balance and CVP and so forht needs to be monitored carefully (which of course will be done in the ICU, not the ambulance) There are a number of good papers and text books out there that discuss this issue that are not too hard to find if you look for them. Paramagic

Sounds like a good thing to happen. Fire has no place running medical. Now if they'll stop sending the engines to every medical call, that would be good

RIP my friends. The medic on board was one I've dealt with several times on fixed http://firefighterclosecalls.com/fullstory.php?101528

I don't think anyone could have PAID for a better assessment on today's newbies. You've been doing this a long time Annie and know how to tell it like it is. A reg # is not a right it is a privilege (and an expensive one at that). It gives one the ability to use and build on the skills they learned in school. It does NOT mean one can walk into a job and figure everyone should bow down because they just got out of school. It gives you the opportunity to (hopefully) be a good practitioner and EARN the respect of your co-workers, some of which could have been doing the job before you were born. Be confident, not cocky, and WHEN you don't know something, ask. Judith, it sounds like you might not have done an e-call in a while (practicum perhaps?) if you've been doing industrial for the last year. It would be in your best interest to build up your skills again and get on with a rural service. Sure it can be inconvenient driving the distance. Even though I do work for a large urban service now, I wouldn't have traded my rural days for anything. I ran calls with EMR's that in the city I'd never get to run due to 3 or 4 paramedics being all over it. There is an advantage to the patient (and your learning) having ALS in certain situations, but paramedics always start with their BLS first. I recommend the same for you as it's truly an invaluable experience. And if you're looking to eventually get to paramedicine, it's good to have a couple years of good experience under your belt.

Some of those rural medics are actually allowed to do them.

National curriculum yes, but NM has always thumbed it's nose at anything national. I would like to see NG/OG and Foles on all rigs not just some.

Not exactly epic. We all know that for every FF/medic job lost, there are ten or more created. Don't hold your breath. Actually, we like to play chess and watch movies in the evening. I thnk that every house here has seen The Hangover. I can't stop saying reTARD whenever it fits the situation (you know, the scene when they're driving in the desert and fat Jesus says that Rain Man can count cards and he was a reTARD).

Not nearly long enough.