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Don't take this the wrong way, but have you had your hearing checked lately? I say it because my old partner was almost deaf in one ear and really had to focus on some patients to hear. A good scope and practice can overcome the problem, but it's something to think about if you just don't seem to be having success, especially when learning.

I was thinking of substituting the name Kenny with Dwyane on some of these > LITTLE KENNY ON MATH (Part 1) > > A teacher asks her class, 'If there are 5 birds sitting on a fence, and you shoot one of them, how many will be left?' > She calls on little Kenny. > He replies, 'None, they will all fly away with the first gunshot.' > > The teacher replies, 'The correct answer is 4, but I like your thinking.' > > Then little Kenny says, 'I have a question for YOU Miss Rogers'. > > There are 3 women sitting on a bench having ice cream: > One is delicately licking the sides of the triple scoop of ice cream. > The second is gobbling down the top and sucking on the cone. > The third is biting off the top of the ice cream. > Which one is married?' > > The teacher, blushing a great deal, replied, 'Well, I suppose the one that's gobbled down the top and sucked the cone.' > > To which Little Kenny replies, 'The correct answer is 'The one with the wedding-ring on, 'but I like your thinking.' > > > > > LITTLE KENNY ON MATH (Part 2) > > > > > Little Kenny returns from school and says he got an 'F' in arithmetic. > > 'Why'? asks the father. > > 'The teacher asked 'How much is 2 x 3', so I said 6', replies Kenny. > > 'But that's right' says his father. > > 'Yeah, but then she asked me, 'How much is 3 x 2' > > 'What's the fuckin' difference?' asks the father. > > 'That's what I said' replied Kenny. > > > > > LITTLE KENNY ON ENGLISH > > > > > Little Kenny goes to school, and the teacher says, 'Today we are going to learn multi-syllable words in our class. Does anybody have an example of a multi-syllable word?' > > Kenny says 'Mas-tur-bate..' > > Miss Rogers smiles and says, 'Wow, Kenny, that's a real mouthful.' > > Little Kenny says, 'No, Miss Rogers, you're thinking of a blow-job..' > > > > > LITTLE KENNY ON GRAMMAR > > > > > Little Kenny was sitting in the class one day. > All of a sudden, he needed to go to the bathroom... > He yelled out, 'Miss Jones, I need to go take a piss!!' > > The teacher replied, 'Now Kenny, that is NOT the proper word to use in this situation. The correct word you want to is, 'I need to Urinate'. Please use the word 'ur-i-nate' in a sentence correctly, and I will allow you to go.' > > Little Kenny thinks for a bit, and then says, 'YOUR'E AN EIGHT, but if you had bigger tits, you'd be aTEN' > > > > > LITTLE KENNY ON GRAMMAR (Part 2) > > > > > One day, during lessons on proper grammar, the teacher asked for a show of hands from those who could use the word 'beautiful' in the same sentence twice. > > First, she called on little Suzie, who responded with, 'My father bought my mother a beautiful dress, and she looked beautiful in it.' > 'Very good, Suzie,' replied the teacher.. > > She then called on little Michael. > 'My mommy planned a beautiful banquet, and it turned out beautifully.' > > She said, 'Excellent, Michael, excellent.' > Then the teacher reluctantly called on little Kenny. > > 'Last night at the dinner table, my sister told my father that she was pregnant, and he said 'Beautiful, just fuckin' beautiful'. > > > > > LITTLE KENNY ON GETTING OLDER > > > > > Little Kenny was sitting on a park bench, munching on one candy bar after another. > > After the 6th bar, a man on the bench across from him said, > 'Son, you know eating all that candy isn't good for you. It will give you acne, rot your teeth, and make you fat.' > > Little Kenny replied, 'My grandfather lived to be 107 years old.' > > The man asked, 'Did your grandfather eat 6 candy bars at a time'? > > Little Kenny answered, 'No, he just minded his own fuckin' business..

Maybe work on a spell check before writing your paper. cheers

Damn, Mobey! Could ya have been a little harsher there? Cutie- listen to what he says. I also had to read your post a couple of times to figure out what you were saying... if you don't spell things correctly and write with some semblance of grammar, people will automatically assume that you're stupid. Sucks, but that's the nature of the 'net. As far as hypothermia and jostling your patient, I believe the answer you are looking for is V-Fib (someone correct me here if I am wrong) because the conduction pathways in the heart go all wonky and the AV node doesn't conduct correctly due to inability to depolarize properly, leading to quivering-bag-o-jello heart. Jostling your patient causes stress and a sympathetic response, which speeds up the heart, which leads to the above mentioned effect. You said it was for a review sheet- what do your source materials say? What are you studying for? Wendy CO EMT-B

As was noted above, that's an impossible question to answer in general terms. Too many variables, and each system is so different. One system may use strict seniority, another may use an appointed system, another may be required to take a written and oral test- especially in the case of civil/career service systems. To answer your question-you need to narrow down WHERE you are talking about and ask someone currently working there. It also depends on your definition of "supervisor". Is this a person who still works the streets and responds to larger incidents, assists in care, solves problems, or is it someone who flies a desk and does scheduling and training. Maybe it's someone who is on a quick response vehicle. Maybe it's simply the senior member on an apparatus. Degrees and certifications are great, but to be an effective supervisor/trainer/proctor, you need to have a certain baseline level of experience in the business. Obviously the amount of time would vary greatly- in a busy urban area, you could see more in a week than some rural service deals with in an entire career.

Let me turn this around on you in the name of thinking this through? How does albuterol increase the amount of fluid in the lungs and what mechanism is responsible? "I was told so" is an invalid answer as I expect and hope my students verify the dogma that I spew at them. If I am lucky, they push hard to understand and perhaps get one over on me. What are the causes of diminished lung sounds and are any of these causes treated by albuterol administration? You will need to research the answers. Furthermore, when giving albuterol for "wheezing," is there an underlying pathology that we are looking to find that will cause said wheezing? After all this, we can discuss your partners decision making and the rationale he/she used to justify the decision to treat. My apologies if this comes off as a "non answer." I hope to read and learn from the fruit of your research. Take care, chbare.

I can't think of anything that should have been done that was not done according to the OP's report so not sure what you think he missed? You also have made an assumption that because he realized the pt was old and (probably) dying that he did not work them up adequately whereas it seems that the appropriate treatments and measures were taken. (i.e. 12 lead looking at the chest pain as well as treating as a trauma pt as far as I can tell). He may have been looking back in hindsight and understanding that the pt's co-morbidities were the cause of his death versus any lack of care on the medic's part. It is also an assumption that taking note of his age and condition caused them to decrease their level of suspicion for occult injuries and complicating factors whereas he did not say whether or not it may have instead raised their alertness to more potential complications. He was obviously taking into account the geriatric considerations or else he would not have been saying that "as far as 90 y/o patients go he was very healthy and I hope to be that healty [sic] at his age". Exactly! The question the OP was asking was what else could they have done and was it possible they missed something that resulted in his death. I didn't see anything listed in their treatments that indicated they missed something that resulted in his death or else I believe in all likelihood he would not have lasted a couple more days. It seems they provided appropriate care for all his possible conditions/co-morbidities and I don't see anything else that should have been done prehospital that wasn't. Cheers!

Without knowing the cause of death, there is no way to judge the OP right or wrong. For all we know, the guy was being discharged from the ER, slipped on a wet floor on the way out and ended up with a epidural. Let's say it was something cardiac. Is there anything else he could have done that would have made a difference? Nope, not likely. Was there a traumatic injury that killed him? If there was, what can EMS do about it? Bring the pt to the ER and that is what was done. I don't think anyone can say that something was missed or done wrong. That is the joy of medicine, even when you do everything right, people still die. It may have just been his time.

Hello, The Aortic Aneurysm could be the cause of the chest pain as well. A Thoracic Aortic Aneurysm (TA)can present with SOB, coughing and chest pain. As opposed to the tearing type lower back pain of a AAA. Basically, a TA can pain fairly convincing AMI picture. In fact, Thoracic Aneurysm (TA) is a DDX that one must rule out in the hospital setting before TNK is given or the more aggressive treatments for a AMI. Sometimes, in theory, their can be a difference in BP from arm to arm in a TA. However, I have never seen this myself. Cheers....

Hello BoCat9, No need to be sorry about anything. Posting is hard sometimes. In fact, I have been mostly a lurker since 2005! =) There are a great deal of possible causes of PVC's as you know. In the case of a AMI PVS's typically are left alone. Relaxing the patient (being kind and maybe an Ativan) can help reduce PVC. As well as oxygen in and pain control. Though not a concern in the EMS setting lytes play a key role in reducing PVC. AMI patient typically have their K and Mag kept the high end of normal as well. Plus, if there are no signs of failure IV Metoprolol helps sooth things as well. Cheers....

Can I ask a huge favor? Is it possible that we can get through a discussion of anything cardiac without the use of 'treat the pt, not the monitor' over and over and over? I mean, we've all heard this ol' saw from our first week of medic school, and many of us from our second or third week of BLS education. The OPs presentation seems to make it clear to me that he is in fact treating his pt, and not the monitor. Why is it when we talk trauma we never hear, 'treat your pt, not the b/p cuff'? 'Treat your pt, not the ETCO2'? For some reason we use each of these tools, as with a monitor, to add to our assessments but aren't considered foolish or medically immature for referencing their data when discussing treatments. Not trying to be a shithead everyone, truly I'm not, but I began to be offended for this poster after about the 3rd or 4th repetition of a phrase that he almost certainly didn't need to hear in the first place. K, off of my soapbox now. I don't really get the logic here WM. So then, do I not get aggressive infact that fell off of the roof onto soft grass, is not 'appearing' hurt and his pulse rate is steady and within normal regulars? Do we not treat the female syncope because she isn't pale, diaphoretic, her pain isn't 'crushing or radiating' and is 'fine now' but 12 lead is showing a STEMI? After all, most BLS providers wouldn't have caught the implications that, in each, the lack of symptoms was possibly a very ominous sign. It seems to me that he discovered what appeared to be an increasing ventricular pathology and was asking if he could have prevented further degradation by being proactive (An attitude that I like and respect a lot) or if waiting to be forced into treating it was more appropriate. Mainly, because I'm a chicken shit, I nearly always choose to be very aggressive where I can justify it as I friggin hate finding myself behind the eight ball when I could have avoided it. I think he posited an great educational question. Awesome advice, but if I may, I believe that at times, if we pay attention, we can give our patients what they need before they really, really need it. Isn't that an example of the very best we can offer in medicine, and isn't that what this thread was really about? Not meaning to snipe at you WM, it just happened I 'got going' on the other stuff after starting to respond to your post.. :-) Dwayne

British Columbia Paramedic student granted full refund because of 2009 labour strike. The 3,500 CUPE 873 members, who had been on strike since April 1, were seeking improved staffing levels, wage parity with other emergency response workers and a multi-year contract Read more: http://www.cbc.ca/canada/british-columbia/story/2009/04/10/bc-paramedics-talks.html#ixzz17dLMtrM9