Leaderboard

One of my classmates recently returned from Afghanistan and brought to my attention a drug they have been using over there in the ANA hospitals, which is also being carried by the Special Forces medics who may be further removed from trauma care. It is a fibrinolysis inhibitor, but I don't think they really know how it works. You can download the study free from the Lancet, July 2010. Is anyone out there using Tranexamic acid or Aminocaproic acid in their prehospital protocols, or considering it? The recent CRASH2 study provides some interesting data to consider. I'm only now finding out about it. Of course, I have no financial interest in it or the manufacturer. BLUF: Randomized double blind controlled multicenter international trial of tranexamic acid (TXA) in 20,000 trauma patients from 274 patients in 40 countries. Given as a single 1g dose, followed by an additional 1g over 8 hours. Patients who "clearly needed" it were not randomized, nor were patients who had clear contraindications. 10% reduction in all-cause mortality 15% reduction in mortality from hemorrhage No significant differences in blood units given, or number of surgeries Trend toward benefit when given earlier after injury Hospital-based protocol, not prehospital No increase in vascular occlusive events such as CVA, MI, PE, or DVT. Shelf stable at room temperature, $9 per dose It's a hell of a lot cheaper than rFactor VIIa. 'zilla

Unions have not hurt nor help the country. In many cases they have helped the Employer and Employee to find a common ground. Sometimes the common ground benefits the Employees and other times it benefits the Employer. It all depends on the Employer and Employee, which has no Union; to decide if one is needed. Many times the Union benefits useless Employees and Employers can't reward hard working Employees. Sometimes the Employer looks at the money side too much. Not to say the Union doesn't either; they want as many people to be employed at their Union sited job to collect dues. Remember that. So the only one who should be fighting for your best interests, is you (Unless you're on trial). That will probably be the best advice. It can get ugly on both sides. Good luck...

OK, now that that is over, I am going back to the original point of this thread. I am a big fan of providers doing thier own research, but to be honest, the nervous system can be really confusing, and IMO at the EMT-B level you need a specific understanding (does not include synapse). The nervous system is divided into 2 parts, the Sympathetic, and Parasympathetic. When the body is injured/struck with illness/under stress, the sympathetic system will be dominant. This sympathetic response is also known as "Fight or flight response". SYMPATHETIC: Primarily driven by the chemicals Epinephrine & Norepinephrine which the body releases to cause the following: •stimulates heartbeat (Force of contraction, rate, and electrical excitability) •raises blood pressure •dilates the pupils •dilates the bronchi •stimulates the conversion of liver glycogen into glucose •shunts blood away from the skin and extremeties for increased supply to the brain, and heart *Causes diaphoresis PARASYMPATHETIC: Works opposite the sympathetic system. Also known as the "Feed or Breed response" This is what system is working now as you sit typing on your computer. •slowing down of the heartbeat •lowering of blood pressure •constriction of the pupils •increased blood flow to the skin and viscera Just a quick thought connect the dots for you: Do you administer an Epi Pen as an EMT-B? If so, what is in it? how do you expect your patient to present after having it administered?

Its cool that NYC has implemented Hypothermic Cardiac Resuscitation. There's allocated hospitals for it. I'm all for change to benefit the patient. It would be great if the Department of Health and Human Services (DHHS) was on board; if they increased their scheduled reimbursement wages this will help healthcare institutions to survive. If they do; HMO/PPO/EPO will increase their remibursements too. DHHS needs to balance Gov't sponsored insurance. Premimums and Copays need to be enforced and inplemented. That's another argument for another time. Things always come full circle. If it was a hit then; it'll be a hit today. There are audits and restriction that has crippled the healthcare institutions. As science has advanced, wages and benifits increased, taxes gone up, insurance premiums on the rise, attorney retainers, stocking & re-stocking costs, vehicle maintenance, computer aide dispatching, GPS, refective strips, denial of insurance claims, payroll tax, etc: this has not made it easy on the employer. Ex. Many people have Medicaid in NYS especially the Nursing Home residents. At the base reimbursement for ambulance service at $139.50 (Regardless of care; ALS & BLS; travel distance: emergency or non emergency; carry down or carry up; morbidly obese or non obese). How do companies survive? Medicaid reimbursements has gone down over the last decade, as expensives has gone up. What I'm saying is; look at your net income and your expenses. Say if your net income continues to go down but your expenses goes up. How do you survive? You won't. So sorry for hating but we all hate something relating to the government. But awesome FYI stuff, thanks....