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Alright, let me pick your brains for a bit. My partner and I were called for a non emergency medical transport from a nursing home to a local hospital. Dispatched gave us the following information "general illness" So we get to the scene and the PT is laying supine on the bed with o2 via nasal cannula. The "general illness" problem was actually difficulty breathing follow by SOB. Find with me, I've gotten used to dispatch giving us the wrong info. It's all good. Other than the SOB PT looked fined to me. PT was able to walk to the stretcher on his own will. So the nurse gave me report. CHF, diabetes, COPD, etc... So I ask the nurse if the PT has asthma. Nurse says, " Yeah PT has COPD, It's the same thing" I felt like I got slapped in the head with a baseball bat, that's how shocked I was. I just stared at my partner. Now, I just want you guys profession input into this. I know for a fact that COPD and asthma are not the same thing, although both problem affect the lungs they are completely different. I just thought this would be something good to share with the city. Have fun. Denny.

Been following this site for a couple years. I'd been interested in being an EMT for well over a decade but was either too busy or too scared to try making a move to this profession. I'm just about to finish this three month intensive course next week for EMT-B. Still have the final Practical & Written, then it'll be off to take the State Exam first week in September. Supposedly the courses' finals are much harder than the states, so hopefully I can pass those two. Feeling pretty confident with the Practical, Written...not so much. Damn Cardio subjects. Been an exhausting process and a ton of learning. Test-wise, Anatomy nearly killed me since I'd never taken any med-related classes in my life. PT. Assessment took a little bit, but just about have it down pat even if history taking is still touch and go trying to to change from OB/GYN-Medical-Trauma and the subtle differences between the three situations. Excelled at Medical Emergencies and Trauma as well as Splinting/Traction materials. Thankfully they have the Practical Exam grading guidelines posted so that's a big help IMO. Now to find a practice test for the Written Exam. Anybody in Boston have any experience finding a job after your EMT-B certification stuff is finished? I don't know how difficult it is to even get a job as an EMT-B or what it involves. I'm interested being in a pre-hospital setting but also very curious how EMT-Bs get jobs in an ER, which I've yet to find much information about or even what they're called to look up requirements. Maybe down the road I'll look into training for a Dispatcher job, but that'll have to wait.

I'm not sure you understand the concept of COPD. COPD is a constellation of issues, that means COPD is a broad term that could include a number of issues. If somebody has a history of COPD, it's your job to identify what type. Also remember COPD is not isolated to older people as certain conditions such as CF are often diagnosed during childhood. Identifying the type of COPD can be challenging as the specific pathologies cross over. Even performing pulmonary function tests may not yield an answer as airflow obstruction and gas trapping are common to most types of COPD. Sometimes you catch issues like emphysema when appreciating the Carbon monoxide diffusion test however. COPD is just a ballpark term and it is your job to put the detective hat on and try to differentiate based on a good history and exam. Asking about triggers, mucous production, history of infections and so on is helpful. Unfortunately, you may not definitively identify the problem at the end of the day, but your therapy will be based on the clinical exam. You have wheezing, increased WOB, prolonged expiratory phase and so on, you will likely administer a Beta agonist regardless of the actual diagnosis.

A- is probably a catch all term for large, negatively charged molecules such as polyatomic ions and proteins.

The anticipated need for IV access isn't enough? If the patient will get an IV anyway, and we can reasonably be sure of this, we should defer establishing that IV access for... what purpose, exactly? Controlled in what way? What parts of the hospital are more controlled than the back of an ambulance? The lighting? The temperature? The mood? Well, if we're going to accept that IV's are not being magically bent by IV gremlins who simply don't exist in the hospital, there must be a reason why field IV's are presenting "messier" than in hospital IV's. What reason do you think is the source of those IV shortcomings? Is it training? Is it that folks aren't taking enough time when they start their IV's? Are they being encouraged to get IV's em route or being discouraged from taking their time getting them? Are they being discouraged from starting IV's in the field and are not getting enough experience doing them? Isn't it part of the job of EMS to adequately prepare patients for hospital care? We take 12-leads even though we cannot perform field angioplasty, for example.

Not every patient transported by EMS to the ER will need IV therapy. Starting an IV prehospitally is not always appropriate IMHO. Starting an IV just because you can, or because you think you should, is not a great idea. I started several superfluous IV's on patients who really didn't need them. Pissed me off. It's not withholding treatment if they don't need it in the first place... with the risks associated with IV insertion and IV therapy are not small... The instances in in which it's acceptable to insert one prehospitally, IMHO, are chest pain patients, possible stroke, respiratory, and fever (possible sepsis). Stubbed toe? Busted arm? Unless you need to deliver IV pain meds, it could wait... Wendy CO EMT-B

:/ I'm hoping he is ok too :/

Octreotide causes vasoconstriction of the splanchnic bed (mesenteric circulation), and in theory decreases rate of GI bleeding. Not sure it would do anything for nose cancer, but if there is bleeding further down in the GI tract, it might help. 'zilla

Wonder how long this time? Or are you a tigger and just need to bounce?

See! I knew this was going to be awesome!!

Okay I am going to do my best to make this coherent, but it is late and I am trying to condense an entire semesters worth of study into a manageable post. So I went to a small, Catholic, liberal-arts college. I am not Catholic, nor was the majority of the student body, but it offered some very valuable educational opportunities. One of the courses I took was called "Christian Healthcare Ethics". We discussed a lot of issues, such as abortion, HIV and contraception use, reproductive sciences and of course Physician assisted suicide (PAS). In terms of euthanasia, there are two ideals that seem to be put at odds with each other -- compassion and sanctity of human life. The Christian perspective puts heavy weight into the sanctity of human life: we are created in God's image thus we must respect ourselves and one another. There are references that we are not the masters of our own lives, but merely stewards of the life given to us by God. But the idea that human life is to be held in higher regard than all other things is something that we seemed to decide with little cause. In fact, the action of Jesus on the cross directly contradict the idea that human life is most important. It was the sacrifice of this sanctity that gave it the significance it has. This is reiterated by early Christian martyrs in choosing to give up their lives rather than using any means possible simply to continue their existence. If we are to hold true that "being alive" is most importance, these actions become unethical. Instead they suggest that there are times when it is appropriate to relinquish your life. The next piece to consider is the morality of the actions of a physician in providing this service. The Bible is pretty clear about murder. You shall not murder is one of the 10 commandments, plain and simple, and there are countless other references. However, I think we need to be more specific about motive. All these references are made in regard to a situation of violence. They contain phrases like "spilling blood upon the ground" and saying that assault on a man is an assault on God. But we are not talking about violence and retribution here. We are talking about an act of compassion, which could very well be argued is the TRUE ideal above all other ideals. Jesus says "love your neighbor as you love yourself". If the cessation of suffering would be the most loving thing someone could provide you with, are we not living the teachings of Christ when we provide euthanasia? In trying to brush up a little on the details of what I remember, I actually found a passage in the Bible that directly supports euthanasia... "Then he begged me, ‘Come over here and put me out of my misery, for I am in terrible pain and want to die.’ “So I killed him,” the Amalekite told David, “for I knew he couldn’t live." Samuel 1:9-10 Basically, what I am trying to get at is that if you take one single line out of context you can come up with an argument for or against just about anything. What we really need to do is look at the work as a whole, and see what the core ethics the book is trying to instill -- love, compassion, forgiveness. I fear that I have not connected the dots as well as I intended, but that's the best I can do for the time being. Perhaps as specifics are brought up I can offer more insight. Thanks for your interest!

I had always considered myself on the side of those who oppose physician-assisted suicide, until I cared for my father when he was in end stage cancer. I wouldn't wish what he went through on my worst enemy, and if he could have moved to take his own life, he would have. The pain he endured was horrible. The stress it put on my mother, and my sisters and brother, were horrible. He hated every second that he stayed alive the last few days. It was all I could do, to not fill him full of every med I had at my disposal, to put him into a deep sleep that would allow his escape from his pain-filled life. He was very adamant that he did not want any life-saving interventions but it was unfortunate that he was not allowed to make the decision to end his life how he chose once the pain and suffering became unbearable. Some of the posts here express concern about ending one's life like this becoming a casual event, that patients and doctors will make this decision like they decide whether they want an extra shot of cream in their coffee. It has to be the decision of the person who is ill, not the family, not the doctor. I don't believe that it will ever be a casual event, or that we have to worry about doctors using it as a regular form of treatment. With proper education, most people are smart enough to make their own decisions. We try to educate our patients on the treatment options that they have. Why can we not do the same in this situation? People with debilitating diseases are generally informed about the progression of their disease, the signs and symptoms that will appear, and the deterioration of their quality of life. With that information, why do we not allow them to make the decision that will allow them to escape that pain and suffering in the way they see fit? My personal opinion is that by withdrawing treatments eg feeding tubes or medications, and then allowing the person to starve, or allow a slow organ failure, and accepting that as a more appropriate treatment than the person deciding to have a quick, less painful death through some other means, is merely a way of splitting hairs to distance ourselves from the negative connotation of "suicide." By allowing the slower, more painful, less dignified death, we can comfort ourselves that the person "died naturally" rather than "suicide." But who did this truly benefit? Definitely not the patient. And in the grand scheme of things, isn't the patient our first priority? Isn't patient comfort supposed to be one of our basic treatments? If or when that day comes that I have such a debilitating illness that I cannot care for myself, that I am a burden to others, and that there is no quality of life, I will do my very best to take those steps to ensure that I do not linger.