HellsBells

Looks like a 3rd degree block, judging by the bottom lead

MONA, right... That's some textbook medicine.

Lol, nice humblebrag.

Interesting, this is not a pt I would like to have to try and intubate. I'm actually thinking that this may be a case where digital intubation might be a reasonable option.

This is standard practice where I work now, I think the main advantage is that it provides an oxygen source during the intubation attempt.

I feel somewhat conflicted about the OP. I do feel that this career needs to be more professional. However, I'm not really too worried about the public at large. While they may not give us much thought when we are not needed, I think that society at large has confidence and trust in us when we are needed. Oh, and I really, really do not want to be compared to politicians, our professions reputation would have to take a serious hit to be brought down to their level of public trust. The area where I think we need to step up our game for professional recognition is with other healthcare providers. I feel that we still play second fiddle to RN's and in a lot of respects our relationship with doctors is one of being dictated to, instead of collaborating with. I'd like to see more avenues for paramedic degrees, research, and upper management and supervisory roles. Oh, and for god sakes, can we please stop wearing the star of life T-shirts on our days off?

I had a similar problem when I first became an EMT in 2004. I was lucky to have understanding preceptors and mentors to help me through my rookie phase. There is no easy way to get over this situation, you have to do assessments repeatedly until you develop confidence and competence in your practice. The good news is that it gets better with time, now that I'm ten years into it doing assessments is second nature and I don't have to worry about freezing up on calls any more. The one piece of advice that helped me was to not think of the assessment as a rigid set of questions you have to ask, but instead a problem you have to find a solution to. I found initially when I first started I was trying to rush through a series of predetermined questions without really listening to the patients answers, then getting stuck when I forgot what the next textbook question should be and also realizing I hadn't listened to anything the patient had told me. Try to really listen to what the patient says, then integrate that into your line of questioning. Generally that will get you out of your head and help with those awkward brain freezes. Also, don't be too hard on yourself, others have been where you are and got through it, so can you.

My first thought was that he passed out drunk and had a foreign body inserted in his rectum, Ala Jakass. However his presentation doesn't go along with that. Maybe get a D-dimer. Possible DVT from sitting around watching TV all day?

I don't know, should they be? There seems to be something Trollish about this post.

What about the fall in the dispatch notes? Is this relevant, or did she just slide off the couch? Allergies? Pill bottles? lets make sure that there are no extra pills missing BGL?

Yeah, I'm afraid that, as Mobey states you'll get differing opinions on all schools from different grads. The advice that I do have is that if you are based out of BC and want to work in BC, its not too bad of an idea to pick a school in Alberta, as its close logistically, and registration transfers over fairly easily. Additionally, if you're thinking of taking school in Alberta, I'd also recommend you take a look at PMA, they have classes out of Sherwood park and Calgary.As a Paramedic in Southern Alberta, I get most of my students from either PMA or SAIT. There doesn't seem to be a particular difference in the quality of students each produces, I find its more the attitude of the individual that makes the difference. As you mentioned, the selection process at SAIT doesn't seem to be that strict, they also have bigger classes and go to school full-time monday-friday. PMA has a rotation of classes that is two weeks on two weeks off, smaller classes, stricter selection process and a shorter length for the program. NAIT I can't really speak to, as I don't get any students from that program. So... its up to you to decide what the best fit for you is. I think the best thing to do would be to go to an open house and/or talk to the instructors at each school, see if you like the facilities and also the philosophy of the teaching staff there; ask what their pass rate for ACP exams. I would really not put too much stock in one off opinions of ex student from each school, as they tend to reflect personal bias, rather than the reality of the institution.

Yes, why? Are you implying that's a contraindication?

I think it would be safe and reasonable to take Bretylium off this list.

I agree with ERDoc that if this is to work, certain Medics need to be properly trained. We have Tactical Paramedics in the city I work in who are trained, and have the proper vests/armor for this scenario, although there are usually a max of 4 on duty at any given time.

Ok Mobey, you're gonna have to give more detail on that one...

Possibly. However, it wasn't stated, directly or indirectly that this was the reason for the sting operation. It appeared to be a very poor inner-city "hood," where I'm guessing the majority of petty thefts go unreported to police. The thrust of the operation seemed to be an excuse to catch young black men doing something "illegal" as an excuse to search them for drugs or other contraband (not that they need a particularly valid reason for this, as the original article points out). Don't get me wrong, these guys are stealing the bike, which is illegal and are caught red handed. To me it appears that the cops in question are using a lot more resources than are required for the nature of the crime. ..and ERdoc, touche for the buzz lightyear xray. But in the case described here, is it likely that if a pouch of drugs had been inserted in the mans rectum, hastily as he was pulled over by the police, that it would travel a significant distance into the colon?

My thought is, what do these officers really think they are accomplishing here? Best case scenario, they find a trivial, irrelevant amount of drugs up his rectum. Yet, they are parading him from hospital to hospital like he is Pablo fucking Escobar. How big do they think this man's anus is? Are they expecting a fully functional meth lab to drop out of this fellow's ass, or what? Furthermore, how far up ones ass can these drugs go? Honestly, if he shoved some contraband up there in the process of a drug stop, I think the digital exam and enemas would quite cover it. Actually, I take back the Escobar comment; they must think this man is Harry "fucking" Houdini. The whole endoscopy reeks of desperation. I wonder if they felt any shame at all after they stole this man's dignity and wasted untold hours serving this "important" warrant and just came up with shit? These moronic tactics remind me of a recent episode of COPS. They were filming a team of five undercover cops in Louisiana who were operating a sting operation in an obviously poor, black neighborhood. The bait was a mountain bike of middling quality. Not a motorcycle, or a Car, or even a briefcase of cash. They were staking out a FUCKING mountain bike. When they apprehended the men stealing the bike, they acting like they'd just made the bust of the year, all back pats and high fives. It didn't even appear that it registered how insignificant and pathetic the whole operation was.

This post makes me pissed off that spinal immobilization is even a technique that exists anymore. Dogma is right. All the evidence points to the fact that this is a pointless procedure. Yet we do it because it makes health care workers uncomfortable not to.

You don't have an option for IO access?

I love the point where they mention multiple interns were set on fire during the testing phase.

What is with the big hard-on for air medivacs in the USA? It seems like the threshold is very low for who they fly out. Only critically ill patients get flights here in Western Canada.

Firstly I think the 75%, of IO use is out of line for sure. IO should be reserved for critical patients where one can't otherwise get access. However, why is there this big fear of initiating an IO? Personally, I'd rather use the IO route than EJ, if those were my only two options. In my career I've started four IO's and only one EJ. In my mind there is far more risk of complications in an EJ than an IO.

There are two obvious ER theme songs - Eye of the Tiger - My Hero by The Foo Fighters.

Wow, is there actually instances where medics slam 2mg of narcan at the hospital door because they think its funny? I honestly would not regard anyone who would perform in such a manner professional, or competent in any sense of the word.

I once brought the results, but then someone still argued with them. Can you believe that?!!?