VentMedic

They also pitted the nebulized magnesium sulfate against "serial" 2.5 mg salbutamol nebulized txs which have been shown not to be as effective as scoring the patient on the appropriate asthma or dyspnea scale and giving the appropriate dose in a breath activated neb (BAN) or an appropriate continuous nebulizer with appropriate doseage. We try to avoid wasting time with severe asthmatics. If it is a feel good treatment for a "cold", then we may just do one or two 2.5 mg Albuterol txs before kicking them out of the ED. By appropriate continuous nebulizer, I mean one that is meant for X amount of fluid for consistent particle size and nebulization efficiency. Inappropriate nebulization is often the problem when people dump too many unit doses into a nebulizer whose baffle is not designed for that amount.

MgSO4, the results have not given significant results to warrant the off label policies even in the hospital. http://www.merginet.com/index.cfm?pg=airwa...n=magsulfasthma The big problem is the inability to get into the airway passages due to inflammation and constriction well enough for good depositon. Some of this patients may require Heliox either by mask or ventilator for several days. It is rare you'll break thru truly inflamed airways in the field. In the hospital we are capable of giving high doses of albuterol up to 25 mg undiluted with a BAN to assure minimal medication loss. This is also how we treat high K+ levels until definitive treatment. High dose nebs are not to be confused with what a hospital calls "continous" nebs nor when you dump a bunch of albuterol unit doses into a neb to get it to run continously. Regular acorn nebs are not recommended for off label nebulization. Remember your nebs in the field are only delivering about 10% of the medication on a really good day. Since most hang face masks for convenience, you may get 5% or < after the nose filters the particles. The other issue is the safety of the crew and bystanders when off label use meds are nebulized. Our nebs can have filters and we use a scavenger if the patient is not isolated. Racemic Epi is used frequently in RSV or bronchiolitis season in infants. We rotate Racemic Epi with Albuterol given at 2 hour intervals. The Racemic Epi may reduce the swelling of the inflamed airways just long enough to get some albuterol or steroid into the lungs with better depositon. We can also initiate a continuous Racemic Epi in a hood if necessary. That is a low dose given continously. The 4 hours in the ED as ERdoc stated is to see what happens after the airways rebound to previous status if definitive therapy such as steroids or long acting bronchodilators don't work as planned. Nebulized lidocaine 4% is also used to reduce "spastic" asthma with severe coughing. Depending on the etiology of the wheezing, don't always expect miraculous results in the field. All that wheezes is not always asthma and not all asthma always wheezes.

Are you referring to EMT-B A&P or a college level A&P? I would hope one doesn't have a hard time with EMT-B A&P since there is very little in the curriculum.

But they're prescription.... :wink: It ain't the same. :wink: :wink:

If you want more info about an EMS that has developed an excellent Social Service referral system, give NiftyMedic911 a PM. Lee County, FL was one of the earlier pioneers in the Community Health area. I am not certain about what other additional services they are still performing.

Prescription Drugs Allegedly Stolen from Florida Fire and EMS Stations http://www.emsresponder.com/article/articl...n=1&id=7410 PAMELA STAIK Courtesy of The Sun-Herald PUNTA GORDA, Fla. -- The Charlotte County Sheriff's Office is investigating prescription medicine thefts that have allegedly occurred at Charlotte County Fire and EMS stations while engines were responding to false calls. The investigation was kicked off Friday, when a Charlotte County Sheriff's deputy responded to a burglary at Fire Station 6 in Punta Gorda. The station had received a phone call regarding a car accident with injuries. An engine and a rescue unit responded, but workers were unable to find any signs of a collision. Upon returning to the station, a firefighter went to his vehicle and found that items in his unlocked truck had been moved around. When he searched a bag of personal belongings, he found that his prescription bottle of Percocet was missing. A deputy checked the call log and found that the name given to the 911 operator regarding the false accident was another firefighter who was home sick in North Port at the time of the call. However, the phone number did not belong to the ill firefighter, but was found to match another firefighter, who is on probation for a second DUI charge. Station personnel have had to lock up drugs, including Benadryl, because this firefighter was known to take them, according to the police report. Another firefighter told deputies that approximately 60-65 Vicodin pills were removed from a prescription bottle kept in his personal duffel bag in December. Deputies also learned of several other incidents since February in which firefighters noticed their belongings had been disturbed and pills stolen while they were responding to calls. The report states that the only known call to be placed from the suspect's cell phone was on Friday, but his whereabouts at the time of the other false calls and thefts are unknown. No arrest had been made in the case as of Monday evening. While department officials have stated that a member of the department is on administrative leave without pay, they say it is regarding an unrelated matter. Fire & EMS spokeswoman Dee Hawkins said she was only aware of two incidents of theft being reported -- one in March and one on Friday. "These other ones were never reported to headquarters, so we were surprised to see it in the investigation," Hawkins said. Despite this, she said the agency is being as cooperative as possible with investigators. "I know the Sheriff's Office is doing an investigation and we will be cooperative with them," Hawkins said. "The chief is reviewing all the different situations. We want to get to the bottom of this, just like everybody else." http://www.emsresponder.com/article/articl...n=1&id=7410

I agree with taking a refresher course. There are usually several throughout each state that offers the National Registry. At least the part with the skills might be helpful. For the education part, a good text or online refresher course would be adequate. An even better option would be instead of retaking the EMT class, you could use that time to take a college level A&P class.

http://www.jbpub.com/catalog/9780763729073/ The other is Dale Dubin's Rapid Interpretation of EKGs. It is a fill-in-the-blank style that is similar to a 5th grade reader in format. You either love it or hate it. It has some very good information if you can get past that style of presentation.

We knew that education and medical oversight was going to become a problem starting in circa 1985 when the Paramedic program began moving further away from the 2 year degree or any education higher than a 700 - 1000 hour cert. Even with the threat of removing intubation there has been little done, except in a few quality services, to improve. The states still have not seen this as a problem and continue to offer individual "skill" certs without enhancing the overall licensing criteria.

Here is a typical two year RT program list of classes not including the prereqs. You can link to the course descriptions and course outlines. Most of the classes are called CardioPulmonary because it is difficult to talk about one and not the other. http://www.broward.edu/ext/DepartmentCourseList.jsp?Name=RET Here is a four year RT program: http://www.catalog.sdes.ucf.edu/current/de...onary_sciences/ Now if you want to see some really indepth cardiac classes, look up an Exercise Physiology/Science degree program. They take it to the Ph.D level.

Are you in a truck by yourself? No partner? And how many others show up? Does the code commander come separate? We like to call it organized chaos in the ED. Things usually get done even if you don't always know their co-workers' names. Experienced people can usually fit in once they get started. Did you ever think that one ED has to put up with the mess of EMS you just described with 6 different EMS people crowding into the ED with one patient? Now, multiply that by 50 - 100 times per shift minimum for some EDs. Add a 100 or so walkins to that. You have ONE patient with at least 2 - 6 EMS providers. The RN as 2 - 6 patients and some of those pts may not be very stable either. Obviously the 3 paramedics on this truck don't share the same success rates as you if the best they could do on this call was a King tube and no IV. Maybe your perfect system could give them some pointers. Again, who didn't not know their place in this situation? Nurse starting IV. Doctor intubating. (probably an RT somewhere around there also) Student doing compressions. Things were definitely getting done. There wasn't a lot of info given here for the other players who may have also been in their place. As a student, the OP may not have known who all the players were and what their functions actually are. As I stated before my job description changes with every ED I work in. You are probably right. A hospital shouldn't expect much from Paramedics.

That depends on what you consider basic cardiology. In RT, "basic" is 3 college semesters and then you do two more advanced. Of course that covers more indepth A&P (2 semesters of regular A&P are prereqs), basic rhythms, 12 lead and hemodynamics which you can not adequately do cardiology without hemodynamics. You hope the classes are only 4 - 6 hours per week because the reading in both the text and assigned articles are time consuming. That is besides the other 2 or 3 classes and clinicals. After you complete the basics you can get into IABPs and LVAD as well as the clinical in the Cath Lab. And, that still doesn't touch even half of what the CVT program students do with cardiology even at the A.A.S level. RT school was a far reach from one Paramedic text with Sidney Sinus node and a Dubin reader on the side.

Try this thread: http://www.emtcity.com/phpBB2/viewtopic.ph...t=accreditation

This would be an interesting mechanism of injury case for EMT(P) students. There were several photos posted on the newspaper website. The front windshield appears to be intact. The ambulance spokesperson did make a statement that the speed was not over 45 mph. There could also be some mechanical failure involved just as speculation. I personally have had a couple of mechanical mishaps like a rear tire from the outside dual trying to pass the ambulance. I would hate to judge this young person too hastily until the iPod rumor is verified. I have heard about some of the injuries and they could be easily missed if some of the same assumptions were made as previously posted. I am also thinking about the recent spinal immobilization thread. I believe a family member posted a list of injuries someplace that hit a news wire or it might have been in the many comments made on that newspaper website. I'm sure there will be public statement in the near future. This is a sad event and hopefully once the EMTs recover they can share their experiences so that other young people can appreciate the responsibility and dangers of operating an ambulance or any vehicle. For those that would like a little review on mechanism of injury: http://www.ehs.net/nsc/4-1moi.htm United States Department of Transportation National Highway Traffic Safety Administration Trauma Systems and Mechanism of Injury

The side window or side front post can do just as much damage. The seat belt may not have locked in hold when twisted toward the side. If the passenger becomes unrestrained, as in the side of the ambulance ripped off possibly taking the seat belt, that person is now a heavy object that can result in a severe impact to the other person. That doesn't include other things that can fly around and impact with the person's head. Again, depending on the angle and velocity of impact, it doesn't take much.

Just like some of the parking lot C-Spine and lumbar fxs you see at very low speed, it does not take much force to do damage when the body is even the slightest out of alignment. The force was on the passenger side created a torquing force. Sometimes the frame of the ambulance or the warping of the panels can tell what the spines of the two EMTs went through. If you plot your vectors you can probably find what the angle that generated the most force and where inside the ambulance. The seat belt is great if you are in good posture, eyes forward and a direct frontal hit to absorb the shock.

The statutes for higher mandatory minimum eduation for entry into the profession will have to change first. Paying better now will just encourage more to rush through the Medic Mill to get to that higher paying job. There will be no incentive to continue with their educaton beyond that. And, if there is a union, they will only support those that think it is unfair that they become educated.

Has she ever been worked up for Munchausen Syndrome? I have seen and heard of similar in Pediatrics which can be Munchausen Syndrome by Proxy. A few years ago there was a highly publicized case where the wife of an RT was tried for endangering her children with Munchausen Syndrome by Proxy. That case also involved fake vomit and a variety of induced symptoms that got one child several procedures including a couple of surgeries. That case walked the fine line of what can be mental illness and should it be jail time for child abuse or psychiatric institution for treatment. It can become very serious depending on which level they want to continue their desire to be a patient that needs attention. The diagnosis is often missed for many years. Hypochrondria patients usually don't go that far and are aware they are exaggerating.

And you too are assuming. Just because there is a visible IV does not mean it is functional. There was a tube sticking out of the patient's face but not the most appropriate airway. The doctor was dictating but with the wrong assumptions. So yes, he was making the wrong assumptions. Each ED has its own culture and takes a life of its own depending on management. I have a different set of responsibilities in every hospital ED I moonlight at. Add a rent-a-doc and my shift can be very good or really bad. There are alot of factors that go into determining the success of an ED and even on the best of days they can vary. For the most part I will say the majority of the EDs in my area function very well. The doctor may have been a rent-a-doc and did not know who anyone was in that ED. The other staff may have been PRN or floats. Unless you are going to work in the ED environment, there may be little you can do to change that or even understand it. Some days things run smooth as silk and then there are times when things just don't click. This may have been a very off day for whatever reason. It seems that it was a very off day for the 3 Paramedics in the back of that truck. Now, as prehospital providers, what options did the 3 paramedics have that could have enhanced their treatment of the patient? If you are a paramedic student, you should be looking closely at this type of patient if his size was a problem. Did you notice any other sites for an IV? What are the defining anatomical features that can help determine if ETI is going to be successful before you do too many attempts? Did you notice how the doctor intubated to gain an insight on a difficult airway? There is so much to learn as a Paramedic student even in perceived chaos. If the ED is falling apart, plan your own strategy in your mind for this patient for future reference. If you have a useful suggestion during a code, then respectfully offer it. If you are the first to notice there is not an IV or a patent one, then announce it. If you see it is a King and not an ETT, point it out. Different airways may not be readily recognizable since some hospitals use several different ETTs and some hospital staff may not be familiar with the many different tubes besides the ETT.

Let's recap: 3 Paramedics bring a pt to the ED with a King airway, no IV and CPR in progress. You are doing compressions. Doctor thinks ("assumes") there is IV access and yells for meds. Nurse realizes no IV access and proceeds to attempt access. Doctor thinks ("assumes") he has an ETT for meds but realizes he now has to reintubate where he could have been establishing a central line if needed. Now who from the people mentioned wasn't doing his/her job with what had to be done first with access for meds and a stable airway? Possibly the biggest fault I find here is the doctor "assuming" too much from the ambulance crew. He was ready to take over from the Paramedics by continuing with the meds, as it should be when an ALS crew brings in a patient, when his nursing staff realized NOT.

King airway and no IV? You're not saying this patient died and it was the ED's fault? The pt's odds weren't that good coming in. It looks like the ED had to start from scratch by establishing an IV and intubating with a stable airway tube. How clear was this made on the radio that this was being BLS'd in? If that was clear then yes, the ED staff should have been more prepared. As I mentioned before, they should expect the least amount of stuff done in anticipation instead of assuming the best. Not to distract from whatever was going on with the ED staff, but, what was the level of certification of the EMS crew?

Bummers! Some of our partners have been together longer than their marriages.

No IV? Also, the only reference to airway was bagging so it is unclear if there was an ETT in place. It almost sounds like this patient was BLS'd in without any IV or meds to begin with. If this was an ALS crew, did they not have other means of establishing access? The doctor could also have offered an alternative instead of having the RNs wasting time now on a peripheral on a really dead patient. If the ED was expecting a little more from an ALS team and was presented with a lot less, that can throw everything off. Of course, it is probably best to expect less and be delighted when there is more done. In the ED, we usually take bets on how much is done depending on the crew coming in. So, it goes both ways for the abilities of the different providers. Maybe the ED doctor likes to run things his/her way and creates chaos whenever on. Unlike EMS where you have the same partner everyday, staff in the hospital may constantly change as does the ED doctors. As spenac stated, any EDs may have to use agency RNs and/or doctors to solve their staffing problems. I myself hate working with some "fill-in" rental docs. The doctor may have his/her own perceived ideas about who should do what from the way it is done in another hospital and try to change things. Nothing ever goes well unless we can get them to leave the bedside for awhile and let the regular staff RNs and techs do their thing.

It's all for the T-Shirt.

For some, that will be the closest they will get to a Barry U education. Excellent BSN program at Barry. Good Masters in Cardiovascular Perfusion but it took a while for it to get accredited.