VentMedic

For the California people, how about a Federal job with Federal benefits? Title: Emergency Medical Technician Agency: Federal Bureau of Prisons Salary: $ 49758 - $ 64203 Sub Agency: Bureau of Prisons/Federal Prison System Open Dates: 06/07/2007 to 06/28/2007 Pay Grade: GL-09/09 Location(s): FCI Terminal Island (California ) Openings: 2 Duties: What are the Major Duties of this Position? The Emergency Medical Technician (EMT) is often the first responder at the scene of sudden illness or emergency and sometimes encounters situations which may be life threatening. Upon arrival at the emergency scene, the incumbent must be able to assess the situation to determine the nature, extent, and seriousness of the emergency, assume primary responsibility immediately,and tactfully gain control and support of any bystanders. The incumbent must select from a variety of protocols the protocol which is appropriate under the given circumstances. Provides treatm ...

Florida actually has two State Statutes that cover involuntary commitment; Baker's Act which concerns primarily mental health issues This act has been under scrutiny for being over used when other forms of implied consent could have been used for medical care. Ex. police officer Baker Acting elderly patient with head injury in MVC. The pt legally may still have to serve 3 days of involuntary commitment in a mental unit after recovering from injuries. Sometimes it's dropped if hospital stay is more than 3 days. However during this time of "declared mental incompetency", greedy family members can gain control of assets with an attorney and simple pen stroke. http://www.flcourts.org/gen_public/family/...in/bakeract.pdf Marchman Law which is for alcohol and other substance abuse issues related issues. This is the one the ER usually uses to get people with a serious alcohol/substance intoxication checked into the clinic for 3 days. Florida's "Marchman" law on the involuntary commitment of substance abusers. http://www.cga.ct.gov/2000/rpt/olr/htm/2000-r-0858.htm SUMMARY Florida enacted its involuntary civil commitment law in 1993. PA 93-39 is called the Hal S. Marchman Alcohol and Other Drug Services Act and can be found at FSA § 397.301 to 397.998. It has nine different parts; part five is devoted to involuntary admissions procedures. The other parts include sections on client rights, voluntary admission procedures, and inmate substance abuse programs. We have attached a copy of the entire act. Florida permits a person to be admitted for treatment against his will in three different circumstances: (1) a law enforcement officer may have him placed in protective custody if he exhibits a need for treatment in a public place or in a way that attracts the officer's attention; (2) any responsible person with knowledge of a person's substance abuse may have him admitted in an emergency if he is likely to harm himself or others or he is so impaired that he cannot recognize his need for treatment; and (3) a spouse, relative, guardian, or three adults with knowledge of the person's substance abuse may petition the court for involuntary treatment.

State policies on consent http://www.jems.com/jems/31-5/103993/ Although implied consent is referenced in the most recent curriculum for EMTs, it's expressly stated for application only in some states, including but not limited to California, Florida, New York, Hawaii, Kansas, Missouri, Montana, New Mexico, South Carolina and Texas. The law in these states allows EMS personnel to transport an incapacitated or intoxicated person against their wishes with the approval of either online or offline medical direction, depending on the state.5 Title 29, chapter 401, section 445 of Florida Statutes is a prime example. It states that a health-care provider may examine, treat and transport a person, even against their wishes, if that person is intoxicated, under the influence or is experiencing an emergency condition, and a normal patient would reasonably undergo examination, treatment or transport.

This guy needs off the street regardless of his profession or where he is. It is too bad he happens to be a FF and Paramedic. California still has a ways to go with their state wide system problems. The other news articles are again not meant to bash the EMS workers. Other states would have not allowed offenders of any great magnitude to enter or stay in EMS. California's lax disciplinary reporting system has actually done everybody from the EMTs, Paramedics and public a disservice. Yes, the articles do create an impression with the public. But, I think they feel somebody has let something bad happen to people they trust and respect. EMS leaders can not blame newspapers for their own failings. There will be good articles coming in California after the State takes some responsibility. What they thought was a good idea in the 1960s and 70s isn't working today. For a good headline about Paramedics; (and they kept the terms FF and Paramedic separate) June 2, 2007 Dramatic baby rescue; Chicago paramedic revives newborn after boy was found in trash bag By Jill Parikh, Norman Parish and Annie Sweeney Chicago Sun Times Copyright 2007 Chicago Sun-Times, Inc. http://www.jems.com/medical-clinical/articles/288488/ CHICAGO — They checked hampers, even the microwave and the freezer. As minutes ticked by like hours, the five firefighters and two paramedics couldn't find any trace of a baby believed to have been delivered not long ago in the West Side three-flat. "You play hide-and-seek as a child but you never think it would be like this," said one of the paramedics, Angelo Tsokolas. "I just kept thinking, where can you hide a baby?" Finally, 15 minutes into the Wednesday night search, firefighter Christopher Tolbert opened yet another closet, tossed clothes aside and started going through plastic bags. He picked up a knotted black trash bag, ripped it open and caught a glimpse of an umbilical cord. "I was shocked to see that, and I turned it over to the paramedics." Paramedic Gregg Bagdade immediately reached into the bag and saw a baby boy, purple but warm, lying on a towel. For more California; http://www.jems.com/survivability/articles/288203 Part of the article; May 30, 2007 LAFD takes steps to improve patient medical care By Rich Connell and Robert J. Lopez Los Angeles Times Copyright 2007 Los Angeles Times LOS ANGELES — Los Angeles fire officials have launched an effort to improve patient care among medics and boost compliance with state laws requiring that serious problems be reported to regulators. In a memo last week to the department's 104 firehouses, Battalion Chief Daniel R. McCarthy alerted employees that the department has an obligation to report certain problems to regional and state authorities for investigation and possible discipline. He cited a Times investigation earlier this month that found breakdowns in oversight of paramedics and lesser-trained emergency medical technicians in Los Angeles and statewide. Fire departments and ambulance companies are largely responsible for identifying their own patient care failures and turning them over to regulators. But the newspaper found instances in which alleged problems were never passed on to independent regulators, even when patients died or were harmed. McCarthy, commander of emergency medical services, wrote that the "negative focus" of the newspaper's disclosures has "created an atmosphere of suspicion" among the public. _____________________________________________________________________________ [Again , EMS leaders can not blame newspapers for their own failings to oversee disciplinary actions and reporting]

ladyemt51_2000, Congrats on doing the two year program. I just wish so many would continue through the full 2 year degree instead of stopping after the certificate. The average paramedic program in the US is 32 weeks. Now as an educator, I really wish the young ones would look at the positive and build on that to secure the future of EMTs and Paramedics. As a paramedic (class of 1979), I would like them to know how far we have come. I don't know about your nurse. :? I just hope she doesn't find out she too can be a Paramedic in just a few weeks of EMT-B and a test challenge in many States. Again, good luck and congrats on your paramedic program.

Ahhh geez spenac! You are self-defeating and looking for the negative. You could Google "paramedics + heroes" and come up with many more positive articles to build an image. I've seen a lot of changes in EMS since 1978 and most have been positive. Raised education standards and national licensure would have been nice but again, EMTs and Paramedics have ourselves to blame for that and not the media or John Q. Public. You can Google for the negative and find it on every profession, healthcare or otherwise. I can give you horrific examples of unprofessional events in every healthcare profession. Court TV just spent a month with a woman on trial for murder. Except, for headlines: Nurse Murders Husband. California has had its share of black eyes in healthcare. The EMS accountability system needs a serious overhaul. They did learn a lesson from there RT division which had a knee jerk reaction after Efren Saldivar, Angel of Death who murdered probably 50 or so patients. 40 RTs were scrutinized severely and lost their jobs at that hospital before they were declared innocent of any knowledge or Efren's activities. Now ALL RTs in California must take an Ethics course every 2 years on "how not to murder patients and what to do if you know someone who is." I wish I was joking about that one. IMAGE; you can not change the actions of a few rotten eggs in every profession. Policing ourselves, making changes to keep from getting burned professionally and not ignoring them or blaming the public for "not understanding what we do" will get back the positive. Yes there are photos of FF and kids. I also have the EMS "heroes" collection sold in many magazines of EMTs/Paramedics. They were "hot" in the 80s and early 90s. How soon we forget that there were some notable EMTs and Paramedics in our history. How about a very famous child Jessica McClure and Robert O'Donnell her paramedic that really gave us national attention? I still remember the moment he carried her from the well. Probably every household with a TV saw that moment. All the true stories on Rescue 911 featured very real EMTs and Paramedics also. We had several seasons of heroes with that show. A little story: 20+ years ago, Miami wanted to get a trauma tax pasted to build a trauma center (Ryder Trauma Center) and enhance a system. They needed a penny tax passed. Miami was in the midst of being the murder and violence capital at that time. They had a news crew follow around EMS and film blood and guts. The tax lost the first time overwhelmingly. The next time they filmed "warm and fuzzy" stuff. EMS worker holding granny's hand, putting a band-aid on a scraped knee of a kid in the park etc. The tax passed this time with no problem. What about respect for a patient's privacy (not talking HIPPA, just common sense) before you have a news crew running around doing a Geraldo? The public knows what a Paramedic is. It is now time to focus on gaining a stand among health care professionals by not being the only profession that requires just 1060 hours for a certificate. And, it is a certificate that many other healthcare professionals can challenge a test and obtain. This part the public probably doesn't know. Side note; Yes I do know about Robert O'Donnell tragic end 10 years after the well save before somebody wants to take away that moment too. However, his death did bring attention to PTSD in EMS workers again.

There could be scrutiny with too much publicity also. I have seen the ads for some of the private Paramedic schools. These can best be described by "Wow, in just a few short weeks you too can do all this and more!". The lax and minimal educational standards along with inadequate competency assurance rates could be brought to light also. I think the public has an idea of what an EMT/Paramedic does more than any other health care professional. There have been movies (good and bad), TV shows (again good and bad) and numerous books both coffee table and novels. Even on the show "Ghost Whisperer" there is a Paramedic. There are toy ambulances and "medic's bags" in the toy stores. In real life, EMTs and Paramedics are witnessed in action way too often on our commutes. If someone gets sick or falls at the office, you hear "Call the Paramedics". Rarely do you hear "Call a nurse" outside of the hospital setting. Any more and the public might get overdosed and nauseated. And don't get me started on the EMS/Firefighter stuff in San Francisco that the whole city had to listen to them air their problems with each other! I got off the trucks/helicopters a couple years ago to be full time in the hospital and university on another career path that I had been pursuing for many years. No more fabulous uniforms or decked out vehicles to ride around in. No more cameras catching my best side in action. It's just me, my patient and the hundreds of other healthcare providers that make a difference for the patient. I have to explain what I do to a lot of people including other healthcare professionals. But all that matters is the patient knows I'm there and what I do.

This article is just one of many articles that is being ran throughout California to call attention to a broken State system. There have been several articles published in this series. Unfortunately it can be taken as a personal attack toward EMTs, it is meant to correct an on going problem. If an EMT gets in trouble in one county, he/she can just work in another county and the State is none the wiser. Until California gets a Statewide reporting system or brings all the EMTs under the same responsbile regulating agency, there will continue to be more articles like this. Much of the support for these articles is coming from the EMTs themselves who are leaking these stories to the newspapers. They too do not want to be responsible for working with unprofessionals. Paramedics and EMTs are getting their share of good publicity from Hollywood and news agencies. Feel good articles just don't always make the front page. I also believe some of the EMS professionals in California are planning a PR campaign after change at the State level. If would be futile to run it now.

There is some literature on the Boussignac CPAP system which is similar in principle function. Much of it is off the pilot study which is many times sponsored by the manufacturer. :shock: Excellent CPAP/PEEP tutorial: http://www.ccmtutorials.com/rs/mv/page14.htm Once again; Terminology: PEEP - Positive End Expiratory Pressure PEP - Positive Expiratory Pressure CPAP - Continuous Positive Airway Pressure PAP - Positive Airway Pressure WOB- Work of Breathing The PEEP valves (a.k.a. as PEP valves in other uses) externally are resistive valves designed to hold to the set "PEEP" in cmH2O then bleed out (like a pop-off). If flow is adequate you will maintain a PAP continuously and in turn may achieve PEEP. If flow is inadequate with patient's respiratory pattern, the bleed out point is not reached, PAP is not maintained and patient expends energy against PEP to exhale. Thus PEEP is not maintained or achieved. The idea is the "stent" with PEEP the airways open while exhaling without increasing WOB. Thus the PEEP can be regulated by maintaining a constant PAP with PEP. CPAP can also be illustrated in "hose jockey speak" as far as flows and pressure. Will the right pressure valves in lines at the hydrant, the illusion of more water is achieved by a constant pressure done by valves and nozzle size. With out the adequate pressure, more water is expended without the same effect. Think of taking a drink from a garden hose. The same flow is running from the turn-on faucet but depending on the bore size of the tube it may come out as a trickle. A resistive valve in line will increase continous pressure to achieve a more desirable flow. We could also get into a discussion of the venturi effect and Bernoulli's principle as it applies to gas at this point. The pressure at the generator can utilize the 50 psi port to increase flow speed in terms of driving pressure without necessary increasing the gas usage. 1 mmHg = 1.36 cmH2O = 0.133 kPa = 0.0193 psi = 1.3332 mbar I believe this article is close to what you asked for. Comparison of 3 CPAP Systems for pre-hospital use. (research done by a Registered Repiratory Therapist) http://www.jems.com/pdf/Respironics.pdf Simple lightweight disposable continuous positive airways pressure mask to effectively treat acute pulmonary oedema: randomized controlled trial. http://www.medscape.com/medline/abstract/15953223 Boussignac continuous positive airway pressure device in the emergency care of acute cardiogenic pulmonary oedema: a randomized pilot study. http://www.medscape.com/medline/abstract/12972896 Laboratory testing measurement of FIO2 delivered by Boussignac CPAP system with an input of 100% oxygen http://www.medscape.com/medline/abstract/12706763 Dynamics of pressure and flow curves of various expiratory pressure valves http://www.medscape.com/medline/abstract/9235483 Boussignac CPAP - aritcle from JEMS http://www.jems.com/jems/31-6/106692/ Boussignac CPAP http://www.vitaid.com/usa/boussignac/index.html When there is talk of sedating patients to keep them on CPAP, then something is not being achieved or taken into consideration. 1) the device may not work on this particular patient 2) pt doesn't like masks 3) high flow may actually be frightening to pt. 4) time for plan B In the hospital, if our pts have to be physically or chemically restrained for CPAP, we start looking for another alternative quickly. Our newer equipment is capable of PAV which is not to be confused with BIPAP or BILEVEL. And no, BIPAP is not CPAP with Pressure Support Ventilation. This is where PAV comes in. Many times we will run the NIV off of our ICU machines as PSV/PEEP or CPAP. This is a whole lecture for another place and time.

I am fairly impressed with the WhisperFlow. The flow generator is non-disposable but very portable and durable. I look for a high flow rate to meet demand. This does NOT translate necessarily into high O2 consumption from the tank. We do own a couple of different WhisperFlow models by Caradyne (now owned by Respironics) in the hospital for back-up in the ER and PACU. Respironics is a supplier of our ICU BIPAP/PAV/CPAP machines. They have been around a long time as have some of their products. They also offer good education and decent support. Excellent article that shows some of the factors looked at when selecting CPAP units. http://www.cardinal.com/mps/focus/respirat...3%20Branson.asp http://whisperflow.respironics.com/Features.asp http://www2.uchsc.edu/anes/ArticleOfMonth/...the%20month.htm

It has happened for every other healthcare profession including nursing which has a big and powerful union. Nursing degrees as a licensing standard in all states happened after EMS got a good start. Diploma nurse programs were still around when some colleges were starting two year degrees for EMS.

DustDevil, you're right on mark with the terminology here. I usually prefer graphics when trying to explain CPAP and respiratoroy phases. You just made me reminiscent of Nancy Caroline's Text and the adventures of "Sidney Sinus node" for the dumbing down part. I see it is still presumed that some texts must be written at that level. RT principles and fundamentals haven't changed; just a few more knobs and buttons on sleeker looking technology. They always wanted us to use a PEEP valve on self-inflating bags but I find them a little futile at times. It retards the exhalation phase momentarily but ends before the next breath and the manometer drops to zero. I will run a valve in line with a free flow anesthesia bag (Jackson-Rees system) and try to maintain an elevated baseline with flow..."flow PEEP" from the DOWNES and EMERSON days. There is one disposable CPAP system that reminds me of a DOWNES generator and actually isn't too bad. There are two devices that I have recently seen on the trucks that are essentially "nebs with a restrictive valve" running on 6- 10 liters off the flowmeter. One patient was being physically restrained to stay on the device. I've been wanting to toss a manometer in line to see what the baseline is holding at with this devices. I've just been too busy switching them to my technology so they can be unstrained and breathe.

Many community colleges in the U.S. that offer an EMS program has an Associates degree. The problem is they don't make the prerequisites (college level A&P, micro, math) to Paramedic mandatory. The certificate only needs the core classes. Thus there is no initiative to finish the degree after you get an entry level job or already have a job. It just takes a big push at the State and National level to get the Associates mandatory before testing for the Paramedic exam on a National level. Once this educational standard is established, other professions would not be able to "challenge" the Paramedic exam. As long as it stays as a certificate, other healthcare professionals can take the exam. Florida just recently saw a couple of additions to the growing list of other professionals that can challenge the exam and obtain Florida license. So far, I believe only one state (Oregon) requires a 2 year degree and I don't believe it has to be in EMS. If anybody reads the fine print references in the EMS magazines, the research for many of the modalities used in EMS are coming from other healthcare professionals and NOT EMS people. EMS is riding the coat tails of others and not even taking the initiative to improve from within or be responsible for the advancement/recognition of their field. Once educational levels are established, there will be a need for Bachelors and Masters trained people with education credentials to maintain these programs. It shouldn't be left to the medic moonlighting to pick up extra money on the side at the local trade school with no ambitions to actually educate. If there has not been enough foresight after 30 years in this profession to see a value for education, then maybe it is time to re-evaluate the credentials and skills allowed. Research is bringing more changes and technology. Putting it into the hands of minimally educated AND trained people will eventually lead to undesired outcomes that will fall on the provider with the patient being at risk.

This is the biggest problem I'm seeing now with EMS buying CPAP devices. There is a true lack of understanding of the basic principles of work of breathing and how the devices actually work. To save money many companies are going with the cheap CPAP models "for ease of use" and are getting no more than a very low flow device with a lightweight and often ineffective resistive value in line. The salespersons for these devices are seeing some suckers in the field and are making a good sale for themselves. As mentioned in the last post, PEEP and CPAP are different when explaining effort and work of breathing. Resistive devices such as the PEEP value on the Oxy-PEEP are commonly used as muscle trainers to increase load strenghtening exercises. If used for rescue, enough forward flow would have to be present to overcome the basic design of this device and to meet the patient's inspiratory demand. Hospital CPAP devices are capable of high flows working off of a 50 PSI system with a sensitive demand value for flow adjustments as work of breathing changes. Every patient is different with will have different flow demands and fatique factors. Too much PEEP and inadequate flow will fatique a pt to failure rapidly. Likewise, too much or too little flow can enhance the resistive value and also increase work of breathing to the point of doubling the PEEP value intrinsically. I'm not knocking any particular name device. I would suggest doing a trial of the device on yourself. See what effort it takes to breathe with this devices on. Many will try them at rest as the salesperson would prefer you did. Try them during or after exercise when you can simulate a little air hunger. See if it can meet your flow demands to breathe with the baseline pressure. A hypoxic and/or ventilation compromised patient may need more than 20 L/M minimum in minute volume in attempts to compensate.

WPW can go undiagnosed for years in children. They will go in an out of it many times before it is picked up. If a breathing problem such as asthma precipitated this rhythm, then you can have real problems. In this scenario the girl made the mistake of telling a school nurse she was having problems breathing who promptly stuck her head into a paper bag.

In some states a Masters degree is required for full time instructors at the Community College level where many of the Paramedic programs are taught. Some adjunct teachers are allowed Bachelors with the Master preferred. Also Research is an area where the Masters would be needed to write for grants. This would give credibility in collaborating with other professionals in pre-hospital research. There are alot of "articles" written in EMS but rarely to they acheive recognition or credibility in mainstream medical journals. Higher education is key to getting your work published in reputable medical journals that will be read by people who establish standards and control the purse strings. There are relatively few reseachers in the prehospital realm to gather the data and compile it into a scientific study. The studiies we have read about on this forum could be setup as a study with approved Medical Direction and funding to see if there is a relavent need to change some of the EMS protocols.

Right DustDevil, RT has been using CO2 for about 25 years for various applications. Rescusitation though we have just monitored our rate frequency to keep CO2 levels normal and not blow off CO2. We've also no longer doing the profound hyperventilation for head trauma. Of course in the hospital we have blood gases and if ETCO2 is used, we have correlated the ABGs to the monitors and noted any discreptencies. We also have the ability to monitor oximetry and BG values from the SjVO2 and A-lines to titrate O2 as needed to keep in a 80 - 110 mmHG PaO2 range. The pulse-ox will probably say 99 - 100% for any or all the values depending on Hb. Medically mixed gases are expensive and not as easy to get as one might thing. The US medical system will have a problem with this unfortunately. Even Nitric Oxide is scrutinized under cost containment and Flolan is used instead in many hospitals. Pulmonary Labs have difficult times ordering their mixes and ensuring delivery of "certified" medical mix gases. In neonates there are some new guidelines in the delivery room for 21% O2 rescusitation. http://www.hopkinscme.org/ofp/eneonatalrev...tters/1206.html This study was done on healthy children with no lung function impairment. If there is a disease process, chronic or acute as it may present in pre-hospital, to cause significant V/Q mismatching, the results probably would not be the same.

What hospital in the U.S. sends a premature baby on a ventilator without a person with more neo/pedi training/experience on board for a long distance transport via ground? Where are they still doing 5 hour ground transports in the U.S. for sick infants? There's a children's network that assists regionally in getting sick infants and children to higher level facililties a lot quicker in most areas of the U.S. These issues are well covered by the AMERICAN ACADEMY OF PEDIATRICS guidelines. The AAP would love to hear about this. They might be able to assist that hospital in getting connected to faster service by Air. I would say you are then operating out of you comfort zone and training. Practitioners that are confident in their abilities and training can cope with stress usually without puking. If the paramedic is busy vomiting, who's taking care of the baby? Not meaning to be critical, just being an advocate for safer transport of infants and children.

DIB is a "slang" abbreviation adopted in the pre-hospital arena. DIB in the ER and hospital means Disability Insurance Benefits and is found on some of the ER admission paperwork as such. SOB has faded in some areas due to medical directors and managers not wanting the charting to look offensive if SOB is taken out of context. They would then make the pre-hospital personnel write it out. So, another shortcut was created that didn't sound offensive. For medical charting it did not make the list of approved medical terms. There is a billing code for difficulty breathing but no abbreviation. DOE; dyspnea on exertion, more commonly accepted now for charting and testing criteria SOB; still recognized for both medical charting and billing codes. Lists of accepted abbreviations http://www2.kumc.edu/pharmacy/medabbreviations.htm http://www.stanfordhospital.com/PDF/SHCApp...dated051305.pdf As for as the girl, if she has yet to be diagnosed with a reactive airway disorder such as asthma or other inflammatory process such as bronchitis ( or asthma), breathing into a paper bag will only enhance that with the dust particles. She may become quieter because her CO2 is rising also with increased retention by airtrapping and the bag re-breathing could push her to a dangerous level.

Carbinoxamine was linked to hydrocone and is mentioned in the investigation of children's deaths. Carboxyhemoglin levels are rarely measured in children so there is insufficient research. If the levels do show high in the ED or PFT lab, it is attributed to exogenous (parents smoking near the child) or they are in the ICU in RDS and there may be some endogenous things happening to which the links in my previous post explained. There were several chemicals that could bring about an elevated COHb level. Hydrocodone: there is a chance for Stevens-Johnson Syndrome and TEN. The pts are often sent to a Burn Unit for specialized wound care and possibily HBO therapy.

A Portland fire lieutenant who was caught on videotape last January kicking a man while other firefighters pinned the man to the floor won't be charged with a crime. http://www.jems.com/news/286001/

The initial rhythm was tachycardic? If multifocal atrial tach which is a baseline rhythm in some COPD pts, adenosine is not useful. if that was the underlying. MAT rate usually exacerbates with the COPD exacerbation and hyoxemia. The pt can have normal coronary arteries with cor pulmonale with EF being affected in later stages. The use of levalbuterol (Xopenex) over the more traditionally used racemic albuterol is controversial among health care professionals. That using levalbuterol instead of albuterol produces less direct effect on beta 1 adrenergic receptors and/or less cardiac side effects has been suggested, but not consistently proven by long term, well designed clinical trials. There are differing opinions on whether there is sufficient therapeutic benefit to using levalbuterol that outweighs the 5-10 times higher price tag. The problem that occurs when using Xopenex; it is recommended for q6 - 8 hours. Doctors want to run it frequently like they do an Albuterol protocol. Some doctors order continuous Xopenex like Albuterol. The jury is still out on that one. In most US hospitals, this is cost prohibitive. There is also more chance of paradoxical bronchospasm which is hard to pull out of. If the doc wants a bronchodilator ran frequently, I'll take my chances with albuterol. More treatment options and versatility. Atrovent thrown in every 4 - 6 hrs. If it's a COPD pt, Diltiazem or Verapamil on board and procede with the bronchodilator protocol if pt and airways want it while watching the HR. If HR continues to increase or pt gets unstable, then treat cardiac more aggressively. Albuterol can still do some dilation until large doses of IV Beta blockers get on board. Some albuterol will remain bound to receptors during b-blocker therapy.

A few month ago a very memorable CO incident occurred in Key West at the Doubletree Hotel. At first it was contributed to boating and exhaust fumes until a death was reported. The hotel boiler was at fault. http://www.redorbit.com/news/health/784137...source=r_health Different pulmonary diseases show elevated CO levels. http://www.chestjournal.org/cgi/content/full/125/6/2160 General sources including endogenous; http://www.mcsrr.org/resources/articles/P11.html

A similar incident happened with police officers in San Francisco last year with very different outcomes in the end. Part 1 http://www.sfgate.com/cgi-bin/article.cgi?...MNGQIG4PLD1.DTL Part 2 http://www.sfgate.com/cgi-bin/article.cgi?...BAGRGKGKUK1.DTL Part 3 http://www.nbc11.com/news/6910795/detail.h...ay&psp=news

MAGICFITZPATRICK posted the abbreviated cleaner version of the story, "EMTs Gone Wild," http://www.nypost.com/seven/05062007/news/...elli.htm?page=0