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Detroit EMS as it is currently is a mess. I work at one of the recieving hospitals where the vast majority of our ambulance traffic comes from Detroit EMS. Essentially they are in the process of converting to a BLS system from an ALS system. The idea is that their transports are generally short and Detroit has many hospitals. However, this is very frustrating in situations where having a medic would make a big difference. Probably the most common situation is a hypoglycemic diabetic where they are powerless to do anything about it. Often the know the sugar is "lo" based on the patients own glucometer but even then our EMS has not way to give glucose or recheck the sugar unless it is one of the two or three remaining "alpha" advanced units. I suspect that these few remaining units will be phased out as paramedics quit. Its not the EMTs themselves that are the problem but the system as a whole in Detroit that is a mess. Detroit EMS is essentially the largest system in Michigan yet they are the only system that is not doing reporting of electronic run data as mandated several years ago by the State. They can get away with this because they are so large and the state knows that if they take any regulatory action to shut them down a huge number of people will be without EMS service. Other issues relate to ambulance availability where over half of the fleet is in for repairs at any one time. Further complicating this is the abuse of the system in Detroit where patients call an ambulance for nearly any complaint, no matter how minor. Worsening this, until recently Detroit EMS did not prioritize their dispatches. This mean that that the my finger hurts cases got the ambulance before the GSW because they called in 1 min earlier. We still recieve transports of patients by police because no ambulance was available, although i'm told its less than in the past. Unlike fire based EMS at placed I have been in the past, our medics do not rotate with the firefighters and are not dispatched with fire. Meaning that when they go to a cardiac arrest or other complicated care the only folks on scene to help with transport and treatment are the two EMTs on the ambulance who have to do CPR, place the combitube, ventilate the patient, load the patient and then drive while the other takes care of the patient. Other places would send firefighters who are otherwise just sitting around to help with CPR and moving the paitent. I like most of the folks I've met that work Detroit EMS and they generally seem competent at what they do but they are in a tough situation. I feel bad that my hospital is perhaps their least favorite hospital to bring patients to because of the very small number of patients we bring to the resuscitation room on the basis of the EMS call. Ultimately I think the best solution would be to dissolve the Detroit EMS organization and contract with a private company. There are several operating in Detroit and every once in awhile they end up getting a 911 type call of some sort of another. They tend to be paramedic based and very competent. Which is odd that most of the medics in Detroit are doing interfacility transports and not 911 runs.

Medical school is quite competitive. However, they do not care what your highschool grades were. They will expect your college grades to be quite good (typically 3.5 is cited as a minimum GPA, but there are ways to recover if less than this) and a good MCAT score. I can highly recommend www.studentdoctor.net especially their forums for leaning about the medical school admissions process.

Just to clarify. The post almost certainly meant "discontinue if they disappear". Magnesium acts to relax smooth muscle and depresses the CNS, hence why its liked for Pre-E/E as it treats two of the problems at once.

The patient will be breathing whatever gas they are administering at the pressure in the chamber. That is, if they dive the pt to 3ATM and give 100% oxygen (probably unlikely) he would be be breathing gas at a partial pressure of roughly 760*3 = 2280mmHg. You can think of partial pressures and concentrations as the same thing. Thus the concentration of oxygen in the blood will be much higher. This pushes the equilibrium between caboxyhemoglobin and oxyhemoglobin towards oxyhemoglobin. That is to say that it "removes" the CO faster. If the patient were to be pressurized in a chamber, but not ventilated with gas at the concentration of the chamber (the partial pressure) then he would have a very difficult time breathing. If the pressure difference were great enough it would be impossible to breathe. You can think of it as if they dive the whole patient with his ventilator, which is what some centers with large walk in chambers can do.

Xanax = pure evil. Its short acting nature starts more addiction problems than anything. He needs to avoid his physician (or anyone who prescribes xanax) and get himself to a psychiatrist to get his anxiety under control with one of several more reasonable options.

2. The letters represent deflections, technically not waves. Thus the p is the first upward deflection, the Q is the next deflection (also downward in the stereotypical EKG...but often you don't see this), the R is the upward deflection which creates most of the "QRS complex", the S is the following downward deflection (again all of these directions only apply to a sterotyped EKG) and the T is the upward deflection. That's not much help but it explains why I wouldn't worry about the question too much (unless I was in the business of computer EKG interpretation). 3.) No one understands this very well. You are correct in expecting the T-wave direction to be opposite the QRS since it represent repolarization. The typical explanation for why the T wave happen in the direction it does is that the myocardium REpolarizes from epicardium endocardium to (outside to inside) whereas it DEpolarizes in the opposite fashion (endocardium to epicardium, or inside to outside). There are several possible explanations for why this might happen, none of which are particularly convincing (to me anyway). This supposedly (can you tell I'm a little skeptical of this as a complete explanation...but its well known often used explanation) reverses the direction of travel of the sum of the electrical potential. Thus its sort of a 3-D explanation where two negatives cancel out (ie you can think of it as -1*-1 = 1. Does that make sense? The truth is that there are several observed EKG phenomena which are not well explained by known physiology. The same is even more true of heart sounds. Here is where the confusion typically comes from in the physics. There are two ways to think of an electrical signal. That is, a positive charge flowing in one direction is the same as a negative charge moving in the opposite direction. Here is a quick summary for EKG: + charge wave moving towards electrode: positive deflection - charge wave moving towards electrode: negative deflection + charge wave moving away from electrode: negative deflection - charge wave moving away from electrode: positive deflection

Cool picture. Is that the relatively famous case where the anesthetist put an NG tube in a patient that was recently s/p skull base surgery?

I like to use the patient's hand to push back pendulous breasts (as opposed to pushing them back myself) for both auscultation and attempts to reproduce likely MSK chest pain. With this method I can then push on her hand to move them in whatever way is necessary to complete the exam. As far as listening through clothing, I admit I do it for heart sounds when I need to, just takes too much time otherwise, but i'm in a hospital setting (not a medic...just like your forums ) so this is through a thin gown. As long as I can hear the heart sounds and document "RRR NL S1S2 no M/R/G" then that's enough for me. I don't do it for posterior lung sounds because there often seems to be some rubbing up and down of the gown that makes sounds that can easily be confused for crackles.

Why aren't babies born with enough vitamin K? That is, where goes vitamin K come from? What other patients may need a dose of vitamin K? What specific bleeding complication is vitamin K given to prevent? That is, we really don't care about all bleeding in newborns, but someone showed that giving vit K prevents a specific sort of bleeding syndrome in kids... If the kid did did have NAIT, what would he/she look like at birth? How likely is it that this would be missed during both prenatal and newborn screens.

The shot they give babies at birth is Vitamin K which is an small organic molecule. Despite similar names in medicine, it is quite different than potassium which exists as a salt, symbol K on the periodic table. However, you are right that Vitamin K is given to prevent bleeding in newborns.

Although there are various degrees, you probably won't miss it. Uterine Inversion It also hurts, which might cause the patient to get your attention.

That's exactly what the obstetrician would be doing.

When I was at the AHA Scientific Sessions I attended a presentation by two paramedics. Their system did a trial of the Zoll Autopulse (or whatever they are calling their newest CPR machine). The two paramedics stood up and presented in a room with many MD and Phd. resuscitation experts and gave an excellent presentation. They even got a couple of questions from the guy who is the "premier" (if you will) resuscitation expert. Unfortunately, I cannot recall the name of the system.

The article is about glyphosate, which is "Roundup". In the article they are using "organophosphate" as a chemical term, as opposed to the common medical usage as synonym for acetylcholinesterase inhibitor. Glyphosate, for example, is incredibly safe for humans and other animals. You can be exposed to huge ammounts of the stuff without any toxicity because it is an inhibitor of a metabolic pathway (aromatic amino acid synthesis) not found in animals (it is found in non-genetically engineered plants and some microorganisms). This is similar to reason acetylcholiesterase inhibitors are harmless to plants.

To my knowledge, there shouldn't be be an organophosphate in any product designed to to kill plants. Organophosphates are neurotoxins. Plants do not have nervous systems the way pests (and humans) do.