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I'm not 100% on this, and maybe I'm being a bit picky on semantics. When you say "each ventricular contraction is not producing enough of a pulsation to reach the peripheral points", I assume you refer to each QRS wave not corresponding to a pulse felt peripherally. My understanding though is that while you may very well see a QRS wave that looks like a normal one, it MAY correspond with zero ventricular contraction. The wave just tells us that there is some conduction through the heart. It tell us nothing about contractility (although it is a safe bet that an asystolic waveform likely points to a heart muscle without contractility). This is similar to pulse deficit where you hear one of the heart sounds but don't feel a pulse because the valve may not open. "Just because each of those ventricular contractions is not producing enough ejection to produce a palpable pulse, does not mean those beats are putting out nothing." I think what you said there is a possibility (ie. QRS wave with the heart putting out nothing). PEA's are a good example of this. But yes, it may very well be pushing out SOME blood, but thats hard to confirm. Maybe you would feel those pulses at the carotid but not the radial point? Not sure about your last question because I'm still learning about that in my rideouts

So from what I got from the article and the proceeding comments, they showed up in case of the need for rescuing anyone trapped in the house, and to protect neighboring properties. As a discussion point, why are the firefighters obliged to fight the fire if the fee is not paid. If all that is at stake here is the property itself, can't this be viewed similarly to purchasing an insurance policy for your property? As in, by not purchasing insurance, you assume any liability if accidents occur. If they accept fee payments when fires occur, I'm sure people would take advantage of the system. There probably are better ways to deal with the funding issues though.

I meant would coronary circulation react the same as cerebral in that it would vasoconstrict with inc o2.. Combined with low perfusion to heart b/c of the congenital defect, wont it make it worse?

haven't read your article yet, only the medscape one partially.. in regards to the too much O2 thing.. i was thinking, for icp, we try to hyperventilate to vasoconstrict centrally/decrease pressure in the brain.. the trouble with hyperventilation is that it can cause ischemia in that case.. going by that, here's my best guess. too much O2 will vasoconstrict systemic circulation.. this cause ischemia since the heart is probably not getting enough blood flow by default given their condition and given high O2 levels, maybe coronary circulation constricts too much (even though the blood is properly oxygenated?) have a feeling im way off lol edit: where is your link btw? i dont see anything so far.. edit #2: NVM, found it..

okay, so from what I read, cyanosis peripherally may be normal for them? and if the case here is that the pipes that would normally allow the infants to temp compensate for not having the LV /aorta functioning is not working, are they now prone to similar symptoms to CHF/pulm edema? could that be why their O2 sat is lower? how are the child's lung sounds? am I way off? found some info on http://emedicine.med...treatment#a1127 if anyone wants to read up on it a bit.. edit: this is too complex for my head right now so according to the above, increased O2 for these kids might not be the best thing for them because it will further decrease pulmonary vascular resistance / increase pulmonary blood flow.. so maybe it will be trying to find a balance of the correct O2 levels / not necessarily giving 100% o2?

Few questions just because its the first time I'm doing this. What does the "2/24" refer to in "59yom c/c back/abdo pain 2/24" It seems from what you said, a trauma cause can be ruled out correct? (ie. patient doesnt talk about any recent trauma history when asked) Thinking some sort of rupture of something in the abdo area. I was also thinking a ruptured AAA but found it interesting that the abdomen was not firm/rigid, so not sure if there was blood loss in that region? But it is still high on the list for now. In regards to the blood in urine, and dyuria, not sure if it would be a common sympton for a AAA but I am now also suspicious of the GU organs. I kinda suspect some sort of internal bleeding because that pressure seems pretty darn low for someone who is normally hypertensive. Wonder where it bled off to though -- I am under the impression that if it bled out to the abdo, you would feel the firmness on palpation.. maybe in the pelvic region? Would it be palpable then? You mentioned that last meal was last night, but we are talking about tonight now (which is ~24 hrs after).. so was he anorexic? If you were to take away the "patient died" part and the low BP, I would be prone to thinking kidney stones. Is this meant to be a scenario where we can ask more questions or are we to base our differentials just on the information provided? If we can ask questions, has the patient ever felt this pain before? Specifically, what portion of the abdo/back is painful? Did he take any meds for the pain? Sorry, more questions than answers here.. All I know so far is that I need to review a lot of my patho

Just started my rideouts/preceptorship over a month ago and was VERY nervous going into my first day. Thankfully, I got a preceptor that likes to push me to get a better foundational knowledge and build upon it. In the time I spent so far, I've unfortunately not gotten any chest pain, SOB, trauma etc calls that many of my peers have gotten, but I am still content with my rideouts because the time spent on offload delay or just in base waiting for a call meant some quizzing from my preceptor. And luckily I got a ACP/PCP crew of two smart people who are always happy to teach me, regardless of how tired/sleepy they may be. In my region, I don't believe they pay extra to precept a student -- it is strictly voluntary afaik. I only wish that we spent more time in rideouts.

haha.. yep, scary to say the least but appreciate the kind words. Can't say I would have thought about drug interactions without looking it up -- but I'm in what will probably be a looooong learning phase. Okay, so since drug interactions have been put out in the open already, I also decided to look up Benadryl.. apparently, it may increase the incidence of seizures for people with epilepsy.. but could not find any specific info on why and can't say it is coming from a necessarily credible source. [http://www.epilepsy.com/epilepsy/provoke_otc] WebMD lists seizures as a rare side-effect to Benadryl, but seizures are probably listed as a side-effect for a heckuva lotta drugs. [http://www.webmd.com/drugs/drug-5680-Benadryl+Oral.aspx?drugid=5680&drugname=Benadryl+Oral] So I guess my question to the mom would be, when did he start taking Benadryl and Keflex. Was the Benadryl suggested by a doctor (probably not?). And how much did he/does he take?

Just wanted to bump this topic up to figure out how this scenario proceeded. I'm a student looking to create some scenarios for group discussion and came across this. I was thinking about alternative causes of seizures and did some research (cheated) and found a probable cause. I don't want to just go ahead and blurt it out because I researched (cheated). So I will ask more questions to get a better picture. Was the mom able to elaborate more on the sickness and reason for the "Kef..." medication use? How recently was he put on this medication?

You're not from Centennial College by chance are you? Our instructor let us know the exact same thing - compound fractures are not to be tractioned.. on the flip side, I can also recall being told that if you have an open fracture but the bone naturally popped back into place, you can use a sager.. I don't have a definitive answer though.. but I found this a bit helpful.. http://www.sagersplints.com/pages/why3.html

Centennial / Scarborough region isn't THAT bad Did my B.Sc at Univ of Toronto which was just a few mins away. Regd. Niagara being too close to NY, why would that be an issue? And about the job market being better, why would you say so?? That would definitely be a deciding factor for me. Thanks for the feedback. Hoping to finish selecting a school by this Friday!

If you dont mind telling me.. what college did you go to and how would you rate your experience? I've made a mini pro-con list for the colleges. But I'm not sure how to find out information on things that actually matter, such as student satisfaction, pass rates, quality of instructors and education etc. My list mainly consists of less important factors (in the grand scheme of things) such as cost, location, campus life and 'reputation'. I almost feel like I should stop delaying and just randomly pick between Humber, Niagara and Centennial

Hopefully people here can provide me some guidance. I've applied to Humber, Niagara, Centennial, Durham, and Fanshawe for the Sept 2010 semester and have received offers from all but Fanshawe. I am hoping some of you can give suggestions regarding which college to choose and why. I've ruled out Durham as their cost seems to be almost double of the others. Which leaves Humber, Niagara and Centennial. I've heard good things about these 3 schools from people I've spoken to but people always seem to speak well about the schools they've gone to. And the general reputation of each college seems equal. The program co-ordinator at Humber said that 75% of their graduates received jobs as paramedics upon graduation, which I was impressed by (but not sure how accurate it is). Anyone know of any numbers on the other colleges? Does it help/hurt your chances to get a job in a certain location if you goto a specific school? Or is your performance in the testing all that matters? I would preferably like to work somewhere near Toronto or Mississauga as I have family here. Also, I've noticed that only Durham, Fanshawe and Niagara are CMA accredited. I've heard that going to a CMA accredited school helps you if you plan on switching provinces. I don't necessarily plan on this but its always good to keep options open. TIA for any advice.

Graduated from BOTH programs? or from both colleges but different programs? I probably should have asked for info a lot earlier The test for Niagara College is tommorrow and in early March for Humber. Gotta love Centennial College for accepting me without any admissions tests! 6 more months to go. Can't wait to get back into the academic environment.

Thanks. Just did a quick search to find out what Dalton's Law of Partial Pressures was.. knew the theory but didn't know of it by name.. guess there will be quite a bit to review