fireflymedic

Great resources to post there Dave - thanks !

Magnums are a good boot scooby - had a pair and wore the suckers out. Unfortunately they don't make the zippers like they used to and when I tried a new pair it kept falling down on me. Only problem - they weren't waterproof - when standing in a small creek scoopin some dummy that ended up in it and it's cold that doesnt make for a good day . Highly suggest whatever you get is waterproof and if not, that you have it waterproofed. May be more money, but worth every cent !

Wore Rocky Paratroopers for years and loved 'em - had the snap over so the zipper stayed up, lasted me several years and held up really well even the insoles. Still wear 'em in bad weather - galls was my resource. Now I wear the pull on Blundstones which I absolutely love - only bad thing is if you end up out in a really muddy area, well guess what happens? Your boot stays and you end up with a muddy foot. They actually do a great job of staying on though with the exception of exceptionally muddy areas (ie solid 6 inch deep mud which was the one I lost mine on - stayed on every other time). The blundstones are waterproof and really comfy and about the same price as the Rocky's. Rocky's run around $120, Blundstones are around $130-$140 depending on where you buy them from. I buy them from a saddle shop because they are cheaper there, but most shoe magazines have them. Mine are six years old and I'm still wearing them four times a week, and just got them resoled.

I'm sorry, but when you are standing right there when the balloon leaves - how do you not know where your kids are? I could have seen if he weren't right there at the time and his brother set it loose - okay, maybe. However, the whole thing smelled like a hoax to me and sure enough it is. Just a shame because these kids will now have to live with the effects of it. Not fair to them at all. I could care less about the stupidity of the parents, but I have to admit - kudos to the kid for leaking the words ! Trust kids to tell it like it is . Anyhow, still glad he was safe. Either way, it's a good thing his safety wasn't compromised.

Great story there - thanks for posting. Glad to hear little girl is doing well !

I think if we could leave anonymous comments as to why the post was negative it might actually achieve what the reputation system set out to do. For example, you couldn't place a negative without giving feedback and if it was inappropriate feedback, then your negative was deleted (ie I gave it 'cause I don't like you etc). There are ways to make it more positive, but if we are truly judging on the quality of posts then that's what we should be judging on regardless of whether we like it or not. The ultimate stupidity of this though is that people are getting positives or negatives for ridiculous comments - such as spenac's "hang in there" - no grading of that is necessary - come on guys !(sorry to use you as an example there spenac, but you were handy). If you make a good arguement with me whether I like you or not, or don't agree a solid arguement I'll reward. I think the vast majority on this board are adults, so let's grow up and starting acting like it. We're not voting for the prom queen here.

Haha - nice terri ! There was one at university that had a really foul attitude and constantly pressed the call light for nothing at all, she just wanted someone. Well, if they didn't come quick enough or answer her right away, she'd call 911 - ended up eventually with the university pd showing up - gotta love old people. Had another that when he was drunk would call our station directly (on emergency line) and curse out out and beat the phone against the wall, curse us out some more and then hang up - he ended up with 30 days in jail for 911 abuse...see there are SOME who manage to get themselves arrested but it went on for nearly a year before they did !

If you have a children's hospital nearby, they are usually very proactive in teaching NRP. There are three around here that offer it during EMS week yearly. As far as digital intubation, my fingers are quite large and I know that even within a patient that had a fairly large mouth there isn't as much room as one would like. In the mannequins I can barely fit my middle and index finger in to drop the tube between. I am fortunate in that I've never been at the point of last resort with a patient that I would use it. Always had other options to revert to. Not to say there isn't a place for it, just is a bit more difficult. I think digital intubation would be more difficult on a pedi due to that as well as the fact you could really only place (for most people) your pinky, perhaps fourth finger in to lift up and you don't have a track for the tube to follow down. If you didn't use a stylet, I can imagine it would be extremely difficult IMHO.

I certainly believe you are in a world of hurt if all of your blades between a 0-3 of both Mac and Miller are bad leaving you only the option of a 4. I've seen several times an adult handle used with a pedi blade due to the provider having larger hands, but I can't help but wonder if you checked all your equipment prior to shift. I'm not trying to lay blame or call it afterwards, but eight blades going bad is pretty significant. If that's the case, I'd be having a stern discussion with my employer. You mentioned one was broken due to an over zealous EMT - do you use plastic disposable blades? I'm just curious. If things did go to crap, then you did the best you could, got the job done, and hopefully with very little airway trauma and after effects for the little one. Sometimes stuff just goes sideways . Hindsight is 20/20 and we can all sit here and say well I would have done this or that, but we weren't there. It sounds like you did the best you could with what you ended up with. Just hopefully it was a learning experience for both you and your partner so it isn't repeated. Did you follow up to see how the little one did? Just curious. Take care and always be safe.

That's a great one ! I would not have been able to keep from laughing, I'm sorry - I do believe that even beats our "porn line" call that we received a few years ago(we discovered our 800 number was the same as a 900 number ahem - yeah real interesting when you're a female and you answer that....)Thanks for the good laugh !

I was informed a little bit ago of a crash involving a TDOT (tennessee department transportation) truck and a Rural Metro ambulance. Evidently the driver David Cline (Franklin FD) hit the truck without ever braking killing himself and the patient - his EMT partner Evan Johnson (Nashville FD) partner was in the back and is currently in critical condition (to the last of my knowledge). Please everyone be stay safe and alert out there and come home each night ! *edited to update with names and dept affiliations

One of the physicians in Baltimore is both a medic and MD - and he displays both on his coat. He functions as the med director for Baltimore Fire (or did I'm not sure if still is or not) but worked shifts as a paramedic as well and was proud of it saying he thought it made him a better ER physician. This was as of a few years ago - as I said, I don't know this is still the case. You know they make more than us, might not be a bad idea

Thanks terri - I've been having issues with the search feature lately not pulling things. Though I did give it a try - don't know if it's how I'm putting it in or what (just not reaching it's happy place huh?). Good link - thanks.

I am curious if there are any departments out there which are requiring mandantory vaccinations for any of the above? Two ground services in the area are mandantory seasonal flu and H1N1 and pneumonia if not had. A prior service I worked for requires seasonal flu (even prior to this) and is implementing H1N1, but has not pneumonia. What are your opinions on this? Should it be required? Employees choice? I have worked EMS quite a while and never missed a shift due to flu or general illness and have never had a flu shot. Yes I come from the school of thought that some people do worse after getting the vaccine and others don't. Everyone reacts differently to vaccines. How do you feel about mandantory vaccines? Give your input !

the information within the intermediate book is correct - chorotropy - think chrono (time) chronotropic drugs increase the heart rate. inotropy - inotropic drugs increase the strength of contraction. As far as correcting the instructor, I would suggest speaking with them aside of class and requesting handouts of the material she is coming from and holding you responsible for. Also clarify what information you will be responsible for (if it is hers then she needs to be giving you handouts for reference if different from your book). If the problem continues and is significant then you can appeal to the chair of the department, and if that brings no success going higher within the food chain. I would highly suggest resolving it independently with the instructor first through the above suggestions before going to the alternative routes. Either way - if this is the case, bad instructor and if unwilling to change - shouldn't be teaching, but since they are, you do the best you can. Go by the book for national registry's account. Similar issues have come up with Nancy Caroline's paramedic book with incorrect material which varies from what is national registry's. You are not alone and no book nor instructor is perfect just remember that. Good luck with class.

I am in agreement there - pain should be relieved. I tend to lean towards toradol for migraines. I have not had a patient with sickle cell crisis yet, but after reading how painful it can be, I imagine I would be more than willing to administer at least some analgesia. When considering whether to give analgesia, I keep in mind that pain is a subjective thing and what may be intense for one person, would be minor for another. Yes our service in particular does come across a significant amount drug seekers as we are a rural area with very little to do (and a known drug pathway as well, however as others have stated, it's not my job to judge them but I'm not going to feed their addiction either. And for certain things, toradol (a non narcotic) actually works better than narcotics (kidney stones in particular). There are indicators of pain besides whether a patient is crying in pain or not - vital signs is a good one. Along the same lines though - we are also responsible for trying to ease our patient's emotional pain as well. This is something harder to do and requires time and compassion but we are just as responsible for doing what we can to ease that as we are their physical pain. Taking 5 minutes to just listen to a patient and hear what they are saying (or in some cases not saying) goes a long way. Sometimes that goes farther than any narcotic ever will. As far as when our transfer of care actually happens - it's not official until the nurse signs off on our report. We could leave them on the bed, give a full report, and still be charged with abadonment if the run sheet wasn't signed off by the nurse. I think this is the point most handover care, but if a nurse signs off for you at triage, then technically you transfered care then. I am aware of this practice, and am not fond of it. I even know of two flight services which utilize it and it still makes me go what! when I was told. It is not true RSI and should not be stated as such - in this case most places refer to it as PAI (pharmaceutical assisted intubation). I am in agreement - proper drug should be utilized for the situation.

Happy birthday to you both - enjoy your day !

I thought all garage doors, bay doors as well, were required to have sensors to keep them from this very thing. That's why we had either remote controls or a side door to come out of the bay. http://m.courierpress.com/news/2009/oct/20/woman-crushed-garage-door-emt-station-called-911-t/

For those missing emergency - amazing NBC put a link to it on the page to watch videos http://www.nbc.com/classic-tv/emergency/video/categories/season-1/32399/

With the increased use of this, I didn't realize my previous employment as a vet tech would be so useful.

If this is a legitimate post - it sounds as if he has tried to throw it into the americans with disabilities act. If that is the case and his employer has made the accomodations he states - that is more than any employer I am aware of would ever make at their own expense (paying for custom shirts - get over it - I had to have my pants tailored because of how my body proportions are - I'm not fat but have a bum and our pants weren't meant for someone with one so I had to have the waist taken in and darted to fit me and look respectable at my own expense). Americans with disabilities act only states they have to accomodate as long as all essential job functions can be met with or without reasonable accomodation and without unreasonable economic hardship to the facility. I think any other accomodation could qualify as economic hardship and if he is at a size that he cannot function within an ambulance, then he is not able to perform his job functions making him eligible for termination. I do not feel his employer is out of line to state he must maintain a healthy weight that he is able to perform his job. In EMS it is for our patients safety as much as ours to stay fit and healthy. If he is as large as he states, then I don't see how he can safely and effectively lift a stretcher or perform many of the other tasks. I've worked with some larger partners (one in particular was almost 400 lbs and employed by a large FD in the area as well). He was healthy for the most part but on yearly physicals he was starting to have some issues and was told he had to take care of himself or else his employment wouldn't continue. He was no longer allowed to make entry on fires due to his size and if he were to go down, they would not be able to get him out quickly. He took the steps to take care of himself and says he feels better than he ever has. I highly suggest that he go and see his physician and discuss alternatives if traditional diets have been followed and still no success. Also - got to remember to put exercise in there !

As far as Etomidate it is a useful induction agent and as stated, much less hemodynamic issues than some of the other agents. However, from my ER experience where it was used frequently, I did see experiences of myoclonus (which is a well documented side effect of etomidate) that some of the residents mistakenly took to be seizures. It may actually induce seizures in patients with a history of such. According to a few studies I've read, there is suggestion to still administer a low dose of benzos to prevent the myoclonus. http://www.anesthesia-analgesia.org/cgi/content/full/105/5/1298 http://www.medscape.com/medline/abstract/9915320 http://www.umm.edu/altmed/drugs/etomidate-052950.htm# Also, rather interesting study comparing propofol with etomidate for induction. Puts both on equal terms, with a slight advantage to propofol for induction - does anyone use it for just induction but not continued sedation? http://www.med.upenn.edu/emig/etomidate%20versus%20propofol.pdf For continued sedation I'm really not a fan of diprivan for a few reasons. The first being one of its biggest advantages - quick on, quick off. Because of that, if you have them on a pump and have a pump malfunction, then you run into issues of them waking up and you will have to continue bolusing them to maintain sedation until you get the pump issues resolved whereas with versed, you will still have some continued sedation. Also, with propofol you still run into issues of sometimes not being able to give enough to adequately sedate and maintain hemodynamic status. Finally, transport is a stimulation rich environment - it's tough to keep them happy. I am aware of the issues that can present with versed, but overall, I like it better, especially for prolonged transports. With a concern of head injury and potentially increased ICP, I would have a concern of using an agent such as etomidate that has the potential to cause myoclonus which will increase it, or diprivan in the instance, should a patient wake up and starting bucking the vent or trying to extubate themselves, that will increase ICP as well. Something to consider all around. Just my 2 cents worth.

Happy birthday Ben !