Kaisu

These studies seem to indicate harmful when an inappropriate field diagnosis is made. In the case of the CHF patient, as opposed to pneumonia, etc. I do not have the luxury of CPAP. My concern was that the one thing I have available is a diuretic. (short of weird crap like nasal intubation.) The only downside I could discern is causing an electrolyte imbalance in this patient. At this time, I do not have to get orders for lasix. This change appears to be precipitated by the "we got idiots in the field so let's write a protocol based on the lowest common denominator" thinking that makes me nuts.

I have caught a rumor of a shift in some parts of the country to decreased emphasis on diuretics in cases of CHF. Does anyone have information on this? I'm thinking specifically of studies and/or the reasoning behind this. Any help or info you can provide would be greatly appreciated.

Now see... that right there is what I'm talking about. It really helps when someone gives us reliable information so that those with our heads up our assets can develop a broader, deeper and more realistic view of what is going on. Thanks for the post.

This is exactly what I was trying to ask. That being said, I have observed fast compressions on every patient I have brought in. That's why I want to go to the medical director and question him.. when it is not busy... when he's got time. If they are doing it wrong, I want to get it fixed because I do NOT walk away from my patient just because I've dropped him/her at the ED. Our medic/ED relationship is more like the one Dwayne describes than the drop 'em and leave type. I've been here long enough that I may be able to make things better.

That is exactly the reason I posted this. I wanted to know if there is something I am missing.

I am looking for your ideas regarding the rate of chest compressions during CPR. We are all taught to do compressions at a rate of 100/minute. My understanding is that this is optimal for allowing filling of the chambers and creating enough pressure to push the blood forward. Now my question - After delivering a patient to the ED with CPR in progress, I have watched numerous residents, techs, etc take their turn on the chest and pump away at rates close to double this. I have looked at the attending in charge to see if he will correct this and I have yet to see on Doc, ED nurse, ANYOME, correct the CPR rate. I have uneasily murmured to the attending that I am concerned about the compression rate to no avail. I don't want to step on toes but I do want my patient to get every chance they can. Is there a reason these people push so much faster in the hospital than we do in the field? I am going to question my Medical Director about this, but he tosses crap out of left field at anyone asking these sorts of questions. It would really help me before I ask him to have as much information as possible. I will grow cojones and confront if required but I would really like to know I have a clue before I do that. PS.. these patients are generally intubated, thus, shouldn't the rate , if anything, be slower than faster? edited for PS

Yeah but he had the British.....;-)

Breast cancer awareness t-shirt - Save the tatas

Oh please - is there an administration in the world anywhere that hasn't. I sure hope he had an understanding of what he was taking on when he applied for the job. Amen to that! So erudite. Thanks for the contribution to the discussion.

Did you read the appendixes? His data is in there. Do you have an argument with his numbers?

TMI Dawn.. TMI BTW - welcome to the site

ROTFLMAO - I loved this show - broke taboos without getting ugly - the things you can get away with saying when people are laughing has me shaking my head. I gotta learn how to do that.

What about that outraged bar owner being charged with serving booze to obviously intoxicated patrons? I mean, if someone is so messed up that he attacks a paramedic with a pool cue, what are the odds that they are sober?

I love reading what you write Annie... and I love this dialog. Your statement that most Americans are unaware of Canadian contributions is right on the money. In terms of under appreciation of military sacrifices and the costs of service to the enlisted personnel and their families, I believe that Americans are at least as ignorant of this as Canadians. My husband has a T-shirt that says "The price of freedom is one the protected will never know". As a Vietnam combat vet with 125+ air assaults under his belt, serving in the Central Highlands in 67 and 68 and with participation in Hue during Tet, he has the right to wear it. The citizens vote this way because of what I believe is a more accurate view of global realities than that held by those not exposed to these realities. There was a middle eastern immigrant in Phoenix a couple of weeks ago that killed his own daughter because she was becoming too "westernized". I don't have to elucidate to you the mentality that believes it is OK to publicly behead infidels or the myriad of other atrocities that are perpetrated on the innocents of the world. Someone has to be prepared to stand up to this and put their lives on the line if necessary. This is the reason American young people are prepared to go to war and this is why they fight. I'm not saying evil people don't exploit this willingness for profit but this is not the reason we fight. I applaud your education. My world view is perhaps colored by the horrid abuses of power that I personally experienced and my survival and thriving without the benefit of education. (I did take some college level courses in economics btw and I loved it. So elegant.)

Fiefdom is my ironic word of choice for the states that comprise our union. It did not refer to Canadian provinces. I used it in the sense that states rights (and the accompanying disparities among states) are a larger part of our political reality than I perceive the issue in Canada. I lived for 40 years in Canada and to relocate from one province to another was easier with less of a required adjustment than moving from one state to another. In Canada, your movement is to a large extent, limited to east and west, along and close to the 49th parallel. In the US, the difference from the post industrial North East and the newly exploding (until this latest recessionary hiccup) South West are profound. EMT Annie - these comment are of course my personal opinion. It is posted in a forum of opinions. You sound like the corporate attorneys that insist that all my postings explicitly state that these are my personal views only and not representative of my company. Who else's opinion would it be? While my most recent comments are colored by a Toronto view, I lived in the city for a mere 1 year as a young woman. I lived for over 5 years in Alberta and the animosity of Alberta to Toronto is almost legendary. The little dog always knows what the big dog is doing, whereas the big dog notices the little dog only when it's yapping becomes annoying. Most of my life was lived in Thunder Bay, and many Thunder Bay residents are resentful of what they perceive as the dominance that Toronto holds. If you spend any amount of time here in Southern Ontario, it becomes obvious that this is where most of the people live, this is where most of the money is and thus, in a system of majority rules, this is where policy and direction come from. - sorry - I didn't create this situation and am merely commenting on it. As far as Canadians serving in Afghanistan and your personal knowledge of it - Thank your relatives for serving. God bless them and thank you all for your sacrifice. If you take a look at the per capita COMBAT troop contributions you have to acknowledge that Americans pay by far the greatest price. You may dispute the political motivations for the involvement but the average American citizen has paid a much higher price than the average Canadian citizen. Canadians indisputably in harm's way serve a larger role in "peace keeping" and support functions than US citizens. The ration of deaths and disabling injuries per capita is larger for Americans than the coalition forces. If you read my post carefully, I am extremely supportive of Canadian Health Care and my prime disenchantment with Obama is his selling out to the insurance companies for short term political gain as I elucidate in this post. http://www.emtcity.com/index.php/topic/17205-news-feed-senate-oks-health-care-measure-reaching-milestone/page__p__231806__fromsearch__1&#entry231806 And Mobey Care to expand on this a bit? Aww.. does that mean you don't love me anymore?

I love it Dwayne. It is the truth. As a "gifted" student with a chaotic family life, I was the bane of my teachers. Here was an eager to please (desperately seeking any kind of positive reinforcement of anyone willing to give its - hence marriages and alliances with all kinds of crazies - but that's another story) and capable individual who would not come to school. Mother would take me to the door in her car and watch me go in, being unaware of the multitude of exits to which I would march without even stopping in the room I was supposed to be in, to spend my days in a tolerant coffee shop, living in my own mind, and my nights with bikers, and ** horrors- the worst of all** musicians, only to re-appear several days later hungry, tattered and tired. At the age of 12 and 13, this was too much reality too fast and the physical and emotional dangers I was exposed to make my survival more or less intact a miracle and the basis of my own personal faith. In the days before kids were tagged like migrating wildlife with cel phones, disappearing for days to explore life was a possibility. I wish it was true that this rebellion was accomplished with an exhilarating sense of freedom but it was not. I was plagued by feelings of "wrongness". What was wrong with me? Obviously the entire world could not be insane so it had to be me. It wasn't until I was in my late 20s and read a book called "The dilemma of the gifted child" that I finally let myself off the hook for being without a high school diploma and the huge sense of personal failure was somewhat relieved. This article makes it clear that the system is failing for everyone, not just those kids on both ends of the bell curve.

I've been in Canada for the last 2 weeks and I remember a lot of stuff about Canadians that I had forgotten. They are really really nice. Toronto is the most multicultural city in the world. Every language and culture you can imagine is represented. They are extremely educated and literate. The quality of the magazines, documentaries and literature available to (and ** gasp ** actually being read) by the general public is superb. That being said, Canadians are for a large part, homogeneous in their standards of living. A good school is a good school regardless if it is Nova Scotia or Alberta. They personally will argue that they have regional/ethnic issues and many resent the dominance of Toronto over the national dialogue but the huge fiefdoms (that Americans call states) are not a part of the political structure. The federal government has a lot of power setting standards and controlling the purse strings in spheres that would have Americans marching on Washington to burn the bastards out. They admire intelligence and the majority of people are what we in the states would consider left of center. I always thought I was a small c conservative (as opposed to the political right in Canada, the captial C Conservative) until I came to the US when I discovered I was a flaming pinko These people are not afraid. They don't have the crime or the personal connection to war that Americans have and thus see the world as essentially a safe place. (This view was greatly shaken by 9-11 btw.) Most firmly believe that if we all sit down and talk about things, the whole world will play nice. The general Canadian impression of the red-neck American with a bible under one arm, a bottle of whiskey under the other and a 45 frightens them. They consider themselves more sophisticated and intelligent. It's a tribute to the American fighting man/woman and his/her willingness to sacrifice for freedom that these cousins of ours safe across the border have so little idea of what it all costs. PS.. Their health care system and access to it is superb. It takes a lot of fear out of people when they don't have to worry about medical care. **edited to add the PS **

One of the finest medics and best people I work with is openly gay. He was working for a fire department and was subjected to harassment of every kind, primarily by the chief. He took them on in court and won. Half the department admired his courage, the other half despised him for bring down one of the good ole boys. He eventually quit and is now working for a private. There was the occasional raised eyebrow and I am sure a lot of day room chatter, but it took very little time for even the skeptics to recognize that this was one cool dude with a lot of courage. So crotchity - the protection is there, but like most things, a person has to be prepared to fight for it. Fortunately, when an individual spends the first part of his or her life coming to terms with difficult stuff, the fight is par for the course and totally doable. I think this is what gives people who have experienced injustice, abuse of power and discrimination the edge over those who grew up with all the good cards. When the excrement hits the ventilation device (because sooner or later it does for everyone) those experienced in dealing with crap have the advantage.

Unfortunately, after a couple of drinks, it happens....

I read this great article here in one of the Canadian magazines. You notice how the TSA people never look at you. They are not looking for terrorists, they are looking for things on the banned list. Every minute they spend shaking down gramma's artificial leg is a minute away from a closer look at the nervous 20 something mid eastern male. (horrors - racial profiling). Note also that of all the officials you are ever likely to deal with, the TSA guys (and gals) are the most resistant to any questions whatsoever. If those guys ever look at you, they see contempt and barely veiled irritation at the stupidity that trips through airline security become no contact disquiet all around. The reason that woman was allowed her 12 inch knitting needles is because knitting needles have not made it to the list yet. By the way - those multi million dollar screeners that will allow those dolts to peer at my anatomy are totally useless if Ahmed decides to pack 4 lbs of plastic explosive in his butt. It is totally ridiculous and has totally accomplished the aim of the terrorists, which is to cause confusion and chaos and cost us billions in time, energy and real money on misdirected and essentially useless crap. *** whew *** end of rant

LOL.. a c'mon Dust, stop beating around the bush and tell us what you really think.

Ditto !!!

More on the non-psychotic hallucinations - the following day my mother was worse. Her delusions were fixed and I was unable to orient her as I had been the day before. An amazing ICU nurse added another piece to the puzzle. He stated that something about putting patients on the heart/lung machine results in these symptoms more often than not. From Oberlin alumni review heart/lung machine side effects For patients who qualify for bypass surgery, success rates are better than 90 percent. There remain, however, serious side effects that often result from the heart-lung machine itself. Some of the damage is caused by blood clots; patients may experience inflamed kidneys and lungs, and there is a small risk of damage to the retina of the eye. Furthermore, even a small clot can damage the brain. A third to a half of patients who are put on the heart-lung machine may later exhibit cognitive defects, from memory problems and difficulty concentrating to depression and attention deficiency. From the university of California More cognitive problems Patients hooked up to the machine face a two- to four-percent chance of stroke and a 25-percent risk of transitory retinal damage. Post-operative infections may be more of a risk when the machine is used. And cognitive deficits are common. Last June Duke University researchers reported in the New England Journal of Medicine that five years after bypass surgery, 42 percent of patients studied still suffered from a decline in intellectual function. The risk was greatest for the patients who were placed on heart-lung machines. Heart-lung machines provoke the release of a riot of inflammatory molecules capable of harming organs throughout the body, including the brain. Microscopic bubbles from the oxygenator or arterial plaque dislodged during placement of the tubes connecting patient and machine can block blood flow to the brain or other organs. Mechanical damage to fragile blood cells can result in clots. Many elderly and very sick patients have been considered ineligible for coronary bypass surgery simply because they are too weak to withstand the rigors of the heart-lung machine. I think you get the idea. Fortunately for my mother, she was back to normal today. I think it's interesting that I was never informed of these risks prior to the surgery (not that it would have changed the decision.) It's interesting that retinal damage is something that occurs from being on the heart/lung machine, and as Wendy pointed out, these non-psychotic hallucinations are related to visual problems. PS.. I love this site! It makes me think and learn.

Just curious - why do you carry a pair of gloves at all times?

Interesting that you should bring this up Wendy. In this thread My linkI talk about my mother's recent illness. Yesterday, when I went to see her, she was hallucinating. Her visuals were vivid and real to her, yet when I told her that no one else could see them she would re-orient herself. She was disturbed by the fact that she was seeing things that others didn't. I discussed it with the ICU nurse, who told me that this was a very common phenomena in ICU. The RN could not tell me exactly why this happened. She said they theorize that it is a combination of medications, post-surgical chemical release, and a lack of visual stimuli. I immediately gave her her glasses, instinctively thinking that if she could see clearly, then her brain might not need to create so much stuff. It really made no difference. The cool thing is, after I explained that what she was going through was normal and she was not crazy, we actually had a ball laughing about what she was seeing. (she has no idea of popular culture or internet virals, but she did see ceiling cat)