Kaisu

OK - so to take this discussion back to the question I believe the OP was looking for clarification on, let me try to summarize: In a case of traumatic arrest, in this specific situation only, (in the interests of getting the answer narrowed down a little) lets assume that this is traumatic arrest - in other words, you as the provider, and in our scope of practice, it IS our duty to pronounce, have determined that there is little to support non-trauma causes for the arrest, the consensus appears to be if 1 - immediate CPR and 2 - down time of approximately 10 minutes ( when you arrive as a transport unit medic) If the rhythm is asystole, you would pronounce If the rhythm is PEA, you would work it Now assuming that is PEA and not CPR artifact (I know I know.. but it happens a lot) Some other questions? What rate of PEA? Would you decide otherwise if the rate is 20 vs say, 65? PS.. thanks to all who are contributing - it is an important discussion.

Not gonna let you have it. Its a valid point. A jury vote of Not Guilty is not the same as Innocent. The accusations are possibly true, which is probably why the agency suspended him. I am just concerned that all of our rights are protected. I mean, if the guy is truly innocent, he will never get past the suspicions. It could happen to any one of us. I run an EMT/Medic rig and I am usually alone in the back with patient care while my EMT partner drives. This medic's partner stated that he/she never noted anything unusual. If I was in the back giving a patient a bj, I am certain she would notice something going on. This was apparently not enough to prevent the medic from suspension without pay and that sucks.

You'd lose - I'm a firm believer in innocent till proven guilty.

so put him on light duty with no public contact, WITH PAY, thus covering their a** while they investigate - or suspend him WITH PAY, while they investigate, etc.

How much do you think they will appreciate the enormous bill for transport, rescusitation efforts, ED room, etc. etc. for what was clearly a doomed effort ? And as you are extrapolating, how much do you think the family of the dead patient across town that could have been saved if resources had not been expended on a hopeless case were not tied up working the hopeless case?

oh for gosh sake. Can anyone seriously believe that a paramedic gave a homeless guy a bj in the back of a rig? I can't believe they suspended this guy without pay over this kind of accusation.

I would not work this code. The bystander stated that he had a pulse - but I have PEA. I don't know that I believe there was a pulse. Traumatic arrest is traumatic arrest. We can't fix it.

CIPA was featured on one of the House reruns last night. The thing was, EVERYONE on the show knew what it was without even thinking about it.

There was the patient who called me an ugly white m*****f*****. I told her "Hey, I ain't ugly."

BTW - in response to your question of how many black people work at our station - NONE. We are chronically short of medics. Send us anyone with a pulse and a cert and they will have a job. We really don't care what color they are.

A-B students get their A-B's for successfully performing generalized studies at a C level. Most people can manage basket weaving if they practice hard enough. When we get to a specialized area of knowledge, we are asking more of them. Those A-B's start narrowing down. Do you expect all A-B students to maintain their As and Bs when they go to MIT and study rocket science. Crotch - that argument is laughably flawed and I know you are capable of much better.

The sensory receptors within the human body are sensitive to tissue damaging or stimuli that are prevalent in skin, muscle, joint, bone and other connective tissues. Those nociceptors (sensory receptors) are sensitive to response to mechanical, thermal, and chemical cutaneous stimuli. It is believed that nociceptor sensitization is a physiologic mechanism of persistent pain. Once nociceptors activated locally, it transduces chemical, mechanical, or thermal stimuli into afferent impulses that enter the nervous system to the brain for pain perception. Particularly, A-δ mechanoreceptors and C-nociceptors appear to be localized to connective tissue between muscle fibers and in blood vessel walls or tendons, and in the joint capsule and periosteum. Particularly, numerous studies have shown that the periosteum, which is comprised of fibrous connective tissue sheath that covers the external surface of all bones, is densely innervated by both sensory and sympathetic fibers. Nerves are distributed to the Periosteum and accompany the nutrient arteries into the interior of the bone. Fine nerve endings are found in bone marrow, periosteum, cortex, and associated muscles and ligaments. The prevailing opinion is that bone pain arises predominantly from the densely innervated periosteum, where is the area of interest for ablating local pain receptors utilizing ultrasound to reduce bone pain.

I do believe the OP was asking about people's personal experience - the straight goods so to speak, as opposed to the party line from a web site or a company rep.

Bacterial infections usually present with high fevers, viral with low. Strep is a bacterial infection, so I would lean towards either a viral sore throat or possibly viral meningitis, neither of which are as serious as the bacterial versions of either.

My grandson is hispanic/black. When we had the opportunity to adopt him, we were worried about whether we would be able to do the little lad justice vis a vis his ethnic heritage. We didn't care if he was purple - we wanted him. The small midwestern town where he lives has 2 black families in it. We are concerned about any racism he may experience, but we also know that as a family, we are well equipped to deal with the challenge. We love him - and will do everything in our power to ensure that he has the same opportunities as anyone else. He is being given love and taught responsibility. He is being encouraged in his interests and we make sure the lines of communication with his birth family are open. The kid has a wide open future. It tickles me that this hispanic/black kid from San Antonia is being raised in Wisconsin, and babysat often by a Canadian woman who was originally born in Finland. His Native Canadian/ white cousin visits often and one of his favorite playmates is kid born to an American woman and an Indonesian man. If he ever tells me he failed the test because he is black, I will kick his ass.

Are you suggesting that the evolutionary process works differently in people of different races? As far as I know, there have been no evolutionary changes in humans of any race for approximately 10,000 years.

Trust Aussiephil - that sick b*****d....

Bill HR40: Commission to Study Reparation Proposals for African-Americans Rep. John Conyers introduced the bill HR40 to the US House of Representatives on January 6, 2009. This bill was referred to the Committee on the Judiciary, which Rep. John Conyers chairs. The summary of this bill states: “To acknowledge the fundamental injustice, cruelty, brutality, and inhumanity of slavery in the United States and the 13 American colonies between 1619 and 1865 and to establish a commission to examine the institution of slavery, subsequently de jure [concerning law] and de facto [concerning fact] racial and economic discrimination against African-Americans, and the impact of these forces on living African-Americans, to make recommendations to the Congress on appropriate remedies, and for other purposes.” This bill will establish the Commission to Study Reparation Proposals for African-Americans and fund the commission with $8,000,000 of our tax dollars. The duties of this committee consist of the following requirements in examining two historical periods of the United States: 1) The first period of history to be examined is between the years 1619 to 1865. The Commission’s examination will include: a. The capture and procurement of Africans; b. The transport of Africans to the United States and the colonies that became the United States for the purpose of enslavement, including their treatment during transport; c. The sale and acquisition of Africans as chattel property in interstate and intrastate commerce; and d. The treatment of African slaves in the colonies and the United States including the depravation of their freedom, exploitation of their labor, and destruction of their culture, language, religion and families. 2) For this period of history, the Commission will determine the extent to which the Federal and State governments supported the institution of slavery in constitutional and statutory provisions, including the extent to which such governments prevented, opposed, or restricted efforts of freed African slaves to repatriate to their homeland. (Italics mine – note that reference is made to State governments making the state sovereignty issue even more imperative.) 3) The second period of history to be examined is from 1865 to the present. The Commission will examine how Federal and State laws during this time period discriminated against freed African slaves and their descendants. Additionally, the Commission will examine the following for this time period: a. Other forms of discrimination in the public and private sectors against freed African slaves and their descendents. b. Any lingering negative effects of the institution of slavery on living African-Americans and on the society of the United States. 4) Additional duties that the Commission is required to fulfill: a. Recommend appropriate ways to educate the American public of the findings. b. Recommend appropriate remedies (italics mine). c. Shall address the following issues: i. Should the United States Government “offer a formal apology on behalf of the people of the United States for the perpetration of gross human rights violations on African slaves and their descendants”? ii. Do descendents of African-American slaves “still suffer the lingering effects” of slavery? iii. Is any “form of compensation to the descendants of African slaves” warranted? iv. If the Commission finds that “such compensation is warranted, what should be the amount of compensation, what form of compensation should be awarded, and who should be eligible for such compensation”? Powers Granted to the Commission to Study Reparation Proposals for African-Americans a. The Commission is to conduct hearings throughout the United States and has the power to “request the attendance and testimony of such witnesses and the production of such books, records, correspondence, memoranda, papers, and documents” that they deem appropriate. If any entity or witness fails to produce the “appropriate” documentation, the Commission “may request the Attorney General to invoke the aid of an appropriate United States district court to require, by subpoena or otherwise, such attendance, testimony, or production”. (This is most probably directed at Southern States (the bedrock of Conservative values) who refuse to provide the “appropriate” documentation. Uh, do you think this violates the 10th Amendment?) b. “Powers of Subcommittees and Members – Any subcommittee or member of the Commission may, if authorized by the Commission, take any action which the Commission is authorized to take by this section.” (No powers are specifically granted other than stated in a. above. This leaves it wide open for the abuse of power.) c. The Commission is empowered to “acquire directly from the head of any department, agency, or instrumentality of the executive branch of the Government” and all indicated entities “of the executive Government shall cooperate with the Commission”. (Italics mine - Executive Government is not only at the federal level, but at the state level as well.) You may read the entire bill by going to http://thomas.loc.gov/cgi-bin/C?c111:./temp/~c111n6e2bn.

Fluids do not run through an I/O the way they do through a vein. On a pediatric I/O, I used 20mL prefilled syringes and administered that way. (tiny kid - 2.5 kg). On adults, you almost invariably have to apply a lot of pressure to the bag - someone can squeeze it if you have the hands - blood pressure cuff works good too. On the lidocaine - our esteemed medical director took it out of our protocols. I complain about it every chance I get

thank you for this strip. Although I identified the pacemaker, I did not know about pacemakers that use a functioning SA node as a timer. I appreciate learning this.

the new pacemakers make the spikes very hard to see. I see it in V5. As for the question of BBB or ST elevations in a paced rhythm, abnormal depolarization means abnormal repolarization. Analysis of the 12 lead stops as soon as you ID a paced rhythm. Your monitors should have a pacemaker detect button, which will mark the pacing. I put that on whenever I have a patient with a pacemaker because that allows me to see if its a demand pacemaker or not and if it is demand, I want to see how often the patients underlying rhythm has to be paced. (of course, you can always ask the patient if they have one, and that big lump under the skin is a dead giveaway )

The new standard is CCR - cardio cerebral resuscitation as opposed to CPR - cardio pulmonary resuscitation. It is our new protocol. Some salient features - 1 - used for adults only 2 - used for Vfib or non-perfusing Vtach only (PEA, asystole protocol remains the same) 3 - used only in non-respiratory driven arrest ( ie. not for near drowning, positional asphyxia, etc) The protocol says - 200 uninterrupted chest compressions. Do not stop for ventilations. Pop in an OPA and attach a NRB mask with high flow O2. Check rhythm after 200 chest compressions. Shock if Vfib or or Vtach. Repeat for a total of 4 rounds. IV/IO access asap and administer epi. No antiarrhythmics. After 4 rounds, revert to standard CPR, think about airway, antiarrhythmics, etc. If arrest is witnessed and EFFECTIVE CPR/CCR performed PTA, then shock immediately. (if rhythm is shockable) On some short transport times, we have delivered patients without ET tubes. Before the nurses in the ED got onto the new protocols, we got flack for it. Everybody is on the same page now.

maybe my eyes are tired from the shift but that appears to be a paced rhythm thus nothing can be said about ST elevations

I didn't think it was funny. I was touched and inspired. It's one of the few times I've seen fundamental principles expressed in an inclusive manner. I sent the link to just about anyone alive in my address book. I do that about once every 2 year. Thanks for posting.

I did not look at her blog. I am more concerned about the bigger issue of freedom of speech vs. academic/employer rights to restrict same. EMS is fraught with examples of individuals fired because of these issues. A medic I went to school with got fired last week because of a text message sent on a personal phone. It was a racial joke (pretty tame compared to some of the stuff this guy has sent). It was used as a hook to eliminate someone that did not fit in. I am not debating the merits of this specific case or any other. What bothers me is the fact that there are no guidelines currently in place to protect all of us. It appears to be at the discretion of whoever is in charge. The fact that you might want to send my butt packing does not necessarily give you the right to do so. If my career - academic or otherwise, is at the mercy of whoever decides to take offense at something I say or post, then that is plain wrong. Potential HIPPA violation is pulled out of people's butts as a blanket condemnation of whatever it is they take offense to, when the fact of the matter is that damn few employers, academics and practioners really understand the law. The practical application of it is a grey area for sure. Pretty hard to avoid breaking the rules when they are not written down. Debating the issue in a court of law is what our system has as a way of clarifying this stuff.