ccmedoc

Put the cuff on the patient, find the brachial pulse by palpation. After you are sure you have the pulse, inflate the cuff to obliterate the pulse and take notice of the number. Deflate the cuff. Place your stethoscope, inflate the cuff to about 10-15 mm/hg over the number you noted earlier, and slowly deflate the cuff. You should hear light taps getting louder. The first taps will be your systolic, and so on....Try not to use the needle fluctuations as these are rarely accurate enough to record for a BP. Hope this helps...I didnt watch the vid so if it repeats I apologize

I think it is from 1983..1983 :shock: ..probably not too valid an argument today...twenty four years later and the changes in the education and expectations of paramedics has changed a bit. Trauma was the focus then. I believe that medical focus has overshadowed the trauma junkie mentality today and hopefully made strides toward a more rounded professional..IMHO

I, personally, think this whole thing is a bit ridiculous. :shock:

Although I do not nor have I ever responded anywhere POV. It is my understanding that if these individuals deem it necessary to light up their POV, they can register with the state and are officially an emergency vehicle when responding to an emergency. At least around here. All they need are stickers and lights and... POW, instant emergency vehicle. I also believe they need an additional insurance rider as such or are covered by their volly fire charter......As far as I have been told, this applies at least in this area of MI.

MFR--absolutely no EMT-B----No EMT-IV in some states---yes EMT-I----Yep In Most states I am aware of, If the Department of health determines that it is necessary to certify prehospital RN, then you can under this mandate, other than that, RN=in hospital or interfacility situations only..This as far as I have been told. We have to have a prehospital license to practice prehospital.(ie. Paramedic). Not sure what good a saline lock will do without the ability to administer meds through it?? :? Kinda what VentMedic said, I guess.. :oops: Critical hour??? Sounds like a TV show :?

As VentMedic pointed out, there are always special circumstances that need special teams. In a system that can contract with specific companies for their CCT transports, then the medics can be inserviced appropriately and trained in the ICU. We have rapid response teams in the hospital on call for NICU, Neuro/Trauma transports, and any CCT that requires a continuation of care from the nursing team familiar with the patient in question. I believe the key is a team approach. We use RN/RRT, RN/Medic, RRT/Medic, and Medic/Medic teams almost interchangeably, based on availability and if the patient may indeed benefit from the continuing care of the nurse responsible for care up to the transport. Familiarity with patient condition should not be undervalued. To the question posed initially, flexibility would seem to be the key, and the willingness of all parties to maintain education and training. Most likely comes down to money...it usually does.IMHO

I agree with this. Being a paramedic does not exclude them from transporting with additional meds hanging, titrating these meds, or initiating additional meds in transport. Educating within the given system and their medication usage would be prudent, but I would assume that they (the medics) were exposed to the additional pharm in their CCT training. A large sector of the CCT market I have been exposed to utilize medic/medic as the rule due to the shortage of suitable transport RN candidates and staffing. Licensure in this instance between medic and RN should not be the determining factor in my opinion as there are qualified and unqualified candidates to be found in both pools...the question is not worth the argument and using medics is more fiscally responsible, sadly enough :roll: I fail to see the advantage of a floor RN when a adequately educated paramedic is available and working in their environment? could you elaborate?

I've always thought that dual medics cut back on the burnout. Never had much of a problem with butting heads or arguments. Just lucky, I guess. Dual medic should be standard of care for a number of reasons...especially with shiny new medics running around..I never ceases to amaze me how a basic EMT becomes gods gift to paramedicdom once the patches are applied.. :roll: Just as the spankin' new medics need direction, the old farts need to be kept on track also..I think more conflict arises between EMT/Medic teams than Medic/Medic teams....Just my thoughts.

Amen...If they are concerned enough to call..they deserve your best effort. They don't have the benefit of your vast medical knowledge and expertise until they do :? . Most of medicine is palliative care my friend. :wink: Not in the least BS if your on the receiving end.

We don't use them unless it is mass casualty or not possible to transport right away (as in long extrication).....Life over limb is the rule, but you better be sure!!!...Generally, in my experience, just pack that puppy and lay on the pressure is effective enough to get to an ED..On a limb amputation, we are allowed to clamp any obvious bleeders....we have field amputation training, but they say they will most often rush a doc out to the scene if this becomes necessary....who knows... :roll:

The pyramidal motor tract, more correctly a "system" primarily involved in mediating voluntary muscle response... There is also an extrapyramidal system of nerve fibers primarily responsible for involuntary motor excitation.... Fiznat, you are on the right track with the dystonic symptoms BUT, I fail to see what either of these do with the scenario. I would think to argue with the original poster, Mr. hammerpcp, would prove to be an excercise in futility. In his postings he would appear to have little to no respect for anyone other than himself, with all the namecalling and such.. Such eloquent verbage... :roll: verbage /ver'b*j/ n. A deliberate misspelling and mispronunciation of verbiage that assimilates it to the word `garbage'. Fiznat, thumbs up for trying to throw in a bit of education into the mix.....Appearantly some are in it more for the argument than for the solution. Not at all worth the effort, but absolutely amusing.

To the original question: Your "rights" are to not consent to any venipuncture where you feel it unnecessary. It could be viewed as blatantly arrogant or incompetent for the lab tech, phlebotomist, or nurse drawing the sample to insist otherwise. Some labs in my area dictate to their employees to "start" in a certain place. Usually the median cubital, cephalic, then basilic veins (in that order), in the antecubital fossa. I would be hard pressed to find a tech that wouldn't listen to a client and proceed where said client had informed them it would be difficult to cannulate or otherwise draw a blood sample. Especially if it is obviously a difficult draw. In short, without your consent (informed consent), the procedure should not take place.

We have unlimited attempts if a line is needed. However, it is generally frowned upon to continuously attempt when the need for an I.V. is questionable. Very few instances is an I.V. more than a convenience..If an I.V. is truly needed, then an E.J., subclavian, I.J., or I.O. is acceptable...an unresponsive patient is preferred before an I.O. is attempted, although it is not requisite.... :shock: . We have continuing ed available in one of three E.D.s or in one of the G.I. labs (everyone gets I.V.) if an individual feels their skills are waning...We also track I.V. success and attempts to possibly reveal weak links in the chain. Most skills are tracked in our company, although it is reliant on the providers honesty in charting the call on the run record. Med Control is almost never contacted for permission to initiate I.V. access. When they are, they usually deny it on the premise that the provider is not confident enough to make the decision. :? .Not much help in the venipuncture area online..

This, and the following comments in his post, are the norm in my experience also..Most ED nurses are not trained to, nor do they want to be trained to, effectively participate in the pre-hospital part of EMS. I do not look for the " RN on every ambulance" to be the norm any time soon....I also do not believe a Paramedic license to be a lesser license to RN, and I'll probably catch poo for that. . They are apples and oranges...I do believe that to be taken seriously as a medical professional, Paramedics will be required to complete educational requirements beyond Medic school, as nurses do with their pre-requisites. Hour for Hour, most paramedic schools, I stress "schools", are clinically on par with an ADN program and some BSN programs, with a different focus. The difference is made through the additional science, math, and basic language skills not required by most paramedic programs.. To be effective in the field, an RN should absolutely complete a paramedic course..start to finish. This does produce a superior Medic, IMHO. In my state, to my knowledge, a nurse practicing in the EMS field, must also be a licensed paramedic. Thus, they practice as a paramedic not an RN.The additional latitude they are granted is generally pharm based, due to the extended education they recieved in pharmacology as a nurse.. This being said, there are good paramedics that run circles around supposed seasoned nurses..throughout the hospital. The difference is that more nurses admit the need for the additional training than do paramedics...sound familiar??? :roll: Just my opinon..

In the assessment it was stated that there was no pedal edema or JVD appreciated. If this patient had a long progression of the difficulty in breathing, a CHF pt. would most likely present with a fair amount of dependant edema, and most probably have some periorbital edema to show. Without a CXR and other diagnostics it would be, and was, prudent to follow the assessment and think some inflammatory etiology was present. As Doczilla pointed out, one dose of steroids will not do appreciable harm to this critical pt, and most likely will help. Risk vs. benefit ...benefit in this circumstance. Fluid in the airways will cause an inflammation in and of itself. The symptomology of the progression, cough, no edema, sleeping throughout the night, episodic nature of the dyspnea, no cardiac history and history of recent bronchial infection all strongly support an inflammatory process leading to any fluid in the airways, not the reverse (fluid leading to inflammation). The big picture says non-cardiogenic, the treatment was accurate and prudent given the circumstances, I believe.... Again I go back to discarding any and all comments given you by this arrogant nurse...Maybe she is in need of some remedial training in regards to respiratory ailments?? Not the best example of nurse professionalism..I'm embarrassed for her!! :oops: .

Not only is it not allowed at bases..A person on duty cannot, or is not supposed to, ingest alcohol 8 hrs prior to working..We have had terminations for violating this policy as have other companies/counties. This should be zero tolerance....

I believe the nurse was grilling you due to one of the side effects of solu-medrol being sodium/fluid retention. I also believe that the Methylprednisolone treatment, given the respiratory distress with this symptomology, was correct. The immediate effects would be beneficial and the sodium/water retention could be addressed with Furosemide, which you alluded to in your post, and observation. This patient would most likely me admitted after this episode anyway...The nurse had no right to question your differential Dx or treatment, as your responsibility is to the patient. The physicians on shift ultimately dictate your treatments, not the nurses. Any question of treatment should come from the doctor as she has no more of a right to diagnose than you do as a medic.IMHO... She's gettin a little big for her britches...

Volunteer emt/Paramedics are definitely a contributing factor to the low wage that most EMS personnel endure. Union is absolutely not the answer due to the fact that they generally do not improve wages or conditions for the exemplary workers, and tend to be more of a benefit for the least common denominator. In areas where there are no vols, and companies have increased educational standards, I think we are seeing increased wages...competition tends to increase wage standards, not union rhetoric....IMHO Many variables affect the wage issue in EMS, as in most other professions..In as how the volunteer ambulances affect professional EMS wages, I believe that Dustdevil's comments are right on the money 8)

You don't stop, period. No discussion necessary. 8 pages...Whew!! :wink:

Ridiculous. This practice needs to be reevaluated and abruptly stopped...Probably in the top 5 most Ridiculous practices I've heard of in EMS....but I'm no expert :wink: Maybe fly it over with air med???? ...Sorry :oops: I'm done Back to the original post...If your doc wants you to start, then maybe you should for your own piece of mind. Sure would be nice to have the rapid test available...Have you specifically requested it??? The major concern in my eyes would be the hep c...Your kinda boned here tho..I have never seen someone come up positive from a needle stick, if thats any comfort.. (edited for content)

What ya been doing in college, dude??? Should have more to show for this sum of money..at least an associates I would think. If your are asking someone to invest in you for Medic school, I think this may be an issue...Any investor is gonna want financials and what you have been doing with your time...Yes?? It may be better to finish college with a degree in something to show that you finish what you start...a little continuity goes a long way.Maybe by then you won't need investors. Basically sounds like more trouble than it is worth...The best you could probably hope for would be a loan-not a subsidy that you would no doubt have to sign a contract for.. I have a bachelor's in biology...heavy coursework in Psychology and Spanish. I graduated 2 years ago. Since then I've interned with a clinical psychologist, worked a year as a teaching assistant in elementary school (which I've always wanted to do), supported/helped an Explorer program, gotten my EMT cert, took Japanese b/c I felt I had gotten fairly good at Spanish already, got hired at the most competitive EMT company in LA (not that it says much, but at least I'm not bottom of the barrel), and gained experience in a busy EMS system, while supporting myself. That's only in two years, if we go further back, I've done a whole lot more. I also passed up a number of job offers, including one with a startup company that's now doing extreeeemely well. I'm where I'm at now, because I specifically wanted to pursue a job in EMS and I needed to get 6 to 12 months of 911 EMT experience (depending on the medic school). Sometimes I do feel like I should be further along, though....

No as not on the injured extremity....sorry about the ambiguity......No need to use a pulse ox on the injured limb....color/cap refill/pulses/temp.....all you need for transport...doppler if you have it and are worried about circulation.. If you have to monitor pulse oximetry for a trauma--find an uninjured limb or body part. pulse ox is not the end-all-be-all of diagnostic equipment..you'd do better with your observations for an injured extremity.IMHO

What ya been doing in college, dude??? Should have more to show for this sum of money..at least an associates I would think. If your are asking someone to invest in you for Medic school, I think this may be an issue...Any investor is gonna want financials and what you have been doing with your time...Yes?? It may be better to finish college with a degree in something to show that you finish what you start...a little continuity goes a long way.Maybe by then you won't need investors. Basically sounds like more trouble than it is worth...The best you could probably hope for would be a loan-not a subsidy that you would no doubt have to sign a contract for.. :?

no.

It is not my partners driving that bothers me with the L+S, it is the response of the other panicked drivers on the road.. Pregnancy, not so much a priority---pre-term..maybe. Trauma with need for surgical intervention and some AMI patients, absolutely..most non-STEMI patients in our area do not go to cath lab, so why priority transport if suspected?? Most often the benefit is not worth the risk of a hot transport.