ccmedoc

I think they both said about the same thing..I do not believe that being a basic for any length of time benefits you...at all. It is a waste of time and effort IMO I would go to a college, get the additional classes and the basic/paramedic back to back. If there is not a CC near you offering the EMS degree, take a couple courses in the winter, EMT class in the spring and summer, then back to college in the fall..I think a couple of semesters full time is more than enough to get a psychology, A&P 1 and 2,Micro, chemistry, a couple of english classes...it will get you on your way to a degree also, in whatever you choose...A couple of steady years and you are an educated Paramedic, given that you can get into a good program that is not fire based...Another topic about this perhaps in the archives... I guess I see them (Dust and Dwayne) as on the same page, as I have seen them discuss this many times with others..degreed medics are better medics out of the chute..the additional educational experience adds to the critical thinking, I believe. How you break up the education is probably going to be a monetary issue also...If it is college or EMT school, choose college.... BTW: Out of curiosity, how do you believe that Dustdevil and Dwayne differ in opinions..maybe I am the one reading things wrong...(now that this thread is hijacked beyond recovery....LOL)

Now you will see why Dustdevil and others say this..here Education is a must..ever heard a medic ask how advanced patho, anatomy, and some chemistry will benefit them in their "profession"?? You now have a good answer....

please delete this post...

hehehe..looks like you asked the right questions.. I believe the best answers to your question have been given above; Dustdevil and Dwayne speak the truth. Heed the words and get an education and not training..you will not regret the extra course work Dust mentioned. You said you want to be a damn good medic, get the additional education..two semesters or so will make a world of difference in your thinking and understanding of the situations you will encounter

Touche'....

Granted, it comes down to education and the ability to understand and process the information gained in the assessment, but this goes for the entire assessment. I think it comes down to being able to identify the common ailments, and knowing the difference between the benign and potential life threats. Not being able to properly assess the patient takes us in to whether they should even be allowed on the ambulance in the first place; a discussion that is a bit long in the tooth. Palpation by itself is one part of the puzzle, abdominal or otherwise. In conjunction to the rest of the assessment, it can be valuable...whether the article's author has the credentials to effectively speak to the EMS community or not... Bottom line for me is if a provider is tending to patients, they need the tools to do it properly..palpation is a basic tool..it should be taught and used appropriately by all licensed providers. This I agree with more than I can possibly convey on this forum...

It is still my opinion that abdominal palpation (palpation in general as well as percussion) is a valuable tool, and to begin instruction at the basic level is not detrimental. I guess I do not fully understand the points you are making; for or against?? As far as the prehospital portion of the article, I do not see where it precludes or prohibits the palpation. MAST is a thing of the past for most areas, but inclusion in the article was prudent for those still in that era, IMHO.. Again this is just my opinion, but I like to be complete in my assessments and teach the same. Due diligence in the palpation of appendix and other suspected abdominal conditions should always be observed also..part of the instruction process I would imagine... EDIT:..maybe I am too progressive for my own good....

"The clinician need not be afraid of properly palpating the abdomen because no evidence exists that aortic rupture can be precipitated by this maneuver." Article by Dr. Robert E. O'Connor MD Proper assessment provides a differential for the provider to work with..I believe that the OP should have shown the student or basic the proper method to palpation. Definitely using this tool to differentiate (potentially) between a hernia, bowel obstruction, or AAA could be valuable..although all are potential surgical emergencies. Palpation, percussion, and auscultation are invaluable tools, if skills are honed appropriately..IMHO

Any health care provider in the field of EMS, certainly paramedics, should e affiliated with a hospital and not the fire service. The biggest faux pas in EMS was basing it with fire in the first place.

I agree with Rid for the most part, but I would have to say that you would stand a much better chance of getting the NP in the field than the PA. NP is closer to the EMS mold than the PA, who most likely has little medical experience past the PA training. NPs have to be a nurse previous, PA could have been an accountant.. I like the ideas of maybe having a rapid response to augment the volley contingent, if they(volleys) are the only way to go, and if the NP was cross trained in the ways of EMS. One question though, and I may have missed this; if the NP or other is off on an EMS call, who covers them? You would have to have at least a pair of them. With the additional training and instructional duties you propose this may well cost more than the, how was it so eloquently phrased ,"...two paramedics to sit on their asses 325 days a year..." What you gain in the additional scope and abilities of the NP (you see which way I lean), you may (will) lose on the fiscal side. This is where this dilemma is based, from what I can glean from the posts thus far. Why not add the PHRN designation in the area, and pull the rapid response from a hospital or local clinic. This is most likely cheaper, and the duality is easier on the planning committee. Besides, a LOT of RNs are paramedics also.. I'm still not convinced the ALS coverage is beyond the fiscal abilities of most, if not all, rural areas. The question then becomes not if there is ALS coverage, but how much...

This is a major problem with the online schools, and community schools operating provisional or unaccredited. Even if they say that they meet all requirements, most legitimate institutions will not honor the credits obtained for transfer. I know a lot of managers who look at the intstitution of learning as a criteria for an interview, let alone a job offer; especially for new grads. The NCLEX pass rates stated are appalling, but revealing. The same can be said about the online university granting a degree in EMS. If continuing the education is of primary concern, research is in order. As for ADN to BSN or ADN to MSN, most of these are online based from the university simply due to scheduling problems and educator shortages. These are fully accredited by the nursing board, and meet all criteria. By needing no clinical requirements (existing R.N.) it is much more simple logistically than basic nursing education, where much clinical experience should be obtained. I seriously doubt if this is a trend, the online nursing I mean, as it will show its shortcomings quickly. Secondary and advanced nursing degrees are a different animal and should not be compared. Online Paramedic and EMS training is spooky. They haven't even gotten the institutional education down past mediocre training yet..This would be a serious step back; or three or four...

Most Trauma centers I have been associated with use a combination of physiological criteria as well; such as vital signs and airway condition, where the injuries are, if they are penetrating or non penetrating, level of consciousness and any loss thereof. Simply using MOI is not adequate, and puts a burden on the trauma team at times, but certainly plays into the scenario. I have also not been associated with the sublevels of trauma classes. Usually class I, class II, class III is enough. Even though you call and indicate the patient meets the criteria in your eyes, an attending Physician needs to class it I am sure. Why wast the time and effort with trying to activate, when simply giving a good report and pertinent findings may suffice. Any trauma patient that is stable and does not have any traumatic injuries "in the box" should be a class II at any rate. If the patient is going to an ACS certified trauma center, level I; the necessary individuals will be present when needed. -I am not an advocate of activating the trauma team because of mechanism or even from the field. Just relaying the pertinent information and allowing the E.D. time to prepare..

Oooooops My bad..enjoy!!

Caps lock.........Far left about half way up, most of the time. Turn it off, and hopefully you will have some good interaction here....

This is exactly how I read them..every time. If you develop a system, and note changes along the way, you tend not to get caught on the small stuff and see the big picture. Analyze all the above and then scrutinize the changes. Very simplistic thinking, if not a bit contradictory. Progressive systems are not in the future here... How do we propose to decrease door to balloon times if you don't know anything prehospital? It starts there, and the sooner the better. As chbare says, there are a plethora of other problems that can be caught with a well educated eye, and a remedy can be initiated, or a wrong treatment avoided. Simply throwing MS, O2, Nitro, and ASA at every chest pain is bush league and potentially very harmful..IMHO -For what its worth

Cocaine induced chest pain presents a potential problem and can definitely lead to complications. Studies have shown that most individuals will present within three hours of use of cocaine (although S/S have been attributed to cocaine up to 4 days after use), and should be monitored for 12 hrs following cardiac presentations; i.e. chest pain, dyspnea, etc. I have read one study that cited mid 40% of patients presenting with ST elevation of greater than 1mm in two contiguous leads, but ruled out of MI by serial enzyme studies; whereas it is thought that only 6% of cocaine induced chest pain result from AMI . Who's going to make the call of 'just another cocaine ST elevation chest pain' and not treat accordingly? Not me... Generally speaking, the cocaine chest pain can certainly lead to mortality and morbidity, and should be taken seriously and treated accordingly. In theory this is limited to nitro, aspirin, and benzodiazepines. There is a theoretical problem with aggressive beta blockade and increasing hypertension due to unopposed alpha blockade. In concluding the 12 lead answer, some ST elevation may be seen, S/S of LVH, RVH, maybe early repolarization changes, and of course the tachycardia you see. It is possible to see Tachycardia dependant BBB also. At any rate, do not dismiss them as just another cocaine chest pain. Especially if they have had a cocaine induced MI before, the chances are greatly increased of resultant heart failure and rapid decompensation. The tachycardia should be managed with benzos and CCB. The adenosine is not going to be warranted in this situation.

You still adjust the flow with the roller....I hope.. I'd chew your fingers off for using the slide clip :P ..In a hurry, this is not best IMO. It is easy to find if you need to TS a line that doesn't run, though. It should be anyhow.. Out of curiosity, do your partners start multiple IVs before they check the clips for the line not running, or do they pick it up sooner than later. Just curious...

I had been shown it in Medic school, But not Nursing school. I am surprised by how many have not been taught, or simply do not care. If you release the clamp slowly, this too can minimize or eliminate bubbles. For piggyback, Tighten the roller on the PB, Spike it, hold it lower than the primary, and slowly loosen the clamp and fill drip chamber to level. This reverse flush will not waste meds, and if done properly, will not add to the infusion. This could be important in both instances. I doubt anyone is going to admit to not knowing..

Another quality post..#17 and counting....I guess I picked my sig for a reason. To Asys, I would say just relax and let it happen. It sounds cliche, but it is true. I would hope that an idiosyncrasy on the proctor's part, or simple semantics would not be a problem. Don't make it harder than it is. I wouldn't let someone who possibly did not even take the exam (quality post) try to minimize the stress I have seen in the students in these scenarios. Maybe not knowing the people is a bonus. There will be no predispositions, and it will most likely work to your advantage. In the end, test taking is presumed to be 80% attitude. Positive attitudes yield positive results. I have seen both in short supply lately... -Don't sweat the small stuff..

I will watch the game for the Cardinals. I have been a fan since the St. Louis days..When I was a wee little sh!t. :shock: St. Louis or Arizona, matters not to me.... 8)

As you should be. The woman can certainly bleed heavily. If the hemorrhage is present, you need to push back in with a fist and use the "bi-manual pressure" of putting pressure to the abdomen with the opposite hand. Gentle, steady manual pressure to stop or slow the hemorrhage. If the uterus is prolapsed, subinvolution could certainly be a problem, and this pressure technique will certainly be helpful. I am told you can feel the uterus start to contract around the fist at this point.. :shock: This I know is not taught often, but it may save your patient. Some of these hemorrhages are very heavy and can be life threatening. I learned this from a midwife. If midwives are available to instruct during the OB/GYN modules, maybe this would be a valid option. Many techniques they use may be valuable in the field, as they spend a fair amount of time out of the hospital delivering babes.. Some of these issues may be prepared for depending on the Gravidity (certainly term pregnancies) of the mother, and previous history of problems. As Gravidity increases, the chances of uterine prolapse, subinvolution, or hemorrhage in general increases..Or so I am told.. Just a thought. :wink: Note:By hemorrhage I mean extremely heavy bleeding with or without possible subinvolution, not normal bleeding from placental separation or birth in general...

Yeah.. I just put that out there for discussion. There is no black and white answer. It may depend on the outcome. If the guy lives and no problem, your the 'life' of the party. But if the guy doesn't make it, you may be looking for counsel.. I don't think anyone can answer until it is in their face. I can't give a definite answer for myself as I have never been in that situation. I think the questions need to be ask though. It makes for good discussion.