ccmedoc

Its difficult to see from this strip as the quality is not great. Regardless I would like to see more leads. From this I would think either A-fib or artifact. Additionally, maybe mobitz type 1 A/V block. More strip to compare baseline would be warranted to try to rule out artifact. Could be from a number of reasons. Any more info on the patient, specifically history and meds?

This is so very true. Sad, but true. This from the same individuals that claim to be professionals :shock: This is not simply the schools fault, or the parents (parnets ?) fault. This is society as a whole changing values and accepting low standards as to not upset the feelings of the lowest common denominator. Obviously if the trend is to change, then parents must become more involved with their children's scholarly ambitions and less concerned with their professional (or not so professional) endeavours. When a person decides to have a family and children, the focus of their energy should shift from themselves to the well being of that child, or children. To often, the school system is nothing more than a babysitter for these families, and simply making it through a grade is enough. This is, sadly, the rule and not the exception. Simply being from an impoverished upbringing, inner city school, or unsavory household is not excuse enough for the plight of our young students. Examples to the contrary are shown every day. As long as society is comfortable with the status quo, and more concerned about hurting someone's feelings than improving their place in society, this will not change in the near future, at least for the better.. (edit)-As usual, just my opinion

Agreed... The most important tools or skills you take to the field are you education and assessment skill. As a paramedic, you should have increased both. You would be hard pressed to find anyone that would say your legal duty or liability was equal to an EMT, simply because of the truck you are riding in. The drug box and the toys do not make a paramedic a paramedic. It should be the education, and the ability to use this education to analyze a medical situation to a higher extent than the basic EMT. I think to even ask the question is ludicrous and a means to a cop out. Do you lose a few IQ points or have a bout of amnesia when you board a BLS ambulance...I suspect some do :shock: -Just my opinion 8)

=D> =D> =D> Very nice writing, indeed. I will have to read it a bit more to grasp the whole thing, as it seems to hold a deeper, more personal meaning than just 'a wall'. Sometimes I wish things were that simple in this life. But then all would be taken for granted. I find it interesting how your vision of 'the wall' changes over time. I get the feeling that this is an intensely personal story that, although very descriptive, the reader will never truly know the feelings involved. This is as it should be. If this is not the case, touche'. Rest assured, I will read it again when I have more time and post again. You deserve the well thought out opinion you asked for, and this is good writing that begs a more in depth reading and some thought be put forth. At any rate, this is very good writing. Very interesting, personal and a pleasure to read. I applaud your style..

Sickle cell is a spectrum disorder, not simply sickle cell disease or not. There are different types, ranging from Sickle cell trait (that will not manifest as crisis) to sickle S (Hgb S) disease (sickle cell anemia). Some classify certain beta and alpha thalassemia in this disorder, but I think this is a minority.. The difference between Hgb C(SC) disease and Hgb S (SS) disease is genetic. Usually the SC is called sickle cell disease and presents with milder symptoms and discharge is quicker. The SS is termed sickle cell anemia, and symptoms are generally the more severe. These range from the joint pain to Gall stones, strokes, acute chest syndrome, priapism, to splenic sequestration (surgical emergency)..Some individuals may have SC for their whole life and never know it. They may attribute the pains to flu or other colds. My guess in the difference between a patient wanting to go to a certain hospital is a direct correlation to how much the staff truly understands SS and SC disease. One may only need labs, fluid and pain control. The other may need labs, fluids, blood products, pain control, and other medications for secondary manifestations, such as itching. If the staff is not accustomed to treating the SS patient, they will simply think they are drug seeking and not pay the attention that the disorder warrants. Some larger hospital have SS clinics that specialize in both inpatient and outpatient treatment. I can see though, as ERDoc says, there are seekers in the population. Most clinics that see a lot of SS, and even some literature (as I have been told in seminars), will tell you that the number of sicklers that seek drugs for recreation is low. Further assessment of the patient to gain insight into the type of pain they are experiencing is acceptable if you suspect this, but don't make the person suffer while you interrogate them. 8) Oh, and some hospitals do have better meals than others.This most likely also factors in to the persons having a lesser crisis... Morphine is the drug of choice to start with as it is LESS potent that Fentanyl or Dilaudid. Versed is generally not used, in my experience, unless some anxiety or seizures accompany the crisis...Most patients do not respond well to the morphine, diphenhydramine, motrin,etc..and need to use more potent drugs. These people are generally on T3, vicodin, dilaudid...at home. I know from experience that MS or Fentanyl do not touch some of the individuals that are older with SS. I have heard that some like to administer the stadol or Nubain..Be careful with these in this population :roll: This is a serious disorder and warrants some research by the members of this forum to understand better IMHO.... edit: Speaking further on MS..I meant to also state that the administration of MS is frequently based on the theory that this drug reduces the body's oxygen demand, acts as a vasodilator, and is very effective in relieving pain..This, along with the MS being easily controlled and tolerated by most patients, make it attractive as first line narcotic..... Carry on.......... 8)

You actually have to CARRY these all the time?? I think that is a bit overkill...Maybe its just me 8)

Yes, I do realize this. I still use it, and you need less of it. The elderly person and children are about the only ones responsive to low doses around here. Most need fentanyl or dilaudid. Its a safe drug IMHO I have never seen anyone vomit or stop breathing from MS. I have pushed it pretty quick at times, and never had this problem. As with any narc, you have to be aware of the patient. As far as MS and fentanyl. They are pretty much interchangeable around here, and up the paramedic as to which he/she uses. Kinda like ERDoc said, MS used to work wonders with low doses, now it takes a ton of morphine, or another drug...usually dilaudid or fentanyl these days. In case I didn't say it...The OP did good. Thats my opinion

I see the point, MS doesn't help me either..I use the morphine mostly for kids and elderly. I also think the 2mg increment is ludicrous. Everyone is concerned about the respiratory issue, this is a bit ridiculous for most people. 4mg - 6mg to start is good in my opinion. If you go by the 0.1 mg/kg formula, 2mg doesn't even enter the picture except for kids.. 8) I think if you stray from the MS or fentanyl, dilaudid is the next down the line....I like this stuff Back to the program.........

Yep..I didn't think too much new came from this. There has been evidence for a while that inflammation played a huge part in AMI. We have been teaching, against convention, that reproducible chest pain does not preclude AMI. Simply because of this fact that inflammation is present. I would like to see more studies, any studies for that matter, about the efficacy of different analgesics in AMI, and the roles they play in outcome to discharge. You have brought up some good points, guys..I wish it would rub off on some others :roll:

For the dose necessary, onset may be a bit slower than morpine and the duration of action is shorter. The duration of morphine is 4-6 hrs, where the duration for demerol is 2-4 hrs. Interactions with SSRI can be devestating, and a lot of people take SSRI. Some retrovirals cause levels to become toxic very quickly. :? CNS side effects are significant, including seizures. Normeperidine, it active metabolite is accumulated in the system. If the patient has a seizure disorder, this drug is not well suited for them. The drug should be used very cautiously in the elderly due to decreased renal function (normeperidine accumulation increased) and can increase the chance of anticholinergic effects in this population. Finally, meperidine is not reversed by narcan and may, in fact, precipitate seizures . There is not a positive point for demerol vs. morphine, fentanyl, or ketorolac that I have seen lately. Given the plethora of probable untoward effects, meperidine is not used in any hospitals around here, and is certainly not well suited for prehospital administration. IMHO.. ...The old 'morphine cannot be used for biliary colic because it causes spasms at the sphincter of oddi' argument is bunk..No study I have read has linked this with any clinical evidence.. One more word.. studies have shown that the pain relief in severe biliary colic is the same with ketorolac as it is with demerol..(Journal of emergency medicine 2001; 20(2); 121-4) This is a short answer to why I think demerol is a terrible drug, especially with so many alternatives available for emergency services edit: firedoc..why do you think fentanyl was jumping ahead? This is a very good, fast acting opiod with very few side effects or contraindications. This is, in my opinion, a very good drug for pain...any pain. Is it lack of familiarity with the drug, or do you have a specific reason??

Demerol is a terrible drug..and it is being removed from a LOT of formularys, as far as I am aware.. -Just sayin'

:shock: I hope for sarcasm as well. Morphine is not, in fact, given for its vasodilation properties..primarily. It is a nice side effect, but the pain management is the primary goal of the morphine. Not as an anxiolytic, but as a narcotic analgesic..big difference. Basically, no pain, no morphine. There is better pharmacology for vasodilation, and I hope you would understand that.. Nitro is given for its effect on the coronary circulation, in hopes of some vasodilation and getting additional blood flow to the tissue distal to the occlusion. I think that Fentanyl is a good alternative to morphine, if you are allowed to use it. I would not think the doc would chastise you for using the fentanyl, although I think with the vitals you cited, morphine would have been acceptable. Its a comfort thing at this point IMHO. Judicious use of nitro is also not out of the question. Its largely situational and comfort based, again in my opinion. As for going out of ACLS and practicing medicine without a license...WTF :? ACLS guidelines are just that..guidelines. If the protocols allow fentanyl for pain, then this is perfectly acceptable. I dont think the OP messed up, I think others are still too attached to their protocol books :evil: (again with the monkeys 8) ) again.....my opinion

My opinion on this is: Although the professional nursing and paramedic paths do tend to separate, the base should be the same(or similar). If the teaching is what he ultimately wants to do, then a nursing degree, specifically a BSN or higher, would give him the knowledge base to do just that; both in clinical knowledge as well as theoretical knowledge. The paramedic programs do not do this. They are much more geared towards training as opposed to education. If the OP had the learning/teaching theory background, coupled with the clinical experience, he could bring the learning to the classroom as opposed to simply training the prospective medics to ‘what they need to know’. I, personally, think that nursing and paramedicine are great adjuncts to each other. I went about the process bass ackwards, and I can see where you would benefit from doing nursing school first. Irregardless, with both the RN and Paramedic license, he would be much more marketable as an educator and a better provider in the field. This is a fact. I suppose it comes down to perspective, or priorities; do you want to be the best medical provider you can be and the best role model/mentor for your prospective students? Or do you want to be ‘Just a paramedic’ with some street time? I don’t mean to insinuate that to be a good paramedic you have to be a nurse, or vice versa. I know some very good paramedics without an inkling of desire to be a nurse, and, of course, the reverse. But if the possibility of getting the additional education is there, and providing top-notch education to a new generation of paramedics is what the OP is preparing to do, Just being a paramedic and getting some street time is not the best answer. I can’t disagree with this statement enough: “I don't see anything wrong with getting a college certificate,then a degree in health sciences,but if you know what you want to do why waste time?” :shock: WOW. Maybe I am taking this wrong (I hope), but this has been discussed ad nauseam in this forum, and this is not the place for another debate on how education should never be a “waste of time”. Like I said, my opinion -Take it for what it is worth

If you want to teach, this is the best way to do it. You will need a Bachelors degree to instruct at the college level anyhow, or any respectable program for that matter. A BSN will give you more than a basic understanding of teaching theory, you will have teaching experience through your projects, along with the tools to succeed in your medic career if you choose to continue to pursue it. This man speaks the wisdom. Do yourself a favor and take heed. If you are far enough along with your basic pre-requisites, you can be done in not much more time. Another couple of years and you'll be amazed at the opportunities available to you!

Kinda serves your monkey reference well, don't ya think.. :thumbleft: OK, thats enough.............back to your regularly scheduled[/font:3dd8abddde]

=D> =D> =D> Convincing these people that they have a say in the future of EMS is very difficult..As educated as most good paramedics are, they do not want to put the additional effort to change things for the better..most of them anyhow...... Their effort is instead put to changing direction in their own career paths..good for them, bad for the system.. professions change their operational strategies all the time..it prevents stagnation and extinction from the marketplace. It would seem one of the few 'professions' that does not accept change well is EMS..is this pride, complacency, or pure stupidity :shock: Self analysis and criticism is not an option for most in this industry...the ego will not allow it.. at any rate, this is IMHO and nothing more :wink: P.S. I have NEVER told ANYONE how wonderful the job is...even though I do enjoy it so 8)

I truly hope this statement was made in jest, or loaded with sarcasm...The alternative is a bit frightening to me...I see a direct relation to this story and the present state of EMS..and why people are not willing to think outside the box... They don't know why..they just don't want the other monkeys to smack 'em around.. I think this was a beautiful explanation, and a darn good post albeit a little close to home for some, I'm sure.. Simply an opinion...but MY opinion 8)

Your instructor may indeed still be nuts...But this is a common procedure for B/P auscultation....Most Nursing programs that I am aware of teach this way..the gaps are real and this does get a more accurate reading than simply pumping to the same number each time, or auscultating while inflating and stopping at the first sound... I believe the way you were taught to be very effective in increasing accuracy of blood pressure readings... -Another opinion... edit: On the B/P on the same arm as an IV..the only damage I can foresee is stopping the infusion while it is being taken or possibly damaging the catheter if the cuff is too close to it..thats it.. What damage are the nay-sayers citing....I would be interested... 8)

Color coding for gas administration is universal..not just to Michigan.. At the risk of starting a fray..Green is indeed for compressed oxygen..generally assumed to be the medical grade 100% variety.. Yellow coding is simply air, compressed 21% oxygen....general atmosphere, nothing less.. The tanks in the ambulances, and everywhere else that carries green oxygen tanks are indeed 100% pure oxygen..whether it is medical grade or not is in the additional labeling..Be sure that you should need an order for these and, as I have said before, too much oxygen is not a good thing, so be careful.. I don't know what to make of the venturi mask comment...we use them quite often in ICU, and they can be used on the ambulance with the correct orders..transfers and such..I don't think Mi. has discontinued them, maybe just certain companies don't buy them..All the ambulance services I have been associated with carry or inservice on them at some point in training..

:shock: :angry8: :angry8: :angry8: :cussing: :cussing: Useless???? This I take offense to... Get a clue, brother....

Relax and take the test...You will probably do much better without the 'first time jitters'.. -Just my opinion

That would be me.... Its about the only constructive thing I could offer..I didn't believe the posts warranted anything else... -Just sayin' 8)

Ummmmmmmm......... disgust

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=D> =D> =D> =D> Well said...