ccmedoc

OH my... :shock: What a butcher in that video.. I guess some numb nuts would call it a central line. I don't.. Central lines would be when they allowed Subclavian and Internal Jugular cannulation in our EMS protocols....the good old days..

Here is food for thought I think you do CPR.. chance is it is futile anyhow. The DNR is in place in the event of ROSC and vegetative state. That is when the battle begins... Let the doc determine resuscitation is futile. You shouldn't bust fanny to the hospital though..depends on the exact orders also. Is it no resuscitation period, or all but CPR? Many variables in all this debauchery. I don't envy the person put in this situation...

E.J. External Jugular vein

I don't care for these much. If you need to carry a boat anchor, might as well be a LP12.

I hate statistics... :evil:

So how many have injected Narcan under the tongue? Right into the base of the tongue, just lateral to midline, right or left.. It is common practice around here, as well as other areas nearby. It is every bit as fast as IV, and if you can't get a line..... :wink: As to the post...I honestly don't remember the first time I used it...

He he he...Yeah, I've seen IVs in these places on burn patients.... :shock: :pale: You know they would rather have one in the neck!!

We don't use glucagon anymore..I'm not sure why, it was stopped long before I arrived.. I have had an E.J. IV with a saline lock in awake and alert patients. No problem. The majority of patients, in my experience, do not complain of excessive pain..during or after. I have actually had patients with bad veins request this site.. :shock: Being that the E.J. is relatively superficial (relatively)..I have never seen a cannulation dangerously near the airway. Hematomas are a different story and you should be careful. I can't see starting an E.J. and then pulling it for a refusal. I would want to monitor for a couple minutes before releasing the patient.

I think, in diabetics especially, the EJ would be better for IV access. Most diabetics have extremely poor circulation in their lower extremities, along with some degree of neuropathy. This could lead to some potentially nasty repercussions from jabbing at veins and possibly blowing them, potentially contributing to ulcer formation. EJ cannulation is fairly common around here. I certainly have no problem with it. We have low instance of hematoma or other complication. I just believe in being extra careful with a diabetics lower extremities...thats all.. About the tunnel vision...... :?:....maybe having a bad day....

It seems to me that if you have only applied to two places in three months...You have no business being frustrated. You need to get out and enhance your chances of gaining employment. EMT-B is not exactly a rare certification.. Make yourself visible to those doing the hiring. Applying online or over the phone is not going to cut it. You need to be out in the world selling yourself. Anything less cannot be considered an effort. A company would be more apt to hire an aggressive individual actively pursuing employment with their company. You need to prove yourself, not the other way around...

Guilty.. Every single time. If the patient is alert I ask first.. I conduct a very thorough assessment in the field, so this is second nature to me and my partners.. (edit) How many have seen medic alert tattoos?? I have come across a handful. Easy to miss, by the way.....

:shock: :-s :pale: Oh...that is a sad, sad statement. I got a chuckle at first, then reality hit... I was having such a good day, too... Enjoyed the post though, as always.. 8)

If you see the links below, this is not common to most transition courses that I have researched. they are usually far longer than six months. The paramedic to RN track is still five semesters,with the pre-requisite classes, and will take the better part of two years. A traditional ADN easily takes three years to complete for dedicated students. Longer for the less intentioned. I have never seen a six month transition, and hope I never do. To only require a paramedic one year of experience is also a bit lacking. The patient contact the paramedic will experience is far less than the contact hours the first year ADN students will achieve. This is why I believe that the transition programs graduate a lesser clinical nurse than the traditional track. This is from my experience, and I don't expect it to be a popular position. I would suggest being careful in the program you choose, and do not expect to graduate from the program with the same nursing knowledge that the traditional ADN graduates have. The basic nursing theory classes are skipped, as I mentioned before. Paramedics generally have a better handle on assessment and medical theory initially but, the nursing model is not the same as the medical model. ( I have colleagues graduated from these two programs) http://www.lcc.edu/catalog/degree_certific...pplied/0222.pdf http://www.delta.edu/catalog/programdetail...ramActionID=353 I am sure if the paramedic graduated from a degree program at a community college, the pre-requisite classes would transfer into the nursing articulation, and reduce the time. A little planning here could save some time and reward you with a better education. Just, as it sounds to me, like wrenEMT is doing. This was an FYI and not intended to degrade anyone or initiate an argument. Take it for what it is worth. I wish you the best and...choose wisely :wink:

Agreed...If the OP is deciding on whether to further education, proper grammar and sentence formation is a must. With research and evidence based everything the buzz, research papers in proper format will definitely be a mainstay of any degree program..AAS or Baccalaureate. Plus, properly composed posts are easier to read for the old farts..

If its state, I don't know....I don't know of which state you speak..... National registry..get on the NREMT website and register..follow the directions, and your in..You should have gotten some paperwork with your testing application that explains the intricacies of finding your test scores..I think :wink:

Not necessarily..The Community Colleges up here give credit for a licensed paramedic with validated working experience. An AAS Graduate Paramedic is attained through the college, with standard college curricula. The program still requires 40-50 credits be attained for the degree. To use the Paramedic to RN track. The paramedic needs one year experience, verifiable medication administration (duh?), and the pre-requisite classes necessary to the standard ADN degree. The shortcut is the same for LPN to RN, and basically skips the first year of course and clinical. After taking the pre-requisites to validate for the program, you will most likely be looking at a full two years to complete it. I think this produces a lesser nurse, as some of the basics are skipped in lieu of a 'transition' course IMHO. Remember....paramedicine is NOT nursing, and vice versa. Regardless of my opinion, the programs do exist. I have known many to go through the transition course only to have problems assimilating to the in-hospital environment. Whichever you choose, best of luck...Just apply yourself and you should be fine. Expect some time investment though..it is not an overnight endeavor.

Everybody knows..The only thing that can cut Chuck Norris is Chuck Norris. And by the way, Chuck Norris will never have a heart attack. His heart isn't nearly foolish enough to attack him. Some more facts about Chuck..................[spoil:223b6aa915]Chuck Norris can get Blackjack with just one card. Chuck Norris eats lightning and farts thunder. Scientists believe the world began with the "Big Bang". Chuck Norris shrugs it off as a "bad case of gas". Dinosaurs went extinct because of the Chuck Norrisaurus. When Chuck Norris jumps into a body of water, he doesn’t get wet. The water gets Chuck Norris instead. For some, the left testicle is larger than the right one. For Chuck Norris, each testicle is larger than the other one.[/spoil:223b6aa915]

This is unacceptable :shock: ....I was kind of interested until this. I think that is the reason it is the last sentence.. If they would allow me to go to my University of Michigan..we could talk!! 8) Could maybe work it with a DNc or DNP program??

No one jumped down your throat, young man...Just tried to understand the premise behind the treatment..

I go with...it depends. It depends a lot on MOI. If there is the least possibility that the lower pain may be a distracting injury to a less painful c-spine injury..I agree with all CID and immobilization. Getting punched in the back...thats a little bit of a stretch.. It is not as much inline spinal immobilization that creates or exacerbates injuries..it is improper spinal immobilization, IMHO. Here is something to look at. Most journal articles on the subject require a subscription to see more than the abstract.. http://books.google.com/books?id=x2rL_2s5o...V9o_M&hl=en

A couple more on the HAT trial...Home Automated External Defibrillator Trial http://www.medpagetoday.com/MeetingCoverag...Meeting/tb/8986 http://www.theheart.org/article/853245.do It seems that I have about half a dozen journal articles on this now..They all say the same thing, thereabouts...

This may be a good read about the possibility of too much oxygen...or not.. :? http://www.emtcity.com/phpBB2/viewtopic.ph...ghlight=#114621

To elaborate on Eyedawns summary..very briefly, as this can be a bit tiresome to explain..: [web:b775ba5441]http://www.accessexcellence.org/RC/VL/GG/garland_PDFs/Fig_16.37.pdf[/web:b775ba5441] See the above visual. It is hard to explain without visuals.The chemicals/proteins are actin, myosin, and ATP. Actin and myosin are proteins in your muscles; Each cycle requires that a myosin molecule bind and break down one ATP molecule for energy. Now to understand rigor mortis, follow the ATP (and especially the breakdown of ATP). When an organism dies, lots of myosin will have ATP bound, ready for a stimulus to start a muscle contraction. This would be like step 2 above. Note that myosin is not gripping actin tightly in step 2. With time, ATP will spontaneously degrade to ADP and Pi (inorganic phosphorus). As this happens in a dead person's muscles, it is as in step 3. This starts the chain of events leading to Steps 4 and 5, even in a dead person. This is where you could have a muscle contraction in a dead person. These random muscle contractions lead to the odd movements of facial and limb muscles in the dead. The myosin stays stuck to the actin UNTIL it is freed by the attachment of a fresh ATP. In the dead, there is no source of ATP, so the myosin STAYS stuck to the actin. Hence, the stiffness (rigor mortis) of death. And finally, the muscle proteins will eventually start to degrade (decompose). As they do, they will release their grip, and the stiffness will go away (6-12 hrs..give or take) I will try to drudge up an old powerpoint or flash video I have on disc. It is hard to explain otherwise. Understanding it and explaining it, especially on a message board is very difficult..for me at least. I have seen dead people sigh..but not in a lab or morgue..Only a few hours dead.. Did I confuse you more??

There, that is a bit easier on the eyes...I will not correct your grammar though. If you want these answered...you would be better served by putting your posts in a more legible format.. That is all... on that I'm curious as to why the non-rebreather...simply because of history? Did you take his pressures through clothing? (edited for content..CC)

http://www.macomb.edu/ProgramDescriptions/...encyMedSvcs.asp http://www.macomb.edu/healthsafety/emergencymedsvcs.asp Is this closer...It is a degree program, no? Much better than a certificate. The Basic is certificate, but counts toward requisite courses and credits..win/win..If the OP wants to further their education, it is already in the works. Again, an opinion..