ERDoc

Looks like a pretty normal EKG. The axis is normal (use calipers and you will see). The is absolutely no BBB. For a RBBB, look in V1, V6 and I. V1 will have the RSr' and v6 and I will show slurring of the S wave, both of which are absent. There is no evidence of LVH either. There are some prominent waves in the precordium, but this is most likely normal (assuming you have a normal habitus). Looking strictly at the EKG, I do not see anything overly concerning.

Getting your EMT while in college is great for your personal experience (though is doesn't help promote EMS as a profession, but we'll put that to the side for now). Which ever way you go, you will get hands on experience which will make you more comfortable when you have to deal with pts in medical school. It will also help you feel more comfortable when you have to do pt simulations in medical school because you will already have the experience of performing in front of someone who is assessing you. A big part of it depends on what type of system you have where you are. I would recommend trying to get a position where you can be exposed to ALS. Doing renal roundup may pay the bills, but it is very tedious and has minimal educational value. You will also be able to talk with the medics and get a more in depth discussion on things that you will use as an MD/DO. I started out as a volley, but I got lucky. I was about 20 miles or so outside of NYC and most of the volley medics had paid jobs in the city so they had a great deal of experience and wisdom to share. I relaize that not most volley systems are setup like this, so your experience may vary.

As others have stated, go by your local protocals. Many units have peds pads available that reduce the energy delivered (though I do not know specifically if they are made to be used on those under 1, read the manual to become familiar with your equipment). As far as the comment by the OP about the hole in the AHA guidelines, you cannot expect them to make any recommendations when there is a lack of research. This would go against every law of EBM. Pediatric arrests are rare (thankfully) so it is hard to design a good, relaible study. As others have said, peds arrests usually don't present in shockable rhythms because it is usually an airway issue (even in the kids with congential disease). So, to design a study to look at defibrillation in an infant population is very difficult. You are trying to find a rare subgroup in an already rare population.

You need to get your bachelors degree first. There are several prereqs that you need to take which include a year of bio, chem, physics, organic chem (all with labs). Some medical schools require math and english. Your major can be anything, as long as you have completed the above prereqs. During your junior year (in April) you take your MCATs. It is then on to medical school (assuming you have been accepted). You then go through 4 years of medical school (same for DOs and MDs). Two of these years are basic science (classroom) and 2 years clinical. During your 4th year of medical school you apply for a residency in the specialty (or specialties) you are interested. In March of your 4th year you find out where you will be going for residency. The length of your residency depends on what field you go into (emergency medicine is 3-4 years depending on where you go). Here are a few websites you might find helpful: www.aamc.org www.studentdoctor.net www.saem.org www.amsa.org www.amsa.org/premed That ought to keep you busy for a while.

Check out the glow sticks, they are pretty cool. Not as cool as Mr. Norris, but cool nonetheless.

Isn't that what volunteer fire departments are for?

I'm a little slow on the uptake, but I just read the article Dust posted. I gotta agree with him. There were a bunch of witnesses standing around and they are criticizing the medics for not jumping in? What were they supposed to do when the car was in 15 feet of water? How far out was the car? It was going fast enough to bust through two fences. It must have been a pretty good speed so I'm sure it was out pretty far.

Without getting into the pathophys and mechanics of all of the diabetic meds (I'll let you do that on your own) any pt on oral hypoglycemics need to be admitted to the hospital. It is mostly the sulfonylureas that are like this. They are long acting and can cause hypoglycemia for up to 24 hours. Other oral diabetic meds, such as the glitazones and biguanides do not cause hypoglycemia and therefore do not warrant admission. They can be treated and streeted. It is the little nuances of medicine such as this that will get EMTs into trouble if they are given enough rope to hang themselves.

:3some:

OK, I've got to admit, that just made a really bad night a whole lot better. :evil4:

Yeah, it might not affect me too much, but it would be a pretty shitty thing to dump it on my kids like my parents have done to me. There are plenty of things that can be done that will affect something that is not groundless without relying on people to make drastic lifestyle changes.

It's no joke, for about 3 weeks after the transplant they will have 2 p waves.

My point is harly anecdotal or hardly one in a million. Can you tell me what exactly my point is?

. What would you do with a diabetic/hypertensive that is on Atenolol, Vasotec and Glipizide who presents with a blood sugar of 44? You give her an amp of D50 and her mental status improves. She is able to eat. What do you do with her at this point?

Sorry to dig up a dead post, but somehow I got to thinking about this. Another cause of multiple P waves is a heart transplant. When they remove the old heart, they leave in old SA node. The new heart comes with a new SA node. So, you get two p waves.

From the US geological survey website (http://volcanoes.usgs.gov/Hazards/What/VolGas/volgas.html): Comparison of CO2 emissions from volcanoes vs. human activities. Scientists have calculated that volcanoes emit between about 130-230 million tonnes (145-255 million tons) of CO2 into the atmosphere every year (Gerlach, 1999, 1991). This estimate includes both subaerial and submarine volcanoes, about in equal amounts. Emissions of CO2 by human activities, including fossil fuel burning, cement production, and gas flaring, amount to about 27 billion tonnes per year (30 billion tons) [ ( Marland, et al., 2006) - The reference gives the amount of released carbon ©, rather than CO2, through 2003.]. Human activities release more than 130 times the amount of CO2 emitted by volcanoes--the equivalent of more than 8,000 additional volcanoes like Kilauea (Kilauea emits about 3.3 million tonnes/year)! (Gerlach et. al., 2002)

Opinioins, even of experts, are nothing more than one man's opinion. He does not use any scientific evidence to back it up (at least in the website that you provided). As it has been discussed on here ad nauseum, you are welcome to your opinion, but you need to back it up with evidence. I'm sure Mr. or Dr. Coleman knows his field well, but in a true scientific debate there has been no evidence proposed to back up his opinion. His credentials may impress a layperson with limited knowledge but they don't have any bearing on the arguement. I am not one of these reactionary people than think the sky is going to fall tomorrow, but based on all of the evidence that I've seen it is pretty clear that our climate is changing in ways that can only be explained by human interference. We need to start doing something about it before it does get to the point where we cannot do anything.

How about climatologists like Michael Mann who have actually spent time involved in real science and not the pseudoscience reported by the industries? http://www.motherjones.com/news/qa/2005/05/michael_mann.html http://www.realclimate.org/

How was her gait when you got her up?

Gotta say, in a uptopian society I am all for the death penalty (although I guess in a uptopian society there wouldn't be a need for death penalty). If you kill someone or rape someone you should be sentenced to death. My concern is the number of people who have been sentenced to death row and later have been found to not be involved with the crime. I would not want to be the one who is sentenced to death or have one of my family members executed if they did not do the crime. In an ideal world I think it would be great, but in the real world that we live in, the legal system here (and elsewhere) is flawed and innocent people would be put to death. Let the bastards rot to death in prison. It will cost us a lot less in taxes (and isn't that the only things the republicans care about).

This is one of the ways that people find out they have an Atrial Septal Defect (hole in the septum seperating the atria). This clot passes through the hole and into the systemic circulation. How long has she been on the suboxone and was she on anything else before that?

:hello1: :hello1: :hello1: :hello1: :hello1: :evil4: :evil4: :evil4: :evil4: :evil4:

I totally agree with you about the cost of living. I left Suffolk County for that very same reason. It's pretty bad when doctors making a good income are considered middle class.

$41K may not sound like much, but you are seeing it from a NYC standpoint. You're lucky if you can afford to rent a studio apt for $41K in NYC. You'd be able to buy a house in Tenn on that salary. There is a huge difference in the cost of living. If you use the CNN cost of living comparision calculator you will see. In order to have the same standard of living in Manhattan as you would making $41K in Chatanooga, you would need to make over $90. In other words, making $41K in Tenn is like making $90+ in Manhattan. To look at the reverse, making $39k in Manhattan is like making $17k in Tenn. So really, it is not that bad of a salary. I've asked this question before, but why should someone be an EMT before becoming a medic? I didn't become a nurse or a PA before becoming a doctor. This is where making it a standard ciriculum designed by a governing board (similar to ACEP, ACOG, ACS or any odf the other governing bodies in medicine) and requiring it to be a college level degree would be a great idea. Set it as a 2 or 4 year program. After that there should be a year long initernship (similar to going through a residency). Make everyone a paramedic and do away with the EMT level altogether (I'll duck now as some people begin to throw heavy objects at my head).

It's definitely funny (especially since it involves a lawyer).