ERDoc

I would agree with the wise ones. It was most likely a DVT. It may have also been PVD (peripheral vascular disease), but more likely DVT.

Ah, there is the meat. Thanks JP. Now I like it better. After reading the study, the only concern I have is one of the exclusion criteria they listed as "having a poor prognosis." What criteria were used to meet this exclusion criteria? I did not see this covered in the paper. Intuitively it makes sense that having paramedics vs. BLS in a cardiac arrest would improve survival, but at least this adds some scientific merit to the claim.

What did they use as their control group to come to this conclusion? I realize that this is just an abstract, but it's hard to agree/disagree with their conclusions without seeing the data. Another variable I would be interested in, would be distance/time to hospital from scene. Again, this is just an abstract so it's hard to draw any conclusions.

I don't know if this is just a paper or will also be a presentation, but a good way to organize a medical presentation is to organize it in the following manner: D-definition E-etiology E-epidemiology P-pathophysiology S-signs and symptoms I-interventions (testing and treatment) X-extra information A good way to choose a topic is to look and see what your weaknesses are. This is the best way to learn what you have trouble with. If you have trouble understanding the tachyarrhythmias, do your paper on them. An interesting topic for the rhythm paper that I find very few field providers know about is Aschmans Phenomenon (sp?) though I don't know if you can get a 6 page paper out of it.

I wouldn't sweat it. We get xrays in the hospital to confirm whether there is a fx or not. You have to guess based on assessment in the field. From what you describe it sounds like you did the right thing. As long as you had a suspicion and passed it along to the ER staff. Would you have changed you managment any? Dust, where did it say that this guy was dioriented? It sounds like he was fine to me.

But doctors have much more time spent in the classroom and in training before they are turned loose. So, what is the right answer?

We turn out doctors without making them become EMTs/Medics/Nurses/PAs first. Why shouldn't someone be able to go on to medic school right out of EMT class? Experience is nice and all, but you need to knowledge before the experience will make any sense. These are probably the same people that don't understand that medicine is dynamic and you need to keep up with the changes. They will do things the way they learned in class and never change while the rest of the world has moved on. Quick, get the MAST pants and apply cervical traction!!!!!

The ER attendings may not get as many tubes in academia, but they get the most difficult. The tube goes up the hierarchy from intern to senior resident to attending. This ends up selecting the most difficult airways for the attending. They may not get quantity, but they get quality.

Yup, nothing like trying to get a Muscovy at Lake Ella. :scratch:

Based on all of the scores, it looks like we are smarter than the average person. :wink:

Yes, the Colts are still from Indianapolis. As for the SuperBowl shuffle, the Fridge was good, but who could forget McMahon and his shades!!!

Maverick's RIO was Sundown. Other great quotes from the movie: "I have the need...the need for speed." "I could tell you but then I'd have to kill you." "We were keeping up international relations, you know, flipping him the bird."

Of the four teams that made it to this weekend, I would have loved to see NE take it, but I'm going with da' Bears.

Damn, I got 19. I disagree with number eight. The lowest number on FM is 87.9. There are no even numbers on FM they are all odd decimals.

Don't get too upset about not getting many tubes in the OR. Even as an ER resident, it was difficult to get tubes in the OR. You hear the same things, this is a diffuclt tube, blah blah blah. I can understand where this is coming from. As someone mentioned, at least here in the US, lawsuits are a very big reality. Anyone can bring a lawsuit for anything, even if there wasn't any injury (they won't necessarily win though). Put yourself in the anesthesiologists position, you are being asked to trust a total stranger that you know nothing about with intubating a fully stable and healthy person. This just reeks of a high risk procedure waiting for a problem to happen. As a resident, I was an MD and they were still hesitant about letting me try of a tube. Now imagine them placing their career in the hands of some nonMD that they know nothing about and you can see why they are so protective. As for the CCRNs, they are protective because they fear for their jobs. They are trying to justify their existance so if someone with theoreticaly less training comes along and can do the job, how do they justify their existence? An anesthesiologist told me the patients that they feared the most were the healthy ones that were going in for elective surgery because if something happened there was going to be a lawsuit. If they too a sick, unstable pt who needed an emergent surgery to the OR, it was going to be a tough case, but no one would think anything if they died because they were so sick. Let's face it, you can teach a monkey to do the simple, straightforward intubations. See one, do one, teach one. It is the difficult airways, where you need to think through the problem that would be more beneficial to manage. These are the ones where the more you do, the better you get.

What sort of equipment are you using to start the IJ ans SCs? By starting a line "above the waist," you are at an increased risk of causing a pneumothorax, it is less hazardous to do a femoral.

Out of curiosity, what kind of central lines are being put in by field providers? Where I'm from the most invasive line is an EJ and this does not constitute a central line.

You also need to find out who the health care proxy/DPOA is and see what there wishes are.

I needed to edit my post after your post. She was a nursing supervisor, not a charge nurse. It is not as easy as you think. They had over 30 chairs in the unit, all of which were full. On top on clinical duties, she had administrative duties too. Don't judge till you've been in someone's shoes. People may say that EMS is a bit simple too, you only take care of 1 pt at a time and, depending on where in the country you are, spend only a few minutes with that pt (not my opinion, just playing devils advocate).

Ahh, per diem yes. They make some great money (no benes). I was talking about full timers. I know the nurses out on the Island don't make that much. Full time makes less than $35/hr. I know a nursing supervisor from a dialysis unit in Queens who was making about $38/hr with 20+ years of experience.

There is no such thing as an airway secured with BLS measures. An airway is only secure when there is a tube below the vocal cords (ETT or true surgical airway). BLS measures are temporizing measures until a secure airway can be established.

Asys, great post, but I have to call you on it. Not very many nurses make $80,000, especially with an AAS. From what I have been told, the AAS nurses are finding it harded and harder to find jobs because most places want BSNs. Most of the BSNs that I have known make between 40 and 60K per year with overtime. I hope some of the nurses on here will correct me if I am wrong.

Probably because in the secondary ABC's of ACLS, securing the airway comes before IV access.

Just so everyone is clear on what they have given up or can look forward to, depending on where you are at. The traditional path to become a doctor starts with 4 years undergrad to get a bachelors, 4 years of med school and then residency and possibly fellowship. Every medical school in the US requires a bachelors in anything. I beleive this is a requirement set by the LCME (Liason Committee on Medical Education) who also says that you need a year of general chem, a year of bio, a year of physics and a year of organic chem. These are the minimums. So schools have additional requirements such as a year of calculus, but those are the minimums. MCAT scores are important, but guarantee nothing. I've known people with unbieveable MCATs who could not get in, and knew people with not so hot MCATs that got several acceptances. There are a number of medical schools that offer early acceptance, how they do it varies. Wisconsin has a program where they offer admissions to medical school to HS seniors. They HS students are guarenteed admission to medical school, but they have to get their bachelors, maintain a 3.0 GPA and participate in additional seminars. Stony Brook University has a program where they offer early accpeptance to Stony Brook University undergrads in the sophomore year. They have to maintain a certain GPA, get their bachelors and attend additonal seminars. These early acceptances can be yanked if the student doesn't get their bachelors in a certain amount of time or their grades drop. Medical school is composed of 2 years of basic sciences (classroom) and then 2 years of clincals. People who are MD/PhDs attend the 2 basic science years and then take a break to work on the PhD. This PhD work, depending on how lucky or unlucky you are can take anywhere from 2 to 7+ years. Once they have completed their PhD, they finish their last two years of medical school and get their MD. After medical school it's on to residency. Residency can last anywhere from 3 years (EM, Family Med, Internal Med) to 7+ (Neurosurg) depending on what your specialty is and if you stop to work on some research. If you want to do a fellowship it adds more time on from 1-5+ years. So, short story long, there is no set number of years, but at minimum you are looking at 11 years before you can call yourself an attending.

Just remember, in medicine there is no such thing as "always" and "never." The only exceptions are, if you are standing on a corner minding your own business, two dudes will walk up to you and shoot you, ALWAYS. The other, if you are changing a light bulb naked, you will fall on it and it will find its way into your rectum. Other than those, there is no "always" or "never"