Just Plain Ruff

So what are the causes of a widened mediastinum? I'm on a plane waiting to leave st louis so I can't do much more than type via tapatalk. Sent from my SPH-D700 using Tapatalk

Isit just me or did this guys heart outline get larger post intubation? Are we dealing with some sort of mass making ventillation of one side to preclude the other from rising? Or is that 2nd image taken at a different angle. Chest ct would be really nice to have but I just read it was down. The question is this. Did we do more harm than good for this guy by intubating him? I still think I see zebras. I just don't know whether they are white fur with black stripes or black fur with white stripes. Sent from my SPH-D700 using Tapatalk

no matter how you try to shine a turd, it's still a turd.

The reason for so much more ed than emt. Remember, you have someones nails in your hands, that's so much more important than having someones life in you hands. How many times have you heard from a little old lady that she can't go to the er because her hair doesn't look good? Sent from my SPH-D700 using Tapatalk

Definately should not be used in nursing homes for lifting or bath care. The minute that happens in the systems I work in is the last day my license will be used. I can understand the occasional need to help the nursing homes with heavy lifting but seriously put a fire truck on that call. There is already an ECP course, it's called CCEMP or Critical Care paramedic.

Me education resume is as follows Paramedic Bachelors of Arts - Administration of Justice Masters Degree in Project management I work in the IT field where I NEVER do administration of justice, and I rarely do project management and I've only done paramedic while on a plane but I do use my experience in paramedic/hospital ER work all the time. Have all those courses and education been for nothing since I'm not really doing any of my degree work in my current job? Were those classes wasted?

Yes, EMS should not be expanding out to home health visits as that is not the best use of resources for EMS to do. With resources being stretched so thin anyway, wouldn't a better use of these APP's be spent getting them to the calls rather than being stuck doing a home health visit for someone and not be able to get away from that visit in a timely manner. If there is one or two of the APP's on duty that their specific job function is to provide during their shift those types of visits then that's a different story, BUT if they are expected to respond to calls while doing these visits then that is just a waste of resources. I mean if we are going to branch out in EMS to do home health, why not branch out into traditionally fire based roles such as fire safety and fire prevention. I mean if Fire can provide medical coverage then EMS should be ok to provide fire roles. I didn't get into EMS to be a home health aide!!! I don't think that this is the role of EMS.

I've been on only a couple of calls where seconds counted. I can point out a couple of instances. 1. Patient with chest pain, codes with us 1 minute out. Shocked him and got him back, he walked out of the hospital 4 days later. 2. Arm caught in Auger, nearly ripped off, massive bleeding. No-one on scene to apply direct pressure. We arrived on scene to apply the pressure and stop the bleeding until we got him to the ER. Patient lost about 30% of his blood volume. Patient survived to discharge. Many problems during hospital stay but really if it took us any longer to get there he would have died. Those are two of the calls that I remember in my 18 year career in EMS that seconds counted. I can think of just a handful or two that seconds truly counted. But you know what is the issue on the seconds count mantra - EMS Agencies are some of the biggest propagators of this myth.

Unless you are working on a very busy shift running call after call there will always be time to get some sort of activity in. But the problem with that is that it's so much easier to sit in a chair, watch tv or surf the net all while munching on snacks that you get from the Unhealthy vending machines. 30-45 minutes of physical activity should be done every shift. Be that walking, running or what not. Like I said in a previous post, make a physical fitness component mandatory as a part of the class. Think of it from an employer's perspective. Employer knows that students from this particular program have this physical fitness component, they will be more likely to hire a fit emt/medic rather than one who did no physical fitness activity during the class. A school that did not allow smoking during class would also be a good deal for an employer.

I'll give you that Dust, EMS should not be doing home health level visits. Let's get real.

So how many of the ambulances that AMR has on the streets are pulling non-emergent patient transfers? If you have 20 ambulances in Vegas on at one time. Let's say 4-5 are on non-emergency transfers. Now you look at how many fire trucks or units the fire department has on duty and since they don't run non-emergency transfers, there is no wonder why they beat the ambulance 2/3 of the time. Case in point - When I worked in Independence MO. AMR had 6 ambulances on duty. Indep Fire had 10 pumpers, 2 trucks and 2 rescue trucks, all of which could run EMS calls. OF those 6 ambulances, at least 2 were on transfers most of the time. So a total of 4 ambulances to cover 110K people and many square miles. is it a wonder why the fire trucks beat the ambulances 2/3 or more of the time? It's simple math on this.

Ensure that an additional experienced paramedic is available on critical level calls by responding alongside paramedic ambulances. While some EMS systems use a “paramedic chase car” to provide the lone paramedic responding to assist a basic ambulance, our approach brings APPs to provide a supplemental paramedic with a high frequency of critical patient care encounters to augment the care being provided by our outstanding ambulance-based EMS providers and fire service first responders My response is this - I have worked in several systems where there are supervisors which respond to all major medical/trauma calls. That puts an additional medic on scene. This APP piece seems like what 4 of the EMS agencies I've worked at are already doing! Every critical medical call and trauma call gets the supervisor and most often there are paramedics on the fire trucks and sometimes even dual medics on the ambulance. How is the above piece different than what I've described? "Number 1 in the web site - Reduce the occurrence of, or minimize, medical crises for persons with specific medical conditions known to benefit from close medical monitoring. Increasing the overall well-being of the patient can prevent the need for EMS response and decrease the time and money spent by patients and other taxpayers for emergency room visits and hospital stays. Studies show that diabetics, high blood pressure patients with congestive heart failure, those with increased risk of falls (such as people over 65 years of age), some substance abusers, and children with asthma may all significantly benefit by home visits from medical care providers such as our Advanced Practice Paramedics." When did this become the purview of EMS? Aren't home health nurses more equipped to handle these types of patients? How is Wake county being reimbursed for the above services? I'm more than sure that EMS is unable to bill for these services which have traditionally been the arena of hospital home health departments. I think that if done right this is a good idea.

Yet the entire population of the Jewish people in Europe was 9.7 million according to a holocaust website I visited tonight. The Jews were 1.8% of the entire European population. http://www.ushmm.org/wlc/en/article.php?ModuleId=10005161 Quite a interesting website. I'm not debating the figures. But I don't think that comparing Hitler's treatment of the jews to the treatment of gays in the US is applicable to this discussion. just sayin.

Allrighty then so what could cause this to occur? His chest x-ray was ok? Did he have a CT of the chest? We are at least ventillating him well aside from the chest rise and fall. Did he have any history of trauma? So what things could cause paradoxical or irregular chest rise and fall. Was this chest rise and fall problem noted prior to intubation? One thing I did notice in researching paradoxical chest wall movement was that one cause could be a issue with the nerve that controls the diaphragm. Could we have caused this issue by intubating this guy? Or could the medications given to paralyze/sedate him cause it? The one thing that I can think of that could cause the damage to the nerve could be due to Cervical spondylosis. Did when we intubated the patient cause the Cervical Spondylosis to damage the nerve to the diaphragm? How old was this guy again?

But the thing is that you made your intentions clear as wanting to go on to bigger and better things than a lil ole vollie squad they are running. My spidey sense says that no matter what you tell the guy now after you've already said your aspirations which go way beyond that of this volunteer service has effectively killed any such interest from Chief "kill your ambition" Charley. My advice is to make one more attempt to offer your services and then move on. In the end, it will be their loss but I for one would not want to be involved in a organization that would want to pidgenhole me into the situation that it seems like they tried to do to you. I'll bet that you could find at least a couple of other vollie agencies that would be happy to have you as well as be happy to let you spread your wings and fly.

My next step is to intubate also. This guy is certainly not going to get any better, hence the requirement for transport. But having him intubated prior to transport is a good idea.

ok what were the results of the CBC and other lab tests? What is his breathing pattern now? Rapid or slow, deep or shallow? I'm going to work on getting his blood sugar down but not till I see what the lab results are. Have the results been reviewed? I would start with 10 units of regular insulin IV. That's of course what my physician ordered for the guy who had the blood sugar of 800+ I'm thinking that there are zebras in this thread though. But I'm still thinking horses.

Maybe they wanted you to be an automaton and give them pie in the sky assurances that you would be there forever. Sounds like they don't want to spend money on you all in the end result of you leaving. The guy who told you that you had to choose obviously wants someone who will put their life on hold and give all their time to the volunteer service and not look for any way to better themself. Are you sure you want to be associated with a service that wants to hold you back and put restrictions on your professional growth?

When did I say that I refused to go to gay bars or hang out with gay people. Did I say that? I'm not sure if that was your insinuation but as a matter of fact, I have multiple gay/lesbian friends. I actually have helped one of my lesbian friends get a job at my company. I also am going to dinner tonight at a restaurant with a colleague and the place we are going is I believe a bar frequented by many gay/lesbian people. I get the feeling that your statements above were rhetorical rather than directed specifically at me.

But on Rescue 911 doesn't everybody survive a cardiac arrest?

If you are waiting on a triage then yes you are in the system. You at least have been what they call Quick regged. That puts you in the system and get's your name in the system. The nurse then if they work electronically (almost all hospitals these days have some form of electronic system)then the nurse works off the list of patients waiting to be triaged. Once triaged you are truly in the system and you are either taken to a room or put back in the waiting room based on severity. I can go on and on but yes, if you are waiting to be triaged then you are in the system. And yes, being in the system means that some type of chart is generated, it might not be what you historically think of as a chart but there is a chart made up in the system. So yes, a chart is generated.

Many agencies don't want to deal with the issue and although they have a EAP program in place (some but not all) most of the agencies I've worked at have just fired those who were caught stealing narcs. It seems like it's the common knee jerk reaction. Many administrators of EMS Agencies don't have the knowledge base that they need to have in order to deal with an addicted employee. They also don't want to deal with the negative publicity that would be out there if their employee was arrested for the problem. It's more reactionary instead of proactionary. I know of several medics who were caught stealing narcs and other meds and they were summarily fired. No offer of help, no assistance even though there was an EAP in place. Report them to the state and their license get's pulled and that's that. If the employee did admit to a problem and asked for help, they were referred to the EAP but when the EAP benefit was exhausted the employee was subjected to such scrutiny that they decided to quit so they weren't subjected to repeat drug tests. If the employee's that I know being subjected to daily or every other shift drug tests and those tests came out positive they were fired. Not a good deal for anyone involved.

I took anatomy and physiology as separate courses and I did not ahve general bio nor did I have general chemistry. I took the anat/phys classes at a well respected community college with a very very highly regarded paramedic program. Unfortunately, I didn't live in Kansas so I was passed over twice based on not being a instate school resident. But I took my pre-req's that the school required before I got into paramedic school on the Missouri side.

Why not just include a physical fitness component into the class. Maybe a 30 minute exercise session prior to the session to start. Make it required for completion of the course. 10 minute run, 10 minutes of calesthenics and then 10 minutes of weight lifting or cardio machines. Have the school offer a membership to the school gym and they have to sign in and provide a printout of their workout or something like that. Shouldn't be too hard. My EMT class had an optional physical fitness component. I took advantage of it so did most of the classmates too.

Yes, I'm wanting to know the following cap refill sclera appearance skin turgor Any skin abnormalities like rash or problem there What do his mucous membranes look like, particularly his tongue, inside the cheeks and back of throat. what are his tonsils like? What color is his urine? concentrated or not? last bowel movement - loose, formed, pencil thin? What are his orthostats? I don't think I saw a 12 lead reported?