Just Plain Ruff

No Scenario here. I just need to get some info. 74 y/o male, sudden onset weakness. He thought it was diabetic reaction, sugar 100 EKG shows Atrial Fib (he knows he has this) Also showed Right bundle branch block(easy to see on ekg) Also showed Bifascicular block (don't know really what to look for on the EKG) What is the significance of a Bi-fascicular block in the presence of a right bundle branch block Did this patient warrant air transport - we were on scene at his house, 85 miles away from nearest cardiac center 20 miles from nearest acute care hospital Just need some references or info on RBBB and bi-fascicular blocks.

Phil, we all know it's just your street cred that we love. You put on a good front but there is no-one I'd rather have as my EMS crew partner in Australia than you.

A collection of shrunken patient's heads. So far we have 12.

Heres what we can complain about 1. Poor educational standards 2. Poor relicensure requirements - each state should have the same level of hours for each cert. 150 hours in 5 years for medic or so on 3. Poor airway skills resulting in missed intubations 4. Abhorrant driving skills even from seasoned EMS drivers 5. Medics/emts/firefighters and the like who are theives I put complaining about a television show (trauma) or House that puts us in a bad light at the bottom of my list.

It's as high tech as CSI Vegas. All the bells and whistles for all the Vegas companies. I really don't have a clue so I'm gonna shut it now. Actually click on this link. IT's a pretty good Google search. http://www.google.com/#hl=en&source=hp&q=EMS+agencies+in+Las+Vegas&aq=f&aqi=&aql=&oq=&gs_rfai=&fp=a2bb256a6b4c6ad7

Who you giving rep to? Don't you know that you are only allowed to give negatives here. Just kidding. Postives are welcome too.

I'm sorry but what the hell are we crying about over this show? So what if it showed the medic in not so great a light. House routinely shows EVERYONE In a bad light. We need to begin to address the real issues in EMS rather than "OOOOH MY feelings are hurt because I didn't get called the right title on a TV Show" I don't really give a rats arse how we are portrayed by the entertainment industry as they do what they see fit and never I repeat NEVER show any profession in a good light. They are equal opportunity despisers - look at just how they treat their own profession. Producers on drugs, actors as murderers, drug addicts, drunks and whatever. It's the entertainment industry people. It's not something that we need to focus our energies on. Let's focus on some other productive topic like Fire versus EMS or Professional versus vollie, now those are two of the foundations on what we on this forum can believe and agree to spend all our waking hours on. For me this is the deal, when i put on my uniform and get that call for someone who is sick or injured - they get a competent and professional responder who will take care of them and will provide them the best care that I have been trained to give. That's all that matters to your patient. What our public or patients don't give a rats ass about is whether you are paid or volunteer, fire or ems, old or new Allthey care about is will I take care of them and either make them better or help them get through this crisis in their life. But hey, that's just me. I think the bitching about things that truly in the scheme of things do not matter truly makes us look like less the professionals. I have a friend, her name is Judy. She follows this forum because I am a member. She tells me that she doesn't understand the hullaballoo over all the arguing if vollie is better than professional or fire is better than EMS. She doesn't really care. but the other day, she fell and broke her hip and wrist. She was not focused on whether a fire medic or single role medic came to her house. She was focused that that person would show up, help her and make her better. The service that responded was MAST in KC MO who are now part of the fire department. They are I guess Fire Medics now. 5 months ago they were the private single role service. The name just changed. She was treated with kid gloves and treated very very well. These were fire medics, the ones who we love to hate here. They provided a very good ride and treatment regimen to her. She was very well pleased. So a fire medic (who we love to hate here) treated her very very well. Isn't that an oxymoron.

I'm spending time going around to local hospitals sneaking into parked ambulances and turning on all their lights and their sirens, putting ky jelly on their door handles and then armor all'ing their jump seats in the back. But seriously - I'm sitting at home taking the week off of EMS. Our hospital is having a EMS Challenge Friday at 4pm. Donut eating contest,(the cops always win), tug of war - the fire men win that one, the obstacle course - the helicopter crew wins that one and a bitching contest which EMS'rs win hands down every single time. The winning bitching argument - Fire versus EMS who does it better.

Someone didn't read the entire thread before he posted. Look for AK's post on Snopes For all intents and purposes, GW was the first president. Too bad for Mr. Hanson but Washington is considered and always will be considered the First elected (by the people - men only though)President of these United STates. An argument could be said for the president of the colonies being Mr. Hanson but he was not publicly elected by the populace like GW was. I may also have some of my history slightly mucked up here because I'm away from my biographies of Jefferson, Adams, washington and the history of the continental congress and the revolutionary war.

Make sure Stryker provides you with their rechargeable batteries. It is tempting for management to purchase the dewalt batteries but those have a memory and after a certain length of use they stop charging alltogether. Stryker has put together their new battery system to have no memory so they don't lose their ability to charge over time. The Stryker batt's are more expensive but over time replacing the dewalts will be more expensive than your initial outlay of dewalt batts.

As you have seen Princess, I have not slammed this service. I simply have expressed distrust in this style of management. You seem to have a great deal of personal experience with this service, why don't instead of you blowing off the handle and calling us out, why don't you come to us and tell us why that service CANNOT survive without letting someone who is CPR trained only drive the ambulance. Before you say they get to run calls with a veteran driver what happens when they are in the front of the ambulance and a patient crashes. The medic needs help and all that CPR certified driver can do is go back and look pretty. Plus, I don't believe that the state of texas would allow this but without you citing sources and just telling us that "Texas made it that way" you need to cite a source because this is just a BAD IDEA. I await your reply. IF you wish to reply privately I'm game for that. Just don't come back here with your opinions or unsubstantiated claims. ok, I was just on the department of EMS in Texas website. Did some quick research on their statutes/rules. Here is what I found An ECA is defined as the following: (24) Emergency care attendant (ECA) - An individual who is certified by the department as minimally proficient to provide emergency prehospital care by providing initial aid that promotes comfort and avoids aggravation of an injury or illness. Sounds like a EMT or First responder. AS for minimum staffing of an ambulance is listed here (g) Minimum Staffing Required. (1) BLS--When response-ready or in-service, authorized EMS vehicles operating at the BLS level shall be staffed at a minimum with two emergency care attendants (ECAs). (2) BLS with ALS capability--When response-ready or in-service below ALS two ECAs. Full ALS status becomes active when staffed by at least an emergency medical technician (EMT)-Intermediate and at least an EMT. (3) BLS with MICU capability--When response-ready or in-service below MICU two ECAs. Full MICU status becomes active when staffed by at least a certified or licensed paramedic and at least an EMT. (4) ALS--When response-ready or in-service, authorized EMS vehicles operating at the ALS level shall be staffed at a minimum with one EMT Basic and one EMT-Intermediate So is an ECA someone who is CPR certified only? IF that's all that it takes then WOW. Plus the drivers that this volunteer service is going to allow to drive, won't they need to be certified by the state of Texas Gotta love those rules.

Well if that is the best full crew that they can provide then maybe there needs to be some discussion of going paid. Is this how it always has been? If it is "status quo" for a long time then maybe a exploration of a paid service is in order. There are small services out there that run 100-400 calls a year and they are paid, not volunteer. How can you be so sure that there are 2 ECA's there? If they are recruiting people who have no medical experience then to me that shouts out that they cannot staff even the minimum crew. Why else are they recruiting people who don't even have First Aid but only have CPR??? This question begs to be answered. I have a service within 20 miles of my part time job that runs 300 calls a year and they run two full time paid crews so it can be done.

It's a failure because you have one person who is either a emt or a medic in the back of the ambulance and someone who can not help the medic/emt do nearly anything when they need it. When the patient starts to crash if you only know CPR then you are about as worthless as a tick on a dog. But you will now be inundated with the Vollies versus paid argument the Firemedic versus single role medic argument will begin shortly there after and finally the Dogs versus cat argument that Dog's are better but Cat's are human discussion. It's going to be a bumpy ride.

Well AT, It's really good that you have bipap but for those of us who do not have bipap, cpap, epap and whatever brand spanking shiny things that your service seems to have Intubation is my only tool. RSI I do have. I've been involved in Effexor overdoses before and they can get bad really quick. I did not go on his Glasgow, I went on the thought that he overdosed as well as was unconscious. I did mention bagging him, perhaps I should have said, let's see how bagging works but I have one hospital to send a patient to and the physicians want them intubated. If I were to fly him, the flight crew would have immediately intubated him if he remained in that state. So to bash me was not a good thing. You have more tricks in your arsenal and I have less. So be it. We have cpap but it's in a freakin closet because they haven't written the protocol for it. How's that for backwards. Before you slam other providers with their treatment you might want to get some clarification as to what we have to work with before you go off and make yourself look like a A*** So KIWI how many pills are missing or do they seem to be all there What are the pupils? Be it a overdose or a Stroke, unresponsive means BAD MOJO

Ok, so this guy is a advocate for counselling of homosexuals who want to be straight. Sounds like a good service. But he says he's not gay. Read the article and see what you think. http://edition.cnn.com/2010/US/05/12/anit.gay.activist.resigns/index.html?hpt=T2

Well have you seen who they are up against? There is no way that this idea is going to come anywhere near providing the benefit that some of the higher ranked ones provide. For example: abduction prevention for children (DVD's and books for free to kids in schools) Just go take a look at what they are up against. They are a worthy cause but not the worthiest.

Ok we've got the basic vitals. What is critically important for this guy is airway control. Get him intubated with that GCS. Once that is done we can get the IV and all that jazz. You could bag the guy until you get the IV in case you need to RSI him. He might not tolerate the intubation so we can RSI him. Do a repeat Dstick with the IV needle blood. Check pupils and then load and go.

I just searched for "How to make a homemade nuclear bomb" and I still haven't been arrested.

She can fight any fire in my neighborhood. She's a very pretty lady and probably doubly pretty when she's topless She's getting her 15 minutes of fame. And probably plenty of dates too.

Counsel to the American Civil Liberties Union." Taking away someone's citizenship is a truly extraordinary step and to do that based on mere suspicion and to be giving that power to government bureaucrats without ever having a court trial will be an amazing step." This struck me as something about the ACLU that I can agree with. But isn't this what the government wants to do anyway. Giving more power to the government What's really frightening is this, we as a collective people are giving away more and more of what it means to be americans to the government. We have effectively given away our right to choose whether or not to carry health insurance. We have to have it now or we will evnetually get fined. We have given away billions of dollars to companies that are deemed "To big to fail" We have given away billions of dollars to banks that did stupid things and continue to do stupid things even after they got the money and they promised to stop doing stupid things. We as tax payers paid tons of money to help others go out and buy cars that they couldn't afford and are now getting them repo'd in large numbers WE as tax payers are going to grant the government the permission to give illegals amnesty under the new law that will come out after we go after climate change We have given billions of dollars in foreign aid to other countries while taking from this country We have promised that Guantanamo will close - where will we house these people accused of terrorism and their citizenship is gone- where will they go if there is no guantanamo We have given criminal rights to the underwear bomber when he proved that he was a member of a terrorist organization and immediately asked for a lawyer, ending the ability of the US to find out more info. We are going to grant constitutional rights to those in Guantanamo and allow them to go free on technicalities. One of these days we are going to wake up and say "Holy shit batman, what the hell happened?" Mark my words, this will happen. For that I fear for my children and their children for they will be paying for this mess we are getting ourselves into long after I am gone. Am I better off lifewise under Obama or Bush, definately Bush. I was making more money under him and many things that happened to me happened after the new guy. So I blame Obama for it all. But seriously. I am basically about the same as I was. But many people I know are not. At least I'm one of the 90 of 100 who have a job, not the 10 who don't. They are worse off than I.

How bout "another fine inground swimming pool courtesy of XYZ Department"

ok for the win Rhabdo was one of her problems DKA was another 5 separate cerebral infarcts, all in different places and all occurring according to the radiologist who read the CT within the last 3 days. She's a train wreck. She is still in the hospital as far as I know.

And if you were to hear me say the pledge, I probably get a little louder at the words you go mute on.

The kids wore the shirts to show their support of the USA. I'm in the conclusion that they did possibly do this to show defiance of the cinco de mayo day but even the Superintendant and the school district administration do not support the vice principals actions. If it was inappropriate to wear the shirt on that day then it's inappropriate to wear the shirts any other day. You can't have your cake and eat it too. This whole cowtowing down to special interests and certain portions of society makes me sick. I already posted a response on facebook and have received much praise, but I have been called a bigot over it too. Well screw those who think I'm a bigot. I don't hold anything against those immigrants that are here legally but if you come here illegally and expect to get all the benefits of the country you invaded (illegally entered), then you don't qualify but those retards in Washington who look the other way with this shit makes me really pissed. don't get me started.