Kiwiology

Hi all Gosh, how funny to be back here after nearly ten years absent. I was researching something for work and it led me onto a report about the ambulance service, which reminded me about how all those years ago (now) that I used to make posts here and how, at that tie, being something quite new and interesting to me, I became a little, well .... hyperinterested .... in it. Ahahaha, I laugh at how much of a wanker I probably made of myself and how long ago that was. I think it was the year I first went to work at summer camp which included a medical first responder course. Maybe it was the year after, I can't remember. Anyway .... I eventually did get on with my medical degree. I was then sitting in the medical library one day and it hit me I didn't really want to be a junior doctor studying and working horrid hours and such into my 40s. I wanted to be an emergency physician or intensivist so no private practice, all in the pubic system, so the nights, weekends, etc are a part of life. I thought bugger this. The uni said I could do nursing or pharmacy instead. My friend is a pharmacist and he is like stay away mate. So I have, and I'm glad I did. So instead, I became a barrister* specialising in defence and various other bits and pieces, including our statutory accident compensation scheme, good bit of medical stuff involved there so super interesting plus I can understand most of the terms. It's basically the same as being a doc; see, diagnose, treat. Just no first-hand blood involved. It's not bad and I'm happy enough. I did go on a nice date with a House Officer not long ago. The irony is not lost on me. She wants to seme again so that's good I reckon. Well, good one, thought some of you would chuckle at this. It's also good for a bit of the nostalgia, which I'm getting a bit all about now that 40 is closer and closer. Take care all Kiwi * We have a fused profession so unlike in England where one is either a barrister or a solicitor, I am both but I tend to take work from outside referrals which more closely resembles a barrister. I'll be applying to be a barrister sole probably at the end of the year.

Fuckwits ... absolute fuckwits. I disclaim little knowledge of tracheostomy care or maintenance but even me, who is dumb as a box of rocks, knows better not to tape the thing. I wonder why they taped it to begin with and what they were trying to achieve? I can understand if they were administering positive pressure ventilation for example then occluding the trach would be beneficial to create a closed ventilation circuit but in the absence of this .... WHAT THE HELL MAN? Looks like this might be a legit win of the lawsuit lottery.

Put him on 100% oxygen and see if that fixes his SpO2. If not and he won't take an OPA then call for an RSI capable Officer provided they can locate significantly faster than we can take him on to hospital; unless backup is very close (a few minutes away) I'd take him to the hospital. The VT could be hypoxia related; see if some oxygen fixes it to start with.

There is good evidence that clinical people administer adrenaline for anaphylaxis poorly; i.e. not giving it at all, giving too much or too little, not giving it frequently enough, giving it too frequently or giving it by a suboptimal route e.g. SQ. There is also good evidence that adverse effects of adrenaline is isolated to supratherapeutic IV dosing. Early and appropriate administration of adrenaline is the cornerstone of treatment for anaphylaxis. All the other stuff like steroids and antihistamines are not well supported by the literature. Give patients > 50kg 0.3 mg of IM adrenaline early and give another 0.3 mg in 5-10 minutes if the patient has not significantly improved. There seems to be a bit of irrational fear about giving people adrenaline, particularly if they are older or they have cardiac disease. Well, there is nothing to fear, the balance of risk is always going to be in favour of administering adrenaline.

Because there is no mandate for higher education for a US Paramedic they are considered third preference for a third preference work visa; basically considered an unskilled (or "other") worker. So, I hope you're not thinking being a UK Paramedic will allow you to get a work visa because it won't. You must also consider that what you see on American TV shows like Chicago Fire is not reality. Having worked and traveled extensively in the USA my advice to you is to visit on vacation and stay put living in the UK; even if it rains alot

Junctional rhythm about 75/min Regular Axis normal No acute ST or T wave changes Don't see any pathologic Q waves Give her two hardenupacetomol and leave her at home.

I wish I'd known how much sleeping at night was taken for granted. ... and that when ERDoc said he'd take me out for dinner and a movie he really meant Dennys on Plainfield and back to his rent-by-the-hour motel on 28th St to watch something from the $1/day bin at Snuff Bunker; the adult subsidiary of Blockbuster.

Nah man it's all good. If you can use your cellular telephone to video the lecture that'd be pretty badass.

Just because Mark Fitzgerald et al say something doesn't make it right or applicable in every situation; personal opinion only but I don't really think IFS is appropriate. RSI or go home. We have significantly increased our dosing of fentanyl and midazolam in RSI such that a standard patient gets 150 mcg of fentanyl and 6 mg of midazolam. Ketamine (100 mg) is used for patients who have shock. I would much prefer ketamine for everybody; midazolam is a poor choice of anaesthetic and no anaesthetist in their daily practice would use it for induction routinely. I should be seeing the Medical Director next week so I might ask why they have chosen this.

Bah! Flimshaw! Balance of risk vs benefit is in favour of not using suxamethonium. I'd use vec or roc, I forget which it is you carry but I'd just use that. IFS is IMO bad ju ju so I wouldn't be using that.

Could have been worse, could have been at Billy Bob's place out on County Road 309 down past the Glumpkin residence. That would have meant at least 3 volunteer "First Responders" showed up in their cars/pickup trucks each with 100 lb jump bags, the local volunteer Fire Department would have also come plus an ambulance or two, and because "it looked real bad" somebody would have responded a helicopter ... and all of this is not including the bevy of neighbours who would have come to help out, one of whom would have been a nursing aid and wanted to do an immediate cricothyrotomy. Now if you'll excuse me, I have to go ensure that County Road 309 has been closed, I hear the helicopter getting close and they are always so fussy about having a suitable area to land.

I generally call bullshit on Medic One. Overall they offer a level of care that is no higher than your average American jurisdiction with a Medical Director who is not a muppet. They utilise the local fire department for rapid automated defibrillation - nothing different than is already done with, for example the New Zealand Fire Service or the Metropolitan Fire Brigade and County Fire Authority in VIctoria. They go on about survival to discharge for witnessed VF (and I think VT) only - well big shit, that's very selective reporting of the best possible data. Forty years ago Dr Leonard Cobb and Gordon Vickery set up what was, at the time, a great system for the best possible chances of surviving a cardiac arrest. It's now forty years later and survival from cardiac arrest pales compared to all the other things which have become important yet it's all they seem to focus on. If as much effort was put into the 99% of patients who are not in cardiac arrest as to the 1% who are then who knows where things would be, and Medic One probably wouldn't be able to keep up their hot air filled reputation. And yes, when I visit Seattle if somebody has a cardiac arrest infront of me I'll probably call Medic One ... maybe, if the Lifepak 10 in my rental car don't fix 'em up

Hi mate, you would have to go down the International route with HCPC which shouldn't be too hard plus you have an EU passport so no visa worries, but, do you really want to work in the UK? It rains a lot and they are a tad limited (although small moves are being made to address that) ... I would rather stay on the continent and work in one of the Doctor/Paramedic systems. Now, can I have some kielbasa stat!?

All I can say is why do you think vecuronium vials have a red cap and ceftriaxone has a green one? .... (noting ceftriaxone in a vial with a red cap can also be bought)

Calling ERDoc for medical control Getting vecuronium and ceftriaxone confused

Initial consensus statement on immobilisation by the Faculty of Prehospital Care of the Royal College of Surgeons (Ed.) http://www.fphc.co.uk/content/Portals/0/Documents/2013-12%20Spinal%20Consensus%20COMPLETE.pdf

Yeah I thought about that, we have IN/IM fentanyl and midazolam plus IM and oral ketamine. Not sure I'd go down the IM route to be honest given that in the patient who is very compromised absorption is likely to be prolonged. Could always get an EJ or IO but again, if the patient is peri-arrest then the balance of risk vs benefit is in favour of just cardioverting him anyway without it, it sounds barbaric no two ways about it but I am sure he'd rather be alive and have a bit of a sore chest.

I would not cardiovert him unless he became very compromised. In NZ EMTs have automated cardioversion, Paramedic and ICP have manual cardioversion; ICP also has midazolam/ketamine. If I couldn't get IV access that wouldn't stop me cardioverting him. I'd rather be alive and have a sore chest than be dead.

If you come fly on Kiwi Air there is no security for our plane with some bullet holes in the side, a Flight Attendant named Manuel Jose Luis Ortega who speaks no English and a bunch of illegal ammo and coke in the back flies into airports not served by TSA ... and by airports I mean dirt strips where a bunch of guys in a Tahoe are waiting. On the up side we operate a dual engine, dual pilot, all IFR capable fleet equipped with EGPWS, TCAS, Cat III ILS capability and all the fancy bits. I keep a .44 Magnum N frame under my seat so I guess we have some security .. it also serves as your in flight meal if I don't like you, and probably a bit of lead poisoning too. Reservations are now open, call 1-888-FLY-KIWI and speak to our helpful rep Mariano who habla un poco Ingles. Note: Kiwi Air is not currently certified by the FAA under 14 CFR 121 nor are its pilots, dispatchers, mechanics or any other staff. Kiwi Air is a wholly owned subsidiary of Upidedownland Aviation Inc, a Delaware corporation and is currently under investigation by the Justice Department. Checked bag not included.

For somebody with HTN a BP of 136 is probably a bit low especially considering she is beta blocked. If she has no compromise then on a 30 minute trip to the hospital I do not see the point of getting all carried away and doing things that are not necessary. For now that's my story and I am sticking to it. What is her temperature?

Our drug regimen is as follows Oxygen Entonox Methoxyflurane Paracetamol Ibuprofen Aspirin Clopidogrel GTN Oral glucose Glucagon Glucose 10% Salbutamol Ipratropium Ondansetron Loratadine Adrenaline Naloxone Morphine Fentanyl Ketamine Midazolam Tramadol Synthotocin Calcium chloride Adenosine Atropine Amiodarone Ceftriaxone Prednisone Rocuronium No doctor orders required for any of them, all are on total delegation.

Our EMS system is similar to the UK but in some ways quite different. The work visa from a technical standpoint is much easier yes because have a primarily points/skills based immigration system. From the perspective of "will the ambulance service sponsor you?" the answer is it's highly unlikely unless you are applying for a clinical development role or have some extraordinary skillset that is not able to be found locally. A few years ago there was an active drive to recruit international Paramedics but this is no longer the case for a number of reasons. It boils down to time and cost. The Nursing Council will give you equivalency as a Registered Nurse (RN) and once Paramedics becomes a professionally registered profession there will no doubt be a crosswalk program between RN and Paramedic. There is no primary involvement of Nurses in Ambulance response but doesn't mean you can't transition to working as a Paramedic. Our scopes of practices are very advanced and we have complete clinical autonomy so probably not much different than you have now. I have an English translation of the SLAS Behandlingsriktlinjer Feb 2011 for a project I am working on, quite interesting.

Give her some salbutamol and take her to the hospital

As usual nobody has thought to mention that without a work visa this idea is defunct. It is highly unlikely you will get a work visa for the US. Ten or fifteen years ago yes it was easy (I have several contacts who got jobs in the US as Nurses (RN) and they had everything set up for them through the employer) whereas now it's very difficult if not impossible. If you went to work in some isolated rural area and agreed to work in primary care nursing for five years or something then maybe. I am not a European (New Zealander) but I have lived and worked in the US and all I will say is that I wouldn't work there again.

I have no contact with my ex and haven't had any since about a week or two after we split, it was as I had never existed. As for the "friendly females" I have known, I still speak to one every now and again on her birthday or Christmas but that's it, nothing more, one I have nothing to do with and the other I see on Facebook every now and again. Then there is the matter of Emergentologists wife ....