Kiwiology

God I wish we could stop using the term "pre-hospital" I really don't like it anymore, I feel that it ties one into transporting somebody to the hospital and is alsmost as bad as the term "life support". What I feel there is a need for is to swing the pendulim a little further towards "care" and away from "life support" more towards a PA/RN focus than a "Paramedic" focus. 90% of the patients ambo gets are not dying and in need of "life support" they need "care" which I don't think is provided well. Why is it not provided well? Because there is often a limited range of options beyond going to the hospital and that needs to change! I don't feel there is a lot of need for an expanded scope but rather expanded pathways.

I think somebody should just do that! Might they be respiratory and metabolic shock by some chance? I'm not being sargasmic here but seriously it wouldn't suprise me because they do not exist. Ask your instructor if for "metabolic" he is referring to hypoxemia caused by metabolic alkalosis and acidosis causing a shift in the oxyhaemaglobin dissassociation curve? This is also called the Bohr effect. If he gives you a glazed over look then that's your problem. Perhaps he is thinking of shock as hypoxia rather than hypoperfusion. If we do that then technically you can have "anemic shock" too! Not dissing you bro but the information you are given doesn't make a lot of sense and is poorly presented; which is a reflection I believe on your instructor and part of the problem of ambo's teaching ambo's. Would be nice to know if he has any formal adult education qualifications or perhaps a Masters in Prehospital Medicine like they do here or if he's just another ambo teaching ambo's. I can't find any ambo I know at ANY practice level who knows what "metabolic" or "respiratory" shock is and leads us to believe that your instructor lacks the pathophysiological knowledge of the shock process (confusing hypoxia over hypoperfusion) or is still teaching material from the seventies. To ask for "specific" vital signs that you may observe it also, in my view, a bit weird. As I said before the only way you will get a "specific" vital sign is to measure it, on that patient, at the time. Anything else is not "specific" and is generalised. A septic patient will be febrile, but we cannot say to what degree "specifically" because we have not measured his temperature, somebody with anaphylaxis will have hives or a rash however that is a specific symptom not a vital sign. I will be quite interested in seeing what your instructor has to say.

I think this dude's instructor is a freaking douche; there are no "specific" vital signs that you can list woithout actually conducting a patient examination e.g. "hypoptension" is not a "specific" vital sign, it is a generalised one; a blood pressure of 90/50 is specific but not all shocked patients are going to have that now are they? Angioedema in anphylaxis is a specific "symptom" but it is not a "vital sign". That question could be worded a lot better. As for psychogenic and respiratory shock, say it once and again, they don't exist. Maybe they were taught back in the day of glass IV bottles, dudes in afro's with lots of gold chains and bling who rolled up in a Caddy and prophylactic lignocaine (there's a big wordy word for 5.43am) The DOT/NHTSA said the biggest problem with EMS students (and presumably instructors as they are often little more educated than what is required to get a cert) is lack of ability with the English language!. I'd believe it, I always have and probably always will until proven wrong.

It, like this dude's instructors brain, does not exist

Listen up. Shock is hypoperfusion - not enough blood getting to where it needs to go. Two broad causes .... Volumetric - not enough volume, can't move what is not there. This is hypovolemic shock Distributive - can't move what is there adequately enough. This cardiogenic, neurogenic, septic and anaphylactic. Whatever crap your instructor told you about metabloic shock is straight out of the seventies and about as much use as MAST pants and calcium. Ask him if he still thinks of "shell" as a form of shock too! Also ask him if he means metabolic acidosis or alkalosis which can shift the oxyhaemoglobin dissassociation curve due to the pH changes. That is my guess at what he means. Anyway .... symptoms will be the same depending on which stage of shock you have and the following will be present to a greater or lesser degree depending on how much blood is lost and how long them have been shocked. I'm a Titanic freak so this may be a good comparision to draw: Compenstated shock (just after it hit the iceberg, can adjust to the changes and carry on) Tachycardic (to try and increase oxygen delivery and compensate for blood loss) Tachypenic (to try and increase oxygen delivery) Nausea and cool skin (precapillary sphincters close and blood routes from extremeties and gut to vital organs) Normal or near normal BP (vasoconstriction) Early decompensation (having a bit of trouble, going down by the bow, tell 2° Lightoller to get the lifeboats ready) Some hypotension (falling cardiac output and vascular tone) Weak pulse (see above) Cold, pale extremeties (lack of blood flow) Falling level of consciousness (cerberal hypoperfusion) Late decompensation (almost overwhelmed coping ability, how far away is the Carpathia again?) Very hypotensive Absent pulses Extremely low LOC or unconscious Irreversable (body gives up as it can't fight no more, Titanic breaks in two and sinks, you die) Death You will get one or more cause specific symptoms too Cardiogenic - cardiac history, chest pain, crackles, JVD/pedal edema Anaphylactic - history of exposure, swelling, edema, crackles, hives, rash Septic - history of infection/sick, febrile, Neurogenic - history of spinal cord injury perhaps a fall Hypovoleamic - um, bleeding? Treatment .... as a basic provider oxygen and supportive care; transport fast and yell for ALS! Generally more advanced treatment is centred around the specific type of shock; Cardiogenic - fluid and inotropic support Anaphylactic - adrenaline, anti-histamines, fluids Septic - antibiotics Neurogenic (spinal) - not sure, I'd guess circulaory support maybe fluid and vasoconstrictors? Hypovolemic - controlled bleeding, volumetric support (fluid) but uncontrolled bleeding is another story, look up permissive hypotension I hope that helps.

Do you have a strip? What treatment is she on? Cardiac history? I am not concerned, PVCs can be caused by the ubiquidos 400 different things; electrolyte imbalances, hypoxia, increased sympathetic stimulation, all sorts. Treating would be appropriate in the case of circulatory compromise, prolonged coupleting or degradiation to VT or VF.

I politely disagree, well about EMS being "young" anyway. It's been around for four decades and in that time has failed to really intergrate itself into the public minds as a profession worthy of true respect. Why? Education and professional standards is your answer. Now this is not true in all parts of the world; in Australia ambo's enjoy a very high reputation both from the public and other health professionals, same here (although to a slightly lesser degree) and in the UK. These are nations with by-and-large very high education and professional standards which run Ambulance as a core activity of the health system generally at a state level; Australia is by state and the UK well, don't ask me how the NHS works! While in times gone by it was possible to get away with "weeks" or "hours" of training, many nations now require a Bachelors Degree or higher which basically excludes all the whackers, firefighters and volunteers thus raising the standard in terms of provider and the care they provide. By comparison New Zealand requires a Diploma (Associates Degree) if you want to be a volunteer and at least Bachelors Degree if you want to be a Paramedic or higher (read: get paid, start IVs and give drugs). While I quibble about some of the Diploma content it will only do good things for the service and it's image. Lets see, what doesn't do do good things for the image of Ambulance Officers (no, no, me excluded) .... - 120 hours of training minimum - No requirement to get any higher education or even take an anatomy class to get certified - Vastly different standards; 600 hours in Texas vs. 3,000 hours in Seattle (try taking a TX cert to Mike Copass in Seattle) - People who drive round with lights, sirens, air horns and decals all over thier personal cars - A plethora of different titles and levels - No real interest in moving beyond the "emergency" sphere of jobs - Fire services trying to justify tax dollar sucking budgets aimed to keeping things on the downlow so it's patch factory won't close - Lack of industrial and political leadership and representation .... and once again, we seem to have centred on .... the United States Where is EMS heading? In the US, nowhere, never has, never will, rest of the world .... somewhere interesting and for the better.

OK ... there's a lot of low cards in that hand, but at least USM have fairly cool looking Ambulances

If you are seizure free for five years and on good, controlled meds then maybe, but you're most probably SOL. You may find a place that doesn't make you drive but I'm not gonna be wagering on it any time soon.

There are, however all others use the PCP/ACP labelling except Alberta (EMT/EMTP) and Ontario, while using PCP/ACP nomanclature technically still uses the term A-EMCA What, I did some research, bet you can't tell me what our levels are

Mate of mine sent me these; from a British TV show about HEMS London They use a doctor and a Paramedic (Intensive Care/ALS) and can do open chest thoracotamies (with a knife rather than a needle or Turkel). I was quite suprised to see some of the drugs they carry such as ketamine, suxamethonium and vecuronium are doctor only drugs in the UK whereas our Intensive Care Paramedics (ALS) carry them here. Flying Doctors Condition Critical Medic One http://www.youtube.com/watch?v=VFl6e6wikYs&feature=related http://www.youtube.com/watch?v=5Gq-Etpyc7Q&feature=related http://www.youtube.com/watch?v=JyMv4kkExBo&feature=related http://www.youtube.com/watch?v=zLK0yeRLlSs&feature=related Blues and Twos http://www.youtube.com/watch?v=PgtFXXcUS9g&feature=related http://www.youtube.com/watch?v=KaiDmdZ6BxE&feature=related http://www.youtube.com/watch?v=jFgpHC6moag&feature=channel

No, you will have to retake the entire course because the American system is just that ass-backward. What province are you in, do you mean A-EMCA in Ontario or EMT in Alberta? Do you fit the NOCP for a PCP? Quebec does not have Advanced Care Paramedic (ALS)

dude that is frickin a1 hillarious :D

WY IL NY MA SC https://www.nremt.org/nremt/downloads/2008_Annual_Report.pdf (Pg. 9) You can always come stay on my couch pro-boner, you'd probably make Intensive Care Paramedic in a year

Yeah .... but there is no crime in Canada, or so Canada wants us to think Canadian ("ka-nae-dee-in") noun: An unarmed American with health insurance

People call an ambo because they have a problem, they need help for some crisis which coincidently might be slightly medical in nature (or you know, a lot medical if the patient is really crook) but I think ambo generally fails to recognise that HELP does not always require an ambulance or transport. There are some interesting concepts being developed that could prove to be quite uselful, CARE in NSW is one such example.

Hello my name is William Bobo, MD from Fort Worth, Texas; what is the problem today? Those medical kits the plane carries are first rate a1 fantastic they are just as well stocked as your typical ALS bag except they only have an AED. All commercial airlines I have seen have a satellite phone-in system where you can talk to a doc just like how you guys talk to medical control.

He did but will as you say, quickly turn red, suit's him given he's an incarnation of the Devil

We are taught 100/min and a vent rate of 8 using a bag mask, we're also getting the MRx with QCPR to enable us to get the right number and depth of compressions.

Ambos need to stand up and take the bull (EMS) by the horns rather than let the bull continue to have the upper hand over the ambos. Broadly .... the following need to be addressed 1. Funding 2. Professional identity and leadership 3. Intergration with the wider health sector- no longer just call and haul/de-emphasis on emergency role 4. Standard education and levels of practice with common cross-jurisdictional titles 5. Industrial representation/pay 6. Fire service 7. QA/CQI

Obama Canada

Assaults on ambo's are not a new thing here and they are getting worse. I know ambo's who have gotten broken arms, black eyes, had thier vehicle trashed or attacked, been swung at by people weilding an axe etc etc and that's not counting the foul language, verbal abuse or things like that. I say you shouldn't have an axe swung at you or your vehicle trashed by a guy with a 4x2 but if you can't take a bit of bad language perhaps its time to look for another line of work. We're up to about probably two incidents a month nationally where somebody is assaulted or threatned with some sort of weapon however little attention is paid to it. About three years ago there was a 10 minute piece on one of our current affairs programs but nobody really cared. New Zealand has since 2000 had an explosion in the amount of crime caused by meth (or P for pure methamphetamine); most of it's pretty nasty with people copping severe beatings or being chased down by guys with swords or nail guns or even just P freaks who have not slept in a while and are overly unpredictable and paranoid prone to violence. Single crewing (i.e. solo officer) responses are still part of standard operation here (it's getting less but rather slowly) so that increases the danger factor because you have nobody to watch your back and work with you to help you out of trouble. The incident where the ambo's got attacked by a guy brandishing an axe was really foiled because the second officer managed to get a gate between the offender and the officers; had this been a single officer response well who knows. Alcohol and youth culture in general is also to blame partly; back in the day if somebody got smart they got a smack in the head and that was it, now, you get knocked down and have six or seven guys kick the crap out of you and stomp on your head a few times while you are on the ground. In the past people left crews alone to do thier job but this no longer seems to be the case; often times you get a whole crowd of people gawking and cheering on thier friend (the patient) and trying to climb into, ontop of and over the vehicle. Tell them otherwise and you start copping a barage of abuse and guys making jestures they are going to shank you, well, are they, do they have a knife? I don't know, you tell me. On that note there have been noises about getting stab vests the same as the Police have; problem is that the service cannot afford them and they add about 2-3kg of bulk to the 20 or 30 kg of gear you are carrying anyway. Anecdotally the London Ambulance Service has them but very few staff wear them. And no, there is no provision here for special charges if you assault an ambo; if it's a first offense you might get a fine or a naughty letter, not much really to deter you and our courts are so backed up it'd probably take two years to get through.

Exactly what this guy was, must be something in the water

Guess it didn't just come down in the last shower then; this one didn't break with amiodarone and wasn't sick enough for ALS to cardiovert. Knowing my luck I'd have zapped him only to have it come up at audit "dude, you were trying to cardiovert artifact!"

Had an interesting job come my way 18 yom cc feeling unwell/dizzy/spaced out/tired all day for no apparent reason Fast AF at about 180 no pmhx/family hx etc etc I have never seen very fast AF esp in a young healthy person with no history of cardiac problems or stimulants like it came down in the last shower Anybody?