Kiwiology

Adrenaline is a high priority, put 1mg in a one litre bag of 0.9% NaCl, shake well and label and give as an infusion starting at 2gtt/s I am not sure but unless things have changed in the last week we do not have hydrocortisone in New Zealand; and yes an immunosupressant is relatively contraindicated in somebody who has an active infection however you need to balance it with the therapeutic effect. Permissive hypercaponea is critically important, ventilate the patient at a very slow rate (6/min) to prevent dynamic hyperinflation Do not waste time calling for RSI qualified R50; asthma is not an indication for RSI and Tony Smith has said he doesn't want it used in an asthmatic patient but as an aside ketamine is a brilliant induction agent for an asthmatic patient because it is a bronchodilator Helicopter eh? where are you? Northland or something? Have you talked to one of the Clinical Standards Officers at all?

Hey y'all The time has come for me to bounce Laters

The term you are looking for is retinopathy of prematurity Terri, you are not wrong per-se but I would still caution the judicious use of oxygen in a patient with known respiratory failure secondary to hypercaponea; ten or twenty or thirty minutes on supraphysiologic amounts of oxygen (i.e. fifteen litres cramed down their gob by NRB) could well have the bad respirojuju And I always thought PEEP and CPAP were measured in cmH20 rather than litres?

So which test is this if it's the same as the NREMT but not the NREMT test? *sniff sniff ... hmm

Good point Trev but it would prove prudent to be judicious with oxygen administration in COPD patients, the target seems to be 90-92% unless they have specific instructions on an oxygen alert card from their respiratory physician and to turn the oxygen down between nebules if you are giving them salbutamol/ipatropium I did a rather large research assignment on COPD when I was at uni, it is rather interesting

I was taking the piss

Well, it's a good idea if you maintain SpO2 > 95% for the patient

But you cannot take the NREMT until you are 18? .....

If only we thought you were appropriate .. Oh snap did I say that, my bad

Oxygen is a specific treatment for hypoxia (hypoxaemia) only. It is not a "general treatment" for patients who are injured or unwell nor is is a treatment for ischaemia, tachyponea or an altered level of consciousness. Prophylactic administration of oxygen is inappropriate and supraphysiologic hyperoxaemia (a greater than normal level of oxygen in the blood) causes small arterioles to constrict which reduces blood flow. This is particularly bad for patients with myocardial ischaemia, stroke or shock and the evidence appears to indicate greater mortality in myocardial infarction patients who receive supplemental oxygen. Remember, ischaemia is not hypoxia (hypoxaemia) and that oxygenation is not ventilation; the concepts are very different. Ischaemia is localised whereas hypoxaemia is global and if a patient has an ischaemic myocardium because of an occluded coronary artery(ies) then cramming more oxygen down his throat is not going to break up the clot now is it? Only give oxygen to patients who need it, and in the lowest concentration required. Most patients only need nasal prongs or an acute (ordinary) mask. Oxygen is a drug, remember that, you wouldn't give somebody 100mg of morphine if they only require 1mg would you? so why give somebody fifteen litres of oxygen when they only require two or three?

Very awesome mate, I am glad you are doing this, it is long overdue. For your interest, here is the New Zealand wide guideline

A First Responder who does the Ambulance Assistant module here can do more than an EMT in the US; if you look at the 1984 EMT-Ambulance and an EMT from 2012 under the new Agenda for the Future you'd be hard pressed to spot any difference except in some of the background knowledge. Background knowledge is extremely important lets be fair however if you cannot do anything with that knowledge than what bloody good is it? It makes me die a little inside to consider that such a great nation is in 2012 still stuck somewhere about 1993 as far as the rest of the world is concerned

If you give insulin to somebody who is normoglycaemic wont they become hypoglycaemic? I am getting fuddled and biochemistry is not my strong suit at 4am Mmmm ... metabolic pathway valiumz

We just give 'em 5mg of salbutamol if they have clinically significant hyperkalaemic changes on ECG but such is only very rarely done I think in this case it would be better to use calcium than insulin to treat the hyperkalaemia. Certainly you want to use insulin in somebody who is hyperkalaemic because of diabetic ketoacidosis although remember hyperkalaemia in DKA is only pseudo hyperkalaemia because the V H+/K+ ATPase swaps extracellular hydrogen (because of the acidosis) for intracellular potassium as one of the acid/base homeostasis mechanisms so this is only a "pseudo hyperkalemia" and that patients with DKA are often actually profoundly hypokalemic. Do not just give your DKA patients an insulin drip and leave them in the corner cos they will croak and die from hypokalaemic cardiac arrest rather quickly

Oh Scotty dear it's like Natalie Maines says, people do not like the truth when it comes out somebodies mouth and that is the reason the world is dangerous. Now, if only I could play the banjo

The world will change, but I certainly do not think it will be for the better in the overall context. Let's say I score some sweet as job as a blowjob tester or something making bank cash, that might improve for me personally but overall, yeah the world is still pretty screwed up eh ....

Greetings, I am Kiwi, I live under the bridge Do not listen to a thing I say nor pay any attention to me Kiwi away!

A Johnno first aider, PTS Officer or Community First Responder gets about the same training as a US EMT here

Nebulised salbutamol for hyperkalaemia is possible in NZ

I am just going to pretend I didn't see this ... Clearly there is some outside influence that was responsible ...I am blaming Illinois

This little girl is not critically unwell with anaphylaxis but has a moderate systemic allergic reaction that will certainly not be getting better on its own. Without treatment it will continue to get worse and lead to a point where she is.critically unwell. I think any hypovolaemia is relative rather than actual and is being caused by the vasodialatory effect of the mast cells releasing histamine. Treatment in my book? fluid loading and a very conservative dose of IV adrenaline

I resent the implication that I am both helpful and fun .... you have undervalued me, I am helpful and totally fucking mentally insane

You may want to consider than if you move onto something else e.g. Nursing, RT, PA, Medicine there is nothing stopping you from working part time or casually as a Paramedic on the side. There are a few casual Ambulance Officers here who work relief rosters at various stations. Oh, and if you haz Degree maybe you can finally explain to me what in the bloody hell a proton is? Science and I do not get along

I think Kanadahara is somewhere in Afg

I think you are best to set up a group of First Responders on campus. We're taking a university setting so it's going to be fairly unlikely you are encountering any people who are critically unwell or seriously traumatically injured who have a need high high level, complex clinical interventions such as at a high speed road traffic crash. Even if you are a residential campus and get people who are deeply unconscious with poor airway and breathing from alcohol poisoning on a Friday night the overwhelming evidence supports good, basic intervention and airway care over anything fancy in the very short term out of hospital setting. Cardiac arrest is probably the most serious situation you will encounter, it most likely be rare (a few times a year) and again the overwhelming scientific evidence supports high quality CPR and using a defibrillator as being the most important interventions over fancy ACLS magic. If you want to educate people to the Emergency Medical Technician level then that's probably not a bad idea; however it is probably not necessary. At the most you are going to need somebody who can do basic oxygen administration, obtain basic obs, use an OPA and a bag mask, operate an AED, do simple first aid for controlling bleeding, treat burns with cold water and cling film and assist with administering auto injector adrenaline for anaphylaxis. As far as what medical equipment you are going to need it is not a great deal; AED, first aid supplies, a set of OPAs, bag mask, a box of glad wrap, some drawer sheets and a couple blankets (handy for keeping nosey people out of view and the patient warm!) and a BP cuff and stethoscope.