Kiwiology

Interesting. It sounds like you really work for a great educational institution and I am very happy to see you working to make some basic biomedical science a pre req to any of that patient touching stuff. Proton? What in the heck are you talking about man that is devil speak just like mitochondrium, sounds almost like some sort of snack food, never mind all of that, where's my suxamethonium gone?

I have seen several programs around the internet from the US and all seem to be short courses or another alphabet soup addon, Bryan Bledsoe had a rant about them a while ago and included an example of two Paramedics who took said alphabet soup class and started calling themselves CCPs when the state they were in did not recognise that level, from memory only a few states actually recognise the CCP level. In Canada the National Occupational Competency Profile for Paramedics does include provision for a Critical Care Paramedic but in reality there are only two provinces I know of that actually utilise them; Ontario and BC. The EMTP in Alberta is a mix between an ACP and a CCP. The education is fairly intense, taking experienced ACPs with several years of experience and putting them through another year to two years of college. New Zealand, Australia and the UK do not have such a level however you could say the AU/NZ Intensive Care Paramedic is in some ways similar to a CCP; certainly the MICA Paramedic (ICP) in Victoria operates at a level closer to a CCP than the traditional ICP, the MICA Flight Paramedic even moreso e.g. monitoring of patients who are on complex pumps, drips, ventilated, ECMO etc In NZ the transport of such patients is undertaken by the Patient Transfer Service (glorified driver) using the sending hospitals A Zero team (transport/retrieval team)

How would that help if I am illiterate and cannot read?

What a load of absolute shit, if you need to expose the patient but do not want them filmed you get two people to hold up a drawer sheet or move the patient into the ambulance ... please stop saying things

The bearded one works you too hard, feed him to some goats

Probably the quickest way for the patient to the get to the hospital Lets face it, not a lot of what the ambos do in major trauma has even been proven to be of help, a focus on quickly throwing them in the car and driving to the hospital while providing some basic first aid is probably better! Philly is bad man seriously, I've walked the streets of New York at 1am and felt quite safe, I didn't even want to get off SEPTA in Philly and just kept on ridin' ...

Nah not you bro

I may happen to dislike certain inhabitants of Hoosierland I am staying south of Mittenworld, who the hell would want to live there?

The Colonel although the bastard wasnt there when I went to get some of his fried chicken OK I meant three states ... and you reckon I am smart?

I confuze, oh well some of teh valiumz will help

Whatever are you trying to say?

What a shame such a microbe does not migrate two states north ... I know the perfect victim

Probably because the ones with high self esteem have caused you to max out your insurance's yearly limit for trauma related visits to the Urology clinic Oh that reminds me of the time I got torsion when I was a kid, damn House Surgeon only gave me two panadol (paracetamol) because he wanted to wait until the Surgical Registrar had reviewed me, and the Surgical Registrar wasn't going to review me until the Anaesthetist had seen me, but he was in theatre ... Im like look the patient won't know any different if the anaesthetist comes down, fondles my throat and asks me to stick out my tongue now will he? I was such a ... weird ... child

So that's your secret!

So is that where you take the medical device and pharmo sales reps?

Oh hardy har har ... need I remind you vecuronium as an innocent looking powder that can be sprinkled into your cereal? I hate medicines which come as powders seriously that time I got vecuronium and ceftriaxone mixed up did not end well but at least that guy was no longer concerned about his infection ... for somebody with gangrene he turned awful blue I dno must be a thing

Um, might be funny for you to write me a letter but I am illiterate, way to go exposing my terrible, terrible secret

Some date you are You did at least pay for the room at the Motel 6 right?

Hey at least I am only scary and not scary ugly even with my exotropia, unlike you I'm not on LinkedIn sorry bro but I am on Ruff's facebook feel free to add me

Bro, that is sad, you need to talk to Dr Rashford and tell him he is embarrassing himself with such indications In NZ ketamine is indicated for "severe pain" and may be used in any patient who has "severe pain" regardless of the etiology of the pain but is "preferably" used in combination with opiate

So a funny thing happened to me last night ... I've dragged myself out of the mental black hole enough to face stupid, bastard, soul crushing not-wasted-on-teh-valiumz reality to try to integrate back into society after the ... unpleasantness ... from which the recovery has been slower, more difficult and more protracted than weaning some elderly patient from the rest home who has a chemo port, morphine pump, CHF, COPD, neutropaenia, sepsis, MODS, MRSA, six kinds of pneumonia, viral cardiomyopathy,, LVEF of like 1% and who has been on a ventilator in ICU for two weeks. I am sure such a patient does not exist, but you get the idea, shut up and stop ruining my medical analogies! I had a bunch of job interviews and caught the overnight bus back home (cheaper than flying) and by chance, swapped seats so another guy could sit next to his friend. The guy I sat next to was some stoner looking type, baggy jeans, hat on backwards, risque slogan on his t shirt etc etc ... he notices I am listening to EMCrit on my phone and asks what I do, I say oh its just a hobby you know I can sometimes sound like I know what I am on about, he is like oh give me an example, so I drag up one of my standard sound bites - that you should not use frusemide in management of acute CHF/APO because most patients are in fact relatively hypovolaemic and chronic fluid retention does not equal acute fluid shift. He looks at me and dead pan says you're right, the pulmonary edema fluid has come from the circulation due to increase pulmonary capillary hydrostatic pressure. Turns out this bloke is a TI (trainee intern) or sixth year medical student who is also in the same class as one of my acquaintances. He is like you;re doing what, going for some bargain basement piece of shit job when you're clearly medically brilliant, you idiot. I told him I applied at Otago and didn't get in so can't apply again. He is like bro I did competitive first year (which I cannot do because I have a degree), didn't get in, did a nutrition degree, applied as a mature graduate and didn't get in, applied as a mature graduate at Auckland and did not get in so did competitive first year at Auckland and got in, I owe well over $100,000 in student loans and am damn near thirty, medicine has destroyed my life and I have decided to take the easy route and become an opthomologist, second easiest route to real medicine next to becoming a GP, and don't you dare say public health medicine because that is not real medicine, you sound like somebody who would actually enjoy doing medicine, so go do it! Fine ... I guess I will go become a doctor, jeez, the things wasted stoner TI's on the bus talk you into. Aw man, now I have to know about chemistry and stuff, damn chemistry ... who cares what the hell a proton or 3s3 orbital is that stuff is hard, now, where is that 20ml syringe of suxamethonium gone? I guess I'll devote until I'm 33 or 34 to studying, sigh! Damn it Emergentologist you better hook my ass up with a sexually attractive "Intern" (House Surgeon) of the female variety for this, I'm giving that Hippopotomus bloke (your boss) the best years of my life Also of note is that "medical student" and "House Surgeon/Senior House Officer" are most likely going to be replaced with "Student Doctor" and "Foundation Doctor" respectively as they have been in the UK; and "Specialist Physician" has begun to replace "Consultant" . I like House Surgeon I think it sounds sort of eloquent and deserving of prestige; I do not like the "Specialist Trainee" terminology which has replaced "Registrar" in UK, you can easily tack on your speciality to become the "Surgical Registrar" or "Anaesthetic Registrar" but "Specialist Derematology Trainee" sounds fucked up and "Specialist Cardiologist Trainee" sounds even worse Wait, now that I think of it, Emergentologist can teach me chemistry, he has a BSc Biochem (suma cum lade) so he must know what in the bloody hell an s3 orbital is And yes Emergentologst, I've been LinkedIn stalking you

Don't feel bad, the old Paramedic (ICO) modules I did way back in 2007 are long dead now but I have moved beyond aspirations of a career with the Ambulance Service.

I guess it depends on the individual Physician you encounter Jeez that lady sounds like she needs the works, did you evacuate here down here?

What was wrong with the patient, i.e. what was the cause of his pain? Ketamine is just another tool in the box, sometimes its the best sometimes its the worst you have to know each medication individually and its indications, contraindications, side effects etc to make an informed decision It is an excellent analgesic particularly to severe pain that is unrelieved or unlikely to be relieved by morphine alone i.e. severely angulated limbs, burns, shattered pelvis, gallstones, renal colic etc

Yep, propofol is also quite popular here as well but so is the fentanyl/midaz combo. Propofol is restricted here to vocational scopes of practice requiring the administration of anaesthesia; so emergency medicine, anaesthesia and intensive care medicine, maybe at a stretch rural hospital medicine I am not sure about that one. So fentanyl/midaz means you do not require an anaesthetist to be present and is used for things like colonoscopy which are often performed in the outpatient, non hospital setting which are not accredited by ANZCA for anaesthesia. Anyway, ketamine has its place, but so does etomidate, thiopentone, sevoflurane, propofol, midazolam etc. My strong bias toward preference towards ketamine is exclusively in the domain of prehospital rapid sequence intubation and analgesia as this is where its extremely low cardiorespiratory risk has a big advantage over benzos, propofol, etomidate etc as a good proportion of prehospital RSI patients are physiology where hypotension, respiratory depression, supression of adrenal function or baroreceptor reflexes etc would be bad. It is also an excellent analgesic in low dosages and a brilliant tool to have when you've emptied your morphine snapoules but the patient is still screaming in pain. To extrapolate the usefulness of ketamine in these situations to an elective anaesthetic is not appropriate