Kiwiology

Bachelors Degree for Paramedic Post Graduate Diploma for Intensive Care Paramedic Trials of extended care pathways From eight levels in 2009 to three in 2012 Guidelines not protocols Total clinical autonomy Can leave people at home or refer them elsewhere Recent changes from four providers to two Amalgamation from seven geographic regions to four Mandatory 40hrs of CCE per year Excellent pay compared to US Standardised induction pathway Registration of Paramedics under the Health Practitioner Act coming soon Stryker stretchers, no more Stollenwerks Clinical Coaches and the national Clinical Support Team No long spine boards or head blocks Heavy investment in simulation technology Things I do not like Lack of Government interest in providing leadership i.e. no national ambulance service Lack of an Act of Parliament for the Ambulance Service Lack of nationalised decisions regarding vehicle design A vehicle design primarily unchanged from the 1980s Pay is crap compared to Canada, UK and AU Pockets of the old entrenched culture that refuse to die The attitude of some people Volunteers

I don't think intubating an asthmatic patient is the best idea and several Consultants I've talked to agree. Asthma is not an oxygenation problem it is a ventilation problem; an endotracheal tube is going to offer no real advantage to an asthma patient in the pre hospital environment than an LMA or indeed no adjunct whatsoever and very careful hand ventilation with a very prolonged expiratory phase. Anaesthetising, paralysing and intubating such a patient carries far great prehospital risk and is not something I would do. Dead floppy people with traumatic brain injury do not become less dead and floppy because they are intubated in the pre hospital environment; there is no evidence whatsoever that points to intubation being of use. There is a small number of extremely recent, extremely well controlled studies that show improved outcomes for patients intubated using RSI in the pre hospital environment There is no evidence that intubation in CPR is beneficial, intervention without evidence should be dismissed without evidence Again, there is no evidence that intubation is better for the patient, intervention without evidence should be dismissed without evidence For the unconscious post-cardiac arrest patient yes there is benefit to anaesthetising, paralysing and intubating them to shorten the time it takes to reach the cath lab and it is what we are doing here.

I used to have a nice FSX set up (by product of my days working for United as a project analyst) but I haven't used it in many many months and don't really plan to do so again. I've got some of my CPL theory papers and whatnot. I spent a bunch of money on the hyper-realistic addons (PMDG etc) and never use them, so yo Emergetologist if you want them you're welcome to them. Why you think I want to become a helicopter doctor? cos I like planes duh As for NASCAR I only watch it for the excuse to drink cheap beer and eat chips and for the crashes Wait, is NASCAR even recognised in the Great Mitten I thought it was hockey up there? for that matter is NASCAR even recognised anywhere north of Oklahoma? "Looks like they're making another left turn here Bob" "Thats right Frank!" *BUZZ BUZZ "Hello anaesthetic registrar? i see, hmm yes sounds pretty crook, give him some more vecuronium and I'll be down later, I'm er ... in theatre" "Wow look at the fireball there Frank!" "Aw bloody hell missed it!" *hurls beer bottle at the telly

Awesome, I will keep you in mind but I must warn you I do not look good in a bikini in winter and I will probably never get out of the habit of referring to myself as the "Anaesthetic Registrar" despite the funny looks received ...

It seems there is so much competition in US; here if you pass and get your medical degree nobody cares what grades you get and we don't have USMLE or equivalent so "step scores" don't exist; one of our medical schools only has distinction/pass/fail no grades for the medical degree and the other is introducing it in 2013 by the looks. I also hear it is extremely difficult to get residency spot as an IMG; sigh!

Really? It's not overly common here but it does happen; mainly in anaesthesia, emergency medicine and intensive care medicine (one can get any one of those specialisations and then do another without too much effort but some effort is required) but there are others e.g. FRACMA (medical administration) is probably the next common one which people get having gotten another vocational specialisation usually FRNZCGP (general practice) Anecdotally it seems very difficult in US to get a residency spot (Registrar post) I am currently also enjoying the hobby of ignoring a psychology assignment (DIE PSYCHOLOGY DIE!)

What's the 20 on this law eh?

I told you you should have become an Anaesthetist didn't I?

Intubating an asthmatic patient is fraught with danger and can bring on the seriously bad ju ju very easily including y'know, death I think the role for intubating a patient without RSI in the pre hospital field is extremely limited to probably non existent; there is significant opportunity to improve outcomes in brain injured patients who have poor airway and/or breathing with RSI and there are only a small number (like 3 or 4) places in the world that are doing it adequately enough which is sad because its missed opportunity

So Dwayne you POS when the fuck is our BBQ?

CRNA is Certified Registered Nurse Anaesthetist They hold a Masters Degree in anaesthesia and have been used for decades in the US; I am not sure of the exact scope of their practice as compared to an traditional Anaesthetist In some EU countries e.g. Sweden they are used in a primary capacity for anaesthesia and the Anaesthetist (Consultant) will move between two or three theatres as required to provide expert support. Recently the Royal Australia and New Zealand College of Anaesthetists put their position forward that never in either country as long as they have the power to do so will anybody except a vocationally registered Anaesthetist or trainee (Anaesthetic Registrar) ever be used in a primary anaesthesia capacity

I thought he was still passed out in the front seat of his car that had been driven into a tree outside his house?

Draw me something with my name and "Medicinae Baccalaureus, Baccalaureus Chirurgiae" on it so the Medical Council will stop hassling me?

I certainly think an LMA (or other supraglottic airway) is becoming more recognised as an acceptable alternate to endotracheal intubation in the out of hospital cardiac arrest so this study would support such a notion This study shows that cardiac arrest patients who received no ventilation whatsoever and just passive oxygenation with an OPA and supplemental oxygen had better outcomes than those patients who received manual ventilation http://ipep.arizona...._Arrest.pdf.pdf http://www.azdhs.gov...onMCCMCC385.pdf So this that in mind if such is true then it sort of makes this intubation argument moot point because even if intubation is the best thing since sliced bread (and I can tell you for a fact it is not, I much prefer going to Chinese bakery and slicing my own bread so it's nice and thick, I also refuse to eat regular crust pizza, it must be so thick I can sink my teeth into it!) um, right, even if this intubation deal is the best thing since sliced bread it doesn't matter because we're killing people by forcing oxygen into their lungs It was forewarned back in 1994 during Intensive Care Officer training that there is nothing in cardiac arrest proven effective except CPR and defibrillation and somehow the notion has not caught on I am going to update my limited resuscitation order to include no intubation, no adrenaline and no positive pressure ventilations

Didn't you read that other thread; there is no point doing orthostatics on people no more so And it's hypovolaemic

I think it was an appropriate design for one group to receive intubation and the other a supraglottic airway. There is also another excellent Japanese study from last year which shows worse outcomes for patients who received intravenous adrenaline in cardiac arrest. Looks like those Japanese are good for more than getting me addicted to their raw fish wrapped in sea weed Our top tax rate is 30% and we only pay that on the portion of income we have over $70,000 for everybody else i.e. those earning under $70k it's 17.5% I know in the US the income tax rates are quite a bit lower and some states (such as Texas) do not have a state income tax. I would rather pay a bit extra in tax so that everybody can get the same access to healthcare It's more "tradition" but in theory yes intubation is the gold standard i.e. best way to protect an airway but you cannot consider that fact alone in isolation yes it might protect the airway better than an LMA, King LT, EOD, NPA, OPA or dancing around the patient reciting some sort of chant but in the overall clinical context of somebody in cardiac arrest it is not the best way to go. Oh so that explains why you're now working in the Emergentology department?

... but but but he might have shock with severe physiological abnormality from the trauma that caused his fractured fibula That would classify him here as status one (or immediately life threatening problem) and make him eligible for lights and sirens You silly Emergentologist clearly your imagination is not as active as mine

Use them to drink beer or point at Dwayne so the Police know who to arrest for drunken and disorderly conduct?

I bet Dwayne would invite some smelly black homosexual but wouldn't invite me ... Just as well. I don't want some smelly black homo at the BBQ it would probably make Dwayne uncomfortable Hmm that didn't sound very nice I know perhaps I will consume another burger and that will prevent me from being able to say such things while my mouth is full.

The big problems with intubation during cardiac arrest are the interruption of CPR and decreasing venous return to the heart by increasing intra thoracic pressure due to inadvertent hyperventilation No evidence has been presented that intubation improves outcomes to neurologically intact discharge and there are far more important things to focus on during cardiac arrest than shoving an endotracheal tube down somebodies gob

LOL that's funny $84 a mo ... that's expensive, private insurance here is like $25/mo Entire time i lived in US I didn't have insurance; so I always made sure to look twice before crossing the street Oh if that female ambo wasn't Asian I'd totally do her

You know what, we do practice medicine backwards, we take in a little money from everybody in terms of tax and allow everybody to get health care for free! Such a crazy idea ... I can't be arse'd typing up a thing right now Man my tooth hurts, I wish we practiced dentistry backwards too last time I went to the Dentist it cost me $400

Yeah I hear people in pain are really awesome as seeking pain relieving drugs Eh, forget I said anything I'm not looking to start a thing ...

It's tragic that in the 21st century a first world nation still allows people who have no analgesia options whatsoever to treat people I mean it's not like it's been known for thousands of years that treatment of pain is an important part of medicine

Excellent post Emergentologist; *sniff sniff