Kiwiology

If you're intubating people you really should be using suxamethonium or equivalent; using sedation alone is bad ju ju

None whatsoever, we use ketamine and suxamethonium routinely Probably an old wives tale like the golden hour, high flow oxygen, spine boards and so on

I am sure Scotty has fond memories of watching Thomas the Tank Engine narrated by Ringo Star as a child just like me, of course that was until I found Rescue 911 one Tuesday evening in 1991 and was molested by that drunkard, prostitute loving, space ship driving, nymphomaniac lawyer carrying a Lifepak 10

Yeah, the new Clinical Practice Guidelines say you should check a pulse during the rhythm check if the rhythm looks capable of producing output It annoys me greatly that most of our cohort have probably already forgotten the majority of what they are taught in terms of biomedical science We are taught basic arrhythmia recognition, recognising ST elevation and localising infarcts as well as some advanced arrhythmias e.g. heart block; as well as the cellular chemical basis of metabolism e.g. gluconeogenesis and oxidative phosphorylation and the electrochemical changes in membranes of excitable cells leading to depolarisation. Our biochemistry paper coordinator said she knows most people just remember it for the exam then forget it and never use such information in clinical practice. The same can be said for ECG interpretation. There are exceptions and I know many cardiac nurses who could probably leave the House Surgeon on his cardiac run for dead or diabetes nurses who can take glucose-1,6-bisphosphate and whop me over the head with it. I'm sure many emergency department nurses can spot a ischaemic changes on 12 lead ECG before the plaque has even deposited in the patient's vascular endothelial cells. Now, now you just wanted to get some experience so you could move next door

All the way down

Dwayne is a punk ass bitch Me on the other hand? I'm a scary mother fucker, when I'm not in the corner rocking back and forth with my pillow, roar!

Made sense to me,but then again you do tawk funny

Absolutely not, you must accept everything I say as Gospel and never question it! In a recent clinical circular, our Clinical Management Group stated

of course mate, i do keep abreast of various things happening around the place i don't like the fire service because they spend a lot of time doing nothing and get lots of money for it ...

Merceedes Sprinters are not hybrid, they are ungodly monstrosities straight from the depths of hell! The Fire Service spend 98% of their time sleeping, 1% doing fire prevention work, 0.9% playing Scrabopoggle or watching telly and 0.1% fighting fire or cutting people out of cars, so it's easy for them to just do medical runs to make themselves look good when budget time comes around Or in jurisdictions where they can't do medical runs they just take over various Ambulance Rescue units ... like oh I don't know, NSW Fire Brigades?

That is quite the monstrosity .... I am not sure how it will do on the narrow congested streets of London I think you'll do best on the motorbike!

I would be extremely hesitant to go near this patient with RSI and even less inclined to go near him with gangsta old school butcher shop style "medication facilitated intubation". Such practice was banned here 10 years ago because it kills people. Nothing against you personally mate but both of these are big no-no's. For a patient with haemmorhage the only thing midazolam (versed) is going to do is drop his blood pressure even more, which really is not a good thing. Ketamine is appropriate as an induction agent because it has a low cardiovascular risk profile and is very safe for shocked patients. Should you want to intubate somebody you absolutely must use a paralytic agent, be it most commonly suxamethonium or something longer acting. To not do this is extremely poor practice and requires that you use larger dosages of sedation (especially midazolam). My anaesthesia texts and discussions with several anaesthetists has lead me to understand that in-hospital these patients are likely to concurrently receive several units of red blood cells and plasma as well as an ED ultrasound to identify the source of bleeding and once they are bit more stable they will be anaesthetised and moved to theatre. One of my more basic anaesthesia textbooks (written for the anaesthetist working in a developing country) talks of the "cascade" anaesthesia technique of fluid (or blood) resuscitation paralysis, intubation, induction and analgesia in that order. Apparently it's an actual thing.

I was in London a few years ago, it wasn't bad. Now, your choice, which do you want to drive; there is a choice of The yellow box or the yellow car or the yellow bike Hopefully Now now, such hostility, would it be better if we moved you onto the motorbike? Actually the East desk has told me Kilo 101 on Newham complex needs somebody ... had any shootings or stabbings lately?

A sucking chest wound gets a defibrillation pad placed over it; three way dressings are a waste of time Give him one litre of fluid as a bolus through a big bore drip; we want to give him just enough fluid to perfuse his brain Whatchoo talkin bout? He most likely has a left sided haemothorax; decompressing "just in case" carries a high risk of piercing the lung as haemothorax will push the lung anteriorally If this bloke does have a cardiac arrest, the most likely rhythm will be PEA or asystole so I wouldn't bother One thing I've never understood is the American phenomonia of "assisting ventilation" it's not something we do here if the patient is spontaneously breathing unless oxygenation is very, very poor and such patients are excellent candidates for RSI. If his oxygenation is OK then you should avoid the temptation to do this, remember this bloke may indeed have a lowered SpO2 because he has lot a considerable amount of his blood volume and haemoglobin (so reduced oxygen carrying capacity); cramming more oxygen down his gob is not going to help because if it can't be carried then it's really no good.

Sorry mate you've been moved onto the FRU for today, which means dealing with pub fights, sick Nana and NHS Redirect And the best part? Because you're on the FRU our big yellow box has been shut down and I'm off to a quiet complex somewhere to read a book and eat my sausage casserole for lunch until I can be paired up with somebody who has C1+D1 ... because I'd be on the FRU as well but the HPC says I don't quite meet the requirements for State Registered Paramedic equivalence so I'm going to do nothing all day and watch telly ... awesome! Red base, November 100 looks like we can't take that suspended after all Yes

Wouldn't that be how about I come kick the shit out of you? Poor kiwi, so unintelligent, can't think up a better comebaaaack

Lets stop this feuding and go get some BBQ, whatsay we load up the pickup truck, get some country music playing and ensure our ten gallon hats are firmly placed atop our noggins? There be an awesome BBQ place I know in Dallas

Actually I am fairly certain it is illegal. I know it is illegal here in NZ and I am sure most jurisdictions have legislation against representing oneself as a protected title holder (whatever it may be) unless you have the appropriate registration for said title. It's illegal for me to call myself a builder, a plumber, a doctor, a lawyer, a teacher, an accountant or a number of other things because I am not registered with the appropriate statutory regulatory body. No, I will not

Patient is status 1 (critical, life threatening problem) Everything besides time to reach an appropriate hospital pales into insignificance and need not be done if it delays us getting him to hospital Get him in the ambulance, either grab a bunch of cops and carry him there or have somebody very quickly get us the stretcher. If we can get a drip into him, something big like a 14g in his AC, then let's do that, if not, I am not worried about it Get going towards hospital with much early notification, the radiologist and consultant surgeon may be on call at home you never know, or they might need to clear CT or open up another theatre

I've been a magnet for the most out-of-it, unbelievable shit my entire life mate, so why should this be any different? Basically I'm a fucking psychological mess, I was raised by demented, fucked up drug addicts and from the age of eight years old have known that my parents do not love each other, I have never seen them show each other any affection, grew up around adults because that is who was in the house sitting in the lounge waiting for my dad to go unpack a brick or I was sitting on their couch for hours and hours waiting while Dad did some fucking drug deal. Or it was laying in bed listening to the two of them scream and argue or it was being a skinny little bitch at school who got teased, beaten up and tormented every single day for years and years, or having your parents drill into you that "you are weird", "you're not normal", "you'll never amount to anything", "you'll die alone because nobody will ever want you because you're so fucked in the head" so this gave me a great desire and yearning that I'd never end up like them, and to get as fucking far away from them as possible, to just switch off that part of my life and never, never, never look back. It also gave me a horrendous fear that what they said about me would come true, something that persists to this day, perhaps slightly less but it's still there. You know that even the fucking most horrendous road traffic accident or cardiac arrest or guy with his arm caught in some machine really doesn't compare to the years, and years, and years of intense psychological torture I had endured so my Clinical Mentor would always say oh you're pretty thick skinned or something, like for somebody so young you just get in and do it .... If we go back two years my ex-fiance and I were in full swing planning married life and we met this fucking muppet cunt who filled us full of shit from day one, absolutely lied his face off to us about everything. We were only one state above in Indiana and the more his nasty, horrendous lies continued the more we thought of perhaps moving down there, as he did offer us a spare bedroom in his fantasy condo, he was such a good friend we said he could deliver our kids, seeing as how my whole like one day of birth and the newborn from my national diploma folder just wasn't going to cut it. The thing was he had Facebook, Twitter, Google Voice, phone numbers, photos, seemingly had all the knowledge and professional contacts, he was so convincing that you sort of couldn't not believe him; not like he was just some random on an internet forum, he was so utterly and entirely convincing he had plenty of people sucked in. When it all blew up in our faces maybe not quite a year later I got angry, I got so fucking angry I wanted to go down there and fucking homicidally attack him, like just fucking flip out and beat his ass to death, like those people you see him on the TV who stabbed somebody up like 300 times or bludgeoned them to death so horrifically even the hardened crime investigators of 30 years experience are out back vomiting. Why did I want to do that? Not because he had lied to me, but because he hurt the person I loved and cared about more than anything in the world, the person who I would do anything for who was so upset I don't think she slept for a couple days, she was pretty messed up for a while. Oh I should also mention at this point in my life (well up until then) I was actually happy, having never been happy and only been fucked up ever since you can remember is you know, really not good so it was kinda nice to be happy. I say that really was the beginning of the end, it was only a couple months later that we broke up and I came back here. Then that didn't go down very well either, it was way fucked up and I still do not really understand it but you know what, I blame myself, I mean everybody else was normal right, so it must be the fucked up one's fault, makes sense. I lost the one person I cared about more than anything in the world and the friends I'd made, and it can only be my fault. I lost the perfect chance at everything I'd been seeking since I was a little kid, ever since I knew that my upbringing was not normal. You have no idea how perfect it was. Then my stupid fucking family got involved and started spreading trash and just caused more problems which I only found out through somebody else. Since September I've been in a very, very dark place mentally and I can't seem to get out, I am deeply ashamed that I let something I worked so hard at and treasured so much slip through my fingers, it's just not a good feeling, it's probably the worst feeling in the world, I wouldn't wish what I am going through on anybody, not even my worst enemy. Not psychiatric drugs nor hours and hours with a psychologist have helped, some days I don't even want to get out of bed, I lay awake nearly every night and struggle with coming to terms with all the crap that has happened, of which Frazier is one part, it really has destroyed me mentally and psychologically and the worst part is that it's my fault. All I ever wanted was to escape my past and get to a place where I could just breathe, just relax and not have to deal with the repugnant, mentally crippling life I'd had to life for the past 26 years, to look at the future with certainty. I had it, I had it so fucking perfect, and I killed it, and that's something I've never really gotten over, even months and months later I still can't sort of put it behind me no matter how hard I try. Then this piece of shit comes back and brings it all back up again, way to go bro. I'm much too young to feel this damn old, but I suppose that is what happens when you travel at twice the speed of life. Oscar 10, status 1 at the moment ... waiting on R50, waiting, waiting, waiting ....

Thanks Frazier, thanks for reminding me that most people I once considered my friends have either been lying pieces of shit or that they are no longer in my life, thanks for bringing home the fact I have lost the people I cared most about and am deeply, deeply ashamed by the fact my actions or inactions probably contributed to that. Thanks for reminding me of the terrible, terrible emotional pain that you caused me and people I cared so very much about Thanks for reminding me it was really so necessary, not Well I'm off to hide from the world for a while and perhaps try to come to terms with why when all I gave you was my friendship you burnt me and the one I cared about. Smooth move jackass

Yes that's perfectly acceptable with either small fixed bolus amounts (10-20mg) or say .05mg/kg

2mg/kg is an anaesthetic dose You can use that dose for cardioversion yes but it will render the patient unconscious

Ketamine is a wonderful anaesthetic drug, it has excellent cardiovascular stability and can be used in low dosages for analgesia as well as in large doses for anaesthesia It is a bit weird in that the patient is unconscious but their eyes will probably still be open and they may salivate a bit