Kiwiology

This. For children the use of a spacer over oxygen driven nebuliser if their asthma is mild to moderate is appropriate. Bloody asthma plans, oral steroids and steroid containing preventer (like Flixotide) and patient education ... I haven't seen given nor given adrenaline for life threatening asthma in over a year!

Maybe he enjoys pain? Who knows

Who cares, put some salbutamol into the nebuliser bowl, plug the oxygen in and turn it on ... viola!

I too can't agree with such a statement; empirical evidence suggests far too much oxygen has been given for years; I've heard it from Paramedics in the UK, in the US, in Australia and even here. Remember, ventilation is not oxygenation and ischaemia is not hypoxaemia. I'll have my thousand dollars now.

Yep, a good sternum rub is all that is needed

Empirically let us consider the following 1) Hyperoxaemia (or at least supra physiologic amounts of oxygen) cause small arterioles and capillaries to constrict which will limit perfusion even more, not good in an ischaemic myocardium 2) If somebody has an ischaemic myocardium it is because there is a block in a coronary artery; the blood that's being blocked will still have a normal PaO2; the problem is a blockage and not hypoxaemia; additional oxygen will not do anything It's also told that oxygen for a normooxaemic stroke patient is a bad thing; I have not studied the whys and hows of that one as much but I would imagine it's the same thing. Is any other drug given out "just because"? IV fluid? glucose? adrenaline? ceftriaxone? midazolam? Hell give me some of that midazolam just because now that I think of it!

... but that defies the laws of basic science, you should only get pissy if your BGL is high and you've got polyuria due to osmotic diuresis /taking the piss Oops too much talk of piss, quick, lay still while I foley catheter you ... Well if your significant other died and you felt those responsible had been in the wrong wouldn't you be complaining? No, you wouldn't, you don't love me that much, infact knowing you, you'd drop me at like nine mile road and make me walk through Harper Woods or some shit, bastard!

Sure, that's why you need a Kiwiologist on the Ambulance, I've got a big kitchen knife that I use to cut up things and I can have a nose around the insides of somebodies gizzard as long as I have my anatomy book in tablet form; not sure how easy it is to use the touch screen with bloody gloves? Now if this bloke met the criteria for termination of out of hospital resuscitation then that's fine, but transporting him back to the scene of the accident is pretty weird. So is leaving his wife behind, but maybe he didn't like her? Heck who knows ....

Sorry to hear you're having a rough time of it, sounds like that good ole ambo deamons have reared their ugly heads again! ... you'd just laugh at my funny accent

What in the bloody hell is this versed nonsense .... we carry midazolam and only midazolam Cool, give them to me LOL funny

I got hooked in 1992 when I was molested by a nymphomaniac, prostitute loving, alcoholic space ship driving lawyer sporting a Lifepak 10 The Ambulance Service has given me far more than I ever expected and I'm very thankful for it The Ambulance Service has cost me far more than I would ever expect and it's nearly destroyed me

Bloody hell ... *checks under his bed for a Paramedic Socialist Nope none there, awesome! Hmm, there is a funny looking bloke with a tea towel on his head tho oh well never mind

Come on there must be something out there, even some sort of yetti or shemales or something that came down from Canada that is better than anal, oh you said annals, never mind bro just my Kiwiness we don't readz so good I think the two most important things here are that oxygen is a treatment for hypoxia not something to be dished out or crammed down everybodies gob willy nilly, that hyperoxia causes capillary and small arterioles to constrict and that ventilation is not oxygenation and ischaemia is not hypoxia. Wait, that's more than two thats like five or something you know two plus two is five right? Kiwi maths bro

Clonazepam; I was taking the piss bro Depends, if they are agitated to the point of being combative or a danger to the crew AND they are incompetent to make decisions so need some midaz to settle them down so they can be transported it's best to have the coppers nick round and give you a hand. Now, if they are competent it doesn't matter how freaked out they get, if they don't want to be seen, assessed or treated then fine, pack up and back to watching telly. This patient doesn't really fit into either category to be honest.

There isn't one; it's just what Iowa calls their EMTP In Canada an ALS person is called an Advanced Care Paramedic, in the UK they're called a Paramedic, in AU and NZ they are called an Intensive Care Paramedic and in South Africa they are called an Emergency Care Practitioner; whilst there may be vast differences in education, operational modality and other such things they are all recognised as being the same thing generically.

That is an absolute lie and I am ashamed you even suggested it ... the most important bits of kit we have are "no love you don't need to go to hospital right now" and the MySky HDI box that the social club pays for so I won't miss whatever has transpired on the telly while we were out. Now that we have the ability to record what's on the telly it's probably best we transport them actually because they're liable to ring back at 1am and I'm just not into being blinded by the automatic lights that get flicked on when the station alarm goes off .... shucks I like my kip

If you are that immature you can't handle examining somebody of the opposite sex you shouldn't be in a position requiring it Except me, I am allowed to be sexually inappropriate because I'm so fucking awesome at it nobody takes offence

There are one or two very small private services here who do events cover but they are more "advanced first aid" and don't require a medical director because they are not supplying prescription medicines; or at most have some GP somewhere that has written them a standing order for entonox Wait, you blokes know how to play rugby? 'strewth I'm heaps gobsmacked mate

First of all let me say you didn't do anything wrong bro. In this part of the world if we get uber crook people like this bloke who need to be transferred between emporiums of doctorologists we send a hospital transfer team with them. Why? Because we recognise that dealing with complex patients who are critically ill and often on more pumps and drips and bits and pieces than you can shake a stick at is well beyond the scope of the Ambulance Service to deal with. Your Paramedic screwed up big time but then again, perhaps he knew very little about the situation in which he found himself and didn't actually know what to do? I'm a knowledge freak but that doesn't mean I should be in charge of inter hospital transports of mechanically ventilated super-crook people because I know sweet fuck all about mechanical ventilation and how to troubleshoot it when things go wrong. It is clear you wish to learn from this situation and I commend you for that.

By-and-large the vast majority of patients who require immediate referral to ED and for whom ambulance transport is the most appropriate method walk themselves out to the ambulance.. Exceptions include things like cardiac chest pain or pain of any kind which we've had to treat (exceptions are isolated upper limb injuries), anybody who's been spinally immobilised or anybody who is reasonably "sick" If you're not walking then most times the patient will be put on the stair chair or the stretcher if it can easily access where the patient is ... if not then the scoop stretcher is a wicked bit of kit, we threw out long spinal boards a few years ago.

I strongly disagree that we should be giving this patient any benzos, hang on, let me go scoff down my morning clonnies and we'll continue .... Many patients present with anxiety/hyperventilation/ some might even have carpopedal spasm or other symptoms; are we going to give them all midazolam? It is worth mentioning some patients receiving end-of-life care are prescribed midazolam or another benzo for administration in the event of severe distress or deterioration but that's different so you can't extrapolate one into the other.

Seems like a bunch of bullshit if you ask me, but then again most politics is ....

Well, first of all we use that long lost ambo trick of talking to the patient and trying to verbally de-escalate the situation utilising friends/family as appropriate Chemically we can use morphine and midazolam but have never been in a situation where I'd want to use it nor have I ever heard of it being used.

There can be some histamine release with morphine, it's not uncommon but is not allergy. There is less with fentanyl.

What are you, a food microbiologist now? LOL I misread nitrite as nitrate, I would say "ah yes nitrite has an oxidation state of one less than nitrate" but that might send our Emergentologist back into the corner on the floor hiding from the demons of basic science ....