Kiwiology

Then you need to change how you educated your physicians. We learn all that stuff and you know, actually touch patients at the same time during all 5 years of the MBChB Mind you, we don't have to pass some silly standardised test either I have seen a lot of "teach the test" in America as you blokes love standardised tests hmmm, I wonder if that is partly to blame, or it could be a false positive

Then you need to change how you educated your physicians. We learn all that stuff and you know, actually touch patients at the same time during all 5 years of the MBChB Mind you, we don't have to pass some silly standardised test either I have seen a lot of "teach the test" in America as you blokes love standardised tests hmmm, I wonder if that is partly to blame, or it could be a false positive

It is rare for us to eat out here - all our Ambulance stations have fully equipped kitchens so meals are generally eaten on station. The McDonalds down the road gives Ambulance crew discounts, when I worked at KFC we turned the cash register off for the Police. Oh and I would rather drink boric acid or take to my limbs with a skill saw than eat at Dennys

Fix whatever is wrong with your medical education that causes these students to have no teamwork or interpersonal skills rather than send them off to an ambulance, thats not going to help any. Another symptom based approach, silly America Our medical students treat patients and start doing actual clinical practical stuff from year one of the medical degree

Nothing here indicates anaphylaxis to me at all We need a lot more information; did he have any swelling or redness, hives, stridor/wheezing, laryngeal edema, anything to suggest he indeed had anaphylaxis? Did he have any cardiac history? Medical history? What was his blood pressure like? It sounds more like a primary cardiac problem than anything else. If it were my patient, we'd throw him on the floor, quick primary survey, chuck an LMA in, sounds like by that time he'd probably have been in asystole so work him on the floor, oops he died, terminate resuscitative efforts and go back to the station to watch telly. Sounds like a much better ending and no teenagers involved.

Cool story bro .... looks like AF with a bundle branch block

There is some ventricular innervation by the vagus nerve, although less than atrial so I would still try some atropine. If it's not effective our guideline is to either pace or mix up an adrenaline drip. Could be a junctional rhythm with some non conducted PACs?

Gosh you lock your ambulances? We don't

I concur and have yet to run into a medical student, house surgeon or registrar that is full of themselves Now I dare say they do exist .... but when they do they are usually called Consultants by then

During year two of the MBChB you have to do one shift with the ambulance service I reckon a PGY1 house officer is more use on an ambulance than a paramedic in some circumstances tbh

Correct you are but this bloke had also been down 20 minutes and was in PEA when the ambos got there, who knows if the cops actually felt a pulse or not? I'm not into giving people the sheet-not-treat Rx unless absolutely necessary

The only treatment this bloke is getting from me is a sheet put over him

Our Intensive Care Paramedics here in NZ are doing RSI and prehospital thrombolysis as well as limited use within IFT for super crook people

That is what Fox News and the Government want you to think! Back in the early days of Mobile Intensive Care / Mobile Life Support Unit pilot project in 1972 you could identify the LSU (ALS) ambulances with the Star of Life on the side. For years up until the late 1990s we always referred to a "Paramedic" (now Intensive Care Paramedic) vehicle as the "LSU" even though there is nothing to distinguish them from any other ambulance in the fleet.

It would probably take this bloke the same amount of time to get his MD (MBChB) as it would to get his PA That is what I am working on ... Ah, five year undergraduate medical education how I love thee

In this part of the world Paramedic requires a Bachelors Degree (3 years) and Intensive Care Paramedic requires a Post Graduate Diploma ontop of the Degree. You can sub specialise to becoming a Team, District or Regional Manager, Clinical Educator, Clinical Standards Officer, Rapid Response, Motorcycle Response, Ambulance Rescue (SERT) and one or two other things. Surely there are equivalent opportunities in the US I mean it's not like the Ambulance Service manages and educates itself without human effort??? Paramedic practitioners do exist here in Wellington and it's a fairly young program c. 2008 but seems to be working well

"RA" is just the LA term for an ambulance Just like "IC" or "AP" (Intensive Care Paramedic) is the Kiwi term for ALS

I'd say its probably COPD

Sorry you are having a rough time mate, but you have a 100 hour wonder course that does not qualify you to touch a patient or set foot in an ambulance outside the United States. You want to know how long it takes to become an "EMT" here? A year ... and that is for the volunteers, to actually get paid for it you gotta go to University for three years and get a Paramedic Science degree.

Yes, lets him give some ondansetron. Transport time should not be a factor to decide medication administration! If he heard a "pop" in his neck then perhaps he nunngered something with his sympathetic nervous system causing massive cholernergic discharge? .... or is that a false positive?

It might be a panic attack If he is that severely nauseous, put an IV in and give him some ondansetron

What has this bloke been up to? Coming from work? Headed home from the strip club etc? Standard ambo alphabet soup special - BP, RR, HR, ECG, SPO2, temp, GCS Respiratory - rate, depth, work of breathing, lung sounds Primary and secondary survey Medical history Sounds like this bloke is either having a massive friggin infarct, a CHF episode or maybe hypogycaemia Could also be an adrenal gland tumor ... or you know 200 things in between

Any signs of trauma? Usual alphabet soup dine in please we are in no hurry - BP, PR, RR, SPO2, ECG, BGL, temp, lung sounds Secondary survey - pupils, broken bones, abdo exam

Wait until September, then show them the foreword of the 2011 Clinical Procedures with the new practice levels and scopes of practice

It was foretold in Mobile Intensive Care Officer class in 1992 that drugs in cardiac arrest are of little benefit and somehow the idea never caught on Amiodarone has been shown to improve ROSC but not improve overall survival rates