Kiwiology

Welcome mate! Why'd you choose to work in the US (esp CA) over Australia, seems like a backwards step! This place is pretty craz, you'll sure meet some good people. Watch out for my pet elephant in the front yard yeah?

For neurogenic causes of coma and poor airway, we give fentanyl, midazolam and suxamethonium. Everybody else gets ketamine as well as fent and sux. Re ketamine and ICP http://www.metrohealthanesthesia.com/edu/ivanes/ketamine1.htm http://findarticles.com/p/articles/mi_7503/is_201003//ai_n53080607/?tag=content;col1 I don't have a secured airway at the moment so I would like to intubate this patient. It may be worth trying to pass the tube without medicines given this may be possible although if not I won't want to be destroying his BP and ICP by buggering around with laryngascopy. If not possible then I'd like to give him a couple mg of midaz and 1.5mg/kg sux and intubate.

Try and ventilate with an NPA If that works get him well oxygenated and then RSI (1mcg/kg fent, 1.5mg/kg ketamine and suxamethonium) or do it anyway if the NPA doesn't work If that doesn't work perform a cricothyrotomy As far as the bleeding, apply direct pressure or if his skull is fractured and all mushy and/or floating just apply a combi dressing (4x4) 500ml NS KVO How far away is the hospital? After we get an airway I would consider (but not call) HEMS depending on how far away it and the ho'biddle is.

Aw sweet does this mean Ima finally be on COPS Damn dudes lets have a chillax and see what we are working with eh? Sounds like a plan to me! Log roll and collar, scoop, move to the ambulance. Basic vitals (BP/HR/RR/SPO2/GCS/ECG) and exam, expose, good look at pelvis and abdo. Oxygen NRB @ 10 LPM IV access Traction splint broken leg

Check the patient, primary and secondary survey; baseline vitals etc

This is outrageous, I am deeply dissapointed ...... that I didn't finish bloody law school!

OK maybe the wrong word but I would say they are a stakeholder, they provider the service, they have a stake in how that service is provided.

There is absolutely no place in an emergency ambulance service for a driver only role. The education framework is designed to transition the prehospital model away from the concept of driver and attendant, and it is worrying that this could be a means to correct the single crewing issue. 1. Incidents involving more than one patient require a second clinician 2. Certain procedures require two trained clinicians 3. Most equipment requires two trained clinicians 4. Cardiac arrests generally require three to four clinicians to offer the best chance at survival 5. Motor vehicle accidents frequently have multiple patients that require assessment 6. Uniform similarities further confuse the public and promote credibility issues 7. Funders and service providers would be culpable for the fraudulent misrepresentation of service provision i.e. claiming a crew of driver and attendant is a safe crew and equitable in comparison with a crew of professional Paramedics 8. The concept is a crude method to crew rural emergency ambulances (driver and clinician) 9. Only having one clinician limits overall capacity for multi casualty situations 10. A driver only concept attracts inappropriate people who are more interested in the red lights and sirens aspect. This creates privacy and confidence issues 11. A driver only concept is internationally inconsistent and would be a backwards step Stakeholders that promote such a concept show a lack institutional knowledge, limited international experience and understanding, and show poor leadership by even considering this.

Record it on your phone and put it on Facebook man

Aw poo .... and I liked propofol so much but does this mean I get ketamine instead, that should be interesting, the hallucinations should provide some neat entertainment

I don't thin naloxone would do anything, it wasn't really indicated ....

We only have midazolam

The treatment of choice for me is some midaz to stop the seizure, wait a minute to see if he loosens up and look at tubing him. This is a tricky one because we are giving midaz for the seizure but we would also give it (probably in a bit lower dose for RSI in neurogenic coma) however for RSI we can also give ketamine over midaz and should also be giving 1mcg/kg fentanyl. So I am unsure as whether to give fentanyl and sux ontop of the midaz (which we gave for the seizure but also will have some amnestic properties) or just give him some midaz and sux. Either way, intubate, add PEEP of 10 and go to the hospital lickedly split.

Dare I say any group called a "First Aid Squad" should somwhow be forever banned from providing prehospital medicine?

Wow thats a pretty horrendous FAIL

This article really doesn't suprise me. Any EMS employer who has thier head out of thier arse should recognise the value and leverage of a heahtly employee and provide cheap corporate membership to the gym

There will be only one Paramedic level; the I/99s have to transition up to Paramedic via a bridge program hence the "I/99-Paramedic transition" It is no different here where current IV/Cardiac officers who are called "Paramedic" have to either do the Upskilling module to be called a "Paramedic" (as we are phasing out Paramedic and moving that title to Upskilled Paramedic) or drop down to Ambulance Technician (BLS). Dust you broken down old sack of crap, use that wheelchair of yours to barge through the crowd and go aft, I think Second Officer Lightoller is loading boats that way.

Yes AM is correct, also that atrial and ventricular rates can be different Do you take the LMA, standard intubation, RSI or .... the mystery box? (the box, go for the box! It could be anything, even intubation or a new boat!) Your patient is clenched up and having a seizure, how would you proceed if you are going to RSI (we use fent/ketamine/sux for RSI but can use midaz for neurogenic cause of poor airway/breathing)

My advice to you is either 1) Don't do anything as it opens you up to what could be never ending legal liability or 2) get higher certified!

I note yet another quality, well well written and fully referenced piece of material appearing in JEMS ... not Perhaps the author has some evidence for his claim?

You could always do a 12 lead you know 12 lead shows anterolateral infarct (couldn't be buggered searching for a copy we know what it looks like) BGL is 4mmol/l; how much D10 would you like? For a symptomatic hypoglycaemic we use 100ml and this guy is certinaly not a sympto hypo and didn't we just get done saying excess glucose in infarct is bad? I'd say ... give him 25ml. SPO2 is now 91% and his rales are getting worse

Last guy who quacked I picked up had an inferior infarct, and you could even see it on three leads!

Yes my mistake, the HR is 130 There is no apparent discrepancy between the date of filling and instructions on the bottle vs how many are left in the bottle The pupils were constricted upon arrival but when moved to the ambulnace you note one is now dialated Patient poos all over your nice, clean stretcher IV NS KVO Lung sounds are now crackles

Ok, so having had basic vital signs taken ... what would you like to do with them? (numbers above) Mocachino and slice of chocolate cake to go are not acceptable answers .... *taps foot

Please participate on only one forum After a day of dragging people strapped to a gurney into your van with tinted windows and giving them drugs (what? ... you make it sound like something bad) you are sent to a guy passed out in his car on the side of the road. When you arrive there are two cops and seven firefighters standing round doing nothing as well as the Engineer who is leaning on the truck looking at the chalkboard menu of the diner he has parked the outside of. Single male patient in his fifties on the drivers side, slumped down over the seat and passenger seat. - Unresponsive, GCS 3 - RR 24 PR 90 HR 130 BP 230/120 SpO2 96 BGL 90 (~4 mmol/l) - Sinus rhythm on 3 leads - Clear and equal lung sounds - Constricted pupils - Medic alert bracelet says diabetic There are two bottles of medication in the centre console; one of Effexor and the other is Captopril. So while the fireys sit round eyeing up the daily specials what are you gonna do?