aryan51

A quick search didn't come up with anything, so I guess I'll just come right out with it Does anybody have any info on how EMS works in Mexico City? It's the second largest city in the world, so they have to have some kind of organization beyond volunteer (just speculating). I'm just a kid trying to use my license to travel, and seeing where it might be able to take me. Background: 24 year old, brand new California Paramedic. Any info would be GREATLY appreciated, thanks!

Still on the topic of giving NTG to patients with XII leads indicating inferior MI's, would you withhold it deviating from most chest pain protocols? And what effects would moving on to morphine have? Would that also drop blood pressure as NTG would? Just trying to figure out what the alternate treatment would be, if any.

Looks like I need to study my XII lead interpretation a little more. I totally missed that 3rd degree. I'm thinking even though we still have borderline stable vitals I'd like to start pacing her due to the long transport time. She's going to need it soon enough anyway. Some new things to consider with this would be how our monitor is powered, and if it is by battery then we need to make sure we have enough for the entire trip. Also possibly thinking about some pain management for the TCP. I have no knowledge on fibrinolytics beyond ACLS, and we don't carry them in EMS where I'm from, so I can't really say one way or the other with them.

Awesome, we've got some ST elevation in at least three leads including some slight elevation in others, along with an outwardly symptomatic patient, so we'll definitely go down our MI treatment algorithm. Any chance when we stop to fuel in Kandahar there is a closer hospital, possibly with a cath lab? Just throwing that out there. What's our pressure after the bolus?

Please bear with my explaining out of everything as I'm still learning. Upon making patient contact I'd like a rundown on the pain. Onset, provocation, quality, radiation, severity, and time. I'd like to do a 12 lead as soon as possible, and continue them every hour of the flight to show some trending, unless symptoms worsen where I would get another immediately. I'd also like to assess why her BP is so low. I can't think why a fluid challenge might not be in order to prep for some nitro. I'd like some lung sounds and to give her 250ml NS. If I can get her pressure up to an acceptable level I'd start off with just 1 spray of SL nitro (0.4mg) to see if we can get some relief. If it works, I'll continue to about 3 doses, and if she still has some pain I'd titrate some MS starting with 2mg and going up from there. Due to how long the transport time is, I would most likely need to be giving multiple doses of MS PRN. I don't want to hog the whole scenario so that's all from me...

Just a couple quick questions from a humble student... With the question brought up of a "normal" BGL in an insulin dependent patient presenting with diaphoresis and slurred speech, while you may be suspecting a stroke given the BGL and the contraindication of D50 due to (from what I understand) possible brain tissue necrosis in a hemorrhagic stroke scenario that is not able to be assessed in the field, would it be harmful to give glucagon to attempt to raise glucose levels without adding D50 to the bloodstream? To try to rule out a higher symptomatic level? Just wondering... Also, was it not the practice of administering "coma cocktails" to unconscious patients before glucometers were available on the ambulance? That's the reasoning I've heard for them, but I still wonder why pupils weren't added to the assessment of the need for narcan. With the addition of glucometers and better assessment techniques I don't see the need for blind medication administration of any kind.

There's also EMSTI's satellite program out of Dublin. The main office is in Stockton, but this program is ran out of American Health Education right off of 680 in Dublin. I'm about half way through and feel like it's a pretty good program. It's staffed by instructors hired by American Health, and they all have a lot of experience to share from local agencies (IE San Francisco fire, AMR Alameda County, Santa Clara county, Livermore Pleasanton fire). The only con to it is anything that has to do with EMSTI itself. In my opinion it's a horribly ran business that has quite a few shortcomings that are noticeable to the students, which is just unacceptable. The American Health staff is what keeps it together, and I would recommend EMSTI Dublin only because of them. But I definitely agree with dust. I feel like when I come out of this school I'll have enough knowledge to pass National Registry, and to very basically function as a medic, but I don't think I'm getting the education I should have to 100% understand everything that is going on during calls. This won't be the case because of my interest in the field and personal studying (Scouring the depths of EMT City ), but I'm sure most of my classmates have no interest in furthering their education. If not for your own understanding and curiosity, this should at least be the case for better patient care. Basically what I'm saying is, if you have the time I'd go with dust's advice of doing your own prerequisites if you choose one of the quicker programs. It will definitely help you in the long run. NCTI isn't too bad and neither is EMSTI if you take those classes beforehand. Also, I know the City College program is very good besides being long, and you can put in for a grant with the city of SF to get it completely paid for (worked out for a friend of mine). Good luck with whatever you decide! If you have any specific questions about the other schools I'm sure I could get them answered for you too BTW.

Holy S. If any of you haven't read that yet, do it. That website seems like quite the menagerie of great minds. Ahem...(sarcasm)

Slightly off topic here, and I apologize for it. I've been noticing in some of the more recent scenarios a lot of lab values. Being a paramedic student, most of those values are new to me. Does anyone have any suggestions on reading material either online or a good book they were taught with on lab values? I'd be very much interested. Love all your scenarios by the way chbare! I'm learning a lot from you all by reading them!

There's also the possible option of pushing some morphine, knocking the kid out, and going to town trying to pull his arm free. You might end up breaking some bones on the way out, but there's a possibility you could free it. Like you guys were saying though, who knows how much time you would have actually in the "hot zone" before smoke inhalation and flames drove you away.

Thanks a lot Dust, now I'm trying to wrap my mind around an emergency C-Section in the field, haha. I can't even think of anybody around my parts that would even begin to try that!

He's saying that if he were the medic on that call, he would have taken steps to attempt an amputation in the field. I'm wondering if this is something that I'm just naive about and only happens in extreme situations, but IS actually possible...or if this person is just an idiot.