kevkei

Like has been stated, unless it is a 2+ page document, leave it on if it relates to what you are applying for. You have to keep in mind, when you submit a resume, it gets evaluated and graded. Though there are few reasons to lose points on a resume (grammar, spelling, format), anything that you submit will add value to your overall evaluation.

So should their supervisors be the only ones to carry guns too? Sure, there are instances of improper use, but there are also cases of improper use of our instruments too (14g IV in the hand, NPA or OPA placement, inappropriate painful stimuli, etc.....) You only hear about the bad cases, not the ones where it prevented to suspect from being shot and potentially killed or it prevented further harm to the public. On the topic of deaths in relation to Tazer use, the vast majority of these can be attributed to a condition called excited delerium. There are plenty of documented cases of excited delerium killing people without Tazer use or interaction with the police at all. Generally, these people are so loaded with CNS stimulants that they get to the edge of the cliff and fall off, regardless of Tazer use or anything else. Yes, it may be argued that the Tazer causes additional sympathetic system response, but so too will shooting them or having 10 police officers jump the guy. The moral of the story is you are damned if you do and damned if you don't. These people will die regardless of the circumstances if they don't receive benzo's to depress their heightened CNS stimulation. To be honest, I don't know of any direct link to in custody deaths attributed to Tazer use, this is more of an assumption made by the media and the public, nor has there been an official 'cause of death' implicating the Tazer. Sure it sounds like a bunch of electrical energy but you need to understand volts compared to amps and it's not the voltage that kills you, it's the amperage. People can get struck by lightning carrying 1,000,000 volts and survive, so what about a Tazer? The problem is we have people (LEO's) out there in bad situations trying to make the best decision they can while the rest of society stands back to play armchair quarterback.

If you will take a moment to look, you will notice that I'm not from the US.

Hey all, I have an info request for you. I am currently involved in a project that is looking at innovative and creative ways to deliver alternative forms of EMS that fall outside of the traditional scope of respond, treat and transport to a hospital. Specifically some examples of what we are looking at: • Expanding the scope of practice for EMT’s and Paramedics, something akin to a Paramedic Practicioner (Somewhat resembling a P.A) • Taking the hospital to the patient in an attempt to meet the patients ‘needs’ as opposed to their wants. o Examples of this would be access to a large referral network. o Working with primary care and urgent care networks possibly with the ability to transport patients to areas other than a hospital E.R Some services that we are researching are Metropolitan Ambulance Service in Melbourne Australia, the National Health Services model out of the United Kingdom, MEDIC Mecklenburg EMS Agency Charloette/Mecklengurg Co. N.C as well as Richmond Va. Do you or your service have any experience in these areas or do you know of anyone that does? If so, I would like to hear from you. Drop me a P.M Thanks for your consideration, Kevin

It's probably a combination of poor planning and preparation as well as assumption. I agree that you should pass the largest ETT size the pt will be able to tolerate. If you plan ahead and have 1 each of ETT sizes from say a 6.0-9.0 ready to go, you can perform the laryngoscopy and take a look and then decide what sized tube to pass. Typically from what I have seen, if you only open up a 6.0 from it's packaging, that is what people will use even if your view is unobstructed and there is minimal edema. An extra 20-30 seconds worth of planning and preparation will save you in the long run and will also benefit the patient. It is value added time with exponential reward. As for the use of Sux, if you are anticipating a difficult intubation, why not use it in the event you fail and run into a can't intubate/can't ventilate situation? How long is the serum K+ shift affected in relation to the Sux's duration of action? I understand that it is often advantageous to be 'better safe than sorry' but I think it better applies to a controlled situation with optimum conditions and if you have an acceptable alternative. The problem that I see is people revert to "I was taught....." which doesn't neccesarily lead to the best decision making. If you have one paralytic and one oportunity to attempt an intubation, use it. I do agree that in the situation of "we prefer to use...", it demonstrates a valid thought process but shouldn't be limiting. On another note, is there any consideration of either nebulized epi or racemic epi as a bridge in these situations?

It's easy to blame the intubation, the RSI, or whatever else. What about considering the fact that if nothing was done at all, he would have arrested. If you consider things that way, it makes the decision to do something a lot easier.

Well, you are being picky and that's okay. I guess I had an episode where I was stuttering while typing.

HellsBells, I'll beat everyone to the chase and keep it short. Treat the pt, not the pulse oximeter. The values obtained by SpO2 are very limited in their significance and are often over stated.

It's a common sense issue really. If everything else has failed to controll the bleeding, why not? If direct pressure, elevation, pressure points, etc has not had the desired effect, it is fair to assume you can sacrifice the limb to preserve life (life over limb theory). Keep in mind, venous bleeds tend to be controlled more easily than an arterial bleed. If it is a laceration of the femoral or brachial artery, blood flow is already impaired so how is the application of a tourniquet going to hurt? Use of a BP cuff is safe and effective as long as it can physically be applied (not effective for example if it is a stabbing located in the femoral triangle). You can more easily titrate it to desired effect than a tourniquet. It's use in hospital for surgery and exploration in the ER happens all the time, it's called a Beer block. I think if all else fails and you can't control a bleed, you would be negligent not to try to use a BP cuff and/or tourniquet as opposed to allowing the pt to exsanguinate because you don't want to cause tissue damage?

To expand on AZCEP, There are two ways the leads can be contiguous, that is, "anatomically" in any of the leads or "numerically" in the precordial or chest leads. If you have something showing in leads V2 - V3, this would be numerically contiguous and looks at the anterioseptal aspect of the heart. What if you have anatomically contiguous changes (ST elevation) say in leads I and V6 (or what about aVL?)? Both are looking at the lateral aspect of the left ventricle so you have enough criteria to say there is evidence of injury in two contiguous leads.

ERDoc, after the use of either RE or epi, don't you guys add a steroid like PO Dex? That is the standard of care here, either they get Dex alone (mild-mild/moderate croup score) or after RE then are discharged moderate-severe). I thought there were studies that were able to defunct idea of the rebound effet with the added use of Dex.

Many studies have shown that there is no better efficacy with nebulized epi or racemic epi over albuterol. Considering the added potential of more significant side effects, albuterol is a better choice. As has been stated, nebulized epi is better where you want to see the alpha effects, like in anaphylaxis (lingual or pharyngeal edema) or croup. IM is okay if given in a large muscle mass (sub Q is a poor choice given the alpha effects it decreases it's absorption) in severe bronchospasm or when nothing else seems to be working. I've found that albuterol + Atrovent (ipatropium) repeater prn works well and if you need something extra in the moderate/severe patients, add 2 mg of Mag Sulfate IV early in your regimen. Keep in mind this is for the asthmatic, not the COPD'er.

Actually it is the ammonia content in the urine that deactivates the toxin, not the temperature (as it would already be the same temperature of the affected area) . Heat, as hot as can be tolerated will denature the protein in the toxin and renders it ineffective.

That's why here, we don't have 'protocols' they are called Medical Control Guidelines because they recognize no call or guideline is black and white, it's all grey. For example, we are encouraged (read, you are stupid not to) to do a 12 lead prior to administering nitro to rule out RVI and to also do a 15 lead in the presence of inferior changes and/or if elevation is present in V1.

One point of clarification if you may. How do you know that it was the diuresis that resulted in the improvement and not the result of concominant therapy or nitrates themselves?

LEt's say for argument's sake, he has a localized spinal injury in the lumbar region. What would be the point of applying a c-collar? Absolutely none. I will advocate that for some people, the limited splinting of being strapped to a board may provide some relief although they are few and far between. For most, it is somehow trying to find a position of comfort. Usually it seems lying on their side with knees flexed and a pillow between is best.

Dust, wouldn't you say though that more EMS protocols are being driven by evidence based medicine these days? If they aren't, they damn well should be. Argee with Rid, tniuqs and Dust that evidence based medicine is the ONLY way to go otherwise it's all Voodoo.

18g on a neonate? I hope you aren't trying to be serious. :shock:

We did too 3 years ago and ended up getting twice what they had offered. The result was due to them not bargaining at all, the offer on day one was the same as their final offer at the 11th hour (bargaining in bad faith). Agree'd. It isn't a bargaining tool if they don't think you will do it, so sometimes you have to prove them wrong. They sold it to city council and the tax payers that they had an adequate contingency plan but failed to mention they could only survive for 12 hours with half of the units we would normally have. Using the addage about serving the patients, all they do is use that as a hostage tool. Why should we care about the patients when our employer doesn't care about us?

CCEMS sucks Say hi to Barry for me.

Why, why, why? Did I ask why? You would be more equivalent to an EMT-I than a basic so why would you want to?

Well that depends, there are forms of Valium that are water based/water soluble on the market now. So not all is oil based. Having said that, Versed would be a much better choice from a pharmacological perspective.

What is a toque? [web:7af692a29b]http://en.wikipedia.org/wiki/Tuque[/web:7af692a29b]

GAmedic1506, so are you telling me that if yo have a patient that states they took 10 tablets of extra strenght Tylenol, you are going to administer AC? I'll tell you why it is being given less and less, because people are better understanding pharmacodynamics and pharmacokinetics. To be specific, our local ER's are now only giving it in few and very specific cases. One needs to understand the LD 50 (lethal dose) and toxic levels of a drug, then they need to understand what those effects will be. For example, if you have someone that has an isolated intentional overdose of 100 tabs of Paxil, they may have toxicity but there is no chance of it being fatal or even causing any harm to the body. AC administration is looked at by evidence based medicine based on a risk vs benefit analysis. The FACT is, the risk typically is a lot higher than the benefit. And don't tell me that aspiration is crap. It is a given fact that charcol is bad and does nasty things to alveolar tissue. So if you want to practice cook book medicine, go ahead. But don't try to tell a bunch of these very intelligent and well respected posters here they are out to lunch. Maybe it is you that needs to look in the mirror?

Clinically, there is no real reason to splint a suspected hip fracture or dislocation. Even for the femoral shaft, greater/lesser trochanter, etc. If you think about it, what is the recommended way to splint a suspected fracture? Splint the joint above and below the injury. Well here you have a very stable orthopedic injury that is being splinted by very large and strong muscle groups around the joint itself. The area of the injury is not going to move. However, what will move is the areas pf the leg distal to the injury. Most pain is caused by people manipulating the leg by trying to adduct it back to the midline and then 'splint' the legs together by whatever means. This is the worst thing to do if they have evidence of internal rotation, the patient will be sure to SCREAM as to how much it hurts when you do that. Talk to an orthopedic surgeon, they will tell you there is no real need to isolate a hip fracture/dislocation. Ususally the best method is to 'splint' by placing it in a position of comfort.