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http://www.local6.com/news/14857286/detail.html Student Arrested After Cutting Food With Knife 10-Year-Old Charged With Possession Of Weapon On School Property POSTED: 3:40 pm EST December 14, 2007 UPDATED: 4:08 pm EST December 14, 2007 An elementary student in Marion County was arrested Thursday after school officials found her cutting food during lunch with a knife that she brought from home, police said. The 10-year-old girl, a student at Sunrise Elementary School in Ocala, was charged possession of a weapon on school property, which is a felony. According to authorities, school employees spotted the girl cutting her food while she was eating lunch and took the steak knife from her. The girl told sheriff's deputies that she had brought the knife to school on more than one occasion in the past. Students told officials that the girl did not threaten anyone with the knife. The girl was arrested and transported to the Juvenile Assessment Center. Watch Local 6 News for more on this story.

Dust and ERDoc are absolutely correct with their advice. Allow me to provide an alternative. You say you are enrolled at a junior college, and the paramedic program is held there as well. Would it be feasible for you to obtain an associate's degree from this institution? If so, you might consider pursuing the degree requirements after your basic class. You would be furthering your base of knowledge, and getting a feel for what the EMS systems in your area are like, while obtaining something that will be useful as a new paramedic. If the degree is not an option, enroll in the first paramedic program that comes available from an accredited source.

Atrovent does not directly act on sympathetic receptors. It will merely antagonize the effects of a receptor that will reduce the effects that you see. To use an earlier analogy, more brake, same amount of gas. Also remember that different tissue locations will have different concentrations of individual receptors. Smaller bronchial smooth muscle has more sympathetic, larger conductive airways have more parasympathetic, muscarinic in this case. This also accounts for the primary way epinephrine works during cardiac arrest. There are more beta-2 receptors in the central circulation (smooth muscle relaxation), and more alpha-1 receptors in the peripheral vasculature (vasoconstriction). The combined effect allows less theoretically oxygenated blood from leaving the vital organs.

I'm willing to speculate on the direction they are going with that statement. Because a beta blocker can help to reduce the release of sympathetic agonists, it stands to reason that having less NE/Epi circulating will allow for some vasodilation. Also, if the beta blocker in question is beta-1 specific, the beta-2 receptor should remain unaffected by it's effect allowing for smooth muscle relaxation. The Mayo page seems to be targeting the lay public with very general information, so it may well be simplifying the way they work.

Alpha blockers tend to be centrally acting for HTN or BPH http://www.mayoclinic.com/health/alpha-blockers/HI00055 They seem to be pretty popular in the local ER for new onset HTN. They can also be used off-label for behavioral disorders. When dealing with beta blockers, one should remember that the newer agents are a bit more cardio-specific. Propranolol was the prototype agent, and caused many respiratory problems. The more beta-1 specific agents also tend to lose their specificity at higher doses.

Alpha receptors are primarily affected by the presence/absence of Norepinephrine. Alpha-1 causes vasoconstriction predominantly. Alpha-2 causes the release of norepinephrine to be halted. The negative feedback mechanism that is responsible for this keeps your blood pressure from going to high when you are placed under stress. Beta receptors are located preferrentially. Beta-1 in the cardiac tissue, and beta-2 in the smooth muscle. Beta-2 is commonly referred to as a smooth muscle relaxant, but that is only part of the effect. There is also a beta-3 receptor that is responsible for gluconeogenesis, and glycogenolysis when stimulated. This is a poorly understood mechanism presently, but the effects of any of the sympathomimetic drugs make it apparent what the beta-3 receptor is doing. As for drugs: Alpha-1: Norepinephrine (Levophed), and Dopamine at higher doses, epinephrine Alpha-2: Norepinephrine Beta-1: Dopamine at typical doses (5-10 mcg/kg/min), epinephrine, dobutamine Beta-2: Epinephrine, Albuterol, Terbutaline

Yes, I am familiar with the SAM sling, having introduced them to the local ER for their use. The fact remains the SAM does nothing for the patient with an associated femur fracture. If you don't have the MAST as an option that will limit it's utility for you, but that does not eliminate it as a possibility.

The MAST is much faster than what you've described here. Place the patient on the MAST, wrap them up, and inflate. The sheet does nothing for the femur, and will only work if you are able to monitor placement and the amount of pressure you are using. This patient is too unstable to consider using a traction splint. The MAST covers both bases very well.

We've only got two choices: epinephrine or dopamine.

If you can move them onto a backboard another way, then it would be appreciated, but often rolling is often done out of necessity. For this situation, I'd place the MAST pants on the backboard before hand and use it to splint the fractures. SAM Slings are nice, but don't do anything for the femur. The HARE/Sager is good, if the pelvis and the patient are stable. If you still carry them to meet your area's regulations, now is the time to use them as they were intended.

The golden hour came about by Dr. Cowley, and his view that people needed to get to a trauma center faster to improve their survival. It was an instinctive mantra that has not been shown to be valid. Lights and sirens, like much in EMS, are useful depending on the situation. We rarely if ever use them, while some of our "city mouse" neighbors use them for every call.

There really aren't very many options commonly available. Standard issue treatments with Albuterol/Atrovent/Epi/steroids/BMV are the only options we have.

Drip rate for Pitocin to control post partum hemorrhage. The only time I've had to look something up due to limited application of the information.

But where is the lightbar? Surely they could have found some space for a few LED's. :roll:

You know what? I've never had a problem with "tween" when drawing up Amiodarone. I don't know how fast I'm drawing it up, but it's not that much slower than any of our other vial based meds. I will also get in line to pick up some of the prefilled syringes, though.

I've got to mention that if you don't question the protocols that you are given, you are not adequately advocating for the patients you will be delivering care to. Many times medical direction will assume what is, or is not available in a community. If the protocol isn't written, we should take the responsibility to suggest it.

Or, you could just take them to the cath lab to be sure On a serious note, Doc have you had any experience using ultrasound or CT/MRI for suspected MI's? Some of our docs have suggested they should be considered.

It's Vtach. Wide-fast-similar appearance to the ventricular ectopy. The patient is perfusing 80 times per minute, even with a much faster heart rate. The chambers aren't filling fast enough to allow for a pulse with every complex. O2, IV(s), start a fluid bolus, "Expert Consultation" per AHA, consider some antidysrhythmic. Transport time will be the deciding factor on whether this patient needs immediate treatment.

It is not necessarily a right ventricular failure. It will depend on where the embolus seats as to what the presentation will be.

Going strictly by the AHA definition, all infants are <1 year old. Most defib/AED pads are going to be too big to be placed on the infant without some overlapping of the conductive material anyway. The AED can be considered, as was already quoted, the AHA doesn't recommend for or against it's use in this situation. Oh, and there are more and more congenital heart kids showing up all the time. While most will be respiratory/airway issues, the CHK's tend to be cardiac in origin and their families will be sure to tell you all about them.

The QRS is only slightly longer than the textbook 0.10 sec so there may be an interventricular delay but nothing of clinical significance. Bundle branch blocks are usually defined as greater than 0.12 sec so that's out. The QRS axis is still within the normal range if shifted a bit toward the left, but not enough to be concerned with. WPW might be a consideration, but the delta wave is usually identifiable in the chest leads as well.

A clean blade and a tube is all you really need. For the frequency that the procedure is actually needed, somewhere south of 1%, you need an option that you have the utmost confidence in. The last thing to suggest is some new toy that sounds good but doesn't work any better than the simplest. The tracheal hook is nice, but a disposable nasal speculum works just as well.

I try to tell them the truth, that being they will not die in my ambulance. Considering that a patient I'm working on will be called once they get to the ER aside, I've never had someone die on me. They will die before, or after my contact with them is made, not during. Yes, I've had obviously mortal injuries/illnesses come across my path, but it is far more common for family members to ask the question than the patient. The patients always seem to know. :shock:

Find the time to get into the full discussion about the issue at hand. It may not be enjoyable for anyone, but as a seasoned provider, you have to be willing to show another the error of what they have said. I probably would have asked, "What in your vast experience tells you that this patient was in shock?" Hoping to find the specific problem, then correct it immediately.

Give me a good history of the present complaint, and past medical history, and I'll worry about the rest. You can mention your vitals, but unless there is a pattern to them they won't mean anything once I leave the scene.