AZCEP

Good idea to find out what you are in for. The education you've received to this point will help, but A&P is more important than the others. Since you can't get into one beforehand, maybe you could find the book and read up on the material. This isn't going to give you the same experience the full class will, but you will at least be exposed to the information. Math isn't really a requirement, but you will end up doing some fairly simple calculations. If you've had algebra before, you should be okay. Good luck to you.

Come now, there is just as much silliness in Canada. You just do a better job of sending it south, than we do sending it north.

Good Lord. :shock: The American educational system at work. :roll:

Along a similar line to spenac's suggestion, bring in an attorney with EMS experience to discuss documentation. Always good to hear what will end up frying you in court.

No, I'm not that good. I just disagree with dropping expectations to justify another tool. The EZIO is a good tool, but that is all it is. It has it's place, and I've encountered many wanting to use it instead of other options. The hype surrounding it, and the other devices has been unbelievable. There have been many times it could be attempted, and not be successfully placed. In these situations, after much time has been spent, someone will place a central line with little difficulty. I'm just not buying into the propaganda is all.

My point is that we need to re educate people right across EMS that in many cases we do have time on our side. We need to make right decisions regarding patient care & what will be best for the long term outcome of the patient.

Drama? Maybe. Retracting his opinion? Never.

Come on now. He wanted a topic to educate BLS providers that no one would be willing to touch. I think teaching them why they should go to paramedic school fits that bill nicely.

With the errors you present here, I'm not sure I'm going to put much faith in your abilities. Get the class name right (Pediatric Education for Prehospital Providers), know the name of the disorder (Diabetes), and don't have speakers that are guessing about the subject matter. Dust will really enjoy this one. Teach them why they should be going to a paramedic class, and not be working 9-1-1 as a basic. How do you manage to have a useful class for your providers when you mix in the lay public as well? This seems to be a contradiction.

Don't think for a moment that Dust will reconsider anything. Yes, kids are different. They are significantly more resilient to the stupid things they will do, and others will do to them. When the environment goes to hell around them, they pick up on it much faster. You want a kid to lose faith in your ability, have anyone near them become an emotional mess. When this happens the entire scene degenerates right in front of you. I would add to #4 that if they are going to become an emotional wreck, feel free to vacate the premises. We will handle your child just fine without you there.

Wow...this is a first for me. I actually agree and disagree with with you in the span of two sentences. There is absolutely no EASY way to do this, but then nothing worth doing ever is. The communities, or regions, that most need the full spectrum of ALS are those furthest from receiving facilities. A BLS/ILS first response may work well, but once they are on their way, these patients need to have the highest level of care possible. I think the biggest stake holder would be the public that is being served.

Had he just come down from the mountains? Was his SpO2 >90%? I suppose bloodletting has it's place in modern medicine after all.

First thing to do is turn the pump off. Just like the patient with a morphine pump that stops breathing, if you treat the symptom without treating the problem, you will get little to no result. Assuming the patient is symptomatic due to the hypoglycemia, treat accordingly. D10 to D50 and watch their blood glucose level. You can reduce the amount of insulin that is being administered, but this is usually reserved for the patient/family to handle when they are able to. I will agree with my American peers, and recommend not using abbreviations. Too many variations to be sure you are getting the information you seek.

Aw crap, not again :roll: Medical control that knows what medics are capable of and support it. Medics that spend more time with current information than a bi-yearly ACLS/PALS/PHTLS class. EMT's that are attending paramedic school. (See there Dust, there is a place for them.) Receiving facilities that have bed space for patients to be placed in.

And supervisor medics blow. Oh, oh, oh...student medics...where do they rate?

For a lawsuit, all an attorney would need to demonstrate was a lack of following accepted standards. Injury would not have to be related to negligence, but it would be pretty easy to demonstrate. Your "accepted standard" flies in the face of JCAHO and AHA guidelines, which will be used to show that the system is negligent. Two years ago, the guidelines were a bit more open to using fibrinolytics instead of PCI. Recently, those changed to emphasize the use of PCI before fibrinolytics if the delay was less than 30-45 minutes.

After reading some of the replies, all I can say is "HOLY LAWSUIT, Batman." Transporting to a non-cath lab facility, only to be re-sent to the same place later for transfer to a cath lab is begging for a lawyer's appearance. The JCAHO standard is 90 minutes from entering a facility to be on the cath lab table. I guess I'm lucky to work in a system with one primary receiving facility that has a cath lab. Although, none of the other receiving facilities that I can transport to have any problem deferring a patient directly to the facilities that can do a cath. JPINFV, we are supposed to call for morphine as well, but our medical direction understands the limits of communication based on geography for us. Not allowing medics to give ASA is ridiculous. I would hope that your dispatchers are telling these patients to take some Excedrin, or Bufferin before you get there. :shock:

Training tells you how to do something. Education tells you that you just might not need to do anything in the first place. How many times have you delivered a patient to a receiving facility that you were sure was on death's door, only to watch the physician take his time and perform little actual treatment, and have the patient walk out before you had the strectcher back in the truck? This is what education can provide you. So many in EMS want to focus on the ability to perform a procedure that doesn't necessarily need to be done. EMS is a field that should focus on gathering information, and making good use of the information we gather. A better educational process would allow the individual to gather better information, and just maybe make better decisions based on it. Entering a degree program, you will notice there are many prerequisites that have to be filled before you graduate. Many of them with little to do with the actual field you are entering. You will also hear many entering students complaining about not needing a specific course, because it doesn't apply to what they are majoring in. Art majors don't want to take algebra. Math majors don't want to take chemistry. Biology majors don't want to take philosophy. The trouble lies in convincing these separate groups that the different courses do relate to each other in different ways. Algebra shows the importance of following set rules to perform a calculation. Chemistry shows an application for the algebra that is being studied. Philosophy allows us to see how the principles of a course have been formed by the time they were developed. There is no "BAD" education, you just have to figure out how it is going to apply to what you are after.

A full 25 grams of D50 might be a bit of overkill. With the age and friability of her veins, 50 mL of D10 might be a better option. It's not as hypertonic, and won't do as much damage to the veins. DNR status might be useful, but this patient still needs treated. Now how about someone find out why her BGL is so low?

Rate related BBB's are pretty common in the patient with a significant cardiac history. As the rate speeds up, the bundle branches are less able to tolerate the increasing stimulation, and the QRS's become wider. When the rate slows down the BBB disappears. Pretty cool to watch happen, if you can notice it at the time. Amiodarone was a reasonable call for this patient. It's not real good at rapid rate control, as the calcium channel blockers are, but it can be effective. It tends to take a long time to take effect, and the patient needs to be able to tolerate the tachycardia while waiting for the drug to work. Amiodarone is a pretty safe choice for tachycardias, but it's not really the best choice for all of them. For the interpretation, when you have a period that slows down, you can see an irregularity in the R-R intervals. By itself, this should lead you to atrial fib/flutter. As the rate speeds up, and the QRS's widen, they also become more regular. A tachycardia this fast tends to be atrial in origin. When you see a rate of 300+, it almost has to be atrial. Good call for you to learn on.

The trouble is this is so ingrained in every student from the beginning of their education that it is near impossible to get away from. Combine this with the inability to find what the optimal time frame is, and there is quite a problem in place. I'd wager this is not the common practice in Australia, and I'm relatively certain it isn't in the U.S. This is definitely a step in the right direction, but everyone has a different set of circumstances to deal with. How, exactly, are we not medical practitioners? EMS is a very specific MEDICAL field. It is significantly different from any other MEDICAL endeavor, but it is still medicine. Even, as you describe, treating symptomatically is much the same as physicians will do. Sure, MD/DO's have more education, and tools at their disposal, but they are still treating symptoms, right? How does it not "put us on par"? When restricted to the information that we are able to gather, in the situation we gather it, physicians will work off of provisional diagnoses until such time as they can gather more information to better focus their management. Until we can achieve the backing of those that put this system in place to begin with--namely physicians--we will never be able to break from the mantra. Just as there are so many ridiculous mnemonics, or sayings, that are used on a daily basis that need to be expunged from having ever being uttered to a student of EMS. The providers in the field have to agree that the old standby's just don't have a place any longer. Everything from A-B-C's to "treat the patient not the monitor", will continue to be mentioned and taught, evidence or not.

Just like any other electrical event in the heart, a given lead may not show the best picture of what is happening. A 12 lead isn't needed to confirm, but you may not be able to see the pacer spike in a single lead.

I've always had the same requirement for my BLS partners, and it is quite simple. Do what I need you to do, when I need you to do it. If I don't have to tell you when and what that is, so much the better. If I do have to tell you, so be it, but don't expect me to spend a lot of time explaining to you how. If you need clarification on why I did, or did not do something, ask later. I'll be glad to explain it.

This is why when you assess a patient for pain you have to use objective and subjective information to decide how to treat them. How does the patient rate the pain? What are their vital signs at that pain rating? Do they look more uncomfortable than they are telling you? All things that are learned with experience, I suppose.

There are many different types of pacemakers, to begin with. The two most common are fixed rate and demand pacemakers. The fixed will only pace at a set rate. These are not as common due to the lack of adaptability to a patient's needs. A demand pacemaker will change it's rate due to the needs of the patient. A demand pacemaker will usually monitor the atrial activity, and adjust the ventricular rate accordingly.