AZCEP

It sounds like you are trying to make more of the situation than is actually there. WARNING: Do not look at the following image as anything other than a single event in several different leads. There is a lot going on, and you will only confuse yourself further if you do. The hexaxial system in the top left shows the axis of this particular problem. The diagram of the heart shows the direction the vectors are following in sequence. The ECG pieces show how the complexes will look when you view them on the monitor/strip. Now, as I said, this picture is of one event. The lead, or camera, is looking at different parts of the heart and showing you the image of what is happening from the given lead's perspective. Consider the positive electrode of a lead to be the camera, okay? Now, what will happen to the image if it gets closer, or comes toward the camera? It will get bigger, or in an ECG's case more positively deflected. Knowing this, what happens when the image goes away from the camera? It will become smaller, or more negative. If the camera is in one position, and the image passes across it's field of view, what do you think will happen? It doesn't really change in size. Another way to look at this would be to watch cars go down the street. If you stand in front of one, it gets bigger. Stand behind one, it gets smaller. Stand off to the side, and don't move your visual field, and the car stays the same size while it is in your visual plane. The ECG gathers the information that presents to it. If the information moves toward a lead, it becomes...? If the information moves away from a lead, what happens? An interpreter of the information would expect certain things to happen in a healthy heart, and when those things aren't there can identify which part of the cardiac anatomy is being effected. This is what makes the 12 lead so useful, and intimidating to some.

NO. The waves that are formed are the same in all the leads. The view that you are looking at them changes. Some will be more pronounced than others, but the ECG is not reading information coming from different sources.

All of the wave forms on a surface ECG represent some degree of electrical activity. In the case of the Q-wave, the impulse is spreading from the left side of the septum (Left Bundle Branch) to the right. This movement is viewed as the positive deflection in V1, and a negative in V6. During the period of time that the septum is depolarizing, the stimulus is moving to the right. Once the septum is entirely depolarized the stimulus then moves back to the left. Check the third image in my previous post. Also keep in mind that this movement takes all of 0.01-0.04 seconds normally, so capturing the event is near impossible. The movement is almost instantaneous. Careful that you don't confuse yourself with what "bigger" and "smaller" mean when looking at an ECG. The view, or axis, of a given lead will change the overall size of the deflections. The more negatively deflected, the smaller, the wave is. The more positive, the larger. If a given lead has a parallel axis to the average movement of the impulses, the vectors that fiznat brought up, the deflections will be smaller than the deflections in a lead that is perpendicular. The larger the deflections, the more information is being delivered to the lead. The more information to the lead, the more accurate the nature of the event. You are speaking of the R and S-wave progression. In a normal heart, the QRS is almost entirely negative when viewed in lead V1. Conversely, the QRS is almost entirely positive when viewed in V6. Somewhere between V3 and V4, the QRS will be precisely biphasic. As you look at where the leads are placed this will make sense. With the movement from left-->right-->left, the information will move away from V6 and toward V1 initially. Then the infomation moves almost entirely away from V1 toward V6.

ACLS is not a certification. It hasn't been for roughly 10 years. Those that have completed the class receive a "course completion" document, nothing more. This does not indicate, in any way, they are "experts". The "expert consultation" recommendation was added to prevent providers that don't know what they are doing from making a bad decision. It does not indicate that the provider is knowledgeable in the management of the situation.

A few definitions first. Q-wave: the first negative deflection from the isoelectric baseline following the P-wave R-wave: the first positive deflection following the Q-wave S-wave: the negative deflection following the R-wave, before the T-wave Now, the physiology of the situation. The AV node relays the stimulus into the Bundle of His and right and left bundle branches. The left will receive the impulse first, due to the right bundle branching further away from the AV node. This causes the septum to depolarize from the left to the right, giving a negative Q-wave deflection in the lateral leads (I, aVL, V5 & 6). Once the impulse has moved through the septum, it will then reverse direction and move left. The movement should be from left-->right-->left, with the repolarization following a similar direction. The left ventricle will depolarize slightly ahead of the right because the impulse is transmitted to the left side first. It is this ever so slight asynchrony that allows the right ventricle to fill and causes a more effective contraction.

Where did you get your numbers from? Every resource I've ever seen has placed the resuscitation of cardiac arrest <10%. All of them included. Yes the patient that arrests in front of you with the defib pads attached will do significantly better, but does this happen very often. Seattle's numbers have been slipping over the years, by the way. Fewer and fewer citizens want to initiate bystander CPR, even there. Yes they can be quite successful if the stars align correctly. Of the 5 successes that you've experienced, how many of them had other factors that led to their resuscitation? Short down time to CPR? Short time to first shock? Not to deflate your "modesty" but there were other factors at work beside your presence. My goodness, you have a lot of people on a scene. While it is ideal to have four people in a transporting unit to work an arrest, this does not happen outside of the city limits very often. This might account for the sucess you described. Let me assure you that assigning a role to each person is good, but it is not without problems of it's own. Unfortunately, the system you describe is inaccurate. The ACLS program is not designed to test anyone on anything more than rote knowledge. Even this takes a backseat to reference material and "expert consultation". The information that is gained from the standard ACLS class is no longer about testing the students to find out if they understand the concepts that are presented. It has become an issue of giving recognition to someone that can attend a class, nothing more. The providers may well have the same expectations, but the emphasis has been taken away from ensuring their knowledge to flooding the market with providers that truly do not understand what they are trying to do. What level are you eluding to here? We are not expected to perform beyond our education/certification. ACLS/PALS/CPR are not certifying entities, and haven't been for almost 10 years. You receive a course completion document, that is all. ACLS is part and parcel of the national curriculum for paramedics, therefore it is part of our scope of practice. The problem is the minimum is not being met with this program any longer. How many arrests happen in your system? Maybe this is why you've had the success you mentioned. ACLS is not 50% of what a paramedic does. It would be a reach to think that ACLS makes up 20% of what paramedics are responsible for. The majority of treatment options may well be better than this percentage, but this does not mean that paramedics are dealing with these types of emergencies on that many occasions. The problem that all of the alphabet soup classes have run into is quite apparent. They all want the healthcare community to view them as valid. To do this more providers need to carry the credential that they put out. If the requirements are too rigorous, not enough will pay for the privilege of attending the classes. So to make the content more friendly, they make it easier to pass, or turn it into a "monkey see, monkey do" curriculum. Watch this video, push on this manequin, get your card. This is not a benefit to anyone that requires someone to administer the treatments that should have been discussed, and practiced in the classroom.

Most pathophysiology texts will do just that. This book will give the information that every paramedic student should be after before entering their class.

If you have one paramedic text you have plenty. None of the current publishers care a whit about the information they are presenting. There is no reason for an EMS textbook to be written at a 10th grade (or lower) reading level. The Caroline version has been the most cartoonish of the three since it's inception, and it holds to this method because the students like it. This says nothing positive about the direction EMS education is going. Find yourself a good pathophysiology textbook and read it until the pages come loose from the binding. A & P helps, but pathophysiology focuses on the things that are broken, and how they break. This tends to allow you to better understand how to fix them. The Manual of Emergency Airway Management by Dr. Ron Walls should be required reading also. Good luck to you.

If you want a treatment plan, you will have to provide more than a 12 lead. Sinus tachycardia, fluid bolus for the dehydration then send them home.

Tranvenous pacing is not indicated in the current guidelines for the management of cardiac arrest. Bradycardias, sure, but not pulseless arrest. As an aside, doesn't it take a significant amount of time to get the TVP in place?

The point being that if you are going to restrict access to one tool, you will need to further restrict all of the other ones also. Once the precedent is set with the elimination of a constitutionally guaranteed right, where does it end? Nobody wants to give up the right to free speach or assembly, but so many are willing to give up this one. Why is that? What makes you think the government will stop there?

Where exactly did you get the notion of getting more guns to people? The statement was to not prevent those that wish to legally obtain them from doing so. The children that are killed are a combination of lack of supervision, and irresponsible behavior with the firearm. Many are also criminal activities. Obviously, not the ideal situation for a potentially lethal tool to be in, but we allow this same group into automobiles with equally inadequate supervision.

I do believe that Eydawn has made a valid statement. I would take it one step further. The right/privilege of gun ownership is guaranteed by the base of the U.S. government. No, I'm not going to walk the tired argument of the 2nd amendment out, but if this right is taken away by the government, what will be next? What will the cost of giving up one freedom be? Is it worth it in the end?

Unfortunately, this is what ACLS has become. Memorize a few steps of an algorithm, and don't worry about thinking. At some point you will discover that you want/need to know what those steps are going to do to someone. It's really been more of a change in the method that the classes are taught, than a strict change of curriculum. This is not unique to ACLS either. PALS and BLS courses have gone through the same dilution. I can support the change in the BLS course because we want more people to feel that they can do CPR, but for the "advanced" provider these classes are almost insulting. In my ambulance, with limited radio contact and little time to call someone to discuss the situation, I guess I'm the "expert". Maybe, just maybe there will be a push from providers to return these programs to a level of respect, but somehow I doubt it. :roll:

The point of ACLS is not to restore the dead, it is to prevent it from occurring in the first place. The chances of surviving a prehospital code is <1% if it is unwitnessed. The chances of surviving a witnessed arrest in the presence of an EDUCATED ACLS provider is on the order of 15-20%. Add a patient that you can prevent from arresting in the first place, and it will increase even more. Nice that you've decided to quote numbers in your attempted southern twang. It does nothing for the impression you present. There was a time that ACLS meant something. Rid is absolutely correct when he mentions that you probably never had the opportunity to be tested thoroughly on what you think you might know. Were you to look a bit deeper than MD/DO titles, you would quickly realize that every paramedic response unit has the same ability to manage a cardiac arrest that anyone in a hospital does. Now before you pull some obscure cardiology suite procedure out, realize that those "special skills" do not have a place in an ACLS guideline resuscitation. Now might be a good time to return to the engine company and leave the resuscitations to those that understand what they are.

And exactly how would more gun laws help anyone? This situation included? Unless you are willing to try to remove every firearm and manufacturer there is no way you will eliminate the gun issue.

Ahhh, but -5 for living in a country settled to make space for undesirables.

You missed it a bit there Bushy. This individual followed the laws. He should not have been able to obtain the firearm in the first place. The merchant that sold the weapon to him might have taken a lax view of the importance of the background check prior to the sale, but it's reasonable to guess that information will be a long time coming. Gun control laws only manage those that are willing to follow them. Even if you remove all firearms tomorrow, those that follow the law will be without, those that don't will still have them. Violent crime will continue, and removing firearms does not change that. Perhaps it would make it less lethal, but the crime would be carried out in some other way.

This individual was a legal citizen that followed all of the requirements for legal firearm ownership. Another law would not have changed anything. This was not a failure of firearm legislation. It was a failure of the mental health facilities to recognize that he had a problem. Place the blame where it belongs.

Check www.erowid.com They have a huge list of street/prescription drugs with assorted street names.

And if not for the strength of the Teamsters, sanitation workers nationwide would be just as threatened by the proposition of someone doing their job for nothing. The comparison is a stretch, at best. Compare yourself to professional healthcare providers. Stop with the claims of other departments being paid. All of the ones that are mentioned are paid for the work they do. Sanitation, public works, etc. do not work similar schedules, their job functions are vastly different, and yet we continue to hold to the claims of equality. Educated, healthcare professionals need to be paid for their time and effort. There is little acceptability in the notion of providing voluntary service with the increases that you will all see in call volumes, and criticality of the patients. We worry ever so briefly about not having enough providers, then wonder how this is possible with the numbers that are still certified/licensed but do not want to give their time for free. Why would anyone wish to jump through the hoops that are required, knowing full well that the only work is going to be for little to nothing? Every system is obviously different, but on the whole the volunteer system is facing it's own collapse. If professional organizations do not take the steps now to prepare for this eventuality, what happens when it does?

JeniF371, Your enthusiasm for what is a new and potentially exciting career is great. It's wonderful that you enjoy what you do. Don't confuse the suggestion to look a bit deeper for information as a demonstration of attitude. Doing so will only help you to understand the concepts that you are looking for. Some of your questions about the utility of this particular device have been discussed, and by working a bit more for the information you will be more likely to retain what you find. If you are concerned with the time that it will take to do a cursory search, why bother asking the question to begin with? The internet is full of information, but some message boards don't get visited as frequently as others. Just look at the replies/viewed numbers. Many will look at the conversation, and decide that they don't want to respond. This can lead to frustration from those that want information and can't get it. Face to face, person to person question and answer sessions are the best way to figure some of these issues out. Talk with other departments in your area that might have the device. Ask locally, then work out from there. At some point you may need someone to actually show you something that you hear about online, or in a class. Also, try to make your question as specific as possible. As Shane eluded, your questions about this device should have been clearly covered in your inservice, or by the video that Vidacare puts out.

Drat it. I suppose I should have looked deeper than Haemophilius influenzae B. I jumped to the conclusion that "flu' meant virus. Didn't even consider it to be a bacteria. Thanks for making me look it up again.

It is not as wonderful as the manufacturer would like you to believe. It is quick, and easy. If you can use an electric drill, you should be able to use this device. It is not a replacement for adequate IV skills. I've had the chance to use the EZ IO, the F.A.S.T from Pyng, the B.I.G from Waismed, and central IV access. I will tell you that a central line is comparable, if not faster, in time, they are cheaper to supply, and have greater utility in the critical patient. Sorry, I'm just not impressed with the addition of options that take away from skills that should be instilled in every ALS provider's mindset.

Might want to check that again ncmedic309. Epiglottitis is viral, croup is bacterial. The similarities between them make field diagnosis a bit of straw drawing. We have to go with the information that is in the scenario for our best "guess". We would assume the child had received the HiB vaccine, but there is no information that says so. Harsh cough with drooling, could be either. Previous cold, leads to a suggestion of viral involvement. Being in the information gathering business, there isn't enough here to satisfy what we want to know. As for what you should spend time on, your treatment options are limited by the basic scope of practice. Patient positioning, appropriate oxygen administration, recognition of a potentially unstable patient, and transport are what you need to become comfortable with. It sounds like you are well on your way.