AZCEP

With the depth of information that is provided in medical school, I would hope you have to spend more time in classrooms to get it right. We just skip the proverbial stone across the surface of medical information for prehospital providers. :roll:

What I look for when accepting applications for students is quite simple. Every line/box/area on the application is filled completely/legibly, and all of the supporting documentation is included. If you are making a "statement" of your intentions, it should probably sound like a introduction letter. Just by filling out the application, it is pretty clear what you "intend" to do.

Off the top of my head, Dallas is doing some, King County Medic One probably is as well. I think Mecklenburg county in the Carolinas is doing some, and you might also try checking through ILCOR for anything else.

Several things going on here...where to start? Congratulations on the incoming child. Good luck with the employment situation. Along the lines that Rid and Dust have brought up, have you considered talking to your local labor board? They might be able to give you some direction that will actually apply to your situation. We can make all kinds of suggestions, but without knowing the legalities of the area, they are just suggestions. As a man who has worked with near-term partners, please stop working if you are having trouble lifting. You are putting yourself, your child, and your partners at risk every time you have to exert yourself. I don't know how the system you are in works, but if you run any calls with you and your partner without backup, this is terribly unsafe. Your partner may not say anything to you, but you can bet they are cringing at the thought of turning a simple, single patient scene into an instant MCI.

As you may well have noticed, very few American providers are still allowed to use central vascular access. The availability of IO has all but eliminated the central line for EMS. I will apologize to vs-eh? for horribly derailing his initial intent of gathering information about the American system, and it's differences from the Canadian. Hopefully, some of my American colleagues will be willing to chime in with how their systems work. Arizona's has been well discussed.

NREMT-B, Your question is a valid one. With a short transport time, and I will assume multiple providers, the ETT should be attempted by the provider most likely to place it with a bare minimum of attempts. If this is not possible, the Combitube is a viable option. The risk of damage to soft tissue is very real, but not placing the device due to this fear is near negligent. The combitube will actually work better if it is used earlier in the progression of the situation. Once multiple ETT attempts are made, the combitube is less able to seal properly. The BLS adjuncts are more than capable of providing some degree of airway maintenance for the short term. Providing the individual doing the ventilating is careful about the volumes and pressures they generate. Also considering the amount of time spent on the scene prior to transport will generally be 10-15 minutes regardless, securing an airway should be a priority, but can't detract from the moving of the patient to definitive care.

Unfortunately, the evidence may well indicate that prehospital endotracheal intubation is not benefitting any patients, it is increasing time prior to definitive care, and the first attempt success rate is dismal. Taking the emotion out of the equation, and looking at the published reports, why should medical control physicians continue to allow us to do this incredibly invasive procedure? Particularly when considering there are alternatives that CAN provide just as adequate ventilation volumes and pressures.

zippyRN, I would welcome you to come ride with me in western AZ so you could see the differences in what we are discussing. Even the central access that is achieved in many hospitals, locally, are not verified with radiology. The risk of sepsis and pneumothorax are greater with prehospital use of the procedure. I've already conceded this point. However, the patient that receives central access is not one that can be deemed a greater risk than benefit. These are done in the most critically ill/injured only. For these patients, whom cannulation is only achievable with smaller guage sizes, central access does provide greater flow rates. Central lines are CONSIDERED after an airway is established, and vascular access has been deemed impossible through peripheral sites. And, no, I am not considering an external jugular IV a central line. As I've indicated previously, we use subclavian and internal jugular routes, and femoral less often.

First, Code 8, know who you are dealing with before you start a fight. :roll: Second, anyone can talk about airway management, very few can do an adequate job of performing it. Third, vs-eh?, the literature is against you on your stand that PAI is just as effective as full RSI. I'm somewhat surprised that it didn't get your full attention when published. http://www.google.com/search?sourceid=navc...only+intubation Just a few for your perusal.

Much better now than when you have to use your knowledge to manage a patient. Vaughn-Williams class IA antidysrhythmics are the strong sodium channel blocking agents. Procainamide is the prototypical example. Because of the "strength" of the medication's influence, the heart rate is slowed. This is due to the influence on the inotropic actions of the myocardium. The mechanics are weakened, so the rate of depolarization is reduced as well. Because class IB are weak sodium channel blockers. Lidocaine, for instance. It has a greater effect on the electrical system than the mechanical. The rate of repolarization is governed by the amount of Ca++ that is moving into, and out of the cell. The weak influence on the sodium channels causes more Ca++ to move out before more Na+/K+ can move. The automaticity is slowed by the narrowing of the action potential. Sorry for bringing that up, but look the picture up while reading the descriptions. It will help you to understand it. Now, as the action potential narrows, phase 4 lengthens. When this happens, the time between action potentials forming increases, and the cell doesn't generate as many impulses. Voila!! less automatic. The cells repolarize faster, and use more time to recover in between action potentials. Thus the rate slows. The QRS can widen because of the slowing of the conduction through the ventricles. If the impulses are being generated above the ventricles, the lower conduction system will slow them down some, widening the QRS. The QT prolongs, because now it takes longer for the cells to prepare for the next impulse. Consider that the cell relies on the previous intervals to help "set" how long it is supposed to take to perform a given function. For the QT to remain constant, the cells need to have the same influences applied to them. When we add a conduction disturbing medication, the cells can be thrown off from what they have determined "normal" to be. The QT widening is a fairly common response to antidysrhythmics. That will depend on which class of medication you are dealing with. Check into the various Vaughn-Williams classes a bit more for a better understanding. Your welcome.

The asepsis of the field is more than adequate for the patients that receive the central lines. Sight prep is no more involved than that for a peripheral IV, and the infusion rate is significantly greater. The whole pupose of using central lines and IO's is to obtain vascular access in patients that you can't get a peripheral IV in. Cardiac arrest and multisystem trauma are just a couple of examples. An experienced provider, with the line prepped beforehand, will have central access in a similar time frame to IO access. We don't go through the triple lumen progression, so the time frame is much quicker. Just a big needle on a syringe, going into a central vein.

We are using 3-5 inch angiocath's for the SC/IJ approaches, and the risk of pneumothorax has been drilled into us. Yes, we have used the EZIO, the BIG, and the FAST. None have been terribly successful to date, while the central IV's have not had any significant problems in the last 5-10 years. Each of the adult IO devices have had their own issues. The BIG caused a few fractures in elderly patients. The FAST didn't want to release the infusion tubing from the handle, and the users would remove it from the patient with the handle. The EZIO hasn't been in service long enough to have documented good or bad yet. To date the biggest problem with the EZIO is the need to maintain the angle while drilling, otherwise it spins off the bone surface and bends the needle.

My experience with them has been that they are significantly better than IO in the adult patient. Easy to establish, rapid response to treatments, etc. The adult IO devices have yet to prove that they are reliable, and any quicker than an experienced provider with a central line. Asepsis is a bit of a concern, but the patients that are receiving the central IV are going to be receiving some heavy antibiotics on arrival at a trauma center/cath lab most times. Just another option to have. Similar to the procedure of RSI, or long bone traction splinting. Other procedures may work, but when the time comes, this may be the only option that will work effectively.

Keep in mind the only drug proven to improve survivability in an AMI is ASA. Not even fibrinolytics or PCI can tout that they improve morbitity/mortality numbers. It's great that your medical control has the leeway to be able to decide what his medics will be allowed to do without answering to some higher bureaucracy, but try to consider that not everyone has the same level of autonomy. Medical directors can want, but until state or regional councils agree, nothing can happen.

We are doing subclavian and internal jugular. We are allowed femoral, but most field providers are more comfortable staying above the waist.

Even with the combined totals, there is not a direct correlation between them. BLS: 110 classroom hours 24 clinical/vehicular Paramedic: 500-600 classroom 500-700 clinical/vehicular So from off the street to paramedic graduate with no field experience in between: Roughly 1350 hours total Most will take the BLS course, then work for a period of time before deciding to go further but this isn't a requirement of all programs.

Absolutely correct. I am judging based on the procedural content. The descriptions you give for the program length is along the same lines. PCP well beyond, ACP not quite the minimum. With the program content differences better delineated, it might be possible to view things differently. Also consider the number of clock hours of "empty" content in most programs. 1500 total hours with 700 clinical, and roughly 120-200 dedicated to review prior to the final examination.

Speaking for NW Arizona only, it looks like the PCP is well above the standard EMT-B, and the ACP isn't quite to the Paramedic. Central lines, medication infusions to include Dopamine, Lidocaine, Magnesium, and Epi PRN, surgical airways are the norm. There are a few medication differences besides the infusions, but few of the differences are used with any regularity. National sScope of Practice aside, very few providers are educated to the level of being able to use all of the suggestions that are in a program. Most will be taught to the level that local protocol allows, no more. Consider also, local medical direction has more influence on what providers can and can't do than state, or national standards do. Good topic though.

According to the Border Patrol, there is no exemption included in the wording of the law. The field agents that are enforcing it will give some consideration to EMS providers, but if the patient can communicate with you, there is a very real risk of being detained.

If you are going to buy your own stuff, try some Karo syrup. Dark or light, it will absorb faster, has a higher sugar content, tastes better, and you can use it to sweeten your coffee at the station while you are waiting to use it on the appropriate patient. Like Rid said, tablets are slow to absorb through the GI system. Or, make them a sandwich and watch them eat it.

This is close, but not quite. The limb leads (I, II, III, aVR, aVL, & aVF) look from the top--down, or base to apex. The plane transects the ventricles into front and back halves. The chest leads (V1-6) look at the ventricles from the CT, or central terminal, out to the surface. The plane transects the heart into atrial and ventricular sections.

The biggest problem with the modified chest leads (MCL's) is they do not view the heart in the same plane as the true chest leads. Limb leads look vertically, the chest leads look horizontally. Moving the limb leads will give you an approximation, but the plane that is viewed doesn't change. Better than nothing, but still not of diagnostic quality reliably.

BLS healthcare provider or equivalent Basic EMT certification with no minimum experience requirement mandated Tb/MMR result within 6 months of beginning of clinical rotations English/math entrance exam score Written/practical/oral board entrance testing There is no pressure to keep seats filled. My program is self sustaining, so if there aren't a minimum number of students we don't do a program. This has never been an issue, but if it should happen we would postpone the testing/beginning of the class just to keep the individual costs reasonable. The students that enter the programs are already employed with an EMS provider. Increasing the entrance requirements, as things stand now, wouldn't change the desire of the students or their employers to choose between programs. My program is run through the education department of a non-profit hospital. Any money left over at the end of the program is rolled into equipment for the next class, or scholarship offerings.

Scary what Google can give you. http://www.medscape.com/viewarticle/449718 I'd never heard of it before either.

Atrovent is prepared with a SOY-based preservative. If your patient is allergic to soy, they can be allergic to atrovent. The cross reactivity concerning peanuts is enough to consider not using the atrovent if you know that your patient is allergic. It is also a reason to consider withholding it from pediatrics. The anti-cholinergic effect is a better one, but we don't want to be inducing anaphylaxis if we don't have to.