AZCEP

The best I could find seems to indicate the patient that receives a heart transplant have more sympathetic discharge, so the beta blocker MIGHT create excess vasoconstriction without allowing for the heart rate to remain normally elevated. I'd have to ask where this other medic heard this. Beta blockers, with any degree of cardiac specificity, would be relatively safe to use.

Interesting thought. Hard to say precisely how the brain will respond in each individual, but your thought process seems to make sense. Might be something to consider discussing with a neurologist/psychologist. Just be prepared for the "I don't know.", response.

That is a great question that many don't even consider before they try doing something they've seen once. Here's a site that might give you the information you are looking for. Be forewarned though, there is a lot you will have to sift through.

Did the patient come out of the car with the same number of parts that she went into the car with? Were all of said parts still functioning upon removal from the vehicle, and arrival at the hospital? If you didn't like how the rescue was performed, why didn't you stop it while it was happening? Why don't you ask the people that were there and saw what was happening, why they did what they did? We don't know anything about how this scene was managed, and you are going to get some opinions you won't like. This thread will continue forever, because someone, somewhere will have another take an what should have happened.

Does this really surprise anyone? Attend any county governmental meeting with budgetary issues, and you will hear similar ideas thrown around. Only when there is a unified voice for the need will those setting policy back away from it. Yep, paramedics should be "illiminated". Right until a supervisor's family member dies because there wasn't one around. Then they clamor for doctors to make house calls, like when they were growing up. :roll:

Lidocaine is not indicated for Aystole/PEA. EVER. It can be considered upon return of spontaneous circulation, but not a moment before.

The guidelines themselves aren't too bad, but the way they were presented for the instructors to use left a lot to be desired. Once you can get these providers that have renewed the credential a couple of times to understand why the changes were made, they aren't so difficult to convince. The biggest problem I've seen is fighting through the dogma that many have clung to from previous versions. They've been out for almost a year, and some just don't want to consider changing what they are doing. The fact that most of the changes have been well publicized for the last 3-4 years, tells me that some of the providers and instructors need to re-evaluate why they are doing patient care.

How is this a start? A first responder is what every person that has looked at a first aid pamphlet at some point in their life is. Allowing first responders to respond to EMS calls cannot be allowed to happen. Allowing BLS providers is marginally acceptable, but anything below that needs to stay home. Someone is going to have to die for this to be recognized as a bad idea.

Only two things are infinite, the universe and human stupidity, and I'm not sure about the former. --Albert Einstein

I thought that I had answered it. :?

Sorry, you don't have that much power...yet.

"No matter your difficulty with mathematics, I assure you mine are greater."--Albert Einstein

Blast!! How do they come up with proposals for grants to study the blatantly obvious?

Without laying the heart out on a table and cutting it into easy to define sections, you can't really hold such tight definitions to it. V1-->V2-->V3-->V4-->V5-->V6 are all contiguous, but some will argue that if V3 and V4 are contiguous then V1 and V6 could be as well. :roll: The kicker is when you explain that V6 does in fact show septal activity, only reverse of V1.

What's hell about it? This happens more often than not for my department.

Good discussion on a topic that is easy to become confused about. In the technical definition, contiguous means viewing the same anatomic region. Unfortunately, the heart doesn't have barriers to divide on section from the next. V1 and V2 are septal, but if the changes present in V2 and V3, you are looking at the anterior wall. Same holds for V4 --> V5. Yes, V5 is lateral, but when the injury occurs on the intermediary tissue, you have to consider them as contiguous. Good to see some thinking out there.

If you don't want "smart-ass" comments, don't ask blatantly intelligence impaired questions. If you looked at all at the AHA site, you would have found what you were looking for. Hell, if you are in such a twist to get the "new" information place a phone call to your local training center and let them do the work for you. God forbid you have to do some of the work for yourself.

Good reason not to go to Paris. I wonder if the same thing is happening in, oh say, Wichita, or Minneapolis? I remember arriving in Las Vegas the first time and feeling disoriented, but then I slept it off. No harm done.

The best I've ever seen was the time the attending met our ambulance in the ambulance bay--outside the ER--jumped in the back and we worked the code for 10-15 minutes before we decided we should probably move inside. When we did, the entire staff was standing outside our ambulance since they couldn't get into it. They just stood there wanting to do something, but there just wasn't any room for them. The worst was at the regional trauma center. My partner and I activated for a fall from ~12 feet. When we arrived there must have been 30 people standing around the bed. As we go to lift the patient over to the ER bed, one of the "team" grabbed the board, and promptly jerked it out of my hands. Board crashes to the floor between the bed and our gurney. I looked at him and asked if he was quite done with helping us. The attending made him sit at the nurse's station for the remainder of the shift.

You've got to be kidding, right? The "new" guidelines have been available since November 2005. You can download them from www.americanheart.org Or, you could purchase the provider manual that goes with the "new" class.

Multi-dose vials are a nice way around your problem with the ampules, but if they aren't available you will be out of luck. I would suggest making sure the needle is securely threaded onto the syringe beforehand. If this happened during this situation, you might have it happen during an administration of an IV medication as well. When you are injecting into an SVN, it is generally better to slow down a bit so the medication doesn't splash. Sounds like a bit of all three of your suggestions would be the ticket.

A patient with scoliosis can't be immobilized the standard way. If you meet resistance, or create pain, stop where you are and limit the motion from that point.

The only cadavers available for my program are the medic students that show up hung-over, and half asleep then try to hide in the last row of the classroom. :x

A couple lightbars, and some "EMT's save paramedics..." stickers, and you've got the ultimate wanker-mobile. Why would you care how easy it is to park? Just carry a note pad to leave contact information on the cars you roll over.

For Demerol it does have an effect on pupillary constriction, but it requires a higher dose to accomplish it. The pupils are another smooth muscle site that Demerol doesn't have a great effect on.