AZCEP

Yep, they will use the Mucomyst, and as long as the LFT's don't remain elevated he will actually do okay. The pink vomitus was probably from the esophageal lining. Early charcoal would have done a good job of binding the APAP that was in the GI tract, but it also binds the Mucomyst.

The major problem with the Combitube is the latex proximal cuff. The King LT uses a silicone cuff instead. The Combitube is also less likely to be placed without causing airway trauma due to the size and rigidity of the device. The King LT is much smaller and can be used to guide a bougie for ETT placement when the situation becomes necessary. None of the alternative devices are without their flaws, but the King LT seems to be the best one so far.

Problem solved

If an individual was stung by a jellyfish, wouldn't it stand to reason that the affected area would be cooler than the urine? Coming out of seawater will reduce the temperature of the area. Often the only thing close to hot water that is available in these situations is urine. Ammonia does little to help with the toxin.

The additions of IVs and combitubes has already been done in many places to the BLS level. Creating an entire level with these skills does not create more capable providers. Plenty of discussions have already been done on this very topic. If we want pseudo-ALS providers, then why not add to the basic without creating an intermediate? The very idea that a partial upgrade is acceptable should be appalling to all ALS providers. Whenever you compromise with the educational standards, who gets the short end of the situation? By it's very nature compromise will create band-aid solutions. The intermediate level should not be viewed as adequate, because it isn't. Allowing jurisdictions to decide what level of patient care they will provide only worsens the situation. If you want EMT's with some extra skill sets, then allow that. If you want full paramedic capability, then support the move to this level. If you want a little of both, you are missing the bigger picture.

The assumption is that when you OPEN the airway it is clear to the point that you are able to visualize. Attempting ventilations proves that the airway is occluded, but does not tell you where. Chest compressions are a more effective way to generate the artificial cough than abdominal thrusts. With the focus on circulation, we should consider that moving to earlier compressions may be a better route to take. The management of FBAO is not typically addressed in ACLS, unless there is a BLS course being done at the same time.

If you know that a patient is on digoxin/lanoxin/digitalis/digitek, you can expect them to be experiencing any number of rhythms. When you place your patient on the monitor, and there is an abnormal rhythm present, it's reasonable to ask about their use of any of the Dig-medications. If they aren't you might have to do something. If they are, you might not be able to do anything about the problem.

Coral snake bites account for less than 5% of all the snake bites that are referred to poison centers anyway. If NREMT is using this as a subject to be tested on, it is rather silly, but that should be no great surprise. Become a firefighter, pay your union dues diligently, get passed on a test that you fail, carry on the grand tradition, wonder why you don't get the respect you want from other medical professionals.

Nice to see that you are looking into things before diving into the mess. AMR has been in the area longer, and currently handles most of Las Vegas proper, while Medic West handles Henderson and some of North Las Vegas. Regardless, there are ALS first response fire departments that cover the entire valley. AMR is a SSM style service, and I'm not sure if Medic West uses a similar system. Right now, my insider sources tell me, AMR is looking for a new operations chief, and there is very little morale at the service. Medic West has pulled most of the talent from AMR, but I've not worked in Las Vegas in a few years. AMR also covers the Laughlin area, but you have to earn the post with seniority. The state of Nevada does not regulate Clark County. You need to talk to the Clark County Health District. They have tests to allow you to practice in the county. They do accept NREMT to allow you to test, but you have to have a sponsoring agency before you will be issued a temporary license. The orientation process goes for roughly 30 shifts, and you have to show competence before you are signed off. Some have real trouble with this, and some don't. The biggest issue is the egos that you run into, and how you manage it. AMR is currently offering relocation bonuses because they are looking for warm bodies. Medic West hasn't really run into this problem yet because of the talent pool they are drawing from. Medic West has been given the reputation of being the better place to work, but the jury is still out on accuracy.

I don't think it is for abdominal pain. The four F's that I'm familiar with: Fat Forty Flatulent Female For cholecystitis

Guess what, when those paramedics you are supervising need something done on a scene, they will not be asking your opinion about how to do it. They will follow the guidlines they are allowed to, then talk to someone up the medical chain of command. In most cases, you will be eliminated. If it is a company operations issue, you might get consulted. The paramedic on scene is the medical authority until relieved by someone of equal or higher level. You don't qualify. Sorry. Go back to school and learn all about how this works.

Get capable personnel under you that you can trust. Once they are in place delegate most things to them. Give them some autonomy to make the decisions that are necessary. Finally, get them educated on how to manage people. It is the biggest issue with most current EMS managers. They are never given the education they need to be successful. Might consider having someone in your organization become very familiar with the regulatory issues that you will run into. This may well be you for a while, but you will be wanting to punt this job fairly quickly. Good luck.

Ditto Rid. The multiple GSW patient tends to not be stable enough to tolerate the time it will take to correctly apply a traction splint. If you can secure the extremity so that motion is limited without it, then that may be a better way to go. I've got to ask, did you have a scenario like this in class? I will guess not. If you never get placed in these types of situations, how are you supposed to know how to manage it? Kudos for wanting the information, and asking for it.

There is no justifiable benefit to the intermediate level. It was created so that agencies could have ALS providers without going full paramedic. As a compromised level, everything about it reeks of too many chefs trying to create something that didn't need to be in the first place. AZ has two different levels of intermediate, the I99 and I85, and both need to be eliminated entirely. For the I85, you take 300 hours of class/clinical, then test to receive the ability to perform all of the add on modules that EMT-B's already are allowed. For the I99, you have to add another 600 hours after the I85. Once this is all done, you can take a paramedic course, spend roughly 1200 hours total and be able to do everything anyway. Complete waste of time, that no one wants to support. The larger departments want paramedics. The smaller don't want to pay for their basics to go to school in pieces. Skip it entirely. Unless you have a lot of time and money to waste.

I'm with you Dust. Of course the intermediate level should be done away with, but that is a topic all on it's own. My guess would be that the test was written to one level, say I-99, and the candidates were trained to another (I-85). I can't really see how they would qualify for the test, but that would be my guess. You've got to wonder how the Department of Health decided to allow the fire service to oversee what they were doing. What kind of lobbying power would that take? It would seem that the public is the major stakeholder in this situation, aren't they? The fire service provides inadequate service levels to the public, and they are going to decide who can and can't pass the tests? This is a good idea HOW?

Aren't the Hemcon and QuickClot issues being pushed by the military? I also thought that using tourniquets was coming back into vogue by combat medics. The research definitely needs to be done, and understood by policy makers. Having a firm grasp on how things are supposed to work is absolutely beneficial when it comes to making a clinical decision. Knowing that a piece of paper tells you to perform a certain procedure doesn't cut it. Having the OK to use a particular medication without being able to weigh the risks and benefits, makes no sense whatsoever. Research says...falls flat on it's face occasionally. Statistically, things should work this way. Realistically, no patient wants to remember what the "book" tells them to do. There has to be a fine balance between the two. Perhaps a mixture of the art and science of medicine. :roll:

Multi-system trauma on one that got run over by a drunk driver. Over zealous ventilation by a "higher level of care" on another.

Could be worse. Could have been the Cubs.

I've done a couple. Was there a question in there that I missed?

Arizona will laugh in your face if you can't prove that you've finished a course that meets the DOT minimum. This is a great move for paramedics, not so good for RN's who think they want to work outside.

I'd add an ABG, Tox screen, BNP, and D-dimer While understanding what the values mean, we should not forget understanding the limitations of each test. Especially the Tox screen.

For a great many lab values, I can't tell you what a "normal" would be, unless the range is printed along with it. When I went through school, lab values were limited to pH, PCO2, PO2, and maybe potassium. Everything else was eliminated. We talked about what the various conditions would do to the body's chemistry, but we never discussed how or why it was important. With the focus that I've placed on the pathophysiology, hopefully, my students will have a better understanding. Even if they know what the effects of highs and lows will cause/indicate.

I do agree that this is definitely a question that has to be asked. The trouble is how can you answer for yourself? Maybe I'm overthinking this, but for someone to be credible, they have to be able to do what they tell someone else to do. A supervisor that isn't willing to clean the toilet, but will read you the riot act if you don't has no credibility. An instructor that tells you how to run a code, but never spends time in the street actually doing it, has the same problem. Am I credible? I would like to think so. When I tell a student something, can I show them how to actually do it on a patient? Most of the time. Am I willing to tell someone that I don't know something? Absolutely. I think I've come to grips with my limitations, but I can't say that others will have the same opinion. These are the hard questions that have to be answered.

This may not be the direction you are looking for, but can we really assess something like credibility ourselves? Wouldn't it be applied by someone else? As a profession, we don't have the credibility due to educational issues. Combine this with the prevailing attitudes that present when we get questioned by other levels of healthcare provider, and you have the makings of a kindergarten class at recess. We want credibility, but we are unwilling to advance the craft, or ourselves. We want to be respected, but we refuse to respect those we work with. This situation can improve, but the mindset has to change before we can hope to effect one. Great topic, and hopefully this discussion will lead to something of importance.

What "needle T" are you referring to? A needle thoracostomy? IV with a three way valve? Too many possibilities to give a good answer.