HERBIE1

I'm not THAT old.

Actually I found out the hard way the effects of albuterol on labor. The wife was in labor, and she is an asthmatic. We waited until contractions were pretty close- 5 minutes apart- before we went to the hospital- 10 minutes away. (2nd kid) Only 3-4cms dilated, so we did laps around the floor for awhile, and things were progressing nicely. Of course she got winded, took some albuterol, and things came to a grinding halt. I asked why the slowdown, and they told me exactly that- albuterol is similar to something used to stop preterm labor. Took about an hour to wear off, and then things went into overdrive- to the point where I almost delivered my daughter on my own in the birthing room.LOL

I responded on your blog, but I will reiterate some of what I said here, and offer a tip or 2. Since your experience is lacking, I would try to differentiate yourself from other management candidates with education. As spenac says, whether or not an area "appreciates" a degree or education is highly variable. Look into management and leadership courses- specifically ones that provide you with theories in various types of management and leadership styles. Ideally a degree would be best, and it does not need to be specific to EMS- management is management- but again- make up for your lack of practical experience with education. As I mentioned, the trick is being able to apply those principles to EMS problems, and for that, you may need some help- depending on what you have experienced so far in your career. I have known a couple folks who had very little practical experience, yet managed to find office gigs within the EMS system. Rare-yes. Also consider taking classes that you could apply to more than one situation- maybe branch out into Homeland Security or public safety in general. Good luck.

I thought I posted this before but it seems to have disappeared. The leave 'em dead thing was a JOKE- from years ago. It was not a comment on the drug's efficacy. I haven't been here in awhile and I forgot how flip comments are too often misinterpreted.I thought this was a more lighthearted thread- my bad.

Not sure if it caused emesis, but I did always hear it referred to as "Leave'em dead". LOL Aminophyline was another one famous for causing projectile vomiting- not a good thing for someone already in respiratory distress. . Sadly, I recall times when aminophylline and epinephrine were the only medications we had on board to treat asthma. Lots of people died because we were so behind the times.

Never had physostigmine, but I recall "fondly" squeezing Procardia capsules. Another drug that I was extremely excited to see go by the wayside- at least for prehospital use- was Verapamil. Never had a chance to use it on the streets, but YEARS ago(25+), I was working in an ER and a 25 year old kid walked in off the street, c/o being dizzy. Turned out he was in SVT and being a pretty new medic, I had only witnessed a couple cardioversions- chemical or otherwise, so I was really interested. The ER used Verapamil, and to make a long story short, after the drug was pushed, the kid's BP immediately bottomed out, he coded and died. To this day I recall that incident like it happened yesterday. I thanked the EMS gods when adenosine became available.

Congrats!

Sorry- didn't finish the prior post. Hope all is well with everyone here, and I will try to jump back in. Looks like I will be teaching again in a couple weeks, have another couple possible adjunct teaching gigs in the works, so it's time to get my brain back in gear. Happy to be back!

Been awhile, folks. Life gets in the way sometimes, and unfortunately, said life sucks. Going through a divorce, helping mom recover from an aortic valve replacement a couple months ago, dealing with her altered mental status-which worsened after the surgery.

Richard- forgive my tardiness in replying. Sorry to hear of your troubles. Positive vibes being sent your way...

This may sound good in theory, but it's simply not practical. I don't know where you work, but there are many places that simply cannot afford to have ALS providers. In less populous areas, you may only have a couple advanced level providers for an entire county. In my state, there are more than double the number of EMTB's as there are paramedics, and we have several large cities. I would imagine in the more rural states and areas with a lower tax base, that disparity is even higher. Unless federal funding is secured to upgrade all services- from training, to equipping the providers, to upgrading the hospitals with needed supplies and equipment, updating telemetry and radio equipment and personnel, I don't think- especially in this economy- it's a feasible concept. Hell- in many places, there is even a shortage of certain doctors because there is no money to pay them, and the cost of malpractice insurance makes it not worth it for them to provide their services in these areas. In our state, other than the major cities, it used to be you could count on one hand the number of neurosurgeons and OB/GYN's practicing. To my knowledge, it's still a problem.

Can seizures be faked? Sure. Obviously you need to take the situation into context as part of your overall assessment. Just because someone was not post ictal, incontinent of urine, or have bitten their tongue, it also does not mean it wasn't a seizure. That said, if a hysterical 16 year old female who just had an argument with her boyfriend c/o chest pain, would you immediately give her a couple NTG's, ASA, alert the cardiac cath team, and fire off a 12 lead EKG on her, to rule out an MI? As was mentioned, zebras may be interesting, but unless you live on the African plain, they simply are not very common.

For the love of all that is holy! When will we actually force parents to be parents? Ethylene glycol(antifreeze) apparently tastes sweet, which is why dogs and kids often drink it. Should we make it taste like crap just so kids and dogs aren't poisoned? Marbles and small toys are choking hazards, so should we redesign toys so that nothing is smaller than a basketball? I can't wait for the inevitable lawsuit on this- that is if one has not been already filed....

Wow. For all the worries and problems I had when mine were young, nothing compares to what you went through. The emotions you must have been feeling then and now-paralyzing fear, anger, frustration, terror, joy- I cannot even begin to imagine. I hope they figure this thing out, bud. Hang in there...

I'm trying to think about the various types of MCI's I have been involved in and where hand signals could possibly have been used. If we were close enough to see hand signals, we would have been close enough to yell, or even take a second and run over to talk face to face. The only things I can think of off the top of my head would be cases where law enforcement is the primary duty and we are standing by- ie a HBT, high risk warrant stand bys, or bomb threats. In each of these situations, things are generally quiet, we are not moving around, and we had a controlled perimeter so there were no extra responders or bystanders running around, getting in the way, or making noise. SWAT and TEMS teams use hand signals, and I see the value there for obvious reasons. When we deploy with LEO's, a major issue is communication. As you mentioned, ambient noise may be a problem, or radios may malfunction. The problem is, EMS is usually in a safe zone, and depending on the number of officers, their locations relative to EMS, and where EMS may be located- in multiple places, under cover- we cannot see those hand signals and are not aware of what actions are taking place. Generally there is an officer assigned to EMS units to protect them and keep them informed of what is happening, but that's not always the case either. Interesting topic. Making me think.