NRPinNEPA

Happy to see you join our ranks, Chris. It's about time!! Knowing you as well as I do, I know you will be a valuable asset to this community.

What he said...

The problem with healthcare is a problem of money and system abuse. Firstly, money. Many primary care physicians will not accept medicaid patients because they know that caring for them is a financial black hole. So what do these people who have no access to primary care do? They use the emergency department as primary care. If they don't have a car they call us. And you know it's true... there isn't a single one of us who hasn't been called for a toothache at 3:00am. What we need to do is reform health REIMBURSEMENT so that primary care physicians can care for medicaid patients without going to the poorhouse, and give us as paramedics the ability to tell toothache boy to go piss up a rope. Cut down on inappropriate use (read: abuse) of resources, you reduce costs.

The hardest thing to do is accept the world the way it is, not the way you want it to be. Personally, I think that we are our brains. When we die, we die, and that's all there is to it. Do I want to live forever? Yes. Unfortunately, I see no reason to believe that I'm going to live forever. Just because I want it to be so does not make it so. Is my view very comforting? No. But nobody ever said life (or death) was fair, let alone comforting.

I am now a Nationally Registered Paramedic!!

I've only got one thing to say to you... cost of living 22% lower than the national average... Ok, two... lots of woods...

If you only have two ALS units for 75 miles, there is a simple solution... MORE PARAMEDICS!! Usually the EMTs who complain about Paramedics not respecting them are the ones who are either too lazy or scared to go to Paramedic school, or have tried several times and failed. I'm sorry, 120 hours does NOT qualify you to perform invasive procedures. Sure, you can start that IV, but what do you do if you suspect you've caused an air embolism? For a CHFer, would you attach saline or just a lock? What happens if you give too much Narcan to an unconscious overdose patient? Your patient is having a Right Ventricular Infarction... would you give them nitro? Can you give Bicarb and Calcium through the same IV? How does Bicarb work? What does it do? How does Calcium work? I'm sorry, but 120 hours with a few 16 hour "extra cert" courses should not qualify you to administer ANY medication. You have less education than a hairdresser and you want to inject substances into somebody that will alter their body chemistry? Substances that alter how their body is working at the cellular level? Substances that could kill them? When I finished my EMT class, I had training. Now that I am finishing my Paramedic schooling, I have an education, and I am going to be continuing on to higher education. Yes, there is a difference between training and education... for example, would you want your daughter to get sex education or sex training? Think about it.

I have heard that a nearby service has an individual living in their coverage area that has some sort of external device that pumps their heart while showing absolutely no electrical activity on a monitor. If I'm correct, as soon as this person moved into the coverage area or got this device implanted or whatever, the service held a ConEd course specifically on this device. A paramedic at our service stated that he cared for her while he was a student and, just for giggles, put the monitor on and sure enough... the asystole alarm immediately went off and a flat line marched across the screen. Meanwhile, the patient was alert and oriented. You never know what kind of crazy stuff you're gonna run into.

4lpm via nasal cannula. IV access. Repeat 12-lead. 15-lead and right-sided 12-lead to capture V4R, V5R, V6R, V7, V8, and V9. Labs: Cardiac enzymes, CBC, electrolytes, BUN and creatinine for giggles. Contact the doctor and request a transport capable advanced life support unit. Since the ST elevation is basically global and the chest pain is reproducible, I'm leaning away from ACS.

CHEAP GPS units are unreliable. Get a quality product like Garmin and you'll be at the residence before the old school EMT has even found the proper page in the mapbook.

How I learned heart blocks... http://ambulancedriverfiles.com/2007/06/sex-relationships-and-the-cardiac-conduction-system/

I took out a private loan to pay my rent and have worked part-time through school.

The first stage of cellular metobolism is anaerobic, meaning it occurs without the use of oxygen. Glucose enters the cells and through a process called glycolysis creates lactic acid and pyruvian acid. The second stage is aerobic. Oxygen enters the cells and through a process called the Krebs acid cycle creates ATP and carbon dioxide. ATP is the energy source, carbon dioxide is a waste. Now, when you're hypoxic, oxygen isn't being delivered to the cells. The Krebs acid cycle can't take place without oxygen, so the lactic acid and pyruvian acid continues to build up inside the cell. Eventually, the cell becomes acidotic, resulting in cellular death. In other words, acids build in the cell and cause the cell to die.

I have big, long alien fingers, so I can digitally intubate without much difficulty. I would prefer it over a nasal intubation any day.

Now, THIS is the oldest thread revival ever... almost five years!!!

I'm definitely thinking ACS on this one. If there is ST segment depression in V1, V2, and V3, but no ST elevation on the 12-lead, I would get V7, V8, and V9 into the mix for a 15-lead. Sounds like a posterior MI. Standard ACS treatment... 15lpm O2 NRB, IV access NSS KVO, 12-lead, 15-lead, ASA, nitro, morphine, draw labs if I'm in a system that lets me do so, rapid transport to the closest appropriate facility (preferably one with interventional cardiology). As for the fixed wing aircraft stuff, I don't have any critical care experience so I'm not even going to touch that one.

I haven't gotten a chance to try it yet, but I sincerely hope that it works better than the actual Facebook Chat, which needs to be buried in a pile of steaming crap and forgotten about.

http://sprojects.mmi.mcgill.ca/heart/puz990914r1.html

JP is right... generally there are three types of trauma patients who die: those who die in seconds to minutes, those who die in hours, and those who die in days. Seems like a pretty wide margin of variability to rely on a rule such as "the golden hour". How about instead training pre-hospital personnel how to recognize potential life threats or potentially unstable patients and letting them using critical thinking to determine whether or not they need to haul ass instead of saying "they're a trauma patient, we have to get the patient with an abrasion on his thigh to a trauma center in less than an hour or he'll drop dead!". EMTs and paramedics using thought and making decisions?!? UNHEARD OF!!!

I believe you might be thinking of "Paramedic Care: Principles and Practice".

Have you checked the school book store or student intranet for used copies?

If you have a quality, educated BLS provider, the assessment is no different than an ALS assessment, only without blood glucometry or EKG monitoring. All the other assessment techniques (inspection, palpation, auscultation, percussion) are well within a BLS provider's scope of practice, as is obtaining a good history. However, with your average EMT, the BLS assessment will have far less knowledge of anatomy and physiology behind it... most EMT programs train only to differentiate between normal and abnormal, not necessarily what may be causing the abnormality. Ergo, I'm not going to answer yes or no, only state that it depends on the individual.

Really? If you notice, the NREMT-P patch has already dropped "Emergency Medical Technician - Paramedic" in favor of "EMT-Paramedic". There is also talk of dropping "EMT" and making it just say "paramedic". With the advent of AEMT, the crackdown on accreditation, and waning volunteerism throughout the country, you're going to see EMT and "BLS" shift closer and closer to a first responder type role until EMTs are essentially confined to volunteer first-response. EMTs won't be on ALS trucks for long. Give it 10 years and see how things are different.

A holistic approach is addressing a patient's needs, medically, mentally, and socially. I wasn't saying that you doubt that I am a caring professional. Yes, there are those in EMS that ignore the needs of a patient beyond the medical. But you can't tell me that there aren't those in nursing who do the same. Just because you are educated in something or taught to do something doesn't mean you do it. However, in the pre-hospital setting, you are limited as to what needs you can meet because you're only with the patient for a short amount of time. I know medics who have let dogs out, locked doors, changed a baby's diaper, etc. Yes, holding someone's hand is hardly the definition of a holistic approach, but it's more than some paramedics and nurses do.

Better educated? That's what critical care medic would be for. Better at a holistic approach to medicine? I'll have you know that yesterday I transported a terminal cancer patient to comfort care who was sedated and, just like his daughter asked, I held his hand the whole way just so he would know somebody was there. I never lie to my patients or their families and I keep their promises. I do everything in my power to make them comfortable. Why? Because it's my job. Better at communicating with patients? I've gone on two and a half hour transports and talked with the patient the whole way, laughing, telling stories, etc. What would a paramedic know about cytostatic regimes? Plenty if they were taught about them. As far as paramedics working in the hospital setting as "ER techs", you mean "go for"s and CNA replacements? Because that's all they seem to amount to over here in the states aside from the rare hospital that might let them get a little close to their scope of practice... let them put a little IV in to keep them happy and keep them from thinking they're a slave for grunt work. My simple argument is that there is no need for pre-hospital registered nurses, or at least there wouldn't be if some places bothered to educate their paramedics.