melclin

I think kiwi mentioned all us Aussies being called paramedics. Here's some cents, it may or may not add up to 2, I'm far too tired to count. Here in Vic at least, everyone used to be called officers (Ambulance Officer (BLS-ILS), MICA Officer (ALS) ). I think it was after someone decided all the AOs should become "ALS" qualified, that they all started being called "Paramedics" (Ambulance Paramedic (quasi-ALS), MICA Paramedic (proper ALS). I think it made sense here, where the non emergency patient transfer is pretty separate and no one really considers Patient transfer officers to be 'in EMS' the way EMT-Bs are in the states. Also, no one (the public) was ever really attached to the term ambulance officer (seeing as though officer is a non-specific term) as being specific to the person who turns up when you ring an ambulance the way Americans/Canadians all seem to be familiar the term EMT. The change in terminology, I think, was supposed to reflect the upgrade to 'ALS' as a minimum level of care, but I don't see how given that no one here is familiar with the trans-pacific differences between and an EMT and Paramedic. In any case it gives people a more familiar word to use for us seeing as though the word Paramedic pops up on the teli a lot, and it looks nicer on the news. It may also be more appropriate from the 'scope' point of view seeing as though our basic paramedics have substantially more education than the American P and a scope of practice equivalent to a progressive service's I or a backwards service's P.

Well to a certain extent that doesn't matter too much (if i get sick of the ambo thing, I'm fairly certain I'm not going to chuck it in for OT or midwifery etc) but the transferability of skills is the biggest downer for me. Specifically because of... I've been to the Broken Hill RFDS base (good museum), it's, foshiz, an awesome gig, I'd love to give it a shot. And I'd like to spend a year with Médecins Sans Frontières. Neither of which are impossible, but it's crazy complicated to work it given the B. Emerg Hlth is officially recognized, but not really accepted in the sense that most people just haven't heard of it. I spoke to a guy at MSF and they do take degreed medics, its just a more difficult process. So there's that to think about. At the end of the day OP you'll get credit for which ever degree you decide on if you wanna up and do the other one down the track. I've heard here its only 1-2 years depending on the time you have here, but there might not be a lot of reciprocity over the ditch given that the degree is newer (I think). Still, you'll get something, and if you can't you can just come over here like all the rest of your countrymen

I think you have to ask yourself which you enjoy more and what your personality predisposes you too. I thought about doing the Nursing/Paramedic double degree, but eventually thought - Why? In what world do I want to be a nurse? What in, essence, floats your boat when it comes to EM? Even if I don't get to play around with the complex knowledge and management like an ICU nurse might (for the time being anyway), while the decisions paramedics make are on the simple end of the spectrum, at least they are their decisions. Depending on where you work, nurses have lots of different scopes, and they certainly seem to have a lot more scope in the states than they do here in Victoria, but when it comes down to it, except maybe for sometimes in the ICU, as a nurse you may know what to do, they may know how to do it, but when it comes down to it, its not really your decision. I like that the role of the paramedic is that of a doctor, nurse, RT etc rolled into one, and I like the idea of the challenge that it represents. I like the idea of un-familiar and uncontrolled environments and the challenges that they represent. All of this is based on very little experience and maybe I'm getting things wrong, but central to the idea of being a paramedic as far as what I've been learning here at uni is asking whats wrong with my patients and what is the appropriate course of action to take - and it seems like that really isn't the primary role of ED nurse, and most nurses really. If that's not the process that attracts you, then maybe nursing is better. Career progression wise, I don't know about NZ, they seem to be about 10 years behind us (thanks to St John?), but I see plenty of career paths for paramedics here: - the 'basic' ambulance paramedic and IC qualifications & practice, then there's flight work for both of those; - further education (masters, PhD) in in epidemiology, public health, clinical practice, education, emergency management (are some that are offered by my uni); - being a part of the adult or paediatric retrieval teams with the major hospitals; - with MICA and flight educations, then there is HEMS work; - the paramedic practitioner (in the same vein as nursing practitioners) is starting up here and is somewhat more advanced in the Queensland and very much more so in the UK; - there's work on standby in mines, oil rigs etc and the pay is pretty good I hear, boring though (in a similar vein there is also starting event first aid businesses, which seems lucrative; - international pt retrieval for medical travel insurance companies (which sounds like the best gig ever); - teaching, academia and research in the universities or as past of the clinical standards/education division of whatever service you work for (Clinical Instructors and Clinical Support Officers here); - health care administration either within the ambulance service and elsewhere. It doesn't seem that much different to nursing to be honest, with the exception of being more enjoyable . If you really want to be a nurse, you can go back to uni for two years while you're still working. Put it this way - There are a lot of nurses in our paramedic degree; there aren't many (none, that I know of) paramedics in the nursing degree.

Very interesting post indeed, Bushy. Yes well, I hate to agree with you. It sure would have been a pain in the arse if I had to wait, as it would have been for the numerous other students in my course who are mature, who work hard, and who are dedicated to becoming excellent paramedics. Because of that group, I think it would be unfortunate to make people like that postpone their education to weed out the idiots or those who are otherwise unsuited. I think you are right that it would work, at least in part, but I think there is probably a better way of doing it, that can achieve the goal of better selection without preventing competent youngsters from at least beginning their education. Like requiring more years to qualify, whatever that may end up meaning. On a side note, the fact that a degree/full license is required does effectively make the minimum age at least 21, which is no different to the police cops, still I have my issues with them as well .

That does happen, except the six months is three years. The bit where grads consolidate their training is in their grad year/s, why aren't they viewed as trainees just as a person who had done six months would be? Whats the difference between putting a trainee with no people skills on the road after six months to continue their training, compared to after three years? The point here is that I think, and it certainly feels this way from our perspective, is with the move to the uni model, all of a sudden the service seemed to expect graduates to pop out as ready made paramedics. No university degree specifically prepares any graduate for the real world of employment in a particular role - it simply gives you the knowledge base required to begin at the bottom rung and begin the climb in the given area of education. While I don't disagree with the things said about the graduates, its not different in any other 'higher' profession (the main ones that come to mind are law and medicine). You get an intern who finishes a medical degree after 5.5-6 years, and they are notorious for their lack of people skills and arrogance. But they are not fully fledged doctors and nobody expects them to be. As you all know, it takes many years of further experience and concurrent study to become a consultant physician. The deal should be the same with becoming a QAP, but it feels like there is an unreasonable expectation put on grads, akin to expecting med students to pop out of med school as consultant specialists. At the same time, the fact that there is arrogance and narcissism, and that it is common in other professions, doesn't mean we have to put up with it. The strategy our uni is taking is similar to med schools and other vocationally specific course all over: more on the ground experience, even as just an observer, from as early on as possible. But here's where it gets complicated, we try to get as many placements as possible, we are in a sense trying to work towards a model more something like what Kiwimedic mentions, but AV jerks us around to no end because of administrative problems and staff shortages and consequently, getting even the minimum required placement hours is like pulling teeth. Chickens and eggs come to mind.

Golden

Well, just as I made some unfair assumption about you, you are doing the same for me. As it happens I'm fine with signal 3s. I'm a believer in the doc in the box theory of EMS. If a consultant emergency physician has the time to see people with skinned knees then surely we can and for a newbie like me it gives me a chance to practice the basics, like simply talking to a patient. I must have hit a bit of a nerve in something I said, as did you did vice versa. I don't know how what I said could reasonably be interpreted in itself to mean that I think I'm a super ambo because I'm doing the degree. Feels like some aspect of what I've written has been similar to something said by others you've disliked have said, and you are unfairly attaching opinion they've held to me. And frankly I think its a bit rude to be making personal criticisms, even if it is an internet forum. One of the paragraphs of your response was just dripping with disdain; and I don't understand what it is that I said that invoked such a response, help me improve, what about what I said p**sed you off so much. Maybe there is some other more negative meaning attached to the word "roadie", when used by someone in my position, that I wasn't aware of. I was under the impression it simply meant ambulance paramedic, as opposed to MICA, from the way it was used by lecturers. I apologise if I'm wrong. Re the "people like you" comments. I don't think I need to point out how unfair a generalization that is. Also, you would be mistaken to take the way I'm talking to you now to be the way I address CIs/whoever I end up on placement with. But it is not unreasonable to expect them to treat us with the same respect they would show any other human being, which sometimes doesn't happen. Don't get me wrong, most that I've met are nice enough, I'm complaining about a minority (although this " Every roadie always seems shocked when they learn that the uni is not teaching their particular way of doing things, and naturally it is our fault as students" appears to be true of far more medics. It is the most common complaint for most students that the tutors at uni all have differing opinions on things and that they are not open to other interpretations, such that we end up confused about the right course of action, esp for the exam. And that's the uni's own tutors, on the road is worse). Also, it feels like anytime we are confident in ourselves, or stand up for ourselves, however politely, or even have any kind of opinion, it gets misconstrued, like I feel it has here, as arrogance. It is not unreasonable to question our roadie/CI/tutor/QAP, it doesn't mean we think we're better than them, its just how we consolidate what we learn at uni with what we see on the road, which are often very different. It would be nice to be able to do that without getting remonstrated for being an arrogant uni student who thinks they know better and is better than non-degree roadies. I'm not that guy and I'm not sure I know any who are. Everyone I know is too scared s**tless/eager to do any job, to do any of the stuff you're talking about. Not saying it doesn't happen, just saying, I'm not that guy, and I don't know many who are in our cohort. I'm displeased but not entirely surprised to hear that it does happen. Re the "we will be your peers comment", well again, I must have hit some nerve and it must have taken on some meaning that I wasn't aware of. It is, after all, technically true. My point was that we will end up being the paramedics that staff the ambulances one day (you know, our children are our future sort of thing) and it is unwise to neglect the education process if you want those kids to be anything but incompetent. Hence I feel that we should be a little closer to the higher priority end of the list for AV, because it certainly feels like we are expected by AV and uni to be perfect once we hit the road, but that they couldn't care less about the process leading up to that (placements). Maybe I'm wrong, but it wasn't really a statement of fact or policy, its just how we are sometimes made to feel as students. It would have been nice of them to have considered us when ordering the first round of prints of the CPGs, for example, or work better at providing more educational environments for students on placements. I still enjoy placements more than just about anything else at the moment, I'm not saying I'm hard done by. Its hardly a tragedy. I just think it would be nice to get rid of the atmosphere that is common on placements where you just feel like there is nothing you can do that is right. I don't think, and I am not alone (its a widely acknowledged, and even published, problem) that it is in the interests of a good education. If anything I think that 'sending the apprentice out for a left handed hammer' type stuff is immature. Regarding the separate matter of your point about the wisdom of criticizing a future employer, your are entitled to it, as I am to disagreeing with it. I'm happy to take the risk in making a lighthearted, mildly derogatory remark expressed in the context of having a whinge on an anonymous internet forum, especially in an environment where paramedics are openly criticizing AV far more seriously than I am. This is not sarcastic at all, I am actually asking to learn: How do you feel students should handle those situations where what they've learned at uni and what they are being told to do on the road are different? Do we ask about it after handover but let it happen? Do we nod and smile, and just not incorporate their poor practice into our own? How do you reckon we go about that in a way that doesn't come across arrogantly but still allows us to reconcile the difference between uni and road experience. How do you think they should act in general?

Haha, not today it won't. Starting fights on the with roadies who will crucify you no matter what you do/say/breath is not wise. Still, my marks don't depend on this forum's "reputation bar" so, maybe That comes in the degree. My advice to chaser a little while ago was to take a ganda at the CPGs to get a little familiar with some of the stuff he'll have to know in semester one. Its just easier come exam time when you are reviewing more complex concepts if you don't also have to spend time wrote learning stuff you could have memorized in grade 3 if anyone had told you; but instead they decided to tell you in the revision lecture a week before the exams.

Yeah that link has said that for bloody ever. There is a lot of commotion about the new CPGs. Apparently they got some fancy company to make them all pretty, and pretty they do look. Except they're bulky, fragile, expensive and full of dangerous misprints (1) and have not corrected the many weird and confusing errors that built up from years of tacking new guidelines onto old ones (2). (1) "CONTRAINDICATION FOR GTN: Inferior STEMI BP>160" is very different to "...BP<160"....f**kers (2) "for mild to moderate severity COPD treat as per....bla bla" followed by, "Regardless of severity treat as per....(different treatment to the first one) Of course, any medic worth their salt would know that's obviously not right because they would understand the rationale behind the inferior STEMI thing, but still, it makes you wonder what else is wrong. Anyway, AV also didn't have enough made for students, despite the fact that as of last semester our lecturers, in their wisdom, were using the new CPGs for exam questions. So we got the new CPG a few days after the semester finished. $58 as opposed to the old $13....f**kers END RANT. Anyway, you can get all kinds of things, including the new CPG from this site, but it'll take him a while to get them too you, and there are a few more mistakes in the downloadable version. http://www.paramedic-info.com/ Either the VU or Monash book shops should have the hard copies in stock by now. Like I said $58, but you'll be needing them anyway, and in my experience, the success of a given student, was directly proportional to how early they sucked it up and bought some CPGs of their own (they're not prescribed texts, just recommended).

I'm sure we're all aware of Rawles and Kenmure's (1) old RCT from which the BETS have sprung on the matter of uncomplicated MIs. I'm sure in this situation I would already have put oxygen on him because we're told we are supposed too, and there's not really enough evidence I know of to defend my not supporting the paradigm. Presumably too, the service would already be p***ed off at me for not "slapping 8 through a hudson" on everyone anyway . I do, however, I feel like this is one of those situations in which, with a Sp02 ~ 100%, extra O2 is of no particular help. Certainly that is the position of the British Thoracic Society which recommends that their is no need for supplemental O2 in non-hypoxaemic pts (2). Although as a student I'm not sure of the wisdom of using that as a reason to not follow service guidelines. Unless there is some research that I'm not aware of, I'm not sure any of us can answer that question with any particular authority. It would be a terrific area to get some research done but I can only imagine the small forrest you would have to cut down to provide enough paper for the ethics approval forms. (1) Rawles JM, Kenmure ACF. Controlled trial of oxygen in uncomplicated myocardial infarction. BMJ1976;1:1121–3. (2) http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Emergency%20Oxygen/Emergency%20oxygen%20guideline/Appendix%201%20Summary%20of%20recommendations.pdf The full version of the BTS oxygen guidelines makes some interesting reading: http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Emergency%20Oxygen/Emergency%20oxygen%20guideline/THX-63-Suppl_6.pdf

Excellent point. I might put that too him. I'm not sure why that didn't occur to me, and it certainly will have occurred to him so I'm sure he'll have an answer. Would it be that difficult to change bags? I mean why not just say yeah, sure, change the bag to a 1600 when you get a ROSC? Thank you nicely put.

My last two paragraphs were directed more at tnuiqs. I wasn't asking anything of you. Maybe we're looking at two different studies, because I am about as close to certain as any person should be, that the heading "sucrose use consensus study" doesn't exist in the one I'm looking at. I've read it. I've scanned over it a dozen times since looking for the heading, and the text search of the articles turns up nothing in either the pdf or HTML versions. We're talking about "Implementation and Case-Study Results of Potentially Better Practices to Improve Pain Management of Neonates" right? There's a heading in there called "sucrose consensus protocol", is that what you were talking about?. In any case, I know the article addresses heel sticks. We've got a our wires crossed I think. What I said in my second two paragraphs was directed at tnuiqs regarding his insistence on the idea that there was some suggestion that sucrose should be used as the sole sedative/analgesic in intubated pt to maintain their intubation. The study was entirely relevant, thank you for finding it. My problem is that, as I see it, tnuiqs has taken a part of that study that does not have anything to do with sucrose analgesia, suggesting that it does, and then making statements about sucrose's efficacy/utility based on it. If I've misunderstood, I apologise, its entirely possible that I got the wrong end of the stick, but I feel like I could be forgiven; some tnuiqs posts are not exactly crystal clear in their meaning. The passage quoted was: "Ongoing Analgesia for the Mechanically Ventilated Infant" which went on to talk about the following,

Yeah I was tired and grumpy last night, and I didn't really realize how non-specific and overly nasty my last comment seemed. It was directed at tnuiqs. The mood ring reference is from one of his posts. Well I'm certainly glad to hear how you feel about your foreskin, but what has that got to do with sucrose's efficacy for analgesia in minor procedural pain. Again we were talking primarily about heel pricks and venupuncture. If the point you are trying to make is that sucrose is being extended to procedures for which it is not appropriate, then say it. Stop with the sarcastic examples and condescending rhetoric. I showed you a reference to the fact that it is accepted that it should be combined with other analgesia/sedation where appropriate, and the article we are discussing mentions it too. Morphine infusions, acetaminophen etc. Why do you continue to argue on the premise that we are suggesting a little sucrose is enough sedation for intubation? I don't necessarily disagree. What astounds me is that after having said, "The point of my question was simply to establish whether or not anyone else had heard of it being accepted practice, and any discussion that grew from there was a bonus. I simply thought it was an interesting idea, and wanted to know more about it, regardless of its applications in paramedic practice", That you still feel it necessary to repeat that point. As an aside, I won't have either kind of access on paeds when graduate, and maybe the glucose issue is worth some further investigation - more likely is that we will just get IO. But I certainly, won't be instituting a new treatment modality because I read some links in forum thread. Now this is what I'm getting at when I talk about condescending rhetoric. Obviously we already have glucose paste in the kits (I think it's actually sucrose) and if we didn't, I certainly don't have the authority to go adding drugs to the bag. You know this. So what is the point of that question if not to sarcastically infer that I'm stupid enough to change my practice and add junk to my whacker bag, based on an afternoon spent on an internet forum? FIRFLYMEDIC: It was numerous comments with that attitude, and a confusing inability to structure sentences, and indeed, entire posts, which lead to my ill-considered grumpy reply. Few things rile me like condescension and poor grammar. Where does the study talk about sucrose being the only sedative/analgesic used for vent pt? The study looked at a number of practices that were not necessarily associated. One was sucrose analgesia for minor procedures, another was pain management and sedation in vent pts. Not once under the heading you posted is the word sucrose used, nor its use recommended. Even if the two sets intersect somewhere, it does not mean they were using sucrose to sedate intubated pts. Even in the section on circumcision, it is clear the sucrose is co-prescirbed with acetaminophen. Am I missing something? Is it the NPO pts? If all your experience affords you the ability to read between the lines, then you will need to explain that. It is not simply enough to post a sub-heading of an unrelated topic in the same paper and then condescendingly tell others to 'read the paper', if we don't understand your point. http://pediatrics.aa...cetype=HWCIT://

I was going to give replying a good go, but I simply could not agree on a meaning for most of what you wrote. I have come to expect a certain amount of illiteracy from Americans (beyond what is normally acceptable on internet forums), but this goes beyond that. I'll try again tomorrow when I'm rested and can be bothered trying to make sense of you and your mood ring. Or maybe I'll just choose not to bother; we shall see.

For venupuncture and heel pricks? Yeah I would, considering they don't use analgesia anyway. You'd have no trouble getting ethics approval to for an adult RCT randomising consenting participants who were having blood taken anyway into an experimental group who receive a little sucrose before hand and the other, a little water before hand. The only problem you'd have would be explaining the evidence base for wanting to do the study in the first place. There's no reason to suggest that sucrose has analgesic properties in adults, that I've seen anyway. Now here seems to be where I've annoyed you. I've read the links posted. I've enjoyed the discussion. I just haven't had time (nor do I feel like making the effort) to extensively follow up every single side issue that I discover in my own reading. One paper, and a chapter of a one book mentioned some other papers about the effects at different extremes of premature birth, and I just didn't feel like fully exploring that component. Not the end of the world. And when I said this: I wasn't referring to the links provided, I was referring to other literature on the matter. I read the paper. The issues of analgesia in the ventilated population were separate to those of minor procedural pain management with sucrose. Never did it suggest that sucrose should be used for sedation/analgesia for ventilation. It wasn't even clear to me that it was being used on vent pts at all for minor procedural pain. I don't know what you're getting so annoyed about. We're talking about tylenol for a bump on the knee and you're talking CABG surgery, then having a go at tylenol for not being good enough. Whats with these assumptions? Can't help but think I've hit a nerve or done something to p**s you off. I did read the articles presented. I didn't study them precisely (so if I might have missed something, by all means point it out as you did, although next time minus the condescending attitude), but enough to engage in an interesting discussion on a web forum - I'm not writing a textbook or doing a systematic review, just chatting. My musings? What musings? What zebras? I just thought it was an interesting idea, and wondered if anyone else here knew of it (at the time I was assuming that the medic in question was right when she said there was no literature on it). "anything else you would like the members of EMT City to do for you". Do what for me? You seem to have attached yourself to the notion that I'm ignoring my studies to go off on wild goose chases, but asking EMT-city members to do important research for me that I'm too lazy to do myself, but that I will then dangerously and ignorantly integrate into my practice. 1) Obviously, they don't have to do anything. If people want to comment, do research or post links, good for them - it very interesting to see the results - but I'm not asking them to go out of their way. I'm hardly putting them out by asking if they knew of a practice being common in their area. 2) As it happens I'm on holidays from uni at the moment, so reading about other practices that are not strictly part of the my future practicum is my prerogative, as are the extracurricular research projects I'm involved in. 3) The 'accepted practices' are part of my degree, and what with paramedic education not being a complete joke here in Australia, I don't really need to log onto an internet forum to hear that I need to learn them. 4) The point of my question was simply to establish whether or not anyone else had heard of it being accepted practice, and any discussion that grew from there was a bonus. I simply thought it was an interesting idea, and wanted to know more about it, regardless of its applications in paramedic practice. Some helpful and interesting posts inspired me to read a bit more on the topic, and I've got what a wanted out of the thread.

tuniqs, What would be the point of an adult study? No one is suggesting it works for adults. In the books I mentioned, it was for kiddies <6 months with an emphasis on the first thirty days with some qualifying factors regarding premature births that I didn't care to go into because I'm busy with some other stuff. As Aussieaid said, its seems to be indicated for situations where, normally you wouldn't give any opiate pain relief. I can't really comment on the methodology in the studies, I haven't had the time to read the articles that closely, but a consensus statement from International Evidence-Based Group for Neonatal Pain, published in the Archives of Pediatric and Adolescent medicine a while back was quite clear in its support for sucrose analgesia. So I'm not sure it is necessarily so simple to say the studies are rubbish. I found the quotes you published to be a little confusing so maybe I'm missing your point, but I don't think there is any serious suggestion that it be used as the sole sedative in ventilated kiddies, or at all in vent pts. All I've seen is that people have suggested doing research into the topic of its use in ventilated neonates. From: Altman, AJ (ed). Supportative care for children with cancer: current therapy and guidelines from the children's oncology group. 3rd Ed. Baltimore: The Johns Hopkins university press; 2004 The point you make about hyperglycemia is interesting. I think it would be very easy to assume that sugar is harmless and not worry too much about the side affects. The cochrane review I mentioned previously says briefly that only 6 of the 24 studies used in the review measured adverse affects and only one reported any negative side affects. The extent of the adverse affects measurement appears to have only involved noting anything obvious at the time of the study (a sudden desaturation was noted as was a one participant who choked on the 'placebo' sterile water preparation). From this, sucrose analgesia was deemed 'safe' in the conclusion. Poor science to say the least.

Thanks guys very interesting. I've had a look around now myself. I don't know what the medic I was talking to was on about when she said there wasn't any literature on it. There's plenty. Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub2 A quick google books search with the term "sucrose analgesia" provides a long list of paeds and neonates texts with substantial discussion of Sucrose analgesia.

I would imagine so, although I get the impression that there was some suggestion by the nurse in the story that it was a bit more than that. Hence my interest. But yeah I'd put my money on the post-vaccination-lollie-pop effect being involved here.

I was speaking with a paramedic recently who mentioned a practice common at the children's hospital: using glucose paste (or maybe sucrose, if that makes any difference) as a mild analgesic for babies and toddlers. Apparently there isn't any literature on the matter, although I've not looked myself, but its common practice. Anyone heard of this/seen this/ done this before? Opinions?

It is an odd and almost uniquely American idea that healthcare is not an essential service and that it should not be provided or at least regulated by the government. You (the collective you) continue to confuse me.

Yes I realise the 6-7ml/kg is nothing new. He wasn't suggesting it. The suggestion was that the best way to insure that this smaller tidal volume is achieved is to do away with 1600ml bags in favour of 1000ml bags. We use flow inflating bags in the Victorian service (in addition to BVMs. The choice is left to the individual medic). Something like the Jackson Reese bags (as is my understanding according to previous discussions with Vent) in a closed circuit with a CO2 scrubber and purge valve attached. I very much like them. The are great for assessing patterns of breathing and getting much more intimate with a persons lungs during APPV or IPPV. My experience with the lung simulators has indicated that it is much easier to cause gastric insufflation with them though, even at a healthy lower esophageal sphincter pressure of ~30 cmH2O.

One of the PhD students at uni has been focusing on ventilation during cardiac arrest and the effectiveness of different sized bags. As I understand it, he is trying to get the ambulance service to ditch the adult size BVM (1600mls) and recommend the paeds BVM (1000mls)for vents during adult cardiac arrest. He's published a number of papers to that affect. Nehme Z, Boyle M. Smaller self-inflating bags produce greater guideline consistent ventilation in simulated cardiopulmonary resuscitation. BMC Emerg Med. 2009;9(4). Nehme Z, Boyle M. Accuracy of bag ventilation in simulated resuscitation. Journal of Paramedic Practice. 2009;1(4):167-72. In the interests of privacy I suppose I should not say which of the two authors is the student in question. I couldn't remove the bold format from Boyle M for some reason, its not necessarily him. The following values were considered desirable, apparently, as per ILCOR guidelines. 1. a ventilation rate between 8 and 10, inclusive; 2. a tidal volume between 480 ml and 560 ml inclusive (based on 6–7 ml/kg for the 80 kg simulated patient); and 3. a minute volume between 3840 ml and 5600 ml inclusive (based on multiple of lowest and highest acceptable ventilation rate and tidal volume). I was wondering what everyone here thought about the idea. As an aside, there was no mention of artificial airway type that I've noticed in the papers. I was wondering if this could be considered a confounding variable. I have used the lung simulator in question and its attachments are probably most similar to ETT pt. Could the airway type make a difference to the outcome?

A tutor assisting us with some giving sets the other day followed up a talk we had from a nurse on drip calculations, by saying in the broadest accent I've heard in a while (roughly equivalent to Bubba's southern drawl) "Now, forget all that crap. In Ambulance we have two drip rates: s**t loads..and none". I laughed and thought of you for some reason.

I'm sorry to hear that. It raises in interesting point for me, a student who is still wrapping their heads around these concepts. I was reading a chapter of Clinical Anesthesia (as all 21 year old university students should be doing during their holidays ) this morning and I came across the following passage, "However, a patient who is receiving minimal supplemental oxygen and has an acceptable oxygen saturation may have significant undetected alveolar hypoventilation". Other than using our knowledge of the particular problem that our pt presents with to infer that there may be a ventilation issue, is there a way of ascertaining this in the pre-hospital context (capnography?)? Its probably not a practical point considering that it may be enough for us just to keep their oxygen saturation up during the short time we see them (no capnography our AP trucks (our BLS), we don't even have pulse ox sometimes, but that's changing), but I'm interested none the less. Respiratory physiology is glossed over pretty briefly in my degree, which I don't agree with. Am I correct in assuming that the issue with masking hypo-ventilation with higher Fi02 is to do with reduced excretion of CO2 --> respiratory acidosis?