armymedic571

Doc that is......Brilliant!!!!! Ruff, along your lines, I am curious as to see how much this family sasks for. That number in and of it self might shed some light as to what their true motives are.............

Patience, Easy wee fella. Nobody here doubts your skills or knowledge! It is OK to disagree......but I digress..... To answer your question- to become proficient at pressure points, I would recommend a partner, the use of 4c6's chart and some simple practice. Apply the pressure point to your partner, check a distal pulse. No pulse.....GOOD....Note placement of that point and how much force you needed to arrest the distal pulse, and repeat. Will this hurt your partner.....maybe.......but it shouldn't cause any lasting neuro deficit.......... Anywho, that's my 2 cents.......

Does anyone here use Hextend (Hespan)? It is a diferent substance, but has been used for years with success????

Besides using an old BP cuff, or utilizing a piece of cloth and a windlass, there are several good commercial tourniquets on the market now a days. The US Army uses the CAT (Combat Application Tourniquet) http://www.combattourniquet.com/, and the US Marine corp uses the SOFT-T (Special Operational Forces Tactical Tourniquet) https://www.tacmedsolutions.com/07/products/product_detail.php?prod_id=2 Having utilized both, they are much better then rigging one. They are a little pricey, and but who puts a prive on a human life.....oh wait, medicare, medicaid, the government............never mind:whistle: ...................

Along the lines of what Doczilla and CH were saying. I could see Dentists being classified as Emergency Responders for Disaster response. Not necessarily for initial care of victms or evacuees, but in support of the responders themselves. Dental care or lack there-of is the number one culprit in the delay in mobilizing soldiers, especially in the National Guard and Reserves. I could see how that statistic could fit into deploying civilian providers to disaster areas. Anyway, just a thought.

plus 1 for cool graphics.........

You wouldn't be able to use the 911 GI Bill if you are in the Guard/Reserves? Not doubting you, but I think I am working off different info....... Also, check out the programs in what ever state you are ETS'ing to. Most states have their own education programs that can be used in conjuction with your federal benefits. I am not saying you should, but it is worth a look, depending on how much school you need or want. Once again. good luck

I think this still begs the question of permissive hypotension in these patients...........

Jeep, Where is your Hubby???? You said he is in the navy, but....is he on a ship, or with the marines?????? That also has a lot to do with what he should or should not sent him and his comrades. If he is with the Marines, I would suggest foot powder, and/or body powder. When I was over last year my wife sent my this stuff called Monkey Butt Powder. it was awesome. Just a suggestion. Anywho, good luck with your care packages..... AM 571

Just a note. TC3 has been updated as of May 2010. For more information or for a request for information check out this link: http://usacac.army.mil/cac2/call/index.asp AM 571

Begs the question of whether blood products are the solution, or something more along the lines of permissive hypotension? but as you said that is another topic....... AM 571

Patience--- To answer your question. The point of the pressure point (no pun intended) is to reduce the flow of the bleed so that a clot can form. As we have already established and you already know, this is an antiquated procedure and has been replaced by more prompt tourniquet use which has oodles (that is a technical term ) of evidence to back it up. From what I can recall, you were to release the pressure point every 5 minutes and attempt to control the bleed with direct pressure and elevation, or having more help arrive (which ever came first. I did not find a specific reference for you, but an sure that one exists somewhere on the internet. Good luck to you and your quest for new employment. AM 571

Hello. When do you ETS? Any plans in transferring into the guard or reserves? Welcome to the city...good luck. AM571

Amen to that........

I think we need to remember that Dr Cowley was trying at the time to sell a concept. Regardless of his data, or where it came from. He was selling the concept of a trauma system, not the hour itself. The "Golden hour" was the punch line if you will, and as Phil has already pointed out, it has been debunked. The fact that educated people still use it only shows their own ignorance.

Ruff, Maybe faith is just that.....faith. Perhaps we are not supposed to understand some things. We cannot explain it away. We just have to hav faith. Who knows what will happen. Who cares.....It's what YOU believe and no one else........... Anywho, stay strong, as for one day, you will learn the answer to that question. As we all will. Remember, dont mourn death. Celebrate life. Jeff

Richard, I have never heard of a cardiac arrest protocol that allowed lasix without some definable reasoning, however I haven't been in the game nearing as long as some of the others. The only reason I can think to give Lasix in an Arrest is if exacerbation of heart failure is thought to be the underlying etiology behind the arrest. However, Lasix's (Furosemide) action of onset is about 5 minutes or so.....approx...... I hae heard of this being done once, but have never seens it done, or done it myself.......

Herb...... I think you have something here.....I don't know if it the hole answer, but it is definitely part of it. To add, I think many Americans feel they are better than other people, because they are American...They are Ass-kickin, cowboy Americans.......Which is great, except that image of America was built by hard working men ad women how went the extrea mile in what ever they were doing. Now it is down right pitiful.

Fair enough.......perhaps I was trying to over simplifiy the process......

I think the first question is, "Why are we still transporting so many cardiac arrests?"............. OK, OK sorry, just had to get that out. I think the question is legitimate, but are we missing something. As CH said, studies show that normotensive patient have been inconclusive, but I think it is more a questions of fluid in and fluid out. Are we giving the fluid so fast that the body cannot process it, causing pulmonary edema? OR Does the patient have extended History of some type of renal problem which does not allow for quick excretion of that fluid. I's & O's? I might be off track, but that where I am headed. Bushy, I get what you are saying, but what is really the winning part of that formula. The fact that you are giving the patient 2 Liters of fluid, or the fact that you are giving cold fluid. Which is lowering the patients core body temperature, which in turn is slowing down the patients metabolism?........I say in any "Artic Protocol" as it is referred to in my neck of the woods, it would be because we are lowering the CBT. It just happens to take 2 liters of cold saline to do that. Once again, I could be headed the wrong way with this, but........any thoughts? Thanks. J (Edited for spelling)

I have to agree with you guys. His SOB is currently being exacerbated by his anxiety, that is being caused by his pain. If we control his pain, (the underlying cause) the rest should correct itself. Once his pain is controlled, we can them re-assess his respiratory status, and most likely get more accurate findings. At least it makes sence to me...

Especially ones that do crossfit.......

In fact, it works against itself I find.......ecspecially if you are trying to nap at work......

Ruff, EMT in PA is right...... http://www.landwatch.com/Centre-County-Pennsylvania-Land-for-sale/pid/144007496 Just one example. Not sure what your price range is, but this is a nice area.... Good Luck..

Bushy......a little off topic, but thank you......maybe I should bring you over to speak to our providers....... To the OP.... Your assessment of the protocols here in PA is correct. One of the base issues when the "new" state protocols were written was they were left vague to be further clarified by regional or local Medical Directors. To further complicate this....many did not. My Service Medical Director is also our regional Medical Direcctor, and unless you corner him.......good luck getting answers. As a general rule, you can give continuous nebs per protocol of any of the prescribed type, ie (Albuterol alone, Duoneb "albuterol/atrovent", or alupent). There is some discussion, as you mentioned as to the efficacy of giving continuous Duoneb, because of the potential side effects of the Atrovent being it is an anti-cholinergic. Depending on your standard of care in your area, placing the patient on the monitor and starting a IV line/lock would be prudent. I once asked Dr Bledsoe how much Atrovent was too much. He relpied, "when the patient starts to seize then you'll know". I don't think he took me serious, but it was funny at the time. Hope that helps......good luck in your search. J