armymedic571

Do you ever consider that this keeps coming up because it is a valid point. Although rare, this is a etiology that can be easily found with proper assessment and diagnositcs. As far as NTG actually reducing the size of the infarct, I agree with Kiwi. I do not think that NTG is as beneficial as people think. However, I think where we make our money is by preventing further infact, and reducing overall oxygen consumption, (which has been proven to have a positive effect on patient outcome) (I will try to find the study).

www.usajobs.gov good luck

Hey, that link was awesome. Thanks. It is nice to see that other feel being a preceptor is a privledge not a right.

Full History and assessment to include diagnostics (BS). 12-lead ????? Oxygen, IV access, monitor. If the index of suspicion is there, transmit the 12-lead to the ED and call command for a referral.

I had to go to the department of labor web-stie and see for myself.. Wow, you are correct. You are entitled to your opinions. But remember, they are just opinions and not facts. If I was a business owner. I would want the most qualified person, period. I am smirking while I type, this thread has made me happy. Being in the military and working in the civilain EMS field, I have two completely opposite points of view on this topic. It is interesting to say the least. I have thought long and hard on this, because as a leader on both sides, I am sure that one day this question will be posed to me in an official capacity in some way. The fact is that I work with gays and lesbians on both sides of my life (military and civilian). When you strip away their layers like any one else to the core, what you have is a person. Just an everyday person, with hopes and dreams and ambitions. I started to dwell on this last year while I was in Iraq, knowing full well that one of our intel guys was gay. I started to think....Do I trust this person. My life is in his hands. Does he trust me? These are questions that cannot be answered in a thread of a forum, but between each other. The bottom line and my point here is this: What two people do in the privacy of their own home is their business and no one elses. If this is not true, as an American Soldier, a free person. What the hell have I been fighting for the last 13 years? I certianly wasn't fight for a politician.............

Hey dude, I think as far as EMT school your SOL. But, if your thing is really medicine, don't fret. You may not be able to ride the ambulace, but working in a facility either a hospital or other such facility can still be an option. How long has it been since your last Seizure? Is it controlled? Are you compliant? Just a few things to ask yourself, before you continue down this path. Good Luck with whatever you do.

WOW

Mobey/firefly.....there you have it. Low volume resuscitation is not a new concept. It has been around for years, particularly in the Military. Yes, our success rates are much greater than the civilian equivelent. As a general rule, we try to keep our trauma patients between 80-90 systolic. In those terms we use two markers as a guide for titration or restriction of fluid. Radial Pulse and mentation. If a patient is mentating apporpraitely and has a radial pulse, we restrict fluid intake. Once there mentation or radial pulses go...they get fluid. However, a few things to note. As Croaker already mentioned. General trauma and Head trauma are two different beasts.....I will leave it at that. Second, most military studies (especially those on trauma are based on HEALTHY Adults with insult to the body), as opposed to average adults with insults to the body. There are some caveats when treating these two destinctly different demographics. As far as Hextend is concerned (Hespan) is one of use. The forementioned still apllies, but one of the biggest mistakes we see is providers using this substance for the wrong reasons. Generally, this fluid should only be used for trauma patients in shocK due to Hypovolemia. We usually see this with exsanguinating extremity wounds. Once we factor Belly bleeds, femur Fx's and pelvic's, we start to alter our parameters. Just some more food for thought.

Actually, I read this article, and find the conclusions of the auther ridiculous. They looked at people that died from trauma. But.....How did they die. Were they brought into the Hospital alive and with Spinal precautions? I think this study is flawed at best. Baylor University gets a big .

<-------------- . I don't know. I saw this and almost pee'd myself. Thanks itku2er for the laugh.

Just goes to show that Verizon is Evil........ But then again. My Verizon DSL works pretty good.

Isn't that kind of pessemistic? I am not following your point? Isn't that what we've been saying? Still......a little extreme. I hope there aren't any systems really like that.

Quite the contrary, Kiwi. We are able to think, which is why we can call Medical Command. The point here is that we have several types of DNR's, advanced directives and Living wills. But, as EMS providers we are only "Legally" able to accept a specific type. In which it must be filled out exactly as prescribed with original signatures. Because we very seldom come across patients that actually have this, I was trying to say that based off of Patient/Family wishes, presentation and pt status. You should call Medical Command, paint your picture (argue your case) and allow the MD to allow you to Cease efforts if that is what has been decided. This is about not only knowing our protocols and standing orders, but having good assessment and history taking skills, and the mannerisms to communicat effectively with Medical command to do what is in the patients best interests when our protocols would otherwise not allow it. Sorry for the confusion.

Not different levels. Just different types. BUT, this depends on the state. In the end, what is important, is that depending on pt status, presentation and wishes (or family wishes). Call Medical Command, and let them make the decision. Most reasonable ER Docs will see your case and grant the patients, or families wishes.

Oldman, Welcome to the NR. You got audited...... Is it supposed to be random, but I have been audited twice. Once as an EMT-B, and once as a Paramedic. It happens. The only people that really ever seem to have problems are those that pencil whip their forms. Which in your case, is not the case........lol

OK Jake, you got me.......Especially since I amin the Army, and I know how true that is...........hahahaha.

As I had previously stated, in some locales, there are specific protocols and types of DNR's that EMS can/cannot accept. Also, there are rules, like the document must be signed and that it must be present. Furthermore, one can always call Medical Command and run the situation past him/her as to the patients current status, Hx and family wishes. I see your point, but it is not stupid. Its the law.

This is a very complex issue. Mostly because laws are so various between states. Also, because it is an emotional issue. I believe it was AK that said , you need to keep your emotions and feelings out of the equation. Regardless of what you believe, everyone owes a death. PERIOD. I find that the issue is more of patient education and advocacy by the pt's family and family physician. In the state of PA we have two types of DNR's (IN-hospital and Out of Hospital) By law, EMS is not legally bound to honor in hospital DNR's, Living wills and the like. As a matter of fact, we can be found negligent if we do. Now, if we arrive on scene and the family has the paperwork and is insisting, do the right thing. Start BLS and call Medical Command. Ultimitely, the ER Doc can honor those wishes. The second is that many families and patients don't ever know about the Out of Hospital DNR. This is one that must be requested from the Department of Health, and has the Department seal on it. It must be filled out in its entirety, have all original signatures, and be physically present upon EMS arrival. Now, how often do you think that actaully happens. At the end of the day, you have to ask yourself, are you a patient advocate? Sometimes, it is just time to let them go. Just know the rules surrounding DNR's and Living wills in your area! Remember, don't mourn death, celebrate life.

Holy Crap. I have been reading this thread for a week or so now, trying to decide when to interject my opinion? Forget it, I've got nothing .........................................................................

This is an excellent point. If anyone watched the video, you will notice that the provider on the video did just that. As Vent has already stated. The key word is "Professional". Something that seems to be lacking........ Good Topic.. Hope everyone has a good day. J

Maverick, That was an excellent post. As you and I have traveled some of the same scenery, I cannot agree more with your opinion on this subject. It would be nice if we (professional EMS providers), could all get on the same page and uphold the standards in which we are attempting to set.

I see several problems with this. 1. Many soldiers/marines with PTSD are already on multiple medications that they must self administer in austere environments. Initially, they (the military medical community) will try to treat these patients in theatre while many are still actively doing their jobs. 2. The addictive nature of morphine, combined with the fact that soldiers/marines are already at risk for substance abuse only raises more questions. Expecially in light that substance related suicides and serious incidence has risen dramatically over the last 5 years. 3. Having had first hand experiences with PTSD, medicated soldiers and the military medical community, I think knowing what the mechanism of action is before more trials are done is the most appropriate thing to do. This is for the safety of everyone concerned. "Researchers have been testing ways to treat it, and the new study looked at whether fast and strong pain relief can help prevent it" It sounds to me that some Navy MD is ust giving morphine to see what happens. Sounds crazy, but I have seen this happen. Otherwise...This is interesting material. I just wish we weren't being used as test-rats.

This sucks. This is in my neck of the woods. Well, hopefully his journey was a good one. RIP.

Tsk, To add to what chbare was saying. Here is the basic concept: CPP (Cerebral Perfusing Pressure)=MAP (Mean Arterial Pressure)-ICP (Intercranial Pressure). The basic theory behind the HHH therapy is to increase CPP to keep an appropraite level of perfusion going by increasing the MAP through IV therapy. This is important because in the case of a stroke it will help reduce the size of the penumbra. HOWEVER.....this is not something that should be attempted in the field. An ICP monitor needs to used, and we have to differentiate between a bleed or an occlusion before we start messing with the blood pressure. Not to mention other factors, like ( heart failure, Beta blocker use by the pt, etc). Like I said, this a basic overview. There is a lot more to it, and to be honest. I don't think I fully understand it. So, I may not be the right person to try and explain it. My system discussed this type of therapy in the past, and you can call Medical command with the request but, this is not something I would do lightly. Your exam needs to be extremely thorough, and depending on transport times and such you could be taking away from pt care trying to accomplish a full neuro exam. Anyway, just a thought. This could have something to do with what you read.....Or I could be in left field. Which wouldn't be the first time.

Scott, Your right. The facts of this incident are not clear. Either way, it's a shame that things like this happen.