jonas salk

A had a partner about a year or so ago who on a chest pain patient decided to do a bilateral BP, and then proceeded to freak out when there was a 6 point discrepancy between the systolic pressures. He absolutely insisted we go in on a 4-2 (lights and sirens, on a CTAS 2) for a query TAA. We get there, the triage nurse did a quick visual assessment and rolled his eyes. We ended up having 3 hrs of offload delay with that patient, through which the patient slept comfortably on our bed. My partner on the other hand just paced, fully expected the aorta to explode. Bilateral BPs can be a 'nice to have' piece of information, but unless there are other signs off AAA, unmistakable signs then you really aren't going to catch anything. And sometimes with the wrong hands, a little knowledge is a recipe for disaster. Granted this individual I was working with has at the best of days only a little knowledge.

Even though I work in the Hammer i live in Toronto and have been following everything Mr. Ford has been doing with keen interest. It'll be interesting to see how your CBA process plays out, particularly as 416 and 79 represent (if i'm not mistaken) the majority of city employees.

and really with take the context of the post into account it really did not require a huge step of logic to realize what exactly he meant.

What is the status of everyone's collective agreements? My service we very recently just got our arbitrator ruling which gave us, among other things, an 8% bump over 3 years, an extra $2.50 for missed meal breaks (to a total of $12.50 now, though personally i'd like to have my two 30 minute uninterrupted meal breaks), as well as a bunch of other things. The insane part is our last contract expired over 2 years ago and this one expires at the end of March 2012. From what I understand, the 8% bump keeps us at more or less the same position when compared to what other medics in Ontario get. So where is everyone else in the CBA game?

My service in Ontario just got our arbitration ruling after 2+ years of being without a contract. We got an 8% raise over 3 years and the agreement expires at the end of next march so really our new contract is only in affect for 9 months or so.

I use the master cardiology black edition. It was a christmas present and I absolutely love it. Prior to that i used a littmann select II scope which worked really well. For school, grab a moderately priced one, or better yet, grab a really crappy one and learn to listen with it. If you can pick up the sounds you need from a POS scope then you'll never had difficulty if you move up to a better one later. If you start off with the best but are later forced to use a crap one then you'll find you won't be able to hear shit.

Yeah, after I posted the question about the ETCO2 I took some time to think about it and realised that I was mistaken for the very reasons you just posted. Would have gone back to modify my comments but the iPhone version of this form doesn't have the edit button. This is was an excellent scenario. ASA can be a very dangerous drug, not quite as dangerous as Tylenol, but it's up there.

any change in condition after the bicarb is in? I'm quickly running out of ideas of what I could do during transport, other than assist ventilations, and monitor. I also expected the ETCO2 to be much higher... Also what does the waveform look like? Any change in etco2 with bagging and the bicarb?

Stale urine gets me to gag a little, vomit not so much. It used to but it kinda wore off after a while. Worst thing I had to endure lately was one of many homeless individuals. It was a rainy day, he was drinking and his sugar was low. he'd been rolling around in wet grass for a few hours before anyone found him. Very much alive, just his normally dirty clothes mixed with water and urine just smelt absolutely terrible. transferring him over to the hospital bed made me gag. One smell that i'll never forget from my days of working up north was the smell people developed after drinking hairspray. It wasn't nauseating, rather, it's just a smell that will stick in my mind.

damn, had a nice reply, lost after accidentally clicking on an ad. Okay, here we go. Given the the amount of ASA he took, along with his tachypnea i'm thinking he's put himself into a nice acidotic state. I'd want to have etCO2 hooked up and do my best to help blow off the excess CO2. Initiate transport, and if he starts giving us trouble in back by being the jackass that he probably is, some midazolam IV/IN. And if you got it maybe some NaHCO3?

I hate driving with the siren on, particularly when it has to be on for extended periods due to congestion. I can't speak for Edmonton, for where I work and where I live (both large cities) it's fire who goes around at all hours of the day with their sirens blaring. I'm pretty sure their check list for calls goes something like this, get paged out, saunter out to the truck, grab bunker gear, climb into truck, turn on ignition, turn on lights, turn on siren, wait for garage door to open, pull out, look at map, pull on to road, ignore red lights, arrive scene, turn off siren only after you piss of medics..... At night, if the road is empty I only hit the siren box if it's a blind intersection or if there are cars about. Personally i'd rather see the amount of calls we go to L&S drop significantly.

I'm not going to say i'd never stop to help, but it would have to be a very specific situation, and the circumstances would have to be 'perfect' in order for me to willing put myself into a potentially dangerous situation. A short while ago i arrived about 40 minutes early for an afternoon shift so i decided to go drive around the block to go to a Tim Horton's for a coffee and a sandwich to eat at base. Right at the intersection where the TH was, i saw a couple of cops in the intersection and a woman lying on the road a couple metres from a stopped car. She probably got hit. But I didn't know for certain, it was raining heavily so there was a good chance that she was hit. I weighed the options in my head and ultimately decided to drive by and forgo the coffee. Was it the right choice? For me yeah. Would it have looked bad if someone saw me drive by while in uniform? Probably, but i don't care about optics and luckily my car has a good tint job . I could also see one of our trucks coming up the road behind me, literally only about 60 seconds away from patient contact. My presence wouldn't have really done anything other than get me soaking wet and potentially late for work. It did cost me my coffee and sandwich though. A couple weeks ago I was Niagara Falls NY doing some crossborder shopping and we stumbled upon a fresh MVC, only ones on scene were PD. It looked relatively minor, but either way I didn't want to put myself into that particularly situation. So i drove on.

AH, okay. Seriously, everyone who complains of abdo pain aren't allowed to walk down a flight of stairs? Damn, that's a restrictive policy. Also tells me that you guys aren't really trusted, are you?

My only concern with this story is why the heck did you stairchair her?! And what's a RMA?

*cough* their */cough*

the IAFF has done an absolutely amazing job making people believe that fire departments and firefighters are needed on every other corner. That's what we really need, an organization that is essentially a PR machine for us. But unfortunately we're so fragmented that it won't happen for a long time, if ever.

What I can imagine is that both 12 leads showed the same ST changes, that whatever s/he was seeing in the current 12 lead were present in 2009.

You could easily write a 10 page paper on something like atrial fibrillation or heart blocks. You just have to get the right sources. My first suggestion would be to ditch regular google and become fast friends with google scholar. There's also journal services that (hopefully) your school subscribes to. You should be able to find a tonne of information on it. 9 pages really isn't that long. When I was in university, particularly in the upper years, i would routinely have papers that were 30+ pages in length, heck sometimes my bibliography would be 8 pages long! Regardless of which condition you go with, start off with an introduction (obviously), then you can start off with either a description of the condition including the patho of it including the dx of it, then you can move into the epidemiology of it, and then go into treatment. You can also discuss sequela and comorbidities of the condition. Wrap it up with a conclusion and your works cited and boom you got yourself a nice neat little paper. (hint: if you're running out of ideas and still have blank space to fill, trying throwing in a few graphs and images, this works well in the section on epidemiology and comorbidities, and if you absolutely need to, try finding a couple long quotes, as if they're longer than 3 lines you need to format them in such a way that they eat up a tonne of space).

Just throwing it out there, the guy is a diabetic, there stands a chance that his normal BGL is pretty high and that 4 mmol/L is hypoglycemic for him.

7 people, assuming none of them are related, is not a large enough genetic pool. You're going to have a large founders effect in subsequent generations which may kill them off. As for who I would keep. It doesn't really matter based on their position in society. The farmer, for all we know, could be a dairy farmer and as such has no real knowledge about tending to crops, while the prostitute may in fact be an avid horticulturalist. The lawyer could be a tax lawyer, not exactly useful in a post apocalyptic society. The army captain may have been public affairs officer and as such doesn't have extensive training in tactics. The physician and med student, while they have knowledge that most others have, it doesn't necessarily mean they'll be of value. Chances are if everything was destroyed, then there wouldn't be much in the way of medical equipment and pharmaceuticals laying around, so even if they could give a diagnosis they wouldn't be able to treat it. As for who I would take with me, I don't know. Probably the people who annoyed me the least. Not to mention the ones who would be less likely to stage a coup.

The 10-2000 button is a good idea, but I honestly have no faith that the system will work when/if I ever need it. The fleetnet system that is used by Ontario EMS (except Toronto, lucky bastards) has a major limitation with the panic button. It bounces off every truck that is it's line of sight. So when a 10-2000 is activated by the button and there are multiple trucks around, the dispatcher's computer registers that x amount of crews are declaring a life threat to themselves. Line of sight is a major issue with it. About six weeks ago another crew in my service was doing a call in a building with about 25 floors and they were on the 24th. The area has poor coverage on the fleetnet system, no one seems to know why. And this building does block out most of the traffic between the portable and the repeater in the truck. This crew had a combative patient and they actually hit the button. So instead of the message being relayed to their truck that was at most only a few hundred metres away, it bounced off another truck (mine) which was about 5 km away, but in perfect line of sight of where they were. Our radio passed it on, and the ACO asked us if everything was alright. We said we were and all went back to normal. Now luckily, the patient the other crew had wasn't entirely dangerous, they just needed help in keeping him from flailing about. They resorted to using the button becuase all their radio transmissions were covered in static. Eventually one was able to call CACC on a landline and request a second unit (which turned out to be my partner and I). I remember another time where while my partner and I were one of the ERs, I had gone out to grab something from the truck and hit the button on the portable. Again there were several trucks around and they all sent out the call. The ACO had to go through all of them to ensure they were fine. Of course as luck would have it, they didn't call me for whatever reason. I think i've set it off maybe 3 times in the past few months, the last time was yesterday. I was working the PRU and set off the truck based one as I was getting out of the to attend to a call. And unlike other MOHLTC run CACC's mine doesn't use the the code phrase so really there wouldn't be any way to indicate we're screwed without letting the threat know.

Has the kid been ill recently? What is the quality of the pain, what provokes/palliates it? Does it change on palpation? What does the kids chest look like? Any previous cardiac history? What does the kid look like? What is his ethnic background? Is he a sedentary kid? or an active kid? What's his family cardiac history like?

For me it's the reliability. But like I said, with the Zoll's incredibly small screen, i generally don't have it viewable.

Yeah the nasties are a concern, but it's somethting we deal with. One thing I hate about my services' older Crestline trucks is that they don't have a separate outside compartment for personal belongings. I try not to eat in the truck, but sometimes I will snack on a banana or something. It's unavoidable. Thankfully my service has bases throughout it's catchment area so (in theory) we are sent to a base between calls. I really dislike having to buy food when working. The food is generally crap, it's bad for you, and it's expensive, and there are probably just many nasties in the back of a McDonalds as there are in the back of your truck lol.

We use the Zoll E and it defaults to lead II. If I want to see a second waveform i have to go into manual mode, but since the screen on the zoll is so small I typically don't turn on the second wave (which is usually SPO2). When I print strips I will for the most part, do it in manual mode so the strip gives me II, I, and III. I miss the large screen of both the LP 12 and MRx, as I like having as much info available from a single glance.