daedalus

awesome dude! I remember seeing my status change from "EMT-Basic" to "Paramedic" on the nremt website, I was on cloud 9 the whole day. Now it will be PARAMEDICinPEA hahaha.

wow... I know of this incident. Would elaborate but I don't think it would be a good idea. Amazing they actually are going through and looking for an attorney.

While unfortunate, the OP's company seemed to be dispatching to emergency calls and was not equipped to do so. It is stupid and dangerous but for now it is a fact. (at least in 06 it was....) In my opinion, all BLS ambulances should have an AED so that a responding EMS crew can provide a higher level of care then a mall security guard...... I know most ambulance companies in the Los Angeles area are not equipped with AEDs, which is a tragedy. I gave charcoal 3 times the past 6 months. All were orders from the med control doc.

Ruff, sorry. I posted that from my phone after I had read your post calling my response "ridiculous". I didn't see that there were followup posts. I generally find you to be a knowledgeable forum poster and enjoy reading what you have to say. Indeed, if Mr. Greene had an ambulance outside I would have expected him to give O2.

Seriously?? Did you even bother to research the facts in the case before posting? He did not have an ambulance, he was not a field employee, and was on break.

The comments on Yahoo news are disgusting. Here we have a man that decided to dedicate his career to helping others (we all know how much EMTs and dispatchers get paid) and when he is shot and killed the public chalks it up to "karma" or "that monkey deserves it". The internet really brings out the inner racism and ignorance of the general public. My own views on the situation are that he did all he needed to do by calling it in. Now, I would have called it in and stayed with the person in distress, but what can an EMT-B without equipment do in a situation like that? Better, what could an EMT-B with equipment do? We better all behave ourselves lest we want to be tried and sentenced in the court of public opinion with the help of youtube and camera phones.

Paramedic school will not offer you what you are looking for. The EMT class will be sufficient for your needs if you are taking it to become proficient in handling injuries in your volunteer groups as a layman. You will never use the knowledge or procedural skills from paramedic school again without working in an ALS system, and these skills rapidly atrophy. You will not be forming field impressions (read: diagnosis) and treating with medication and invasive procedures as a layman, so you will have wasted a year of your life completing a paramedic program just to learn first aid when an EMT class will be more then enough for you. As a layman, some of the EMT scope will not even be available to you while working alone.

<br><br>While I agree that local acronyms should be avoided, and I do try to avoid them, Hs and Ts are really a nationwide (possibly worldwide in english speaking countries) acronym used in the American Heart Association materials for emergency cardiac care, and mean the same to everyone everywhere. These are taught in the standard ACLS course. Similarly, I have never heard of ROSC being used to describe anything other then return of spontaneous circulation. I do understand the advantage of spelling things out and will opt for that in the future. <br><br>Six Hs and five Ts are common etiologies of cardiac arrest:<br>Hypovolemia, hypoxia, hydrogen ions (acidosis), hypo/hyper kalemia, hypothermia<br>Toxins, tamponade, tension pneumo, thrombosis, trauma. <div><br></div><div>Now you can see why it is&nbsp;convenient&nbsp;to refer to the above group as just the Hs and Ts, as it would be an exercise in redundancy for the AHA to make students rehash this list during megacodes.&nbsp;</div>

I have always looked at it as addressing one of "the Hs and Ts". I run my bag wide open during codes, but it is purely an empirical intervention and I have no data to back it up. I would stop doing it if evidence to suggest it has a negative effect on outcomes becomes available. As a side note, I have protocols to infuse iced saline wide open if ROSC.

The problem with high altitude is the lower barometric pressure and lower pressure of inspired oxygen (PiO2). You have air at high altitudes, and the gasses present are in the same proportions as at sea level (O2 is still 21% of the air), however, there is less air in general. Think of the molecules making up the mixture we call "air" as being more spaced out and less abundant at high altitude. Without proper acclimatization, hypoxia is the primary offending agent behind AMS, HAPE, and HACE. Where as decompression issues from diving relate to how gasses dissolve into solution (blood) at different pressures. For example, HAPE is a form of pulmonary hypertension brought in by hypoxic pulmonary vasoconstriction. Hydrostatic pulmonary edema develops, and hence you get the name HAPE.

I don't even know what leads I am looking at, and saw what looked like one PVC in the entire set of strips. I will tell you that I get fluttering in my chest all the time, the cause of which is the occasional PVC as seen on holters (I have congenital heart disease so I am monitored carefully for any chest complaints) I have had done. Worse with stress, lack of sleep, caffeine, and chocolate. Bothersome but quite benign in my case. Probably yours as well. You may want to look at the provoking factors I listed above and see if those apply to you, and what you can do to cut down on coffee/energy drinks/soda, try and get a good nights sleep, and use stress reduction techniques (I exercise and meditate). Normal hearts are sensitive to these things, however yours might be more so because of your coronary artery disease.

I knew you were not having a go at me, I am sorry if my earlier post had that sort of a tone. I know, it sounds crazy, but I do not see medical assistants as any sort of a problem in our health care system. The role they fill is very specific and they do in fact go through classroom training. They are the doctor office receptionists and assistants, not licensed providers. They are not allowed to do anything (including taking vital signs) with out a physician requesting so, and everything they do must be from express delegation from the physician. Did I mention that MAs CANNOT work in an acute care environment. No hospitals. They can only give meds in an outpatient doctors office in non emergency situations. They exist to make life easier for the physician. They cannot work independently, cannot preform assessments. In this type of situation, you can guarantee that the physician has spent time in the room with the patient due to environment and workings of outpatient medicine. EMT-Bs on the other hand, and paramedics who go through mill programs, are huge embarrassment for our country.

NSTEMI (a heart attack, that did not produce ST segment elevation on EKG) Non Q Wave (see above) Peak Cardiac Triponin .86 (an elevated cardiac enzyme marker, signaling damage to the heart) Marked Hyperlipodemia (high blood fats, can be cholesterol or triglycerides, which is a risk factor for heart disease) Marked Hypertension A-symptomatic (high blood pressure, another risk factor for heart disease) Severe Cardiomiopothy (cardiomyopathy is dysfunction of the heart muscle) Ejection Fraction 25% (your father has a low ejection fraction, normal for an adult male is around 50%) Akanisis of posterial wall (the posterior wall of his heart does not contract normally due to damage, as see probably on ultrasound) Severe Hypokenisis of anterior lateral wall (same as above) Mitroregurgitation 1+ (mitral valve regurg is abnormal movement of blood back through the mitral valve during systole. This can be physiologic (normal) when it is mild.) Your father's heart was damaged due to a heart attack, and possibly was damaged before hand by previous cardiac events and/or chronic hypertension.The diagnosis of mitral regurgitation and of wall hypo/akinesis is made after echocardiography of the heart. This would be a routine test to preform after a patient has sustained a heart attack. From the results, it would be extremely beneficial for your father to followup with his cardiologist at all recommended appointments and to follow all treatments prescribed. I merely defined the terms you are working with, which is not medical advice and therefore does not violate forum TOS

Even if I wanted to delete my post, I can't. It would take administrator/moderator privileges. Besides, I do not entirely agree with the OP so my comments will stand. The gate to bring this thread back up for debate was opened by you when it was resuscitated from the murky depths of time.

A more practical reply: What do you intend to use it for? For a paramedic student or paramedic, I would recommend a Littman Classic II. It is lightweight and of excellent quality, and it will let you hear everything you will need to hear as a paramedic. The old adage is true to some extent, in that the ears of the provider are more important then the actual stethoscope. However, you need quality equipment along along with a quality education. The crap rip off sprauge stethoscopes they keep on most rigs just won't do in the discrimination of borderline lung sounds. Remember that the cardiology stethoscopes are designed to pick up on subtle sounds that take years of practice to recognize, and the meaning of which is not even taught in the standard paramedic program. The character of opening snaps and murmurs, the midsystolic click, etc are sounds that have no immediate relevance in the prehospital emergency environment (notable exceptions include ventricular gallops and the murmur of a mitral valve prolapse). Remember that when you buy a stethoscope.

Strongly disagree. If it takes someone at least 6 months to a year to "master" the limited, basic skill set of an EMT in order to go to paramedic school, something is wrong. If I had my way, any John Doe could enroll directly into a paramedic program without EMT first, provided they had completed the pre-reqs to include human anatomy and physiology, intro to psych, chem 1, english. EDIT: this is why I do not like thread resuscitations. I incorrectly assumed the OP's thread cam about recently when in fact it is dated to 2006. I will leave my post above as it stands, but it is not my intention to start this type of debate in an ancient thread.

I don't think you understood my post. A medical assistant can give almost any medication in the IM route if they are told to, but they have almost no training in pharmacology whatsoever. Why is this possible? Because no knowledge of pharmacology is required for their job description, the physician is present during the procedure. This is exactly what medical assistants are for. While prescribing morphine as a physician, or deciding to use morphine using independent clinical judgment is not menial task, giving an IM injection is. The physician can spend her time educating the patient or writing the chart while the assistant gives the injection. "In every instance, prior to administration of medicine by a medical assistant, a licensed physician or podiatrist, or another appropriate licensed person shall verify the correct medication and dosage. The supervising physician or podiatrist must authorize any technical supportive services performed by the medical assistant and that supervising physician or podiatrist must be physically present in the treatment facility when procedures are performed, except as provided in section 2069(a) of the code." Are medical assistants allowed to administer injections of scheduled drugs? If after receiving the appropriate training as indicated in Item 1, medical assistants are allowed to administer injections of scheduled drugs only if the dosage is verified and the injection is intramuscular, intradermal or subcutaneous. The supervising physician or podiatrist must be on the premises as required in section 2069 of the Business and Professions Code, except as provided in subdivision (a) of that section. However, this does not include the administration of any anesthetic agent.

There is a reasoning behind this and it actually does work out to be a good arrangement. It is not like you are imagining, rather a physician can instruct a medical assistant to give certain medications (like PPD, just an example) by PO, SC, and IM routes. Medical assistants are not educated or expected to understand the drug or the disease the drug is given for, because the physician is physically present in the office and has already examined the patient. MAs are not licensed, and cannot act in any manner like an RN (who can for example, using standing orders, independently decide to give medications without consulting a physician). MAs must be directly instructed by a physician in order to give a medication, and can only do so while the physician is inside of the office. They cannot give drugs by the intravenous route. In California, MAs can give a patient an IM slug of morphine while an MD/DO is in the same room and personally verified the dose. However, an MA in California is not allowed to document pupillary responses because it is a form of assessment. Patient assessment is beyond the scope of practice of an MA. Initially weird, but when you think of the very specific role they play (keeping costs down by allowing physicians to hire lower paid assistants to staff their office instead of paying RNs a nurse salary to do menial tasks), it makes sense. Now, in response to this thread, some of the posts do not even deserve a reply. Nobody with a 120 hour "education" or even a whopping 300 hour EMT-I "education" should be claiming to be an expert in BLS level care. I never understood why EMTs think they are better at the basics then Paramedics are. I spent a lot of paramedic school relearning the proper way to bag a patient, insert nasal airways the proper way, etc. I have said this before in another thread, but I was humbled the first time I went into the OR and found that getting a good mask seal was a lot harder then I had thought. Glad I got expert (by anesthesiologists) training in this critical aspect of emergency medicine. EMTs spend maybe one day learning how to bag, and the instructor teaching them may only be an EMT.... It is like the blind leading the blind.

Good post. You have to remember that more then 40% of Americans actually reject Darwinian evolution in favor of intelligent design (no, these are not the religious folks who acknowledge natural selection but believe in a guiding hand. These folks reject all forms of evolution). More then 45% of Americans literally believe that the earth is only 5,000 years old. 60% of American Christians believe that the bible is the literal word of God. How is that for some taking the bible at its literal face value? For the complete set of these mind blowing statistics and respective background on the polls I would direct all of you to the footnotes in (book) The God Delusion (Dawkins). http://richarddawkins.net/archive/all_content/latest By the way, I am not arguing from a Christian perspective. I hope my posts convey an equal scrutiny of all religions.

We could argue that there is no longer any original holy book. The bible, Koran have been altered so many times to fit the agenda of various groups that it really doesn't matter anymore. The fundamentalist Muslims really, truleybbelieve that the way we live in America represents human kind thumbing our collective nose at god, and that their own children's eternal salvation actually is in peril because of it. This is a recipe for disaster, and it seems like t he only people who can be honest about this in our country are conservatives, which is a shame because liberals could add a. Lot of wisdom and a different perspective to the problem if they would take their heads out of their politically correct rectums. I really am aiming not to offend anyone on the forum with my posts, btw. I only hope for honest debate and conversation. Her eis some interesting video from TED

What does the unibomber have to do with religious extremism turned jihad? Different motives and different people, not the same. The 9/11 plotters were soley motivated to drive those planes into the towers because of their beliefs, beliefs about what happens after we die, and that is a dangerous thing. It is possible to be so educated that one could engineer a intercontinental missle, yet still believe that dying in the name of Allah guarantees you and 70 family members admittance to eternal life in Paradise. By the way, how would you interpret the Koran? What parts do you leave out and which do you tenants will you subscribe to? I don't think it's a matter of interpretation because the koran is crystal clear that fighting in the name of Allah and killing infidels is a very god thing. Just as the bible commands you to stone you daughter to death (in no uncertain terms i might add)if she has sex before marriage. Religious moderates who choose to Ignore these passages do so because of secular influences on their lives, secular values. Yahweh never told us it was ok to stop killing gays, but most of us don't.

Here here! See, most, including I, value tolerance. As Sam Harris would say, the only way that we are going to be able to move forward in the world today in the face of multiple separate groups of people with irreconcilable, incompatible views on what happens after we die and what our creator demands of us before then, is to value open honest conversation. It is merely an obsession with being "politically correct" that demands that we here in America subscribe to the idea that we must be tolerant of intolerance. The creators of southpark were threatened with murder for depicting the prophet Muhammad in a bear costume in a cartoon, and the liberal ideologues have the nerve to tell southpark to be more sensitive to others and that their cartoons are inciting intolerance. American liberals tell us that it is ok for extremists to threaten murder for such things, because it is the religious laws in their land and who are we to tell them they are wrong. Yet, it is a seemingly one way street and as Americans we must bend to the will of everyone else and do not have the right to be angry over an islamic church being built were our way of life and citizens were attacked, lest we be viewed as intolerant and bigoted to suggest that we do not wish such things built near ground zero. Keep in mind, I am a very politically liberal. I envision an open society where everyone is free to believe what they wish, I just find it infuriating that we are required to tolerate intolerance for fear of being labeled as unaccepting of other cultures if we do not. And this is not a Christian perspective because we are not a Christian nation, but a secular one.

As I recall, Christians are still compelled to follow the teachings of the Old Testament. Religious moderation provides the cover for religious extremism, as it provides cover for cultural relativism.

While I agree that as a whole, the Islamic religion does not represent the views of extremists, it irks me that a mosque (a representation of Islam) is being built at the foot of two amazing structures destroyed by muslim extremism. Some of you here might argue that it was actually socioeconomic and political factors that gave rise to Muslim extremism that took countless lives on 9/11, but you would be wrong. Most of the conspirators including the pilots in the 9/11 plot had PhDs, and were from wealthy backgrounds. Recent psychological research into religious extremism finds that even after you correct for poverty, lack of economic opportunity, etc, extremist views in the middle east actually increase. "Go forth in Jihad... [9.39] If you do not go forth in Jihad, He will chastise you with a painful chastisement and bring in your place a people other than you [to go on Jihad]"... Um, have you read the Old Testament? Yahweh of the old testament is perhaps one of the most unpleasant, cruel, jealous characters ever to be written about in any book.

I have no idea what the point of this thread is???