Dustdevil

Phys and pharm aren't training. They are education. More accurately, the EMT-CC would be "all the training with none of the education."

Any system that utilises, or even believes in tympanic thermometers sucks. Any system that does not carry or routinely utilise ANY kind of thermometer sucks even more. [Refer to the "Inappropriate use of Lasix" thread for explanation.]

Hmmm... I am seeing some confusing concepts here that I honestly cannot relate to. Number one among them would be the inability to accurately differentiate decompensated CHF from even the most serious case of pneumonia. Anybody that can't do that shouldn't be on an ambulance, period, much less pushing drugs. Almost everytime I have given furosemide, I have seen a positive impact on the patient's condition, especially in rural settings. Of course, there are certainly those patients who are so severely decompensated that simple diuresis is not going to be enough to turn the tide. And, of course, there are those patients who are given a hefty dose of furosemide, which immediately take affect, but the patient is not catheterised (but still in control of their bladder), and it only causes the patient more distress. And then there are those patients who don't get furosemide at all simply because the system doesn't allow catheterisation, and the medic doesn't want urine in his ambulance. Because of that, there is probably just as much inappropriate witholding of furosemide as there is inappropriate use.

:head explodes:

Good times! ENA conferences are tonnes of fun. Of course, "tonnes of fun" takes on a literal meaning at any conference involving nurses. I told you that you'd like San Antonio, Bro! Tell the Philips rep to PLEASE start offering illegal kickbacks to the Army purchasing agents! I am so sick of these worthless Medtronics monstrosities that I am ready to drop them into Lake Habbaniyah from the back of a Chinook! :x

I do agree that better systems base their protocols on current literature and evidence. But even in those systems, there is commonly a "one size fits all" approach that keeps medics within a rigid protocol framework, and does not allow for clinical decision making that may yield better therapeutics for a given patient. We see it here on EMT City all the time. Medics quoting their protocol as if it were the Holy Grail of medicine, when in fact it is inappropriate for the situation at hand, yet that medic remains blissfully ignorant of that fact and smugly satisfied with himself because he successfully, yet mindlessly, followed the recipe in his little cookbook. Protocol is not evidence, even if it is evidence based.

Definitely. But that is definitely not a positive argument for the Intermediate level. It makes grasping paramedic school a little easier because you have already done it once. That's like saying repeating the grade 9 makes it easier the second time. Sure, but I don't think anybody would recommend that we take the grade 9 twice just so the second time is easier.

You just sort of answered your own question. The current BS programmes are not comprehensive, scientifically and medically based programmes. They are just paramedic school with a bunch of management and administrative crap thrown in. When we speak of a BS prepared medic being better, we are speaking of a programme which does not yet exist. We are talking about MEDICAL education, not just more hours for the sake of having more hours. This is analogous to nursing education. Contrary to the whining of a bunch of ADNs, a BSN is not just an ASN with a lot of pointless managment courses thrown in. It is usually (in the better programmes) quite a few more hours of clinical education including advanced assessment, critical care, patient teaching, and specialisation electives. That is what an EMS BS should be too. We have to get away from this assinine theory that a 900 hour paramedic school teaches you all the medicine you need to know, and that further education should be nothing more than "management courses." No other medical profession thinks that way. That's why we are the laughing stock of medicine.

Barry rocks hard! OH MAAAANDY.... I NEEEEEEEED YOUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU :headbang:

Sounds like that hurts! :shock: Good thing they're unconscious!

Dude, where do you come up with this stuff?

Mercedes numba one!! :thumbright: The only thing wrong with that ambo is that fugly Star Of Life on it. As for the constant denigration of advanced education coming from those who don't have it, if you had it, you wouldn't begrudge it so much. A properly laid out medical education doesn't include 18th Century Literature and such in their degree plan. Sure, you can do anything you want with your electives. If Medieval history floats your boat, well hell... it's your 16 hours to do what you like with. But you can't judge the value of an education by what few electives somebody chose to take. As was already stated, you can very easily pack four years of actual relevancy into a four year degree program. And whining about others who have or promote education just really makes you look lame. It's like standing up and screaming, "I AIN'T GOT NO EDUMACATION AND SCREW ANYBODY WHO DOES!"

Yes. I still don't understand why you bothered to post this nonsense. Can you help me out with that? If you yourself -- who claims to have actually been there -- does not know enough about the situation to judge it, how in Hades did you expect us to? What was the point? Was there a point? :roll:

Come on, Man. I don't believe you, of all people, just said that! You don't think four to five years of entry level education is revolutionary? You're one of the last people here I thought I'd ever see judge an EMS system's quality by the size of its drug list! :?

I'm depressed.

Good for both of you! Nobody recommends that doctors take off a couple of years between med school and their internship. Nobody recommends that we take off a couple of years in between middle school and high school. See your future. Be your future. Go for it!

All I gotta say is you better use a glass syringe, or it probably ain't gonna work.

I too have seen that method, and I use it as part of my differential, but a true Murphy's Sign is actually elicited during inspiration, not expiration. A true positive Murphy's is when the patient abruptly stops his deep inspiration because of the pain elicited by the palpation. I suspect the other method considers that, depending upon the patient's style of breathing, his belly may be expanding on expiration instead of inspiration. McBurney's is a different sign. McBurney's Sign is simply point tenderness at McBurney's Point, which is the usual location of the appendix. It is one sign of appendicitis, although not a terribly reliable one.

Now the real question is whether your instructor worded this question this way because he is an idiot, or because he wanted to prepare you for the sort of confusing, nonsensical questions you will see on the NR exam. This indeed is the sort of crap that is on NR. :roll:

How much some whacker "loves it" does not exactly instill confidence in thier competence. I don't give a damn if my provider "loves it." I only care that he is damn good at it.

So what exactly was the point of asking for opinions on a scenario that you flat out refuse to give details of?

Hmmm... I would have to say that it IS for abdomial pain, since that is how cholecystitis generally presents. Using that mnemonic is part of the evaluation of abd pain patients to narrow down your diagnosis. There are actually six F's for cholecystitis, however four of them are demographics (fair [skinned], fat, forty, female), and two of them are signs (flatulent, fever). Generally when you hear somebody speaking of the four Fs, they are referring to the demographic terms, and not the signs. If you find somebody with all six Fs and a positive Murphy, you can pretty well stop looking for your abdominal pain diagnosis.

Too shocked to even choose an appropriate subject title, eh? That's pretty bad!

Does anything else really need to be said here? :roll: Type any way you want, dude. Just don't get all bent out of shape when nobody here chooses to take you seriously. You alone will be responsible for that.

Ooooooooooooooohhh!!! SO SORRY! You were well on your way to being a star rookie here, but you forgot the cardinal rule. THE SEARCH FUNCTION IS YOUR FRIEND! :wink: The topic has been beaten to death on multiple occasions. Thirty seconds with the search function will give you more replies than you want.