Dustdevil

You are correct. Ventilator dependency is a concern with almost all ventilated patients, including CHFers. Obviously, it is much more of a concern in COPD, but yes, we have to be careful will all patients who go to a vent.

Kev, we need to save a link directly to your last post to use everytime somebody whines about how hard medic school is and asks if they really need to know all that biochemistry just to be a medic. Excellent job.

I hate all that absolutely pointless and useless crap that people say on the radio. All those words they insert into their conversations that they wouldn't use if they weren't on the radio. It's as if pressing the microphone button transforms people from a normally speaking person back into a truck driver on a CB in 1975. Some of the many examples, in context: "Show us on the scene." (uhhh... it's YOUR job to show yourself on scene, not mine.) "We're gonna be enroute" (Gonna be enroute? Call me back when you ARE enroute!) "At this time patient's blood pressure is..." (Yeah, right. Your EMT took that BP 20 minutes ago.) "Be advised we're back in district." (How exciting. I'll alert the media.) "We're transporting times one." (How disappointing. I figured you could cram at least 4 grannies in there for your dialysis trip.) "Conscious alert and oriented times three." (Sooo... then which parameter is he NOT oriented to? Or was your training so poor that you really think there are only three parameters?) "Negative response to painful stimuli." (That would be "NO response," not a negative response. A "negative" response would be if she punched you in the face for twisting her nipples.) "We're clear scene, Negatory injuries." (10-4 good buddy!) Your really eat-up wackers will cram as many pointless words and phrases as humanly possible into every radio transmission, as if they are a broadcaster being paid by the word. A lot of them actually clear their throat and put on a special radio voice for the event. For example, instead of simply saying "28 priority 3 JPS," which the dispatcher understands perfectly clearly, the wacker will say something like... I just want to shove the microphone down the throat of those idiots.

Of course she is. She's Canadian! :love4:

Diphenhydramine has anticholinergic properties which can create at least two significant problems in asthmatics. First of all, it can prevent concurrently used beta agonists (salbutamol, etc...) from working properly, which is of especially major concern in those taking maintenance doses. And second, it has an atropine-like drying effect on the patient, resulting in thickened and less manageable secretions, and subsequent congestion. Unless an asthmatic patient is in full blown anaphylaxis and circling the drain, diphenhydramine is just bad ju-ju all around.

No! It is NOT a BLS topic! It may well be an EMT topic, but it is NOT a BLS topic. If your MD lets EMT's perform brain surgery, then that becomes an EMT skill, but it does NOT become a BLS skill. There is a difference here that is more than mere semantics, and you need to understand that difference if you are going to practise responsibly and professionally. BLS does not define a scope of practise. BLS is a very specific group of basic skills. The key term there is BASIC. Anything that is advanced is not basic. Anything invasive is advanced, not basic. And "Basic" is a term we are using to describe the skills being used, not the certification level of the provider. The inability to separate the two in your mind is frightening.

BLS pharmacology is an oxymoron. But yes, the distinction between "assisting" and "administering" is an important one. One that most EMT's seem to forget. Regardless, if you are participating in the administration of dangerous drugs, you are practising ALS. Period. I don't care if you're an EMT, a PCP, an EMR or a MFR. Drug administration is not BLS. And it is not merely semantics. It is a very important concept for basics to understand. If you run around thinking, "Oh, this is just BLS because the let EMT's do it," you're going to screw it up and kill somebody. It's serious business. Respect it as such.

This is an ALS discussion. Medication is Advanced Life Support, regardless of the certification level of the person administering it. This is not non-invasive first aid. And EMT's/PCP's need to very clearly understand that they are practising ALS and not take the responsibility so cavalierly. EMT (PCP) and BLS are not synonymous. :roll:

Sweet. Sounds like you are vindicated. Your clinical judgment was on the money, even if you weren't absolutely sure why. Nice job! This is the kind of case review that reinforces your knowledge and gives you confidence in your assessment skills. Again, the key point here is all that wheezes is not asthma, or even COPD, and you called that one.

Seriously, if you can't bring yourself to ask a simple question about insurance in a straightforward manner, then good luck asking patients about their vaginal discharge. There is no secret to it. I suppose the best way is to simply ask, "what sort of health insurance do you have?" They will either tell you or say, "none." In which case you can then ask specifically about supplemental. You have to just suck it up and do it. But yeah, in a perfect world we wouldn't be expected to be admissions/billing clerks on top of being a medic. Unfortunately, with ambo services going bankrupt every day, even the FD systems are putting more focus on billing info these days. It's a necessary evil. Beats the hell out of socialised medicine though!

Optimum results will be very dependant upon what type of studier and learner you are. I take you to be of above average intelligence and learning ability, so really, as long as you have good reference sources, anything you do will be helpful. As AZ and Rid said, most books and programs are laid out in a logical sequence anyhow, so simply sitting down from Chapter 1 and reading forward will work well. Again, I know how tempting it is to skip through those first few chapters on cellular function and biochemistry. The Kreb's cycle has been the death of many a nursing student for fifty years. But think about it, the true point and benefit of doing independent study ahead of time is to get a leg up on the HARD stuff that takes time to understand. The easy (and more interesting) things like gross anatomy, cardiology, and respiratory physiology are not going to present a problem to you when you get them in class, so if you have only limited time, I would focus on the hard stuff in those first few chapters. Wow. Cool to see Frederic Martini's name in there. When I took A&P II nearly twenty years ago, most all colleges were using the Hole (yes, John Hole is his real name) book for A&P. It was what we had used in A&PI. But come the second semester, Martini gave us all a free copy of his brand new text to stir up some business and most of us loved it. I still use mine for frequent reference. It has apparently become a standard. I didn't realise that Martini co-wrote the Bledsoe book. Anyhow, I think I would look for a programmed learning text or system instead of a standard textbook. Something that actually guides you through the learning process in a pedagogical fashion with frequent questions, reviews, fill in the blank progress, and other specific learning tools. Just reading a dry textbook without any interaction is a tough way to go, and is not for everybody. Usually not ideal. One example (although there are many) of such a programmed system would be this: http://www.elsevier.com/wps/find/bookdescr...ion#description That would be a lot more instructive than simply reading a normal text. But of course there is also something to be said for simply buying the same $100 dollar A&P book you're going to have to buy for the A&P class anyhow too! The book costs will definitely add up on you fast enough without buying too many elective books. Good luck!

Heart failure? Respiratory failure? Both? :dontknow:

And, as always, minus five for posting an ALS topic in the BLS forum.

Valid concern. Unfortunately, the lack of vital signs, as well as the patient's absence of full mental orientation, makes it very difficult to comment intelligently on this specific case. Don't you mean obviously NOT? 95 on supplemental oxygen sucks. And with the sound of her chest, I'm not surprised. Possibly. But there are multiple situations where a patient's cardiac history has to be weighed against other factors, and non-cardiac respiratory distress is one of them. If, given the info you have from your H&P, you believe that the respiratory distress is critical, then you have to go with the salbutamol but keep a very, very close eye on the patient's for signs of intolerance. This is a clear example of why all that boring stuff in paramedic school is truly important. Because cookbook protocols simply cannot make these kids of decisions for you. It takes a clear understanding of your patient and the pathophysiology of his conditions, as well as the pharmacology of the agents you chose to administer. If you lack any of those understandings, then no, you certainly shouldn't be administering any treatments at all. If you do, and your patient is in serious need, and you're more than five mins from the ER, then sometimes you have to take a chance. But as AZCEP alluded to, all that wheezes is not asthma. If the lungs were that wet, I would have been looking more towards fluid relief than bronchodilation. A little NTG and Lasix sounds more reasonable than salbutamol, given the information you have provided. I hope you don't actually believe that a 12 lead in and of itself is a definitive diagnostic tool. I hope that is not what is being taught in schools today. It is not. I don't see any problems with trusting our 12 leads. But I see a HUGE problem with a lot of the medics out there attempting to interpret them with inadequate education and understanding of the concept. And any doc will tell you that an EKG alone is not enough to definitively diagnose an AMI, so banish that thought from your mind. That has been pretty well covered above. Again, don't get hung up on EKG's alone, and the cookbook protocols used to treat them. Always refer back to rule number one of cardiology which is... But to answer your question, yes. You were quite correct to be sceptical about using beta agonists in this patient. I would venture a guess that medical control simply got so tunnel visioned by the respiratory symptoms that he wasn't seeing the same concerns that you were. But, as I said in the beginning, it's really hard to say with only the info we have here.

I guess I'll mention the obvious. They should definitely avoid crack, heroin, PCP, LSD and meth. Probably pot too. Most anything inhaled that isn't a steroid or beta agonist, for that matter. Mushrooms are okay.

They're firemen. What do you think? I would bet the only concern they regularly express is about having to run EMS at all.

Find out who did the study. Chances are it was one of two "consultants" who make the exact same recommendation to everybody who hires them. That's like hiring Motorola to tell you whose radios you should buy. It's a one size fits all bill of goods. Consequently, the "study" results are suspect. The politicians need to ask for independent evidence to support these idiots claims and go over it with a fine tooth comb. Hell, just asking the "consultants" how much time they have personally spent as paramedics should immediately discredit them. The list of drawbacks to the PUM is too numerous for me to even want to get into right now, but I got a good start on it in the other topic about AMR. There are definite positives to it, but they are clearly outweighed by the negatives. And most of the positives they promise never materialise. It doesn't matter who runs it -- AMR, Rural Metro, Paramedics Plus, CEMS, or Abdul's Ambulance -- working for a PUM sucks arse. For your sake, I hope it doesn't go that way. But it seems that usually when politicians blow $50k on a pointless study, they tend to want to follow the recommendations they get from it, so chances are you're buggered.

Uhhh... LP, it is often useful to read the original post before replying to a topic. :? This has nothing to do with scene responses.

Okay, just did a couple hours of research on this "Myth Busters" thing and found that it was a BUSTED myth, not a substantiated one. http://www.nationmaster.com/encyclopedia/M...usters-Episodes says: Their specific findings were: 75lbs from 3 feet (official ANSI test height and weight): mashed the leather down a bit, but nothing injurious. 400lbs from 3 ft: more deformation in the steel plate, but only damage to frangible foot was a broken metatarsal (big toe). Adam: "I want to see some toes cut off or crushed beyond all recognition" 400lbs from 6 ft: a lot of pancaking of steel cap and lots of broken bones beneath, but no toe amputation. I'll keep my steel toes, thank you!

Hmmm... I think I understand what you are saying, but I am not quite sure. Are you saying that significant crushing weight will push the steel cap down and cause a traumatic amputation? I can see that. Not sure how much of a factor that is though. Seems like any force significant enough to do that would be so traumatic as to crush the foot severely enough to kill it anyhow. But you raise a very good point that I have not ever considered before. Are steel toes tested to a national standard like ANSI? If so, what is that standard and what will it withstand? Did you actually see this addressed on "Myth Busters" or were you just using that jokingly? Hmmm... definitely going to have to look into this one and possibly rethink it. Grace, I have no idea what you are talking about. You were the first one to post here in over a month. :?

I spent half my career in rural systems where the nearest big city was an hour or more away and there wasn't so much as a WalMart or Dairy Queen in the district. I still got plenty of intubations in. People die in the country just like they do in the big city. Yes, there are more people in the big city, but there are significantly more paramedics too. Being one of 300 medics working the big city doesn't guarantee you many more intubations than being one of three medics working a rural county. Again, unless we're talking frontier, I just don't see where the law of averages changes significantly between most systems.

Very true. During the discussion, there was a mention of services where medics only do three or four intubations a year. WTF? Where the heck is that happening in a full-time professional EMS system? I don't care if you are urban, suburban, or rural, if you are a full time professional, you are getting several times that number of intubations a year unless you are on the remotest frontier where people are cold and stiff before you ever get to them.

I don't think you need boots at all, unless you're jumping out of helicopters into rugged terrain. The ankle support they supposedly provide is seriously overrated, if not bogus. They take a lot longer to get on if you are sleeping/relaxing sans footwear. They're more expensive than shoes. They're uglier than shoes. I just don't see a point in them, and personally would probably prohibit them at my school or service to cut down on the wanker look. Steel toed safety shoes and ankle boots are preferable in all respects, as far as I am concerned. I have worked for agencies that required steel toes and those that do not. It seems to vary a lot. But then again, a LOT of agencies simply don't have their $hit together on their safety programs either. Their ignorance accounts for a lot of the variation. Seems like a great many agencies spend more time designing their badges than they do considering the safety and functionality of their uniforms.

It's already happening in some places in the US. Texas is doing it relatively appropriately. Tech school medics are still called "EMT-Paramedic," but degreed paramedics are "Licensed Paramedic" with a completely different patch that does not have "EMT" anywhere on it, nor does their cert card. It's a nice incentive to medics to pursue another level of education, addressing the rampant problem of medics who think since they are medics they no longer need to continue their education. I would expect other states to follow. I would especially expect some sort of restructuring in those states that require a degree to be a paramedic, like Kansas. But nobody with less than two years of FULL TIME college education should qualify for such credentials. If you don't have at least as much education as the glorified photographers we call x-ray techs, you still have a long ways to go.

Remember when you took your EMT test they told you if something says "always" it means always, but if it doesn't say "always" it doesn't mean always? Well, the same caveat applies in real life. I didn't say that anybody always did anything. I did not lump anyone into anything. In fact, I went out of my way to mention some specific exceptions. You're just too caught up in your own territorialism to read correctly. :roll: