Dustdevil

I wish that were true. Since I am in the middle, that would mean we would get Philips, which is ten times better than either Zoll or LP. Unfortunately, I have yet to see one here.

Yeah, but I can't spell it.

The LP10 was better. I don't like the 12 at all. As firejeep said, whoever designed it obviously was not a medic.

Whose word? John's word? I don't know John from Adam, and neither do you. Why is his word so unimpeachable? Do you believe everything you read?

I do. The layout of the LP12 sucks. Confusing. Not logically laid out. Not easily recognized in the dark, or even at all without focusing. Too much reliance on multi-push buttons. Too big. Too many pointless accessories. Ergonomically a pain in the ass. Basically, I just don't like it. The Zoll is a tad bit better. Much better layout. And the new M series at least has the handles in a better position. But the design of the case itself, like the LP, leaves a lot to be desired ergonomically.

No. Once it is on, it stays on. Rapid fluctuation of oxygen intake is not consistent with the principle of homeostasis. It taxes the system. You simply have not the sufficient means nor knowledge to properly evaluate the patient in the depth necessary to reduce or remove their oxygen. They need to be at the hospital and have blood gasses evaluated before that happens.

Meh... I tend to lean towards the theory that damn few communities in the country are even prepared to handle routine EMS, much less mass disaster. I would much rather them concentrate on getting paramedic staffed ambulances everywhere they need to be for daily operations than stockpiling a bunch of disaster crap to sit and expire somewhere. Maybe that's just me. I'm just crazy that way.

People who assume that if you say basics are inadequately educated that you mean they are idiots or nimrods. Get a thicker skin (and an education) or get out of the business.

Probably not a very experienced or educated emergency nurse. Nurses come out of school with a more long-term holistic approach to patient care than we do, as it should be. They get very, very little education or training in immediate, emergent concerns which deviate from the norm. That is why there are two completely different professions. Completely different concerns.

Basically, schools are going to have to address this in their own teaching and testing methods. Your own written exams should reflect the style of NR by making them situational. Same thing with your classroom methods. Students should be presented with a scenario or two to support each and every concept they learn. Rote memorization of facts simply wasn't cutting it in EMS education, and now NR is exposing that weakness. The best I can recommend is to make all of your instruction, both didactic and practical, scenario based. Make your students feel that everything they learn is part of a total patient scenario and not just an isolated, meaningless piece of info. So long as they know the information, and are used to thinking in terms of patient care, any intelligent student should do fine. Although, firemen may not do as well. :wink:

The issue of accurately communicating the situation to dispatch so that they can start adequate resources to the scene cannot be overstressed. An important part of that communications would be to make sure all inbound units are aware of the street conditions, in order to hopefully prevent a pileup. Officially, you are the triage officer, meaning you do not involve yourself in rescue or treatment. However, in this situation, I agree that it is probably reasonable to assume that your partner is the only victim who may be in a relatively safe position to approach. Not to mention that she is the hands-on favourite for the sympathy vote. So... Burn victims - unsafe to approach. Require properly equipped extrication resources before triage. Crash victims - unsafe to approach. Should be wearing protective equipment, so in a better position to help themselves than you are to help them. Partner - The only patient you can reasonably be expected to approach, meaning all of your attention should be focused on her. If she is in immediate danger (still in the road), then an emergency move is indicated. Hopefully, other medical resources will safely arrive before more patients are brought into the safe zone. If not, at least you have had a moment to secure ABC's on your partner before you have to resume triage. Of course, you can what-if the scenario to death. Radio system fails. More apparatus crashes. Building collapses on firefighters. Meth lab explodes. News helicopters and medical helicopters collide. Guy who started fire starts sniping at responders with an AK-47 from across the street. Pit bulls escape from back yard and go on rampage protecting their owners. Good times!

Just to muddy the waters, I have more than once seen a COPDer misdiagnosed as a psych patient by providers, both pre-hospital and in-hospital. Could it be that your patient is acting combative because of hypoxia? Could it be that your patient is hallucinating because of steroid psychosis? Could it be that we aren't teaching either one of those concepts adequately in EMT and paramedic schools?

Incorrect. It is an ALS skill being performed by basics. If basics perform IV therapy or drug therapy, it does not make those interventions basic.

Hmmm... In the context of treatment decision making, I would consider it wrong to place any meaningless label on your patient. We are to treat our patients as individuals, not as diseases. I have always felt that respiratory was one of the weakest links in EMS education here. And it really is. Giving people broad labels like COPD without sufficient education to fully understand them is just plain dangerous, as evidenced by this scenario. But even if you do fully understand the pathophysiology, such labels don't add anything significant to the pre-hospital picture.

Hey Woody! Who could forget you or your avatar? I don't know where you can find firefighter pinup girls. But I have pics of the most beautiful girl in the world. I say just get her tattooed to you and have Kat put a helmet on her.

All sitcoms and drama's are insulting. They are insulting to the intelligence. I don't watch them.

Not to mention the little fact that this was not a COPD patient. It was an asthmatic. Hypoxic drive is not even a concern in this patient. And even if this were an emphysema patient, the treatment would be exactly the same.

Not only was the HFD figure a gross exaggeration, but the figure for your "head paramedic" is also a fantasy. If an HFD medic gets a full arrest per shift, and he intubates both of them instead of his partner doing one of them, then that comes out to 2 intubations a week, which is the number I stated. In over twenty years, much of it in the ghettos and barrios of Dallas, it was pretty damn rare to get two tubes a shift. Certainly not twenty. They don't see that many patients per day. Not even in a week. In fact, the vast majority of ghetto runs are BS runs. Now you're saying that this "head medic" gets twenty a week and she's not even with HFD? Come on, dude. I hope your math isn't really that bad. Otherwise, you can forget ever taking the hyphen out from between para and medic.

Did you read the scenario? What on earth gives you the impression that this patient was not in severe respiratory distress? I can't imagine that anybody else here got that idea. He's stopped working. He's struggling to speak because of his dyspnea. He's hypoxic enough to be in a panic about a mask over his face. And his Sp02 is 72! Yes, you can titrate oxygen. But you titrate it DOWN, not up! It's been that way as long as I can remember. This is nothing new. Oxygen is not like other drugs where you have to titrate up because high dosages will be harmful to the patient. Oxygen is the very opposite, in that dosages too LOW will be harmful to the patient. Use your head. Think this through. Tell me one single medical or scientific principle that would make you think being stingy with oxygen on an asthmatic is a good idea. I want to hear your logic.

Well, we still don't know what "HFD" is. :? Regardless, the biggest HFD I can think of is Houston, and even their busiest medic would be lucky to do 2 intubations a week. Me thinks you might be exaggerating a wee bit.

Nah, I'm with you, Intothis, and CHPmedic. I am confident it is A-fib with ectopi. Neither the P's nor the complexes march out. Close, but not quite. So make that a cardio nurse and a pedi nurse saying A-fib.

Completely disagree. And I suspect you won't find a textbook or instructor who will agree with you. There is absolutely no medical or operational justification for that. If your EMT school taught you that, your school sucks. Juice, you did just fine. I completely concur with everything you did. No jabs. You're doing what basics do best. First responder. No problem at all with that, as you are obviously doing it well. I do, however, have an issue with your manager delaying care for this patient.

By the way, minus 5 for starting an ALS thread in the BLS forum.

Safety, I am mostly in agreement with your points. The only comments I have would be: 1. Improper placement causes death because inadequately educated, inadequately experienced, and inadequately intelligent providers are commonly incapable of determining the proper route for inflation. Look at how many full paramedics still intubate and inflate the esophagus. So you know that the chances of improper use of the combitube by lesser providers increases exponentially. 2. While I agree that you can make an excellent case for just about anything in a CPR, I have seen and heard too many stories of inadequately educated responders doing things simply because they can. You give them that tube, and by God, they are going to find an excuse to use it. Consequently, I would hope that any system that has basic level providers using them makes it positively clear that a full-arrest CPR is the only situation they should be deployed in. Of course, the true answer lies in the system providing adequate paramedic coverage for their community so that a bandaid approach to care isn't needed in the first place.

Combitube does not offer a direct pathway to the pulmonary system. Combitube is available in limited sizes. Combitubes do not seal the trachea at all, so they do not protect the airway as an ET does. Combitube utilizes high pressure cuffs which cause damage to the pharynx, esophagus, and trachea. High pressure cuffs offer inferiour seal. Inferiour seal creates air leaks and inadequate ventilation, as well as aspiration danger. Blind insertion creates high risk of trauma on insertion and inflation. Blind insertion increases risk of inappropriate placement. In appropriate placement causes death. Combitubes have no place in the hands of anyone under the education level of a paramedic.