Bieber

I don't think it's anything to be anything about. It's the color of your skin, it's irrelevant, it doesn't matter.

I agree with you. It shouldn't be. And I don't think that race is Kiwi's point of contention with him, which is why it shouldn't have been brought up at all and why nobody on either side of the fence should bring it up. It's irrelevant. Like him, hate him, whatever, but do so on the quality of his character and on his policies, not on his race.

Hey guys. I'm bringing this thread back to life because, well, I lied. I am considering taking the CCEMT-P course this summer and I'm looking for some feedback from you guys. First of all, yeah, I know, I'm probably getting ahead of myself. In fact I'm sure of it. But my question for you guys is, even though that's true and even though I'm a new paramedic and the critical care courses are designed for providers with several years of experience under their belts, would it be wrong of me to take the course? I don't plan on trying to get on with a critical care service anytime soon, and honestly all of those services around here require three years of experience to get hired on. At the same time, I'm hungry for more education and more knowledge and I want to learn this stuff. I'm already signed up for classes this summer for my Bachelor's/RN ambitions, and I'm not going to sacrifice those to take the CCEMT-P course. At the same time, if I could do both, I would really love to. Right now, this isn't about getting into working in critical care medicine as much as just learning more about it and gaining more knowledge and education and making myself a better provider. So, thoughts?

Kiwi, whatever your political ideology, the race of President Obama is an unimportant and irrelevant aspect to his presidency, and bringing it up the way you just did is unbecoming of you and is a step backwards from the level of integrity and character you generally show.

I agree.

Man, I want to come work for your service!

I would love to have nitropaste, and I think it was requested a while back but denied for some reason or another. As far as dealing with the nitrotabs and CPAP, it's a pain. You just gotta go through the obnoxious process of taking off the mask and popping one (or two, per your protocols) in and then refastening the mask. Are those all by standing order?

I guess it's probably different in New York, but do you feel like you needed the extra protection? Have you ever had to put it to the test yet?

Yeah, I know, I'm just wondering if he's advocating all civil EMS providers wear body armor while on duty.

I agree with Dust and Lonestar, I'm not a huge fan of the pullovers. What's this about body armor though, Dust?

Ruff - Haha, well, I don't know about that, but thanks. And every little bit helps. What are you gonna do after you retire from being a paramedic? Prmedic - That's awesome! Tell me what book you're reading right now. Is it available on Amazon? Herbie - Thanks so much. I do my best. Docharris - I understand it's sometimes hard to find the time to work on those "extra" things that don't really seem essential, but I want to encourage you to redouble your efforts. If there's anything we can do to help keep you motivated, let us know. Maybe we need to start a book club on the forums? Haha! I get what you're saying, and I have the same problem. It really just comes down to forcing myself to sit down, put away any distractions that might be there, and really throw myself into the reading. A lot of times, especially now that the weather's getting nice, if I'm at work I'll just open the bay doors and go sit in the garage with a book. No partner distractions, no TV or computer. Just you, your book, and the beautiful weather. As far as avoiding falling into the "I know this" mindset, why don't you put yourself to the challenge and look up some quizzes or buy a book with practice tests for the NREMT? You might be surprised at how much you've forgotten (I know I am), and that might help motivate you to go back and brush up on the basics. Tcripp - That right there is a great way to learn! It seems like I myself have far too often accepted that "I didn't know" and didn't bother to look up something related to a call, and I'm working on putting a stop to that. If you work in a busy service, sometimes even just jotting down the stuff to look up on a pad and googling it after your shift works. BEorP - Awesome! What do you have your master's in? Are you going to be going back to school to become an ACP?

Another thing to consider is that the patient could very well have had RIGHT sided heart failure as a result of COPD, which could also cause pedal edema. It doesn't sound, based on what you've said, that this patient's problem was an exacerbation of CHF. Anecdotally, it seems like bronchodilators in CHF's flood them like crazy. I think I've heard conflicting stories as to whether or not they've been shown to worsen the pulmonary edema, but in my limited experience, it's seemed to be the case. That this guy didn't get any worse, while it doesn't necessarily prove he wasn't having a CHF exacerbation, still means that he didn't get any worse. And that's goal number one.

Sorry it's taken me a while to respond to this thread a little more thoroughly. I'll try to address everyone's responses in this post. Dustdevil - Good plan! 2c4 - What do you think you could have/should have done in that scenario? Ugly - Thanks for the reply! Just remember that it's very difficult (see, impossible) to rule out cardiac involvement in the field. Still, you make a good point, not all chest pain is cardiac. Bernhard - I really, really liked your treatment plan. The patient has no other visible signs of past medical history not previously disclosed. Consider your treatments in both scenarios to be successful in relieving the patient's pain. Only one question, though, why the oxygen if the patient's SpO2 > 95%? Dwayne - I was hoping to hear your thoughts on this scenario, and you didn't disappoint. There's a little bit of truth and a little bit of fiction in this scenario. I removed the KED to do a proper assessment, you'll be happy to know. In the initial scenario, the pain is described in the first scenario as being localized to the sternum. Only history is mitral valve prolapse, for which they take an unknown medication (it sounds like an antihypertensive) and no allergies. The patient is mostly quiet unless you speak to them, but is appropriate and consistent with an alert and oriented x3 person who is competent and of sound mind, and denies any weakness/dizziness, nausea/vomiting. Assessment of the chest reveals no structural deformity, CABG scars, or signs of an internal pacemaker/defibrillator. No reaction to the IV, and the accident does appear to be the driver's fault. I want to ask you, Dwayne, what made you give the aspirin? Are you concerned about possible adverse sequelae resulting from it? Why didn't you give the nitro? Dartmouth - Thanks for sharing! 1EMT-P - Likewise! But I demand a decision out of you. Fentanyl or no fentanyl? And now, for everyone, a challenge question. How do the anticoagulant effects of aspirin compare to other blood-thinning agents (specifically thrombolytics) in terms to short and long term mortality in trauma patients? What about patients who take aspirin versus those who don't?

Hi guys. This post is a tangent from the other thread talking about EMS Unions. I mentioned paramedics bringing medical books to work to study, and it made me want to discuss the issue further. And so I'm not hijacking the other thread, I went ahead and created a new one. We talk a lot about continuing education, but we don't really get into a lot of detail. Of course there's always more alphabet courses to take, and other educational opportunities to take advantage of while off duty, but I want to talk about work. Specifically, what are you doing while you're at work? As most of you know, I'm a strong believer in advancing EMS education, and I have some great news for you guys: we're all alive in the information age! My dad always talks about how the greatest change he's seen in his life is the shift to the information age. When he went to college, if he wanted to read about something, he had to go to the library. And I'm sure many of you had to do the same. Thankfully, the idea of necessarily making a trip to the local library has gone out the window, and we've entered an era where you can literally find out anything about anything with a few clicks of the button. So what are you guys doing while you're at work? I hope you're not just frittering time away playing Solitaire on the computer or talking about that great fishing trip you had, because if you are, I'm afraid I must DEMAND (see, not ask) that you change that. Fortunately, I suspect that many of you, who have already taken that first step to become more than "just" paramedics by spending your free time on this forum are not like that. But if you are, or even if you aren't but just don't know where to start, this thread is going to help change that. The point is this, guys. We have an awesome job. We literally get to sit around watching TV or playing on the computer for a good amount of our days. We are poised to act, but when there's no action to be done, I think we can all admit that at times we get a little lazy. I'll be the first to admit that I take naps at work, or dick around on the computer, but I also like to study as well. And really, it's a great time to do so. There's no other time of the day when I'm going to get paid for studying, and furthermore, it makes me a better provider. So what about the rest of you? Are you taking advantage of paid study time? If not, why not? And if so, I want to know what you're reading! There's a lot of medical information out there, and it can be hard to figure out what the quality textbooks are and what aren't. So again, what are you reading? What are the pros and the cons of the book? Is it available through Amazon and how much does it cost? Currently, I'm in the middle of medEssentials for the USMLE Step 1 Third Edition by Kaplan Medical. The pros? It's an awesome book full of AMAZING amounts of information, the cons are it's more of an abbreviated guide, so additional references can definitely make it an easier read; but a little googling won't hurt. It also requires a stronger foundation of the sciences than what we're traditionally exposed to, but if you're willing to do a little extra reading to update you on some of the subjects you may not have covered in paramedic school, it'll be well worth your while. You can pick it up on Amazon for about thirty bucks. http://www.amazon.co...04577625&sr=1-1

A better question is, how many EMS systems have successfully created room for improvement? And how can we apply their methods to other EMS systems? I think I smell what you're stepping in. All the same, the problem is, just like we agreed, apathy. Opportunity doesn't come out of thin air, you have to make it yourself. Looking around the world, and even in a few parts of the U.S., we see that opportunity isn't impossible. It's only a matter of us creating it for ourselves. Nurses have done it, again and again; from creating nurse practitioners to CRNAs to critical care flight nurses and so on. Same with respiratory therapists. And, really, the same with every medical profession out there with one major exception: paramedics. We want and we want and we want, yet we never seem to get off our butts and actually do something about it. Why is that? A lot of things, I'm sure, but I think one major hinderance could be the fact that, in our day to day jobs, most of us don't interact with many other healthcare providers. I know that sounds oxymoronic, because we are regularly at the hospitals and amongst our partners, but think about it. When you're not on a call, where are you? Probably sitting in a station with your partner somewhere. And that's it. You and your partner. You may not regularly interact with admin, and admin may be more than just physically distant. Unlike other medical providers who have a hospital full of fellow nurses, doctors, respiratory therapists and so on, we remain secluded, not only from other medical professionals but also from ourselves. And furthermore, exactly who is your partner? Are they a fired up paramedic like yourself ready to take on the world of medicine with nothing but a pair of trauma shears and a stethoscope? Or are they one of those who are either just biding their time till retirement or moving on to nursing and sick of EMS? Have they long since lost the will to try and change things? Do they bring medical books to work to study while they're on duty? Or are they busy playing on their phone or talking about fishing?

All by yours truly. Disclaimer These videos are purely for comic relief and in no way reflect actual events or the behaviors, beliefs or opinions of the author or any other paramedic. All portrayals are purely for the purpose of humor and all events are fictional. Episode 1 http://goanimate.com/movie/04JA5JJ2ZBV4?utm_source=linkshare&uid=0IIxOTZC-F5c Episode 2 http://goanimate.com/movie/0u7hijoUf4R0/1 More episodes forthcoming!

A national union would be invaluable to EMS. Just look at the IAFF or the ANA and what it has done for their constituents not only professionally but with regards to wages and their public image. EMS could become so much more with the help of a strong national organization, however there are a number of obstacles that stand in the way of such a union and EMS. The first and foremost obstacle is apathy. We in EMS simply don't give a shit about our jobs. We really don't. The vast majority of paramedics out there go out, put in their hours, and go home. If they're younger, they bridge to nursing quickly and get the hell out of EMS before it eats them alive, and if they've been in it for a while, they're just biding time till they can retire. The job's not taking them anywhere anyway, so why bother to put any effort or heart into it? Additionally, it's that same apathy (amongst other issues which will be addressed below) that keeps us from increasing our educational standards. Why the hell is anyone going to go and get their Bachelor's in a relevant field if they plan on staying in EMS? It isn't going to change what treatments their protocols allow, and it isn't going to raise their pay any, so who gives a shit? The other obstacle between not only EMS and a national union but also between EMS and raising their educational standards or expanding their treatment options are opposing unions. The IAFF doesn't want to raise educational standards, in fact they seem to want the exact opposite of that. But there are so many fire based EMS services that what unions do exist (NAEMT, for example) are too afraid to take a strong stance on the matter. They won't advocate non-fire based EMS because many of their constituents are fire-based EMTs and paramedics. And any strong pro-education, anti-fire EMS union is going to meet a lot of resistance not only from the IAFF but at worst opposition from the NAEMT and at best an apathetic response by them. Furthermore, increased educational standards and increased treatment modalities (treat and release, release and refer) will be opposed by the ANA whose job is to protect nurse's jobs, including home health nurses. Local unions are great for individual services, but on the national standard don't make much of a difference. Furthermore, in this anti-union age we seem to be entering, it's going to be difficult to convince certain cities and counties to go along with them depending on the local politics. Nationally, anti-union folks would be easier to tackle by appealing to the common man's sympathy towards and respect for civil servants and emergency responders; and by making this a national issue it would be easier for all services to be represented by the political big wigs who can push the issue more efficiently than perhaps your local EMS director. I don't know, guys. It's a complex issue and I am doubtful that I will ever see a strong, national, pro-EMS union in my lifetime. We would need a strong voice who can reach paramedics all across the country and somebody with the charisma, knowledge, and political savvy to convince all of the numerous dissenters that such a union is going to actually benefit them and will improve their jobs. And considering there are numerous national and state-based associations that have historically failed to do much for EMS, getting people to believe that this hypothetical union would be any different would be quite a task indeed.

Probably because if they feel that patient needs to go to the hospital, they're responsible for that patient and can only release them to another appropriate medical provider in order to maintain a continuity of care. It's a liability issue, really. If they simply release the patient that they think needs to go to the hospital, they're putting their trust (and license) on the line in the hope that that patient will actually follow their instructions and go straight to the hospital. It's easier and less liability for them to simply call EMS to transport the patient.

I'd be willing to help with the designs of the T-shirts. Believe it or not, if you ever find yourself in Beloit, KS and go to the Mitchell County EMS station there, in the training room there's a painting of the Star of Life done by yours truly. Also, get togethers? Why was I not told of this?!

Non-diagnostic simply means that there's no signs of disease present. It doesn't exclude MI from the potential diagnosis, the EKG just isn't of diagnostic value (due to a lack of pathological changes) in that particular patient. The patient's only history is mitral valve prolapse, and they take an unknown medication and have no allergies. Let me change up the scenario just a little bit, though. Let's say the patient is now cool, pale, diaphoretic and has ST elevation in leads V3 and V4 and says the pain is radiating to his left arm and jaw. How does this alter your treatment?

What I know: Cystic fibrosis is an autosomal recessive disease that results from a mutation of a gene and is characterized by excessively salty skin, thickened pulmonary secretions, greasy stools and frequent pulmonary infections. The source of the increased and thickened secretions is due to a mutated protein in the ciliary epithelial cells. The same thickened mucous appears elsewhere in the body and can result in pancreatitis (and subsequently diabetes), GERD, splenic enlargement, appendicitis, and other symptoms of the disease include portal and pulmonary hypertension and right ventricular hypertrophy and frequent infections. It's frequently screened for by testing the salinity of the skin and the long term prognosis is, frankly, poor. Lung transplants are often necessary, and most people with the disease die before reaching forty, if I'm recalling correctly. What I learned: Some further reading from my class notes and the internet reveals that the gene involved is the CFRT (cystic fibrosis transmembrane conductance regulator) gene, and that the specific mutation in about two-thirds of all patients is the deletion of F508, which comprises the codon for phenylalanine at position 508 and ultimately which is responsible for a halide anion channel that is involved in producing mucous and digestive secretions. Without this protein (or without its proper functioning), those halides can't pass through the cell membrane (in the respiratory cells, the halides along with thiocyanite are trapped inside the cells, increasing the viscosity of the mucous produced and additionally with the entrapment of the thiocyanite, which is necessary for creating hypothiocyanite, an important antimicrobial in the respiratory system, this decreases the potency of the immune system, and on the skin they're trapped outside of the cells, causing the high salinity due to the combination of the chloride halide and sodium). I also read that bowel obstruction and meconium ileus is common in children, poor growth, and cystic fibrosis can also present as a coagulative disorder due to vitamin K malabsorption. The most common respiratory infections in patients from 0-18 are due to staphylococcus aureus and haemophilus influenzae, after age eighteen pseudomonas aeruginosa becomes the dominant infectious agent in respiratory infections. Thickened mucous in the digestive tract is the underlying cause of the failure to growth (due to malabsorption), pancreatitis (blockage of the pancreatic ducts with these thickened digestive secretions), and bile duct blockage can result in cirrhosis. What you should know: EMS wise, the problem we're most likely to be presented with is dyspnea secondary to the thickened bronchial secretions. Probably the best treatments we in the prehospital realm can provide are going to be bronchodilators to open them up, IV fluids to help thin those secretions, and oxygen therapy. Corticosteroids may be beneficial too due to the inflammation caused by the mucous buildup. I'll add some more about the long term treatment of cystic fibrosis tomorrow, unfortunately I can't finish this all tonight. In the meantime, I'd like to learn more about benign early repolarization.

You are the second paramedic on a dual paramedic 911 ambulance responding to a motor vehicle versus motor vehicle accident at a busy intersection in an urban setting with a posted speed limit of 40 MPH. Dispatch advises you are the second truck in and may respond non-emergency traffic. Upon arrival at the scene the first truck advises you that your patient will be in the blue car that has pulled over in a nearby parking lot. You park your ambulance next to the patient's car, which you note to have moderate passenger side damage that is consistent with a T-bone strike, and you see that the other vehicle involved--a van--has moderate front end damage as well. There are no scene hazards present and fire personnel are by the driver's door immobilizing the patient with a C-collar and KED. When you get out, a paramedic from the other ambulance advises you that the patient is an 80 year old male single-occupant driver of the car who was struck by the van while attempting to turn left in front of them at the intersection. He states that the patient was restrained, had no loss of consciousness nor any symptoms prior to the crash but following it began to complain of chest pain localized to his chest with no radiation and described as dull. There is no accompanying shortness of breath, nausea or weakness nor is the pain exacerbated by palpation or respiration and is not relieved by anything either. The first on scene crew advises they did a 12-lead EKG which was non-diagnostic and the rhythm lead showed a regular sinus rhythm with no ectopy. The patient cannot recall hitting his chest against the steering column and there was no airbag deployment. Inside the vehicle, you also note no significant compartment intrusion or spidering of the windshield. The patient is alert and oriented x3 with no speech deficits and appears to be in no significant distress and has a patent airway, unlabored respirations, a strong and regular radial pulse and warm, dry skin consistent in color and has no visible injuries noted by exam. Vital Signs HR: 88 Resp: 16 B/P: 122/78 SpO2: 100% on room air Blood Glucose: 128 Pain: 8/10 EKG: Regular sinus rhythm, no ectopy. 12-lead EKG: Non-diagnostic. HEENT: Pupils are round and reactive to light bilaterally. Mucous membranes moist. No nasal flaring or perioral cyanosis. No soft tissue injury or deformity to the skull. No abnormal secretions from the nose/ears. Neck: No JVD, retractions, tracheal deviation, subcutaneous emphysema, soft tissue injury or deformity/pain/tenderness to the cervical spine (however exam is limited due to the patient being immobilized with a C-collar and KED prior to your arrival). Chest: Equal chest rise, adequate depth of respiration. No soft tissue injury or structural abnormality to the chest wall noted. No CABG scars or signs of an internal pacemaker/defibrillator noted. Abdomen: Soft, no bruising, distention, pain/tenderness. Pelvis: Stable. No pain/tenderness. Posterior: Unable to assess due to the patient being immobilized with a KED prior to your arrival. Extremities: Neurovascular function intact x4, no numbness or tingling. Neurological: Alert and oriented x3, GCS 4, 5, 6. Respiratory: Lung sounds clear and equal bilaterally. Cardiovascular: Radial pulse strong and regular. GI/GU: No nausea/vomiting. Integumentary: Skin is warm, dry and consistent in color. For the treatment of ACS, your system carries the usual aspirin and nitroglycerin as well as fentanyl but no thrombolytics. There are three hospitals that provide PCI in town, and two of them are also the certified trauma centers although the third one will take minor trauma patients. All of the hospitals are within twenty minutes of your location. Go!

I'm with Mike on this one. I had a big long post to put here, but I realized I was really just reiterating what he said. So instead of posting it, I'll just defer to the master's original work.

The only thing I know about Florida EMS is that I've heard it's almost all fire based.

In all honesty, man, you are getting way, WAAAY ahead of yourself. And this is coming from the guy who's usually known for getting ahead of himself around here. Take a deep breath and chill. You need to get your paramedic first, then get your Bachelor's in a relevant field (the sciences, management, etc.), and maybe even your RN as well if you want to expand your knowledge of medicine. From there, you can start having a look around and seeing what your options are--and by then, you should have the resume and the experience to reasonably expect to do anything more than ride on an ambulance.