PCP

Yes, I believe he did have an allergy to stainless steel ha,ha, ha, The cops did know about the restraining order but I am not sure why they did not handcuff and take him to jail. Could it be because the lady allowed him to get into her car and was taking him to the local Tim Hortons??? On my home that evening I stopped in for a coffee as I was heading off to work at another ambulance station that night, and low and hold guess who was there and asked for a ride to another town? Yep, the same guy who I was trying to talk out of the car. Funny people in the world I tell ya!

I rememberd what the guy said he had and why he was scared to get out of the car. He said he had a conditioned call " Transthoracic Syndrome" Anybody ever heard or read about this condition before?

hey sorry about that my friend. guess I kinda went off on a different path. I would say yes they should be stopping compressions to give the two ventilations. Now that being said that is based on my training through the Heart and Stroke foundation. I am not sure where you are from and what your protocol is down there. I would talk to someone in your area and confirm what is expected in a CPR situation. I find it very confussing at times, as I was shown one way on how to do CPR and it is alway 30 compressions to 2 ventilations and then I take my OFA training again and they are telling me to give a breath once every 5 seconds while your partner is still doing compressions. Another thing I just learned through the organization I work for is when the AED is charging to deliver a shock, we are to be doing chest compressions during the charging portion. But in school and through the Heart and Stroke Foundation we were told not to touch the pt. while the AED is charging..grrr why can't they make the same rules for everybody!

I was curious to know if the company you work for has put GPS units inside of the ambulance and if so how often do you use them? The BCAS has supplied every car in BC with a GPS unit. I use to work in a small town so we never had to use it to find a address, but I feel it will come in handy when I start at my new station as I don't know the roads and if I am driving sure would be nice to find the fastest way to the Big Green "H" Do you think they are a waist of money and we should stick with using maps or do you think they are worth the money and the money should put towards training and new equipment?

WOW! That is an amazing poem and really hits home and it really made me think of my 1 year old twins at home and how I want to make sure they are safe every day. As well as not taking my work home with me after a bad day of sad calls.

The most bizarre call I have been on is my partner and I were dispatched out for low impact MVA. when we arrived everything was normal the police and fire on scene. What had happened was a car with two occupants had stopped in the middle of the road and the SUV behind them ran into the back of their car doing about 15km an hour. The driver of the SUV was not injured and the driver of the car said she was fine. Now comes the bizzare part. The passanger of the car said he was scared to move and did not want to get out of the car. The lady driver was telling him to get out and let us take a look at him and transport port him to the hospital. He just kept saying he was scared to move and he just did not feel wright. So my partner kept asking if he had neck pain and the pt just kept saying he did not feel wright and he was scared to move, as well as he mentioned he had some sort of condition that we had never heard of which turned out to be false. Any ways, after a while my partner asked to speak to the woman driver in private, and let me try and talk to the pt and find out what was going on. He told me he had neck pain and that his legs felt funny. Now remember it was a low impact MVA at 15km an hour, so I was thinking okay maybe he has neck pain, but there was no damage to either vehicle, but who knows. So I told I am going to have to put a hard collar on him and put him on the clamshell and take him to the hospital. Well now he is saying he is fine and he could maybe move now. So after about half an hour he eventually got out of the car and walked over to our ambulance. While inside of the ambulance my partner was taking notes and I was taking a BP and then came a RCMP officer holding the guys backpack and a few other things and said to our patient that the lady left and asked him to give him his stuff. The freaked out and the cop had to ask him to relax or else he is going to jail. Turned out the lady had a restraining order against him and she was on her to drop him off at the Tim Hortons when they got into a fight in the car and she stopped in the middle of the road to kick him out. Sorry the story was a little long but had to paint the picture.

I will take a kick at the can. I am not a ALS paramedic so there is not going to be any 12 leads or tubes happening with me. A flail chest is where three or more adjacent ribs fracture in two or more places. I was lucky enough during my precepting time to see a pt. that had a flail chest. His flail segmant was on his upper back which was caused by a fall and hitting a lawn chair. Any ways back to the questions. I am going to assume this pt in this video was in a MVA, riding a motorcycle crashed and hit the handle bars or something that was stationary that would cause blunt force trauma like that. Primary and short term concerns: course pneumo., tension pneumothorax, spinal concerns, hemothorax, paricardial Tamponade, myocardial contusion,Myocardial Aneurysm or Rupture, Traumatic Aneurysm or Rupture of the Aorta, breathing concerns for sure would need to bag this pt., want to look for any signs or symptoms of internal bleeding from a lacerated spleen or liver. By the look of that fellow there would and could be multiple things wrong with him and that could go wrong within minutes or hours. Long term concern is a Pulmonary Embolism may occur, pneumonia, ummm cant really think of anything at this moment as it is three in the morning. I would for sure be loading and going with treatment enroute, notifying the hospital what I am bringing in and my ETA. This is a trauma pt and the "Golden Hour" is very important for this fellow and he needs surgery. There is not much I can do for him other then what I will do for my treatment. TX- first of all make sure he has a patent airway, check the breathing fix what I can in the breathing (BVM, splint the flail sagment with as many abdominal pads as I may need folded up covering the entire flail segmant and start taping it down. If the flail sagment is large and is going to take too much time to apply the pad and tape I would a pillow and have them hold it there for support or use a first responder to hold for the pt. If spinal immobilization was not required I would place my pt. on the side of the injury. while in tranport I would be starting an IV on the guy and depending if the BP is below 90mmHg I would run my line at TKVO or I would bolus him 500ml at a time and auscultate the bases of the lungs before and after every bolus checking for pulmonary edema. in between boluses if multiple boluses where needed, I would be running through my head to toe again looking for any other injuries that may have been missed while on scene. Just by looking at the guy on the video I think I would be calling for a medivac for this guy, as our hospital where I work would only be able to stabilize him and he would be flowen to Vancouver, Nanaimo, or Victoria where they could do Surgery for him. Hope I was not too far with my answers. I must say great post!

I am learning very fast that my first impression of a pt is usually not what I am thinking at all is wrong with them. Hopefully that will change as I get more experience.

I know a guy from the "Sooke" station who is doing his ACP training at SAIT right now as well. You may know him, his name is Marcus Mcpherson. I use to work with at the mine site that I work at as a first aid attendant. Actually my cross shift is there right now for the next two days with your class I am assuming as a observer. He is wanting to take the course starting next September. Thanks for the post and the information. Good luck in you ACP training.

Thanks for the advice I will try that on my next patient. Another piece of advice I was told today was to use the bell end when auscultating the lungs. Has anybody had any success with using the bell end of the stethascope while auscultating lung sounds?

It's not a boring question at all. What causes the gastric distention and please if I am wrong anybody feel free to correct me, as I am fairly new medic. My understanding is gastric distention is caused by when someone is using the BVM and is pushing too fast and too hard and not letting the bag on the BVM to fill back up with oxygen before ventilating again . You want to be just giving enough air by pocket mask or BVM to make the chest rise, if you give too much air it will just go straight into the abd and start to cause the gastric distention. I am not sure how long it takes or how much air needs to be exposed to the abd. before this starts to happen.( Time to do some research tonight for myself) You are correct that gastric distention does increase the risk of aspiration and that is why the person at the head needs to be careful when ventilating a patien and watch for the signs of the distension. I know in my OFA level course that I just had recert, they taught us to ventilate the pt. every 5 seconds while doing continous chest compresions, but in my paramedic program we did the 30/2 standard and that is what I use. When a paramedic inserts a OPA that is keep the tongue from falling back into the throat and occluding the airway which then would deem as a patient not having a patent airway because the tongue is blocking the airway passage, but once the OPA is incerted and in place the patient is now deemed as having a patent airway. This is because the OPA is allowing as a device that as mentioned keeps the tongue from falling back and occluding the airway and allows for an air passage and for draining of any vomit which may occlude the airway deeming the airway not pantent do to the occluding vomit chunks or blood. Hope I was able to answer you question for you and if I missed anything or made any mistakes in my answer anybody feel free to correct me as I do not want to be leading someone down the wrong path!

I have been struggling with taking a pt. BP for some time now, as I know Practice makes perfect but it it does not seem to be helping me very much! I have read the books on how to take a BP, but for some reason I seem to be having a hard time figuring out the exact location I should be placing my stethascope on the brachial artery. I have been told I may not being pushing hard enough to hear the BP or I am pushing too hard, as well as I am told different spots as to where I should be placing the diaphragm on the arm. Any tips would be great as I am tired of telling my partner that I need to retake the BP as I did not get anything and I am not about to LIE!! Another problem I find is alot of time I am unable to hear the pt. breath sounds. I palpate the ribs and find the intercostal space so that I am not placing my diaphragm over the rib so I am not sure where I am going wrong? My guess is I am not placing the diaphragm in the correct area on the pt. or I should maybe be using the "Bell" end of the stethascope insted? I feel silly asking these questions, as I was kind of shown in class, but not much time was spent on teaching us the proper way of using a stethascope. Any suggestions would be great as I dont want to be making any vital mistakes!

I am sorry, but I do not understand how and why you would not have the local ambulance transport a patient to the hospital unless if YOU feel that their life is in danger? NOt sure how your system is run, but ours is run that fire and ambulance respond to medical, trauma, mva calls and it is NOT up to the first repsonders to decide if the pt. needs to be tranported or not. Yes a pt. can decline to be transported, but we always do our best to talk them into going to seek further evaluation by a physician and if we can't then we "code X" them and have the police, fire, or family member sign as a witness. Waiting half an hour for a family member to transport them to the hospital to me is just looking for trouble. PATIENT CARE IS NUMBER ONE and that includes TRANSPORTING!!

When I did my practicum I was lucky where my preceptors where willing to let me watch for a couple calls and then they let me attend the calls. One thing to remember is show respect when you are being precepted and ask lots of questions after a call, as well as ask for feedback good or bad. I have been told by a few preceptors that the worst thing a student can do is not show respect to them or to the other crew members working at the station. For the most part I am sure you know your stuff, all you have to do is apply it now. The preceptors are there to help, which most cases they will let you do your thing, but if they feel that there should be more questions asked then they will ask them or suggest to you that you should be asking specific questions. Good Luck!

I know myself or any of the partners I have worked with have never gone through a cell phone looking for "ICE" for the most part the hospital staff or the RCMP will contact the family incase of an emergency. When dealing with a pt. I feel looking for Incase of Emergency contact phone numbers is probably going to at the bottom of my list, just because if I am having to look for "ICE" that usually indicates that the pt. is unconscious, as if they are conscious they can call themselfs or ask us to call a family member. Just my thoughts!!

Good evening everybody! Just wanted to introduce myself as I am new to emtcity. I live in Nanaimo British Columbia Canada and I have just recently received my Primary Care Paramedic license. Basically I can start IVs, give certain medications for a pt. experiencing SOB, drug overdose, Anaphylaxis response, chest pain, hypovolemia, and medications to a pt. experiencing a hypoglycemic emergency as well as we run a Not yet Diagnosed protocol which is a combination of checking for low blood sugar or if they have overdosed. I am not sure as to what level of care that would be considered down in the United States? I work for the British Columbia Ambulance service who currently employ about 3400 EMR, Primary Care Paramedics, Advance life support paramedics, ITT medics, and Critical Care Paramedics. I have been with the service now for just over 2 and half years and loving it! As stated above I just received my PCP license and now I am able to transfer out of my remote station that had about 200 calls per year to a station that I am starting in December that gets about 5000 calls a year! We run three ambulances out of the station one is a full time car, one back up car, and the other one is mainly for transfers from one hospital to another which round trip depending on which hospital we are transfering to is any where from 1 and half to one way to 3 hours one way. Any ways, I am looking forward to chatting with you all, and hopfully getting to learn some new things, as well as sharing some great stories! Take care and be safe out there everybody! Brian Strachan.