PCP

wow that is really harsh!! I am pretty sure he was not down at ground zero looking for his fellow workers now was he!!

Hey welcome to the City!! after reading your intro as mentioned sounds like you have had a rough road but are taking the steps to get back to the right place. Hope school is going well for you and that you are enjoying it as much as you did the first time. Good luck on finding some work in your area. Lots of work out here in BC, Canada for medics!! Welcome again and look forward to your future posts. Brian

Welcome to the City!! you will find some very useful information on this site. Jump into discussions even if you don't know the answer ask questions. People on this site are very helpful Have fun and look forward to seeing your future posts Brian

At least your honest about not feeling comfortable about transporting a post-seizure patient and you request for ALS. That to me is also good patient care. You are lucky you have that choice to call for ALS. I don't have a choice I have to feel comfortable about transporting a post-seizure patient as noted before I do not have ALS in my community. Great job on calling for ALS as I am sure some medics will not call for ALS even if they are not comfortable transporting. Brian

All I have to add is we had a local Dr. come into our station and talk to us about what to do if someone is having chest pain and it confirmed that it is cardiac chest pain. The Dr. said that giving ASA is more beneficial to the patient then giving Nitro, and sooner we give ASA the better. Sorry not very informative. I know ASA is a anticoagulant or (clott buster) and thats why it is important to be giving the ASA sooner than later. Our protocol states to give 0.4mg of Nitro followed by 2 chewable ASA

Thanks paamedicmike. As for us paramedics we are taking a training course starting early January. As for the ER Docs I am not sure what there training will be or introduction to this will be. I just assumed that they would know what we are using. Great point to make as to make sure the Docs know what we are using. I googled "King LT airway" and from the information I read and the pictures it looks and sounds pretty basic as long as I use the correct size as Mobey mentioned. <BR>Once we have inserted the airway is there a strap that we use to secure the airway in place so that it does not move around while ventilating a patient?<BR>And is there a chance of the tube ever coming out once the balloons have been enflated?

WOW!! Okay, thank you for the information. Sounds like it will be easier to use than I was expecting and by the sounds of it, If I can not ensert the airway, than I best go back to school..LOL.. Silly question time...So if this mechanism is inserted into the Esophagus would that not cause gastricdistention? Or is that reason for pumping up the balloon so that it blocks the air from going into the esophagus and redirects the air down into the trachea?

Welcome to the City. You wil find some very useful topics about EMS here and everybody on the site from my experience are all willing to answer any questions you may have. Sounds like you have figured out your passion in EMS. It is a great career as you get to help people and you are alway learning. Again welcome to the City and I look forward to seeing your posts in the future Brian

Hey no problem Jake. I find it funny that using BGL was not approved for abbreviation in your area. Oh well we all have our own abbreviation's. Now I know if I ever see FSBS again I will know what it means. Thanks for that

Oh shoot I should have known that I knew that those are the medications to control seizures, but did not realize that is what the ALS crews will administer. It makes sense that if the patient is not given those medications that it is pretty much impossible to start an IV on patient having seizures. So So time for another silly question. How does one adminster those certain medications to a actively seizing patient? I thought they are administered through an IV? So when those medications are administered is there a time line as to how long they control the seizures? Is it possible for a patient to start to have seizures again after the administration of any of those medications? What does FSBS stand for? Brian

ummm ya, I thought it was an interesting screen name and was very creative!! As Dwayne mentioned do not get upset and not post anything or get into discussions due to the responses that you have received from your first post. Every person who has posted about your screen name are very valuable and respected people on this site and can answer pretty much any question you may have except for me as I am new to the site and a pretty new medic as well. Any how, welcome to the City

In our service it works both ways. If you are working out of a community that has an ALS car and they are not busy, they will be dispatched along with the BLS car. Of course in most places we do not have ALS, so it is up to us to treat and transport the patient. The only places that I can think of here in BC that have an ALS car are: Vancouver, Victoria (multiple ALS cars) Nanaimo has one ALS car, Prince George has one, and Kamloops has one. Other than that it is up to us to deal with any seizures. I do agree that it is helpful to have an ALS car on scene do to their knowledge and treatment that can do, but I feel confident that as a Primary Care Paramedic that I have knowledge and tools to treat this patient. The biggest thing I feel is that no matter what level of care you are the best patient care is to get them to the hospital. some questions that need to be asked are why is the patient having seizures? how long have they been seizing for? any hx of seizures in the past? Is there anything I can do for this patient? are they diabetic? drug overdose? if so treat the patient for those and if not, ABC transport!! To be honest I do not fully understand what tools the ALS crews have to treat a patient that are having seizures? Maybe someone can let me in on the secret!!

Here in BC. Canada we as Primary Care Paramedic or EMT-I ( I think?) are going to be taking a training course in the use of the King Airway. As of right now, we are only able to use the OPA for securing someones airway. My question is what are the pros and cons about using the King airway? How difficult is it to isert into the trachea? How much time should be spent attempting to place the advanced airway, before just resorting back to using the OPA? (Remeber I do not have ALS available in my community.) Thank you all for your answers and comments Brian

First of all I would like to add that it is very nice to see that you care enough about the new medic that you are going to be precepting. I have found through being precepted by a couple different medics that some still enjoy their job and actually take the time to help the student out and others just didn't care. So good for you for caring enough to ask this question! I have to say the biggest thing I found helpful coming from my preceptors was getting the feed back from them on what I could have done better or what I did well on the call. Without that feed back it does not give the student a chance to learn from their mistakes or give them the confidence that they are looking for, which helps them be a better Paramedic. Talking about the Pathophysiology is huge as there is lots of that to learn in school and I found by talking to my preceptor about it helped me understand it better. Let the student do as much of the call as he/she can, then when he/she gets stuck that is when you as a preceptor I feel should jump in and prop them in asking more questions or do certain procedures. I am sure you will do great at precepting, just remember the students are going to be very nervous so be understanding when they make mistakes or don't know the answer to something. Brian

Congratulations!!! It is a great feeling getting your license after you have put in all the hard work. Now comes the real learning on the job. Sorry I am not much help on what to expect when it comes to the interview. Just relax and answer the questions to the best of your ability. DO Not make up answers. I am not sure about where you live, but here in BC i have heard of people making up answers in their interview and when the interviewer called to confirm a persons answer it turned out they had lied. Guess what? They did not get the job! Good luck and congratualations again

I spoke to a friend this morning who is a ER nurse and asked him about giving Salbutamol to a CHF patient as well as talked a bit about what is going on with a CHF patient. From my understanding now is that giving a CHF patient Salbutamol is a good thing, as it opens up the bronchioles which will then allow for better oxygen exchange in the lungs. I also learned that a patient experiencing pulmonary edema from CHF is due to left heart failure. when the left ventrical decreases in cardiac output it causes the fluid to back up into the lungs. I may be wrong, but when a pt. has CHF along with pulmonary edema, Starling law is no longer affective. Taht is the ventrical is unable to stretch to its maximum compacity, which in turn causes the preload to be affected. In my understanding now of CHF and giving a pt. Salbutamol is that it will not cause the patient to experience an increase of fluid in there lungs, but will indeed help them, due to dilating the bronchioles helping the patient get better oxygen exchange. I believe the mechanism that causes the pulmonary edema is a circulatory issue due to the left heart failure. Part of what I was taught in school was that at times we may need to bag a patient with CHF due to the poor oxygen exchange in the lungs and pending respiratory failure. I have never seen it, but I know of paramedics that have had to bag a patient that where a foamy substance is coming out of the patient's mouth due to the overload of fluid in the lungs. Our objective is to bag this patient and attempt to push the foamy substance and the fluid out of the lungs and back into the circulatory system, so that the patient will be able to have better oxygen exchange, which then increase their respiratory efforts, hopefully keep them from going into respiratory arrest. Well there it is my second attempt of trying to figure this problem out and hopefully answer some of the questions asked. Thanks for all that have participated in this discussion as I find discussions like this very helpful in understanding and learning more about certain complications that a I need to deal with as a paramedic.

Hi chbare, No it does not, but I am going to take a look and find out. I was attempting to answer the question based on what I know of salbutamol and CHF. I was assuming based on the B1 and B2 effects of salbutamol that it would increase the fluid build up in the bases of the lungs. Sorry for attempting to answer the question without researching what effects salbutamol would have on a CHF patient. As I know on the website we like to keep things straight forward and try not post incorrect information. Take care, Brian

Okay, I am going to take a crack at this question. Albuterol is a brochodialater and has two effects. One is the the B1 effect which increases heart rate and blood pressure and the B2 effects will open up the bronchiols which will increase the pulmonary edema. Wheezing in a CHF patient are a sign of the lungs' protective mechanisms, since bronchioles constrict in an attempt to keep additional fluid from entering the lungs. So by giving the pt. ventolin it will increase the cardiac output and open up the bronchiols allow more fluid to pool in the bases of the lungs. diminished lung sounds are caused by pulmonary edema which is caused by the heart's reduced stroke volume. The heart's reduced stroke volume causes an overload of fluid in the body's other tissues. This presents as edema, which can be pulmonary, peripheral, sacral, or ascitic. From my understanding is that when treating someone with CHF is to apply high flow O2 @ 15lpm don't have them walk to the stretcher as this can increase the laboured breathing so use the slider board and slide them over to the main cot. Have them sitting up with their legs raised as this will promote venous pooling, thus decreasing preload. Great discussion! Brian

Welcome EMSgirl911 I have never heard of a EMS apprentice before, how does that work?

Yes, I am using the Littman Classic II as most BLS providers use. I just feel I need more practice and that will come as do more calls. I want to be able to provide the best care to my pt. and I feel by being able to take a proper set of vitals including diagnosing lung sounds is VERY important to pt. care along with listening to my patient.