RavEMTGun

When googling VQ I found this great educational read (don't forget to click forward)! http://www.scottishintensivecare.org.uk/education/icm induction/respiratory failure/vent2.htm CBHare: the 100% SpO2 with a high A-a gradient... how does he have a high A-a gradient but still good sats? How does tubing fix the A-a gradient? Additional Question: So how do we avoid alveolar collapse secondary to oxygen displacement of nitrogen? Ensure good TV and MV? Only run high flow for a short time? How common is this problem really? What is the mechanism that causes the damage to the type 1 and 2 cells?

If two sides are diametrically opposed, compromise is difficult, no?

Since someone asked, my little example is a summary of exactly what happened in a county near me. Crazy but true!

Trauma portrays us as unprofessional sex crazed sexist adrenaline junkies... THAT'S BAD! That video portrays Adolf Hitler, the worst villain in history, as the head of EMS and Bledsoe, RidRyder, and dustdebil as his Nazi generals... THAT'S FUNNY? Uhh.... alrighty then... I'm with Kiwimedic (but I'm not going to waste good booze) However, Downfall was very well done movie. http://www.downfallthefilm.com/

Where is the video link?

What a great thread! Can you expound on this more, especially the iatrogenic PEEP? Wouldn't alveoli collapse from N2 displacement followed by a return to indadequate TV or at least high deadspace? Alveolar cell damage? Can you explain this further, especially the A-a gradient?

PART 2: Commissioner: Not anytime soon. Fire Chief: Fine. I'll buy some ambulances out of my current budget and staff them with fire medics. Commissioner: You don't have a transport license. Fire Chief: Yes, but eventually you'll have to give me one or the public will wonder why YOU are stopping the FD from saving lives. (This is why Fire will always win)

I hear that the AMA was very upset about General Hospital. Trauma is more retarded than Saved by a factor of 10.

Paramedics was very good. I thought Third Watch was good as it focused on Fire, EMS, and Law which kept one topic from getting too overplayed, although EMS got underplayed as the show went on. A hospital based EMS show might be good because when they can't write about the outside world, let the crew work in the ED... plenty of drama there and plenty of hot nurses and doctors for the medics to hook up with for the romantic side of the show.

A DIFFERENT PERSPECTIVE: County commissioner: So there were 4 structure fires in your district last year and you didn't even save any of the foundations. You have 3 stations staffed 24 hour with 75 full time paid FFs on payroll. You have $10 million dollars of apparatus, three expensive buildings, and a Godzilla sized personnel budget. Why on earth is the district giving you this much money? You guys barely do any fire fighting and when you do, you fail! Fire Chief: Over the last few years I made all of my Firefighters into EMTs and we respond to all medical calls! And car wrecks too! My people could save your life, commissioner! County commissioner: So you are doing what the ambulance service already does? Except they take people to the hospital. And they only have two small stations and 20 full time paramedics and $1 million in apparatus and they are mostly self supporting because they can bill their patients. They are very busy. Fire Chief: We usually beat ambulance to the scene by 30 seconds! I'm also starting to hire paramedics to offer better care for those 30 seconds we are there before the ambulance. We can make money too if you let us transport patients! You should buy us a couple of ambulances! County commissioner: You want more money??? Besides, that would put the ambulance service out of business! Fire Chief: You know, that's a great point. You don't really need them. You HAVE to have a fire department. The district has got to pay for us. Look, there is a solution here. Let us take over EMS! I'll just make all my firefighters into paramedics ASAP. That will help you sell this to the voters. When can I expect delivery of my new ambulances?

Explain to him that the problem is NOT the FF-EMTs or FF-Medics, it is the Fire management and the bean counters. Management wants EMS call volume and income to subsidize and justify the fire side where calls are down thanks to building codes lobbied for by Fire. Part of that plan is to quickly and easily make and keep as many FFs as EMTs/Medics as quickly and easily as possible. Increasing the barriers for their FF's (who they want to wear many hats) to become and remain medics by increasing education standards is not in their plan. The line Firefighters are usually plenty professional. I think most Fire EMS people who actually want to do EMS (and there are plenty who don't want to do EMS) are people with no problem with increased education as long as they get out of it what they put into it (in opportunity and pay for time). However, most Fire Management isn't that interested. They are FIRE Management, right? Remember, it is Fire-EMS, not EMS-Fire. Nevermind which side gets more volume.

Sometimes you are merely checking for the presence of breath sounds. In such cases, sometimes (depending on the patient), environmental factors may make it preferential to auscultate through clothes if you can (you can do the real auscultations in the ambulance). EMT-B's especially are rarely well trained in identifying breath sounds anyways. Overall, yes. Big problem in EMS. (especially failure to expose for trauma... I've seen chest trauma treated as an AMI when a simple shirt lift would have showed massive contusions.

Umm... how bout using a new neb each time? What's the problem here? IV ventolin? For respiratory? Sounds less effective and more dangerous...