P_Instructor

Perfusion good/adequate. Request from MC will be posted later. What else can be done to determine the specific rhythm is this case? Why the coumadin? Looking for more opinions.

Yup, still asymptomatic, but could this change into anything else. What is the cause.....maybe just the heated argument with family member, but could this develop into something else? Nothing significant except the coumadin. Patient not specific on cardiac history other than defibrillator. Was just seen at physicians office 2 days ago and everything checks out normal.

Sugar good. Medical Control contacted with confirmation of 12 Lead. While on phone with RN who is getting MC, you notice that it appears the QRS looks slightly more widened. Second 12 Lead performed reveals wider QRS, still LBBB. This confirmed by MC as he get on phone when second 12 Lead successfully transmitted. BP now 96/66, RR 14, HR still 150. Transport time will be 15 minutes. Any requests?

Called to residence for patient who's implanted defibrillator has gone off 5 times. You arrive and find elderly female sitting in lounge chair, conscious/alert/pink/warm/dry. Was arguing with family member and defibrillator goes off 5 times. Has no complaints of pain or discomfort. History of diabetes, cardiac. Only significant Rx is Coumadin. BP 130/90, HR tachy at 140-150, RR 14 non-labored. Patient completely asymptomatic. Oxygen per EMS PTA. Monitor placed show tachy undeterminable rhythm, not narrow, not significantly wide, rate 150. 12 Lead performed reveals undeterminable rhythm except for LBBB. Loaded to rig. IV established and oxygen continued, perfusing well, BP now 110/80 (normal BP low 90's). Opinion: What would you do......Adenosine, Amiodarone, leave alone, or what else to help you determine rhythm? Patient continues to have rates is 150 range, defibrillator has high and low settings.

Scene safety is scene safety, no matter while on duty or not. This gentleman looks like he took an oath to help whenever he could. The circumstances apparantly were stacked against him. Sometimes it is just a shame. My prayers are with the family. On a personal note, I probably would have stopped also to render aid.

Dust, keep me informed on any statistics for the course. I've been teaching an online Basic course (hybrid) for the past 3 years, and the success rate has been very good. The main problem is the skills format and if the students are receiving enough training in this area. So far, so good, but like anything else, could get better.

This will vary dependant on where and what type of service that you provide, and how the operational plans are set up. We on average clear in approximately 10-15 minutes for BLS, and 15-20 for ALS. For both, the crews are still subject to call and clean up. For ALS, medication restocking is not an issue as boxes contain enought meds for 2 ALS calls. PCR's in some areas are required to be completed prior to availability, but for us, whenever we can get them done withing the shift, then faxed to the receiving facility. Most of the time, this is done relatively soon (within an hour). Again, opinions will be based upon the agencies operational plans.

1. Abdominal exam not addressed in protocols? This is a standard. How can you potentially treat a patient without a complete and thorough assessment? 2. Do the exam, and if taught properly (non 'poking', but gentle palpation) you could find out much good information that can be disseminated to the ER to prepare them for whatever event. You need to assess for lumps, bumps, masses, palpations, etc. Who knows, it might only be a 'diastasis recti', but without exam, you could hinder the idea of rapid transport of a dissection. 3. We don't teach what is in the chapter per say.....teach the curriculum which includes a good thorough abdominal exam along with history of the event. Teaching the newby Basics any other way could compromise good assessment tools in the future. Don't jump down their throats, teach them the proper way and what to look for, whether they or you can do anything for the complaint or not. Complacency can be a killer. This is only the opinion of this poster.

Let me lift my big, flabby right cheek and check to see if it is true...............................rats.................need to increase my arm strength......................

To keep on living the dream baby.................... Stay alive, don't break my back, produce excellent student paramedics, blah, blah, so-forth and so-forth.......

We currently have that feature. All 911 calls are sent via text to rig cellulars. It gives address, cross street, and reponding units. It is useful, however, if the EMDs are busy, we may not get the text until we are already on scene, but this does not happen all to often. Just another decent tool to make sure you know where you are going to hopefully reduce response times.

A very Merry Christmas and joyous New Year to you also. P

Welcome to the site. You'll be exposed to many differing opinions on many subjects. Get set to absorb.......

......said that all FDNY members "take an oath to assist others whenever they're in need of emergency medical care. It's their sworn duty." A union spokesman said Monday that EMTs generally consider their jobs to be a 24-hour kind of thing. "Our people tend to spring into action whether they're on duty, off duty, whatever they're doing," said Robert Ungar, spokesman for the Uniformed EMTS and Paramedics, FDNY. The city's EMTs have a "very strong bond with the people of New York City that they serve," he said. "They view themselves as always being on duty." He said the union was waiting to see what the results of the Fire Department's investigation would be. "If there was unprofessional conduct by these EMTs, the union does not condone any type of conduct which in any way can harm members of the public," he said. On Monday, Bloomberg repeated comments he made over the weekend criticizing the EMTs, saying refusing to help goes against human decency. "There's no excuse whatsoever," he said. The process is moving faster that I expected........see posted NEWS ROBOT entry of entire article.

You've got to be kidding....look at the threads.....minimum open the airway, keep her from harming herself any further, positioned appropriately, and do what you have been trained for, even if have no equipment available. They went through training, they are better suited to assist this patient than the lay person. Be the first responder, stave the bagel until after assistance. Would, could, maybe, who knows......they need to have some PRIDE in the profession.

TK, I believe the original version, these were field EMT's and not dispatchers waiting for the food.

You are correct. My opinion does not really represent what was intended. What you stated is the opinion I did want to mention.

Published thru AAOS Emergency Care in the Streets, 9th edition: "A variety of laws and ordinances, many of which differ considerably from state to state, regulate the actions of the paramedic. However, the most important premise affecting paramedics is one that doesn't appear in any of the statute books; it is the rule of doing what is best for the patient." "Paramedics always have the responsiblility to act in a reasonable and prudent manner and to provide appropriate care and transportation consistent with their education and training, their medical director's protocols, and the tranport protocols in their EMS system.' I add that this should be done at all times, whether on duty or not, whether ordering a bagel or not.

I don't know much about Bloomberg, but that is the most sensible thing that I've ever heard of........at least he is willing to speak out. Thank Vent.

If these bozos were also fire guys, I bet they would have been to the patient's side within milliseconds if the patient would have been ablaze. No excuses. If they are in the medical business, it is the duty to at least 'want' to assist in whatever capacity possible. Total failure. Should be fired and potentially held accountable.

Extra points if you get to start a jugular for fluid replacement.....

Yeah....I does smell a little 'smokey'.

I was just going to post the same article. I think these membership programs are going to expand. Wow is the word.

Slowly we are making headway. Are the healthcare problems in the US going to hinder this? Who has stock in tanning machines and materials.............. http://www.cnn.com/2009/HEALTH/12/17/cancer.research.breakthrough.genetic/index.html

Better be thinking of LZ.....If you can't hoist, then hoofing is next. If you land on the beach, do you have sand filters for the bird? Who else is there. A few off based questions, but still important.