Arizonaffcep

The FD I used to work for did something along those lines...we had hired several "new" people (some had been with us previously, and went to other departments, but they decided to come back) as probationary FF's. Then, within a year, one was promoted to captain, not even having finished his probie year. Now...this guy (I'm friends with him) was very qualified and good at his job. He's been in fire service for around 10 years or so and really knows his stuff. Most of the field people, while happy with WHO got it, were pissed HOW he got it. It boiled down to, he was hired as a probie, and hadn't even finished the probie year and promoted around 3 or 4 other people who had been there at the dept. around 4-5 years (not including past experience) and had already completed all the classes for captain. And, before anyone thinks, well they just didn't know their stuff-they did (do). Aside from personality issues I had with a couple of them, their skills and knowledge base were all quite good. (Un)fortunately, it did backfire on the department, and this guy realized (again) how screwed up our management was and left again...for ah, "greener" pastures shall we say, where he's now either a Lt or Capt. and doing well.

Good vid!

http://www.chucknorrisfacts.com/ all u need to know!

I don't know why we just don't send Chuck Norris over there. Just him on a raft with no oar or motor. That's all we need. He'll take care of it!

Free tape worm with every meal!

What's that saying, that if you show a strip to 5 different cardiologists, you'll get 6 different answers... :mrgreen: Added: My first inclination was to call it A-fib...but it is regularly irregular. Maybe controlled? My guess would be maybe some a-fib/flutter with a block of some sort. If you look between the first 1/2 beat and the first full one, there are 3 little bumps that could be flutter waves? It occurs again between beats 4 and 5, but then there are 5 bumps. [s:5230eb3d5a]Maybe the Pt's pleasure... :shock[/s:5230eb3d5a]: HPV?

Sad huh?

Our "Difficult Airway Cart" contains: various sizes of the AirTraq, Bougies, Tube Exchangers, disposable blades for one of the Glidescopes, additional reusable blades for the other, a DL kit, Combi Tubes, 2 double Cric Kits, 1 surgical and the other a Seldinger (the two are in a single kit, we have 2 kits), Trachlights, and a variety of Intubating LMA's and standard LMA's. Also available (when Dr. Sakles is working) is a Glidescope Ranger, Pentax Airway Scope, and several other things I'm sure I'm forgetting.

Out of curiosity, I was under the impression that Clark County and LVFD could both transport. This being the case (assuming my info is good), the infrastructure is already in place for them to assume sole transports, as opposed to a third service (please note, I am not condoning this action, nor degrading it, just making an observation).

To make our butts look big(er).

Do a search on Dr. John C. Sakles out of UMC...he's one of our ED docs and is currently doing research on difficult airways and intubations in the ED. Also, in conjunction with him, www.theairwaysite.com is a good resource.

1. (bolded) Sorry if you construed an attitude...that's why I put a devil smiley face at the end, I was being a shyte. (if you look at the line that was after where your quote ended...I actually did answer the question. Although prehospital don't draw cultures here, just the most widely used...PT/PTT, CBC, and chem panel, liver maybe) 2. I still work prehospital, and those are the tubes we carry. But my FT job in as a medic in the ED. The only people allowed to do an art-stick at UMC are 2 people...Docs and RT's. The lab doesn't use phlebs to get their blood, they rely on RNs, medics, and PCTs. We are trained on getting blood, but do not have a phleb cert. 3. (underlined) Ya...no one in AZ is THAT progressive! However, as the saying goes...when I'm King of the World....

I assume they would want an LMA on a patient who isn't going to be intubated for any real length of time, otherwise, why not use an intubating LMA and intubate them?

The "text book classic" description of appendicitis is pain that starts around the umbilicus, guarded abd, and as the infection gets worse, the pain moves down and to the right, eventually ending up right over the appendix. Of course, if it sudenly feels better, it probably just burst! Hello sepsis!

Ya...its another point of lawyers being dumb. From my understanding, the isopropyl alcohol CANNOT be detected when running a BAL, because it is a totally different form of alcohol, and requires a different test to find the level. This being said, the best option is iodine of some sort. The PD test kits that are used here come with them, and when I draw for PD (AZ law says it's ok for PD to get a sample of blood from a PT without a warrant IF there is a draw being done for medical purposes) I use the iodine swab that comes in their kit...I figure it just makes everything a little easier.

You almost make it sound like it would be a bad thing to be public health...

Reminds me of a joke... What goes "clip clop, clip clop, clip clop-BANG BANG-clip clop, clip clop, clip clop?" An Amish drive by!

I still stand by my opinion. I wouldn't use permissive hypotension on this specific pt. If you have any links to the info you were talking about, I'd love to read it, as I have no connection to the military at all, and even less of a connection to new stuff they are developing. Although this does bring a good point...in civilian life...we see a lot of research in most areas in medicine. But it seems to me (perhaps I am looking the in the wrong place) that there is little research truly being done prehospital wise. Occasionally, I hear of something here and there, but not often. I have my own theories as to why, but I would think this specifically would be a HUGE area to do a large study on. After all, most of the studies I saw on Trauma.org were hospital in nature, only a couple were prehospital, and there was a great deal of all the studies that were inconclusive at best. Just a thought. About the OP, with the HR at about 95...I still would bet real $ he's on a beta blocker, which can and will mask S/S of shock...It's one of those that they just physically can't manifest the tachycardia associated with shock...so you can't rely on it, which it's one of the key indicators for early shock.

Wow! What state do you work in? Here in AZ, DHS is debating the whole "Paramedic National Accreditation" thing. Currently, the LOUDEST voice against Ok'ing it for the state is Phoenix Fire. They say it would be such a hardship! $11k over 5 years! Which is funny, because they always seem to have the best of the best equipment... :?

YES. I work FT in the ED at UMC in Tucson. Artery sticks are out of our scope of practice. But thanks... For cleaning the culture site...I usually just spit on the area, rub it in and make sure to lick the needle on the butterfly... :twisted: chlorhexadine gluconate...70% Alcohol, 2% chlorhexadine gluconate. They come as swabs.

The answer's simple...with that you are only dealing with one or two germs, vs a plethora:)

And Oxy-Clean!

Where I work now, the light blue (sodium citrate) is coags, d-dimer, and genetic studies (on ice), gold top is one with the serum separator thing and it does liver, vitamins, serum preg, all kinds of things-some need to be protected from light (vit. studies), dark green lithium heparin is ETOH, venus lactate (on ice), mint top, lithium heparin with serum separator is chem pannel, 3ml lavender blood pannel (edta), 6ml lavender (edta) is for type & screen/cross and other blood product screens. We have separate blood cultures (orange top is arobic, green is anerobic), we also have grey tops, but we don't use them in my department. We also have heprin filled syringes for blood gasses.

http://www.trauma.org/archive/resus/permis...ypotension.html This is a good link for a huge amount of studies done. About half (ok, I didn't count, please don't hold me to that exact ratio) say permissive hypotension is good, the rest say it doesn't matter. Only a few of these specifically dealt with prehospital use of it. Be that as it may, the use of permissive hypotension is designed for uncontrolled hemorrhage. The sticky point of a GI bleed is: 80% stop on their own. This is what I've been getting at with this debate on this thread, the fact that the patient had melena means that it is not an ACTIVE large uncontrolled bleed. This situation for this patient is NOT that. It MAY in fact still be bleeding, but it's not a large bleed. It seems to me like the bleed has been occurring (I would assume without the patients knowledge) for a while, possibly a couple of days. So...this is a chronic bleed, IE, NOT ACUTE. Now...I'm not saying the patient's condition isn't acute, because it is. He obviously died. Now, there are some parts to the story which we don't have and I would assume we can't get, which is when did the melena start, although the better question is, when did the ABD pain start? As that would probably give a better indication of how long he's been bleeding. Hope that answers the question.

It was time for a smoke :twisted: