DartmouthDave

Diplopia

Hello, The old service that I worked for counted stand-by (very small percentage...at most 20 or so per year) and almost anything as a call. The smaller communities (staffed by paid-on-call EMRs) counted anything as a call as well. The main station had a volume of 5000 for a population of 22,000 people. Plus, around 400 medevacs. One small town cited a 400% increase in calls as a need for a full-time staff in a year without any change in population or overall acuity in the community. In effect, this skewed call volume and made it difficult to see what we actual did and when. Plus, over time, we lost some cedibility because the numbers we so 'inflated'.

Hello, That is crazy. What is wrong with using a reference card. Your preceptor may be comfortable with the medications that your protocols have. I am sure if a odd medication needed to be run the preceptor would have to bust out a calculator. D

Hello, Just watch the bag and it should be 1/2 done in 5 minutes. If not, speed it up some and have it all wrapped by the 10 minute mark. In all reality, trying to counts drips in a back of an ambulance over a 10-minute run isn't practical or particularly accurate. Plus, the Amio is well diluted in a 250cc dag. Oh, don't forget a filter as well. Lazy math

Hello, I am sure you would get credits if you went to SAIT or NAIT as opposed to a private school. NAIT/SAIT can sent an academic transcript for assessment. D

[/font:f5a0398982] Hello, I would say 'load and go' if the patient had been seizing for 20 minutes. Any interesting history on this patient? D

Hello, I think code and post-code management is getting muddled here. If you get a ROSC then one may need infusion(s) depending upon what is going on (i.e. brady, runs of VT, et al.). As for the Bicarb gtts. I have never seen them run on any codes/post codes. Any pH problems in theory will slowly correct with decent profusion and oxygenation. Cheers, David

Hello, We have the Zoll M series and the Zoll CCT. They tend to drain the batteries fast. We have bought two of the larger batteries and they tend to last longer. (Many of our ambulance do not have invertors and we have long transport times) The NIBP tends to say "Recheck NIBP" a fair bit when the BP is less-than 90 or the hear beat is irregular. Also, all of our Zolls have phantom pacer spikes appear. Soon we will have a software upgrade to fix this. Plus, the Masimo SpO2 sensory has a hard time picking up a SpO2. Again, "Check SpO2" keeps chirping off. Even when you change sensitivity to high and have it average the SpO2 over a mear 4 seconds. Also, the standard cable is too short if you remove the Adult Masimo SpO2 sensor and attach the Neonate, or the Ped SpO2 sensor. It is hard to reach things. For example, we have the Baby PodII. A simple transport incubator. The Zoll with the neonated SpO2 won't reach the infant inside. We had to order longer ones. The Zoll CTT (I can not remember about the Zoll M) has a unique SpO2 port in the back. So, if we lose, or break the Sapo2 cable for the Zoll CTT we can not replace it with the pile of surplus SpO2 cables we have. Last, Zoll has a unique pressure line. So, you need a Zoll transducer and set up to connect to an arterial line, central line for CVP or an ICP line. The old ProPaq104 fit the standard Kolb transducer set up. Of course, we tried to order a Zoll--->Kolb cable from Zoll but they didn't have one. We had to order it from an other company so we can simply hook up of Zoll monitors to a patient without much fuss. The local hospital uses LP. The LP and the ProPaq104 we had seem to do the job just as well. Of course, I am use to the LP. I am sure that has nothing to do with my opinion on this subject. The Zoll CTT has a temp and two pressure lines. This display is clear and colourful. Nice clear 12 leads. I guess I can learn to love them!!! :wink:

Hello, Cool case. I once had as a patient who overdosed on Fiorinal tabs (ASA/Butalbital/Caffine). He took it because he had an old closed head injury and it helped stabilize his mood. His levels had been quite high and he required dialysis. It has been awhile so I google ASA overdoses to remind myself of all the things that I have forgotten. I found a great tox reference at the following web site. http://www.yrbhp.markham.on.ca/pdfs/Pharma...acology2001.pdf Thank you, David

Hello, Yukon Emergency Medical Services...Whitehorse, Yukon. Cheers, David

Hello, I didn't mean to irk so many people with my post. The area in which I work is very particular about anything in the nose for Basal Skull fracture. Also, I saw an NPA inserted in a pt with a decreased loc, and low stas ect... who bleed profoundly and aspirated a ton of blood. Of course, unknown to those inserting the NPA was the fact that she had mechanical heart valves, had been taking too much Warfarin (her INR was very high) and had very high BP. I work at a major stroke ctr that covers a large geographic area, and a couple of times pt got bad epitaxis from NPA post TPA infusions causing some grief. When reading the posts these couple of cases came to mind. Just points to ponder when you open the airway bag and the OPA and NPA are looking back at you. (and with any luck, prevent some grief at work) David

Hello, I agree with the good points reguarding NPA (suctioning, tolerance, ect....) However, OPA are better in certain situations. 1. Basal Skull # 2. Pt. on anticoagulants, and anti-platelets (ASA, Warfarin, Heparin, ect...) because they may bleed allot!! (learned that the hard way one) Now a unsecured airways is full of blood =( 3. CVA pt. who may be in the window for TPA, ect..... They will bleed once the clot is busted from everywhere a laceration is. =( Thanks, David