paramedicmike

Yes, you do deserve it. You deserve it for a variety of reasons not the least of which is that if you had actually done the research you claim to have done you'd recognize how the quoted statement demonstrates that you have no idea what you're talking about. Take your attempts at free advertising elsewhere, please. That you specifically mentioned that the other place requires a minimum number of posts before you can post freely points to your attempt at as much free advertising as you can get. Admin has already intervened in this thread. If he's interested in you advertising he'll respond to your queries. Otherwise, please, just knock it off.

Beats mine by 20 points. Well done, indeed!

Without knowing specifics as to your situation please consider working with a trainer. A good, reputable trainer will listen to what your needs/goals are and will be able to tailor a workout to achieve that goal. They'll do so safely while attempting to minimize your risk for injury. Some of the physically toughest providers I've worked with have been smaller women like yourself. You can do it. It's just a matter of getting it done and not quitting on the physical gains you'll make while prepping for the test.

Welcome. Unless you can pull a few extra inches of height out of your legs you're left with pretty much one option: continue working out. Do test rules not allow you to lift above your shoulders?

Say what? Where's your physical exam? The only way you're going to have any idea as far as forming a differential diagnosis is with a good history and thorough physical exam: something we in EMS aren't always good at. (Before you think I'm dinging you I'll say upright that I'm not. We're all human. We all do it to some extent.) Focal neuro deficits? Ok... wide variety of neuro considerations to be made. Do they resolve in a given period of time? Consider TIA. Progressive or persistent? Consider CVA. Fever or other considerations for infection (e.g. urinary symptoms, cough among others)? Sepsis. History or exam findings that point you down another road? Consider an alternate diagnosis. Several services with which I'm familiar use lactate POC testing for suspected sepsis but not for anything else. Locally, prehospital lactate POC in suspected sepsis has increased our recognition of sepsis, decreased door to antibiotic times and improved our overall sepsis outcomes. From what's been posted this guy needs a center capable of handling an acute CVA. He needs safe, rapid transport. He needs continuous monitoring. He needs serial neuro checks. He needs a head CT. He needs a neuro consult. Intervention will depend on what's found after work up with imaging. So what was the outcome of this guy? It's an interesting case with what sounds like a monitored progression of his symptoms.

Incorrect. Lactate is a marker for cellular hypoxia. It does not point towards bleeding in the body. Rather, it points towards a lack of perfusion which can be caused by a variety of factors. So fine. You check a lactate and it's elevated. Then what? Is this ischemic? Is this hemorrhagic? You still don't know. Will it impact your care? Not likely. Is it entirely bad? There is some evidence to suggest that lactate can be neuroprotective in a stroke. Here's some reading for you. Here's some more. Ok. So you check it and it's elevated. Then what? Treat your patient not the number. If you have treatment guidelines that address lactate levels in CVA then please share. Otherwise, outside of suspected sepsis what benefit is offered by knowing? Is there a purpose to doing it or is it just cool to roll in and have a lactate value?

What's a lactate going to tell you? Is there a sepsis concern here? Doesn't sound like it. Sure, if you have point of care testing capabilities you could get a baseline so long as it's not going to take away from getting this guy to a center with interventional neuro capabilities. He does not need the community hospital unless it's on the way and the helicopter can meet you there. Otherwise, to be cliche, time is brain. Twenty five minute ETA on the helicopter (birds don't carry people) plus a ten minute scene time plus a 15-20 minute flight time means 50-55 minute ETA to the stroke center versus 45 minutes by ground. Why are you still on scene? Drive.

Reversal concerns aside the care will be the same. Support the airway and ventilations. Monitor. Titrate narcan to ventilatory effort or at least try to. Transport.

Welcome. What kind of information are you looking for that would be different from any other opioid overdose? They're opioid analgesics. Treat an overdose like you would any other opioid overdose. Fentanyl was our go-to analgesic at my flight gig. I use fentanyl all the time in my ER gig. It's great for pain control without the hemodynamic hit. It's also good for procedural sedation with a little versed.

Check with your state EMS office for information about local or regional resources. Some states, Pennsylvania for example, have CE programs set up for no cost online learning to registered providers within that state.

Welcome. As you noted this topic has come up before. I don't recall any responses to the various threads producing any guidelines along the lines of what you're looking for. If you do hear anything please share here. There are others out there looking for similar information.

Rough week.

Welcome.

Welcome. This site may be helpful to you in finding an accredited paramedic program. It looks like there are three in Montana. You'll have to do the research as to their EMT-B offerings or if they'll accept your state certification for the paramedic portion of the training. Find a program that offers at least an associate's degree. We are a profession. If EMS wants to be taken seriously then it needs to take its education seriously.

Welcome. Not entirely sure what you're asking. Are you wondering if you should work a person who died in bed, is still warm because the blankets were pulled up to the chin, is pulseless and apneic, has asystole confirmed in three leads and has noticeable lividity just because they're still warm?

Interesting approach. I can see small boluses to help get things moving. I would've gone to CPAP and considered norepi for this as well as I, too, am not sure of the CPAP contraindication for this patient. The lasix puzzles me. I'm not sure I'm following the thought process involved with that. I don't know that this is really a case of too much fluid so much as it is fluid in the wrong places.

Back when I was in school I got bounced around. This was good and bad. I got to see a lot of different practice styles. If I was paired with a rotten preceptor I only had to deal with him/her for the short duration of that assignment. The downside was that I worked with a couple folks who were *really* good clinical teachers and I only had the opportunity to work with them for that assignment. As I mentioned above, though, every place does things a little differently based on clinical site and preceptor availability. Your mileage may vary.

Welcome. That's an excellent question to ask the WY Office of EMS. They will be your best resource.

Good advice above. I'll add something a little different: Open your mind. You've been doing things long enough to develop your own ideas and your own way of doing things. This could potentially come back to bite you over the course of your paramedic education. Open your mind to new ideas. Open your mind to new ways of doing things. Unlearn your bad habits (hard to do, yes). With regard to your direct questions rotations will be handled however your program handles rotations. The process varies from program to program. It will depend on local resources, clinical sites, preceptor availability. While most places try to keep things simple sometimes local limitations can complicate even the most simple of things. Expect things to be pretty straight forward; expect that there are new and innovative ways to make a mess of it. Kinda' like the Army. Keep us updated on how things are going. As always, if you have questions let us know how we can help.

The six most dangerous words in the English language: "We've always done it that way."

At least here in the States it would require a hefty paradigm shift in order for this to happen. Insurance would have to get on board. Doctor's offices and urgent care centers would have to get on board. There would have to be a change in the education of those staffing the ambulances to safely make the determination of where best to take the patient. Not saying it couldn't happen. Not saying it won't happen. It's just gonna take a while to get there.

Uh... did they know each other?

Dust served in a number of capacities in his career. He was a military medic. He was a civilian medic. He was also a nurse. If there was ever someone who could post knowledgeably about both sides of the coin he was one of them. I also find it funny that even after his death he's still able to make someone so angry. I'd like to amend Ruff's question just a bit. Rather than ask, "you angry...?" I'd like to know *why* are you so angry?

The manufacturers will survive. We use them frequently in the ER. People walk in after their MVC complaining of neck pain and someone in triage throws a collar on them. I know. I know. Anecdote will get me nowhere. Spock is right, though. The worst spinal injuries I've seen have all walked, or limped, into the ER. Like the guy who walked in after a mountain bike accident. "My neck's a little stiff." C4/5 fracture/subluxation. Or the little old lady who took a header into her basement floor while bending over to pick up laundry. Type III Dens fracture. For the time being, unless someone can be clinically cleared (e.g. Nexus), collars will still be used until someone can be cleared radiographically.