AnthonyM83

I'm sure he appreciated that comment.

Definitely a misleading headline. Do we know why it went down?

Unbecoming because of the half dressed girl posing on their car. Conspiracy/Accomplice for letting her have possession of that firearm (unless that's legal in their state). In reality, I wouldn't recommend firing them. Discipline, yes.

My story is I like helping people, but I need a challenge and need it to be interesting. Won't post more about me, because it doesn't much have to do with my interest in better EMS.

I prefer TPAL, because it breaks it down. That's what our local perinatal center uses for their forms.

I know our local EMT school teaches it. And it's in both Mosby's and Brady's paramedic texts.

Hmmm, we use it with just about every single pregnant patient...at all provider levels.

AHA Guidelines 2010 . . . coming to a training center near you (late '09)

For the people who work in hospitals and use Parity to mean pregnancies that made it over a certain number of weeks....is the same definition used in all hospital's you've worked in? Is it in your textbooks? Or could it be a regional thing? Basically my EMT friend is in nursing school and was surprised to find she was being taught a different definition than what she'd been using when reporting to nurses all her time as an EMT. And the nurses who work at the hospital she's doing clinicals at have no idea EMTs/Paramedics are taught a different definition.

I think we're all on the same page as far as which one is Para and which Grava (unless I'm having a semi-dyslexic moment?). What concerns me is that EMS books (including my Bledsoe's Brady book) are giving an incomplete definition of Para (live births instead of viable pregnancies).

I was recently told that the common EMS definitions of all pregnancies versus live births (Gravidity vs Parity) seen in many textbooks is not consistent with what hospitals and other healthcare providers (like L&D nurses) use. Apparently, hospitals use Parity to mean how many times she has been pregnant over 20 weeks (or similar time period...24 weeks, etc) regardless of stillborns or miscarriages. I think the common EMS definition I've heard from several places is useful to use, but it's inappropriate to report GP to a receiving nurse/doctor using a different definition (even if they're going to eventually ask patient themselves...in some emergent conditions it might not be possible right away). Maybe someone who works both in EMS and hospital environment can clear things up for me.... Thanks.

Refer to a PHTLS textbook and make a copy of the section going over indications for needle decompression. Forward it to him and let him know you're worried about other medics/officers coming up to you and asking why you acted incorrectly (whether they're really asking you or not), then provide the paper and tell him you thought you acted appropriately based on that (or protocols). Thus confronting him about the issue, but not being aggressive to point of getting yourself in more trouble. If you were going to be more direct, I feel like you would have already, so just giving you a 2nd option.

Alcohol does inhibit anti-diuretic hormone leading to dehydration. Creates a number of other imbalances, too. It doesn't seem like syncope from dehydration would be too common, unless already dehydrated or going in a hot tub. It depresses your CNS, including your reticular activating system which maintains consciousness. It's assumed that when you depress it enough, one passes out. Which can be a good thing, so you stop drinking. Of course, there's the potential for aspiration (though most still have a gag reflex after passing out). As an EMS provider that's a concern. As far as how alcohol specifically makes you drunk, it's not fully understood on the biochemical level. It basically slows and/or alters transmission of messages among neurons by screwing with depolarization (among other things).

Did he specifically state SBP of 110 for actively hemorrhaging patients, versus those where they were bleeding and hypotensive but where bleeding is no controlled? Were these studies done in the hospital or prehopsital?

If you redit your post to include paragraphs and separations, I'll take a read. As it is now, way too much jumble for my eyes to handle. Busy shifts can definitely be good shifts. I'm here to gain experience and get good at running different types of calls. If someone doesn't make it, I see it as experience and opportunity for refinement in skills that will help the next person who actually might have a chance. There is such thing as a good shooting. Just depends on what the "good" part is referring you. I wouldn't take it to refer to the fact someone was hurt (it goes without saying that's not good). Saying it was a good shooting doesn't change that.

It is generally taught that you can orally rehydrate and passively cool a heat exhaustion patient. Water or electrolyte solutions are preferred (Gatorade, Pedialyte, even Normal Saline), as they will replace their electrolyte imbalances. They should be conscious, oriented, and able to drink it themselves, generally. Cooling may include loosening/removing clothes as appropriate and even fanning. Heat stroke patients (as determined primarily by ALOC) should not receive oral fluids. Cooling is generally more aggressive and can include active cooling with cold packs (not in direct contact with skin) and even luke warm wet towels (recool towels as they warm up). Contact ALS. Of course, O2. Remember, local protocols may describe exactly what to do or may not address it at all. You may have to go with what you learned in class and from your textbook. Also remember that a patient can easily start shivering if you are too aggressive. During ER clinicals, we had patient with temp of 108.6 Nurses started dumping crushed ice all over him. I voiced my opinion, but it wasn't my place. He very quickly started shivering, which creates a lot of heat and worsened his condition. In addition, his skin was now very cold, so capillaries vasoconstricted, which further impeded heat loss.

What's the usual raise most companies get over 3 years?

Did you actually read the post?

Psychosis?

$8/hr on 12 hour shifts. $10/hr on 24s. To put THAT into perspective, minimum wage is $8/hr.

I like the acronym just because it's more encompassing. The classroom way should be like the field way, otherwise it was a poor classroom way. Even if someone with common sense would disregard the order of ABC's, it's more satisfying to have the "ABC's" actually fit the situation. I'm not "sure as hell" doing that for sure. Evaluate the bleed. Is it "MASSIVE"? Evaluate the level of hypoxia. Is he blue and about to lose consciousness? I would then make the decision. There's a few steps to that process. Depends on the scenario. I can't bring back ischemia brain cells (whereas I can get patient to a hospital for a blood transfusion). BUT if he can handle the choking for 30 seconds while I slap on a TQ, then I might do TQ first. Depends. That's one of the classic problems with testing in EMS. Do we test to see if they know and can do the baseline order of procedures? Or do we test to see if they can treat a patient? The latter scenario might be very incomplete. He might be able to save the patient, but barely, but not show knowledge of other things in the scenario because they weren't applicable. The examining entity should make their testing methods very clear to the testees beforehand.

Why? Seems good to me.

I'm not sure where to go with this thread. Should Democrats slap Republicans now? How quickly will that turn ugly with several people jumping in from both sides to the point you can't follow the thread. My usual reply to Democrat bashing is to look at history and analyze how many things we now see as historically 'wrong' were initiated/perpetuated by the conservative parties of the time.

I'm assuming he's not alive anymore....?

There's a tendency (especially around here) for medics to be off chest compressions or just letting sats drop for an extended amount of time while trying and trying to get their tube. As part of our school trying to emphasize not doing that, they gave us a 10 second goal for intubation (as well as keeping CPR going). Just part of the whole idea of not letting other areas of tx suffer just to get your tube.