AnthonyM83

I don't think there's been any mention of anesthesia for IO's in either in my class by any instructor or main lecturer or mention in the books. Maybe it's a newer thing, since many places started out only using them for cardiac arrests, thus the issue wouldn't come up...

Prehospital? Or not?

They wouldn't dare try that training machine in Los Angeles... I would assume they'd get the same results. 1/16 seems about right ...

The way I describe decorticate and decerebrate. Decorticate: You move your arms to your "core". If getting painful stimuli, this at least is still protective (though primitive), so it gets a higher GCS score, 3. Decerebrate: You move your arms outward, as if "celebrating" (think of an exaggerated image of someone celebrating at a party). If getting painful stimuli, and you put your hands outwards, not protecting your torso at all, that means you're seriously screwed up, so you get lower GCS of 2.

Vent, I'll have to find that information source. We were told in class that the county had done that study, so haven't read results. Have the feeling not all the info is readily available since *I believe* it was an internal study from the EMS Agency to see how county resources are being used and figure out needs, etc. Information that would make sense for administrators to have. And yes, the lack of preparation field personnel have is astonishing, which is partially explains the hesitancy to do any but the most routine procedures around here (along with many just not caring). The paper could be informative, but I believe a political stance paper would definitely be acceptable, as long as it involves literature review.

I've found that in mini-MCI's the whole START Triage usually isn't used. Responding unit just goes through and decides who's "critical", who's "ALS", and who's "BLS". I haven't been on any of the large-scale MCI's here in LA, but from speaking to several who have, it seems the START Triage and the whole NIMS program has worked very well. The key, of course, is having resources to practice as a whole (rather than just studying your Triage sheet)... actual drills/simulations are required.

Ooh, that's the other one I was considering. Only concern is lack of articles/research on it, other than raw numbers on assaults. Which might be enough to prove the point there's a great concern, but the rest of the paper might have to be based on experiences and presumed prevention studies. If anyone has sources good sources for this topic, let me know...

I know the feeling you're talking about, and why you'd associate it with a parasympathetic or vagal response. It's different from the feeling when a car's about to hit you or a patient comes at you with a knife or when you hear a loud noise. Like was said, it's more like when you see a family member injured or realize you just F'ed up big time. You get the adrenaline rush, but at the same time feel your stomach get queezy or even feel the blood rush out of your head (not in the vasoconstriction way, though). My guees is a vagal response (as when hearing bad news), but also adrenaline release, which overwhelms parasympathetic, but you still feel remnants of it? Or maybe it's the same Epi and sympathetic response, but your mind attributes it differently...and thus evokes different emotion (fear versus anger versus PANIC)?

It's a five page paper. Basically a literature review, so I would need decent journal sources. There has to be enough written on the topic. Yup, it's for paramedic school. It would be college level. Some good ideas guys. Some might be way too broad. Some I don't know much about, but would be interesting. Right-sided MI's might be good. I know the differentiation is often ignored in the field. Keeping CHF'ers out of the ICU is a real important one. I think he probably gets a student each class doing that, though... Efficacy of drugs we use would be very informational. The ALS vs BLS would definitely be a good one, too. I gotta see how much research is out there that breaks it down in formats I could use. I know LA County did a study on it and concluded 90% of calls only need BLS. Out of the 10% qualifying for ALS, 3% were going to die no matter what, other 3% would live no matter what, and the other 3%'s outcome completely required ALS intervention. Managing rare conditions like myelomeningocoele would be interesting. I didn't know we could induce seizures for positioning. Bet there's very little written in context of prehospital care, so would definitely be informative. Maybe something that could go to JEMS eventually... Pediatric dosing errors. It'd be interesting if we could find out causes of them prehospital (misreading Broslow tape? Incorrect administration...I've seen OD happen with PR valium....etc) Keep them coming.... What would be interesting or fun to write about Or what would be beneficial to the EMS community, even if just locally?

Was wondering if I could get some help brainstorming some ideas for a paper topic. It can be pretty much any topic to research that applies to prehospital care, for school. Ideas I've had are: Inducing Hypothermia Ultrasound in the field Pain management methods Newest CPR studies I feel like all of those have been done...and our instructor reads about 120 papers a year, so I'd like to do a topic he hasn't seen 5 times already. Throw out any ideas, any at all...

Don't even remember what thread OP is talking about (I'm sure there was a recent event that brought this up), but I do suppose admin might as a group decide if they want to increase lookout for thread derailments that could be restarted as a different thread (when admin splits an existing thread into two). Because honestly keeping it semi on-topic does promote learning and that way you don't squash the side discussion that comes of it. Of course, I'm talking about total thread derailments, not the small side discussion and natural conversations that come from any online discussion.

Yup, and I have that Firefox spell check, too. Where it red underlines any word it doesn't recognize, "real time" as you type it. Then, you right click for options. But I do admit, my spelling is superb...my fingers not being able to keep up with my mind is the actual problem

Well that settles that part. For those who said it would be criminal not to report it, you better have a legal statute or code that backs that supports your statements (if what the license were completely expired/lapsed past 60 days). Generally, knowledge of a crime through the grapevine isn't conspiracy. The state would have to have a specific law forcing others to report their coworkers.

I don't think we can change the STEMI criteria, but it definitely means we should take that patient very seriously and be aggressive in timely medication administration, quick off-scene time, and constant EKG monitoring. The study just correlates with 30-day mortality, so they're not necessarily going to croak on you...but you should do whatever is possible to limit heart damage (ASA, decrease myocardial O2 demand, ER notification).

http://www.medscape.com/viewarticle/589781...mp;uac=106044SV Lead aVR: Importance of the "Forgotten 12th Lead" in Patients With ACS In recent years, more studies have demonstrated the importance of lead aVR during the analysis of the 12-lead electrocardiogram (ECG) in patients with acute coronary syndrome (ACS). (Continued at the site...Easy read, like two paragraphs plus an abstract)

Sure...but I don't see much problem with it. Every code you run just makes you more proficient for the next one that WILL matter...as long as we're not transporting or anything...

I keep hearing stats on how traumatic arrests have one 1% or .1% whatever chance of survival, thus we don't even attempt. What confuses me is how close that is to non traumatic arrest survival. It's not like medical arrests are that high either. You'd think that if 5% (or whatever stat for medical saves...they seem to vary each time I look them up) is enough, then .1% would also be enough, especially since the one save is worth a lot... Or am I being told bad data?

Not that I'm trying to support a possibly dated mentality about the cranial vault thing, BUT we have to also consider that it's a contraindication, so number of NI's with head trauma are already going to be miniscule, especially in prehospital care (I imagine where most NI's occur? since we don't have RSI and such) which has only been around for a short time.

If you can, I'd probably chat with the doctor. He's going to be the one calling his primary care physician, doing any additional prescribing, and reviewing his records, so probably good for him to know (in case nurse don't relay all the meds, or he overlooks it, etc)

Nice. A "Miller" Lite (Actually a Mac 4)

Modified from one of the oldest tricks in my book. When too drunk to a speak or walk, just lean against something, hold a drink, and pretend to be in thought, while occasionally scanning the room (so people don't think you're fading). The less you do, the less they notice. Works the same for counteracting adrenaline rushes

LOL Absolutely not. My comments were totally from a psychology perspective. Like if room starts filling with smoke, but no one else runs out, the person will stay also. Or if a man with a business suit starts walking despite the Don't Walk sign, everyone else does too. It just boggled my mind what made these experienced people take or not take action, yesterday. It was just observational ramblings...

Thanks guys. I never really announced it, but I'm in medic school full-time now. BUT still in didactic (not internship, not clinicals, yet) I just happened to be shadowing an ER doctor I had met when was in the field. This was unrelated to school. I just wanted to get an idea of how our doctors think and what we can do better in the field to help them. We're going over charts and such, when we get notice of a full arrest en route, no details (guess he coded enroute). Well, just happens that while we're waiting, my school's paramedic internship coordinator walks in. She's riding along to watch a student being precepted. (So, see where this is going... student shadowing... full arrest coming in... preceptor coordinator there...this happens to be one of the official hospitals for ER clinicals for my school...and we had already finished airway and cardiac block) Basically: -Patient arrives (Enroute went SOB to bradypneic to agonal to arrest, first rhythm asystole...2 rounds epi/atr so far) -Short, fat neck. They couldn't get ETT, so dropped a Combitube. -Doctor offers me intubation. I get the go ahead from my teacher/coordinator. -Standing there looking calm and relaxed amongst the chatter (but really my heart's POUNDING). I pretend it's just another scenario and patient's an actor. -Game time. -I try to slip blade in, but he reminds me I have to scissor the mouth open first (hey, the dummies didn't require that!). -Fat freaking tongue...how the hell do I even get the blade down there to look (I forgot to slide in from right to left...) -Okay, now I see a lumen, edges look like they're probably cartilage, but can't be sure (can't see ridges...too bloody...I suction...still can't be sure)...no way I'm going in if can't be sure. -Been ten seconds, so I pull out. RT bags a bit. -Doc shows shows me how to position blade deeper. -I go in again...now I see the ridges/bumps of the cartilage. Ah, there are the chords. -Crap...where'd my ET tube go? Left it right there! . . . Oh, RT is holding it for me smiling... Thanks! (I'm so used to not having assistants in practice). -Slip it in. Doctor confirms. Tada. Details on code for those interested (and interesting observations on the nurses): Now back to CPR. I'm trying to think of H's and T's...but they come sooo slowly (In megacode practice, I rattle them off the fastest with signs and treatments...go faster brain) Anyway...doctor is running the code... next rhythm check, VTach, shock him, next check, a sinus rhythm at 140...pulsecheck...yup! Some Ami...even got a good BP Does well for awhile, then bradys down and pulses diminish into a PEA. Maxed out atropine, so just epi and bicarb. Get pulses back. Happens again, epi/bicarb, comes back. So orders a Bicarb drip. Doctor goes out to chart and arrange CT, ICU, and other stuff. I stay...My first real patient...I'm committed now. Now it's just me, a nurse on the phone with ICU, RT, and two nurses shuffling in and out. I go back to EMT mode (I'm the ambulance guy, I stand in corner and watch you guys work and try to learn). BUT see HR dropping very slowly. I call it out, but no one does anything. I go up and take a pulse. Chubby neck..hard to feel through the fat, think I feel weak intermittent ones. I ask others in the room to help me check, they all come over and do so (wow, never told a nurse or any of the staff what to do...) We all wait a little too long saying we can't feel one (I'm not used to feeling femorals...I expect one of them to call out "no pulse, it's a code"...but instead they just keep looking and remarking they can't really find one). Alright Anthony, what more do you need, he just met the indications. "So, he's in PEA, let's start CPR". The nurse starts compressions. (Wait, WTF, you told hospital staff to do something?...and they didn't hesitate to do it. Why the hell is my word any good.... maybe cause I'm dressed up like the doc and not in my little EMT uniform? they KNOW me, though...i'm ambulance guy) Anyway, shake that off. What's next? Uhh...no one's doing anything. They keep yelling to hallway to get the doctor to see if he wants to give the same drugs as last time to see if it'll work...but can't find him. Time ticking away. Screw this. Why are we getting caught up in this? We're all ACLS certed, right? He's in PEA, we should give Epi...that's a standard...why do we need the doctor? Do a quick legalities check in my head (preceptor approval (though she left already)...official contract with ER and my school so insurance stuff is good...nurse usually precepts a medic, so don't need the doc...so I can act like a medic right? "Okay, guys, this is a PEA. PEA gets Epi, so I'm just going to push it, okay?" (I get an okay) Then I push Bicarb... we end up with pulses again. Basically, the point of all the above is It was really a mind trip to realize how nothing was being done if the doctor wasn't there and even more that they looked to me for our next move, our next drug, whether we start CPR. Nothing against nurses. And I know most of the ones here are Type A personalities...but I forget how many Type B's there are. They need someone to decide...and as soon as they do they do their jobs great (they were helping me out with technical stuff the whole time like reminding me to pinch the line). Maybe it was cause they knew me from the EMT days, but it was weird how easily they took me as the leader and even kept checking in with me. I still have a confused look on my face as I type this. That guy would have gotten nothing more than CPR until they found a doctor.... Anyway, end of story, is he stablized. The rest of it was just me, 2 techs, 2 RNs, and RT. Took him up to a floor and transferred him. But even for that, I had to tell them to stock up on more Epi and drugs. Then someone said "you're staying with us!" I don't know if I just seemed like I knew what I was doing? Or dressed like I was? Or they associated me with the doc cause we were side by side the previous 8 hours? I don't know. I just know they've been on SO many more full arrests than I have. And it feels weird leading someone of a higher authority than me. Leading other EMTs on-scene, I'm great. I run scenarios with students all the time. I'm an FTO. But THIS...was like your teacher in high school coming to you for advice or something...just seemed off. Oh, and at the end, the doctor thanked me in front of everyone for being able to "show up" my experienced peers who couldn't get the tube and on my time. That was probably the best part of the day. I thanked everyone for letting me be a part of their team and left to celebrate.

-When pedestrians purposely leisurely start walking across the street in front of your ambulance going L&S when you're already in the intersection. -When you can be on-scene to a call, before it's dispatch is finished...and not a rare occurrence.

Congratulations, Man. Well Done.