AnthonyM83

Huh? Why would you get banned for not becoming a paid member?

Thanks Admin. I do like the concept

I'd be happy to do that. K-5 teaching assistant was one of my previous jobs. PM for email and bio stuff.

LOL I will one day, but not yet. That original question was asking whether it mattered if leads are on chest or arms. That thread combined with some other journal studies explaining the importance of actually placing them on the limbs convinced me they must be placed on limbs. My CURRENT QUESTION is why on earth the text would say to flip the leg leads in left-right direction. It specifically says that the RL electrode stands for Right Leg, even though it is placed on lower left chest. !?!?!? It's basically acknowledging that they're limb leads, acknowledging the monitor instructions and labeling, then telling you to do it differently. WTF?

Here are three sample schedules: Los Angeles County Fire Dept (1 day off, 2 days off, 1 day off, 4 days off, repeat) Los Angeles (City) Fire Dept (1 day off, 1 day off, 4 days off, repeat) 48-96 Schedule (used by smaller cities in LA, like Redondo Beach FD) (48 hour shift, 96 off, repeat) (lot of good info in the link) I listed them in order of least desirable to most desirable, in my opinion. I would imagine 48's would only work in quieter areas (maybe why the quieter smaller cities adapt them more), though they are or have been used by larger departments (San Jose FD).

Probably. Guess being top 10 poster doesn't get me that "Elite status"...gotta get that 2,500

In skills lab, we instruct applying an ECG monitor. The textbook, "Prehospital Emergency Care, 8th Ed" by Mistovich (2008) instructs a different configuration than what our EMS system uses. I was hoping someone could explain the logic. Our basic ECG consists of four wires: Right Arm (RA) : White Left Arm (LA) : Black Right Leg (RL) : Green (Grounding) Left Leg (LL) : Red That setup is usually referred to as a 4-lead, though only 3 leads views are seen. For 12-leads, electrodes are placed on limbs exactly as labeled (Left Arm, etc). For basic monitoring, they placed on limbs or chest. NOW... For 3-lead or 4-lead monitor, the textbook instructs: RA: Negative ("usually white"): just under right clavicle at midclavicular LA: Grounding ("usually black, brown, or green"): just under left clavicle at midclavicular, but "it can be placed in other areas on the chest in the 3-lead configuration" (since grounding) RL: ("usually red"): left anterior axillary at about 7th ICS LL: ("often green"): right lower lateral chest wall For each, it includes statement such as "it has RL, on the head of the electrode - indicating 'right leg' placement, even though the head is placed on the lower left lateral chest". It never addresses why. Why would that be the standard...and why would leg electrodes be flipped. I have to assume this is (or used to be) standard in some areas... For 12-lead configuration, it instructs identical placement of limb leads (or manufacturer recommendations). The 12-lead part, I'm going to just say is wrong and limb leads must be placed on limbs. One of their own photographs shows V3 in the wrong location, even though they do explain V1-V6 correctly. For lab tomorrow, I'm going to teach our systems method, but I'd like to have an explanation of why the book explained it that way. Thanks for the help.

Eh, really I've rarely gone back to a message. But every now and then you get good info or a good explanation of something. OR you want to remember the exact screen name of someone you communicated with about something. Of course, I have trouble keeping my desk uncluttered, too....

Just wondering what the PM limit is for the new site? Suddenly my inbox became full (though still getting some new messages in). Deleted a bunch. Down to less than 150 old messages in inbox, but still have the Inbox FULL message. Thanks for the help

Woah, there. I know MY employer didn't ask if I were willing to do anything for the position. Who knows if his did. YET, it seems like he's doing it just fine. All he's done is fulfill his obligation and come to us for some advice (which indicates he's willing to continue fulfilling it). And I know I'm young and maybe illusioned, but is that really how you guys would communicate with your wives...or is the poster being facetious (based on the first part of his post which sets the tone, I gather he's not). Seems like that (mindset...not the actual words) are just asking for relationship problems.

As a side note, AHA is scheduled to come out with new guidelines in Dec 2009.

I think most likely it's going to be constriction from psych meds...as far as what's most likely. Course it could be something totally different or even unknown. Let us know what you find out.

AHA DOES say to go straight into CPR after shocking, without pulse check. No pulse check after shock until 2 minutes of CPR.

Yes, he's protecting his own airway, but the poster gave the impression it patient was making it difficult to assess and treat him. Yes, it's outside the box...but if he got an index of suspicion for opiate OD that could be causing the ALOC, then I can see making the decision to use Narcan. It can also help differentiate which s/s are from opiates versus trauma/hypoxia, possibly. Doesn't quite seem like blind use to me (he's not pushing Narcan on every ALOC trauma)...but like I said, I AM here to learn, so interested in others' opinion.

How is he behaving compared to baseline? Are the constricted pupils normal for self? Try to get a full medication list. Some antipsychotics (among other meds) may cause pupillary constriction. Certain CNS injuries can also cause it. What are his vital signs? And what is a CO rating of 1? I'm not familiar with the readings.

Definitely gotta congratulate you on dropping the smoking habit. It'll do you good and put less stress on your body. Wish you a strong recovery...keep us updated.

You could divide it into the main "blocks" you see at many paramedic schools (cardio, resp, neuro) . . . or divide by video, sound, ppt, flashcards.... or some other might be: protocols (or at least links)...and maybe a "professional" category for things like the New Curriculum and educational standards etc...?

Couldn't you liken that to an O2 sat? You could have a good have someone well-oxygenated with a good O2 sat on one call, then on another call with good poor oxygenation but even better O2 sat? BUT combine a bunch of things and it might lead give you an index of suspicion. No pulses, might make me review the person doing CPR again... and I might say: "Nope, he's doing a good job. We're good there." or: "Hmmm, that's not as good CPR as it good be, gotta remember to get others to switch out with him for a few rounds"

Why not focus on more than just that if you have the time? It's already assumed you're watching for good rate, depth, and recoil. Pulse check might increase your index of suspicion on faulty CPR (combined with questionable rate, depth, recoil, fitness of provider, time doing CPR, etc) and of hypovolemic state (combined with skin signs, medical history, environment, ECG rhythm, etc etc). I try to have my fingers on the neck before CPR is stopped to do the pulse check, so how does that slow the team down? Especially, when you have everything else taken care of. It's one thing to take action based on a random assessment that has no evidence base and another to note several common sense findings that could add up to a big picture combined with evidence based assessments.

While pulses present might not indicate effective CPR, the lack of pulses during CPR may indicate ineffective CPR (or hypovolemia, etc). And no, I don't have evidence of it, but if every single time CPR is done, pulses are felt...then suddenly with one patient pulses are not felt...it's common sense to attempt to problem solve.

When do you guys check pulses (for ALS, only) during an arrest? How do you cycle through you rhythm checks? I've been told best practice is: Discover No Pulse Being CPR 2 Minutes 1st rhythm check (with pulse check) Shock/No Shock Immediate CPR (w/o chance to see rhythm) Push drug appropriate for last rhythm seen (even if it may have converted after the shock) 2 minutes Rhythm/Pulse Check Shock/No Shock Immediate CPR Drug for previous rhythm seen etc etc I've also been told by some medics they take a moment after the shock to see if there was rhythm conversion after shock, then continue with the 2 minutes. Also, if you happen to see a distinct rhythm change during the 2 minutes of CPR after (even though it's hard to see b/c of compressions), do you stop and check pulse or finish out the 2 minute round? (This is all of course assuming intubation with asynchronous CPR where you can't do a pulse/rhythm check while person stops CPR to give breaths every 30 seconds) Just looking to see how different medics run their codes and stagger their drugs and rhythm/pulse checks (and if they respond to them or finish their 2 minutes), AS WELL AS what they consider 'best practice'...

Not the mention the pink puffer standing by next to him... and I hope you cleared cspine on both of them

Is he tachying out? I'm calling cardiac tamponade from that chest injury or compensated shock...

I ask what his disability is that he needs to take NyQuil and for documentation.

What meds is she taking to try and curb these? Obviously not working well enough with 9 a day and one lasting an hour. Even if they're common, an hour long sz is just asking for some sort of airway problem. Yeah, everything's fine until she aspirates and dies in the bathroom where no one notices or can position her right.