AnthonyM83

I'd say SVT. P waves look too similar to be MAT in my opinion. FL_Medic, what does the PR interval length look like to you? I can't really see the smaller lines, but didn't seem that significantly shortened by eying it... What's QS pattern? I thought that's what you called it when there were no R's...but there are. Will a junctional pattern make that ST looking depression? As far as the notched T-waves, if you don't think that's from a hidden p-wave, then where are the actual p-waves that you did see?

I see. Around here LA (I guess you meant the state) there are a lot of explorers (teens 14-21) who ride out with paramedic squads. They usually get to assist putting O2 on and stuff like that...they mainly do it to ride out on the fire engine, but many times ride on the medic squad just for experience (or if they prefer it). What I was really trying to get at is how does one know they're good working on the squad if they're not yet an EMT? Congratulations on the achievement, either way. Just trying to clarify.

Do you really get to practice your full EMT skills and assessments when riding the squad? I'm a huge supporter of explorers and try to include them in as much as I can when they show up on calls...but usually the medics they're riding with get to practice their assessments and decision making skills, not the explorer, especially if not an EMT yet.... Just saying, how do you know that you know you're doing everything right when riding along on the squad.

Meant to say would you normally NASALLY intubate dead people? As in they're not actually dead yet if you're performing that skill, usually...spontaneous breathing is usually required...

Not often, though I hear about it a few times a month (not bad for their size). From the situations described, I believe they're classifying LVNR as lethal force (or right below it) on their use of force continuum. It's reported to the public through their blog everytime it is used.

I believe statistics were only based on class pass rate. While it's not a great indicator, it's very hard to find good indicators. Pretty much impossible to track students after they graduate. EMT curriculum does not honestly require THAT much from students, but what they do require (and what the school requires) is best learned if course done short-term. Also note statistics are based on a specific subpopulation, since the course is expensive (already semi-successful, lots to lose, usually more serious about course, etc). In the end, we're still limited by number of hours.

Is that what the data says? A local school around here found it had a slightly better pass rate for 3 week course than the 3 month course. I assume the reasoning to be that if it's full-time, they put their entire lives into it and less likely to lose interest in such short time. They're academic and hands-on skills testing didn't get worse, though. And it is NOT an easy program, academically, compared to other EMT schools in the area.

How would you manage a patient who has been "choked out" by police? Would you recommend transport by ambulance? For those who have the option, would you send it BLS? Would you tell PD they could transport themselves if at all. This is, of course, assuming everything checks out normal with patient (not on-drugs, no significant hx, no other injuries, pt calm now, AO3, etc). Does it qualify as syncope? It was trauma with loss of consciousness, technically. Does that change anything for you? Realistically, kids choke themselves out all the time and usually don't have trouble unless they accidentally damage airway, but was trying to think how I would fit it into a protocol...

Would you usually intubate dead patients? Usually a skill used to prevent them from becoming dead . . .

I don't think he had that option . . . Four to one? So is one of those Flutter waves hidden in the T-waves (which would explain why they're so big and notched?)?

You have to provide details on that statement to give it value. The pass rate could have increased because the instructor was really good or because they made the class easier. I know of a school that has an EMT with no college degree and about 5 years experience. When he coordinated classes, not only did he make the material much harder, but much clearer and pass rates did increase. Those EMTs also stand out when they do ride-alongs with our ambulance company. I walked into a lecture a bit ago and they were differentiating locations of baroreceptors and chemoreceptors. 100x better than my 6 month, twice a week EMT class I took. But in the end, I think it does come down to class hours. You can make the most out of them with stellar instructors who care about molding a thinking EMT, but you're going to be limited. (But if we make all systems ALS and limit BLS to first responders, not as big of a deal

Not to defend SoCal EMS, because a lot or most of it is retarded, but there is probably a reason? Wonder who pushed for it. Would this cover a lot of hospital to hospital transfers, like ped asthmatics in ER transferring to pediatric hospitals. A lot of patients are 'stablish' according to hospital, but require a monitor en-route. Least private medics can do just a tad more now . . . ?

As far as breaking through the cribiform plate itself, that takes pretty little effort. During a cadaver lab, our medical director had us push through it with one of the surgical tools (similar to a screw driver) to demonstrate this. No wind-up was really needed...mainly wrist action (and cadaver was in 40's). As far as this translating to NT contraindications, doesn't mean too much...other than massive forces from pt's original injury aren't necessarily needed to break through. Of, course that'd be a pretty damn specific injury to have...

When you save it to your computer, then zoom in, do those F waves seem to have little dips at the top of them. Is that just how they look sometime or is there something hidden in them (probably not, just throwing it out). As far as the rhythm, I see what Spenac sees. The PVCs are spaced out pretty regularly, too. ?

Just reviewing my cardiology and want to clarify some points. Looking for pretty in-depth explanations, so more technical, exact, and detailed the better...I think I get stuff moderately well, but want to clarify (cough:: Fiz ::cough) 1) I need a better precise explanation of depolarization and repolarization. I was initially taught K+ is inside during resting polarized state. But just re-read Bledsoe's cardiology section that's making it seem like Na+ is mainly inside right before depolarization. When does stuff rush in/out, relative rates, effects, etc. 2) What counts as the exact borders of waves? When does a wave end? (When it passes the isoelectric line?) For example, in QRS. Is the S wave the entire downward slope from the very tip of the R? Or does it start when the downward slope from the R passes isoelectric line and end when it comes back up to isoelectric line (think I know, but gotten different stuff from some people) 3) And one I still haven't been able to get answered, though I think I know just based on working it out in my head, but want to be sure: If the QRS complex is mainly positive, then why is the T-wave ALSO positive? Is repolarization also positive ions going into the cells even though overall negative wins out inside? Is it because of physical direction in which myocytes are repolarized? It's not intuitive (you'd think it would be opposite deflection than QRS...)

I don't post it, just so I'm free to honestly discuss company procedures or problems that may come up without tarnishing the name (or getting myself in trouble). But depending on the shift, 12 hours straight was common. Not seeing station until 1AM was uncommon, but not rare. (Of course, I worked a particularly busy assignment.)

I would imagine an ET tube to have more force than a floppy NPA. I've been told it's not really a contraindication for NPA, but that it is for nasal intubation...or at least a relative contraindication... (with a cribiform plate fx an ET could push right in...)

They usually end up in dispatch until their license clears...

Eh

Yeah, I believe that can significantly contribute.

Yes, it will make physicians more in charge of EMS, but honestly, at least it will bring professionalism and attention to it. It can lead to better research funding, training, standards, us having more influence through them. And they're never going take our place (least in any of our lifetimes).

Here's a nice hospital screw up...DNR bands that look like the Livestrong bands: http://www.sciencedaily.com/releases/2007/...71218122409.htm (I don't actually think the ones being advertised would look like that...just related story I found while trying to get an image of the accepted DNR bracelets in CA)

Fiz, looking back did he have any signs of opiate OD you might have picked up on even if you weren't thinking head trauma?

Don't know what our number was, but I as far as time actually doing something (calls, move-up to cover another area, and holding walls), was pretty daily occurrence to start shift at 7AM, first call 7:30AM....run straight without break until 8PM... little downtime until 10PM...then run almost all night. But like I said a LOT of it was move-ups and waiting to offload patients.

Naw, depends on your protocols. Like mentioned if you get an official DNR bracelet, it's honorable in CA. It won't be mistaken for as regular jewelry by the patient though.