AnthonyM83

I sat in on a short paramedic prep lecture on pharmacology today. Lecturer was discussing the difference between anticonvulsants, antiepileptics, and benzodiazepines. I just want to run what I remember by you guys, since I didn't have the chance to take notes. Anticonvulsants work at the muscular level. Doesn't much matter what the cause of the seizure is. If a seizure is in progress these work best, because once it starts it's harder to control that brain activity with antiepileptics. They work by blocking sodium channels. Examples: Klonopin and phenobarbitol? Antiepileptics work in the brain. They're good for preventing seizures, but not for intervening with in-progress seizures. They're used more to prevent seizures in those with seizure disorders. They work by blocking Chloride channels. Examples: carbamazepine/Tegretol and phenytoin/Dilantin Benzodiazepenes can also be used to prevent/stop seizures, though apparently not as good as an anticonvulsant if seizure in-progress. Also used for anxiety. Examples: diazepam/Valium and lorazepam/Ativan Is this how you guys classify the drugs too? Am I recalling the lecture correctly?

Many EMTs take the local PHTLS class. It's a great course, very skills based. You don't need to know any ALS skills, just know when the ALS skill should be used. For example, during testing, you might be all EMTs in your group, so you would verbalize that if you had ALS you'd do a needle decompression. If there's a paramedic on your team and you're being tested, you would tell your paramedic to needle decompress them. They go over the ALS stuff too...it's just basic IV, EKG, intubation, needle decompression for the most part. You'll learn a whole lot. The principle of assessment and quick load and go you learn will definitely help you as an EMT. For sure. I HIGHLY recommend the class.

Think about how much damage a pulmonary embolism or stroke might do compared to a severed leg, though (possible consequences if the clot broke free). Instead of putting him at risk for that, why not just have him go into surgery to fix the leg.

I posted about this awhile ago. Our agency doesn't allow any facial hair other than a mustache. They say it's due to OSHA regulations, though when I posted some people said their policies differ, so I'm not sure what's actually "required". I was pretty bummed I had to do away with my goatee when I started working here.

Wow, had no idea...

Maybe I shouldn't have replied to the poll, because our system is a bit different. PD answers the 911, forwards to FD Comm Center, then dispatch it to appropriate fire station and ambulance company computers simultaneously. Our company's time starts clicking from time the computer beeps (They have 8:59 min to have unit arrive). The ambulance crew itself has 8 min to arrive from time the local ambulance station rings.

Seems like you have two different issues going on there. The thing with the additional training hour is that your system can't hold back the entire state who is trying to advance its EMS system, just because the expansion in scope of practice wouldn't be worth it to your guys. Your other option is not doing the training and going down on level on your EMS title. Your state is getting what a lot of areas only hope for (more education and scope), but you want to hold it off for everyone? Imagine you were getting your original training right now...you couldn't skip out on the last 200 hours of class just because you wouldn't be using those skills in the system you were going to work. No, you did the work to meet the state standard because other citizens are counting on it.

The answer I usually gives is that it allows you to do better decision making when you come upon a situation where there's no protocol for it or you're not sure which protocol it falls under because it's so similar to more than one. I'm especially interested in why we have to know things so in-depth. For example, how does knowing the organelles of a cell alter our treatment in the field? It seems to be in-depth biology education that people often question (even those who enjoy the education itself). How does it alter treatment/behavior in the field?

One of the most common questions I hear when discussing increased EMS education is how will that affect what providers do in the field? What are some good ways of explaining this? This question isn't just coming from lazy providers, rather from intelligent people who always have their face in a medical or EMS book because they like knowing. I'm looking for overall explanations as well as specific examples that could be helpful for those asking that question.

Well, if you feel like you're keeping it all bottled up and feel like you're going to explode, then you should definitely talk it out. The issue is that a lot of people don't feel like it's all bottled up. They're just kind of over it, but if forced to talk it out, they re-hash the anxiety of it and it can lead to PTSD development. It might be different for EMS workers where we have a series of events over a long period of time. Don't know

We develop some impatience, both with people not getting to the point or with people not taking action right away. I imagine as with cops, there's some traits that come and based on time on the job...as a new police cadet I got royally pissed off everytime I saw someone doing something stupid in their cars almost in a self-righteous way...after awhile, I just learned that's the way the world was...sure cite them to curb the behavior, then move on. I'm curious about similar behaviors for EMS personnel.

Not always. On constantly bumpy roads, you might be able to make out a radial pulse, but not track it constantly, thus not knowing where exactly the systolic is with a pretty wide margin of error (depending on road, patient cooperation, etc). Also, sometimes you can get a carotid pulse...but you can't really palp that...

I was going to post about this same thing. I mean, I understand the concept...it might be hard to even palp it on a bumpy road....but it doesn't seem very scientific...

Maybe they were trying to beat each other on-scene...

Follow-up: Maybe the reason you don't see doctors talking down to each other about what they did is there's less of a variance in education and thinking ability than amongst medics. While many are smarter or went to better schools or have more experience, most know the same standard stuff and know how to deduce stuff from what they know. There's only a EMTs I know, where even if it's something off the wall, I know they checked their sources or logically deduced it as I would have. Similar to how I trusted information from most fellow biology majors on science topics...even if unrelated to biology, if they told me a fact, I know it was as true (as could be) b/c they wouldn't buy into random sources.

I actually appreciate that. In a way, it's saying he sees you worthy of even possibly being able to 'play the game' and it only does me good by toughening me up, reminding me what I don't know, and making me realize what I could know...how good I could be. I do the same with my trainees. As far the whole topic... man this field more than anything I've done has practiced me in giving quick concise defensive explanations for my actions. Either from management, dispatch, field supervisors, partners, nurses, doctors, especially FFs, you get called on everything. Your only chance to defend (or one-up) is right there on the spot or not at all and everyone around you thinks you screwed up.

YOU HAVE 6 DAYS to to submit your suggestions for higher education requirements. http://www.nemses.org/draft_standard...s_document.pdf Just scroll through some sections from left column, like cardiovascular, trauma, assessment, patient complaints, hospital clinical experience, field experience, COURSE LENGTH, student assessment, etc. Write some suggestions for EMR, EMT, AEMT, or Medic. Takes like 5 - 10 min Send To: db@nemsed.org; dc@nemsed.org; jf@nemsed.org; kn@nemsed.org; lk@nemsed.org Subject line: Comments on ______ (Include specific subsection from left column)

Like LA? We had two witnessed cardiac arrests yesterday. One we got to ER parking lot and medic was still insisting to take time to intubate in the crowded van ambulance (en-route only did IV...and she definitely had airway issues...aspirated on her hematemesis)). Second one he spent several minutes without CPR doing his repeated intubation attempts...his partner asked him if he wanted the combitube and reply was "Naw, I don't like those things"....Guess you don't like your patients living, either. Gotta get that tube, right? Eh, sorry, I'm just ranting again

People always suggest it when we can't get a reading, but honestly, it's pretty hard to get our hard-plastic concave finger probe to close tight enough around an earlobe. Is the disparity in readings based on the size of blood vessels? Bone?

Well I thank him for his work and contributions. I hope someone carries it on.

Nice . . . As far as the term, it's commonly used here, though I suppose someone new to the area could be confused...though first time I heard that lung sound as a new EMT, I knew exactly what everyone meant when they said "tight". It's hard to use a different term, because you're not actually hearing a wheezing sound...and you're not hearing absence of sound. You're hearing air having trouble pushing through passages, it seems...and if it is wheezing it's so compressed that you don't hear actual wheezes anymore...(though they might both be from same cause) It's a pretty common sound, btw....I'd say almost half of our asthma patients have tight sounds rather than the sound of wheezing...most are pretty stable and get enough relief to hold off inbutation from an albuterol nebulizer.

Paramedic shot while transporting a patient. No details on how or why, yet. Stable at this time.

I hear a term all the time that I didn't learn in school, but it makes perfect sense when trying to describe lung sounds..."tight". How would you document that? It's not just decreased, like with a pneumothorax. It's not actual wheezing. It's much less crackly than wheezing, rales, or normal lung sounds. The medics usually relay it as "wheezing" to base, so that they'll be allowed to give albuterol and it usually offers immediate relief. Guess it sounds like constriction of airway, but no stridor or other sounds...just tighter.

If you didn't get D as your first letter, you might want to check your math. Remember to multiply by 9 before the subtraction phase.

I saw that some episode and laughed about it, too! As for the shows themselves, I think they're great. The public and other EMS professionals learn about the profession, what actually happens in the ER, and the dangers of certain activities like drunk driving. I bet it's motivated more than a few young people to go into EMS. I don't know if it'd be the same with a crew in the field, since that can make them pretty uncomfortable and still feel like an invasion of privacy. They called 911 for a private problem, not for a TV crew. It's different in the ER because most are really critical.