AnthonyM83

Someone double check me. I had to get this offline using three sources, plus occasional google. Wish I had a PDR for more consistent information (and OD info).

Anything of note in the baby's sleeping area. Anything found on a total body check (insects, wounds)? Pupils? What has the parents/baby activities consisted of since birth? Any outings? Any visitors? Is this acute? Progressively worse?

Indications: PSVT including those associated with Wolf-Parkinson-White Syndrome, when vagal manuevers are ineffective. Will not work on A-Fib or A-Flutter. Contraindications: Second and third degree AV blocks. Sick sinus syndrome Dosage: Adult: Initital 6mg. May repeat within 1 - 2 minutes at 12mg. Repeat again after 1 - 2 minutes at 12mg. Peds: Initital 0.1mg/kg. Double if no effect. Max out at 12mg. Immediately flush 2 - 3 mL saline. How Supplied: Rapid IV bolus at port closest to patient (IV access near heart preferred). Administer over 1 - 3 seconds with immediate 20mL saline flush. Side Effects: Light-headedness, hypotension, parasthesia, dyspnea, headache, transient bradycardia and ventricular ectopy, palpitations, nausea, chest pain, flushing. Drug interactions: Methylxanthines (caffeine, theophylline, aminophyle) antagonize adenosine and may decrease effectiveness requiring larger dose. Dipyridamole potentiates adenosine and may require smaller dose. Carbamazepine may potentiate AV-nodal blocking effect and may require decreased dose. Warnings: May cause asystole, bradycardia, ventricular fibrillation, ventricular tachycardia, atrial fibrillation, comple heart block, and broncospasms. Short periods of asystole are common (up to 15 seconds). Patient should be in secure position. Precautions: May cause other arrhythmias. Be prepared to treat if not transient. Use caution with asthma and lung disease patients, as adenosine may cause bronchospasms. Pregnancy: No clear risk in human studies. Overdose and treatment of: Overdose rare, due to short half-life. Persistant effects may be treated with methylxanthines. Use appropriate drugs based on presenting patient and rhythm. Description: Adenosine is an endogenous nucleotide and class IV antiarrhythmic used to slow tachycardias associated with the AV Node, such as AV re-entry tachycardia. It slows AV node conduction time and interrupts AV node re-entry pathways, converting to sinus rhythm. Onset within 30 seconds with half-life of 10 seconds. Clinical Pharmacology: Activates A1 receptors which activates inward potassium channels and inactivates inward slow calcium channels. This leads to hyperpolarization.

Guess he's just not going to answer. Interested in discussing reason or just throwing out accusations?

If no air transport available, then you better do your best to get going as fast as possible to limit compartment syndrome and try to save his legs, if possible. Tourniquet and go. BLS trauma care. O2 and warmth. Detailed exam. Reassess.

I would wonder where exactly I would run to...the nearest hospital is two hours away, which is ample time to bleed out. I'd rather he spend an hour building up compartment syndrome than two hours bleeding out without ALS (in the back of an ambulance? or how would you ground transport?) I would keep him pinned and concentrate efforts on keeping him warm and calm with some oxygen. Use the time to get a medical history. Get workers to setup the equipment to free him when air transport arrives. Perhaps, allow him to make some phone calls to his family. Is your nearest facility a trauma center? If not, could they get the appropriate resources there in that one hour, so you don't have to fly to a hospital farther out? Ummm...ask for his insurance and billing info? jk jk

Has baby been given any medicines? What has his diet consisted of since born?

I guess the National Highway Traffic Safety Administration just appointed 25 EMS reps to its advisory council . . . it'd be nice if someday we had people from this site on there....THESE are the people and organizations making the changes and having influence, apparently. The National Association of EMS Educators are the ones right now getting to increase those educational standards we've been talking about over and over on this site. The ones we'd like to "one day" get a chance to influence...yeah, they're deciding them right now. At least visit the http://www.nemses.org/ site and see if there's feedback you'd like to give to them...now's your chance before the standards are locked in indefinitely. This will be replacing the US DOT standards. (PS Maybe Admin could change the title of this thread to something that gets more people to click on it....)

Did you completely ignore my post or are you getting to it?

And here's the organization with the job of coming up with the new educational standards to meet the new national scope of practice. http://www.nemsed.org/ Is anyone involved in this stuff? Here's a meeting their having in DC in a couple weeks... http://www.nemsed.org/meetings.html

Seems like a great idea to me...

Hope it works out for you. I should note in my system, most EMTs are young guys just doing it to get into the FD, so having someone truly interested in medicine might be a step up. If your system consists of all older professionals, you might still be either too much of a liability or just lacking life experience to be on-par with them. In my system everyone's lacking life experience

Any skin tenting? Sulken eyes?

The only 18-year-olds hired by our company seem to be full-time, 4-year, college pre-meds. I think it's because they're more likely to follow the rules and be a bit more mature, since they're generally more self-directed and care about their future. They're not here to be whackers, rather to get patient interaction.

I just realized....I don't think we've discussed the new NHTSA upcoming guidelines....or did I miss this thread.... www.nhtsa.dot.gov/portal/nhtsa_static_file_downloader.jsp?file=/staticfiles/DOT/NHTSA/Traffic%20Injury%20Control/Articles/Associated%20Files/EMS_Feb07_PMS314.pdf Basically FR, EMT, Adv. EMT, and Paramedic levels...scroll through for charts on scopes of practice.

How many of you have the TB vaccine? I didn't even know there was one...apparently it's only 80% effective and only for children, but it came out after WWII...so maybe I did get it? Don't have my childhood medical records... TB is pretty common around here. Lost track of how many patients we've transported with it...seems like pretty much every homeless person has it...along with hepatitis...(I've gotten the Hep B series, but apparently there's a newer Hep A vaccine too)

We would need many many more resources to have that ability, including enough personnel that they wouldn't become burnt out by stopping to help stalled cars (and give rides?) when they signed up to be a medical professional. I've been the guy with the flat tire on a very dangerous windy road and had ambulances pass me by before becoming an EMT. I felt that hope that they'd help because they were 'helping people'. I've also felt bad for passing disabled vehicles. But great majority of shifts, we're running NON-STOP, literally, non-stop either call to call or move-ups to other areas with depleted ambulance coverage from 7AM to 8PM (and later on many many days), often without food. So if I do have a second of downtime, I'm just tired out. Not burnt out with the job, but either busy going somewhere or just pooped out. EMS doesn't usually have all these resources to stop at over a dozen cars a day (per ambulance) and then give rides to gas station or call people for them etc etc. Though, that would definitely make for a good inviting community...but we need someone to give us those resources.

It might very well be the system that doesn't know how to use that basic cert level. I think many of us believe they are useful as first responders. This would be us criticizing the system, not the actual basics. About a third of your post was devoted to hours under your belt, but you must realize we have to refer to the common norm of 120 hours, rather than to the exception of 250 hours. Not that 250+ hours is adequate for where we'd like the EMS field to be. You also list personal accomplishments, but what the heck does that have to do with the EMT-Basic cert level that's being discussed? There's a few others here with undergrad/grad degrees in biological sciences, heck there's doctors that maintain their paramedic certs, but how does that relate to whether the EMT-Basic cert level is adequate and useful to the level of proficiency, competency, professionalism, and ability of the EMS system we'd like to have? You threw out accusations at the end of that post, but didn't support them. There wasn't much support in that whole post. I'll await more. You also know Dust doesn't reply to things right away (he's not even on everyday). Maybe he doesn't even feel like replying. Who knows. Give it time.

I don't know why I didn't stay in the Bay Area.... I believe Care and McCormick are both minimum wage...

I honestly haven't listened to it all, but if Dust was just talking about increasing professionalism, education, and overall uselessness of Basics (as used in our system today), I don't really see anything wrong with that. Those are his main ideas he tries to disseminate ant it would make sense that the interview content (meant to spread idea to other EMS personnel who don't use EMTCity) would mirror the content of his posts here. As far as the Basics argument, you realize that the main problem with them isn't that the people holding the cert are stupid, but rather the cert level itself and education needed for the cert level in inadequate to provide the kind of quality EMS we're shooting for? When you get down to it, Basic's training, even if top student, (unless you go to one of the rare super programs) is based on very simple algorithms. He and others think that's inadequate. Our society deserves better and our profession should be putting out better.

Working for a private ambulance company, I'm definitely in the customer service field. We're all about the customer. This doesn't mean bad medicine, it just means we're there FOR them, not just TO treat them. We don't really do anything extra...we just try to leave a good impression on them as an ambulance company. It's not like we're trying to get repeat customers either since who transports them is based on where they are when they call 911.

Was he altered? Isn't this common when coming in with a trauma? Some resident always checks for rectal tone...

We really should have an FAQ for people who have been offended by Dust. I think the most common cause for tension from people with Dust comes from thinking they are specifically being targeted by him. That they are specifically being told they're idiots or whackers or being played by the system. Almost everything Dust comments on is ABOUT the system as a whole. For example, if he talks about how worthless basics are...It's not like he's a medic on a high horse and thinks only medics are good enough to help and anyone who isn't at that level is a washout retard. Rather, he's saying in the overall EMS system, having the level of EMT-Basic is a bad idea (other than as first responders). Not because there's not basics who surpass their level of training and try to get educated, but because that specific cert level with that specific training and scope isn't really helpful to having a good EMS system. Or something close to that... In your case, he's criticizing programs that get their students to buy into that mentality. You can either become curious about what he's saying and seeing if you can get a bigger picture understanding of what's going on or just resist it, as a newbie knowing you're right. Every now and then he explains this. Our EMT class was pretty down to earth, so when I came on this site and Dust told me for the first time that EMTs didn't have enough depth of understanding, it clicked right away. (Well, actually, I think my reply, was we didn't need education because we were just technicians following basic algorithms...point is our class had already seen the training level of EMT-B for what it was)

I think that's actually part of it, to be honest. I as far as being lazy...I don't think so. I think it's just that we know how little we could actually be of help at accidents scenes after going on so many. Another might be based on big city versus small towns. In LA, you can see up to 3 accidents on your 20 minute freeway commute to work. Then, you're going to see maybe 1-5 more on your 24 hour shift. Then maybe another one on your way home. Times that by however many shifts you work. Things are so congested around here, no few accidents get enough speed to be critical. But I know other areas where "flingers" and high speed head-ons on 2 lane rural roads are common, so maybe you would stop more there.... But yes part of it is looking silly stopping for most simple accidents when EMS arrives. It makes you look like you're a newbie rushing to help...even most roll-over are totally fine. Always the chance, but if you're stopping for all of them, you're going to get weird looks.

I think a lot of EMT classes don't do an adequate job of going over disease and transmission risks from the job, so let's discuss this here to be better educated about it in the field. My main concern is usually TB and Hepatitis...the ones everyone seems to freak out about in the field and ER, followed by MRSA. TB is scarier because you never know when someone with it might start a coughing fit without warning, especially in the back of the ambulance. Hepatitis I believe is a blood-borne pathogen only? so I have a little less concern. MRSA can be passed on skin contact, but less likely to really debilitate you at a young age (what about when you grow older and still a carrier from 40-60 years ago?). Does anyone have more info on the basics of disease transmission of the common ones we see out there?