AnthonyM83

Thanks for the info guys. This gives me more to backup myself up when reminding others about the accuracy of pulse oximetry readings, which really was my reason for posting.

How reliable are patients' assurances that there has been no drug use? Does it ever happen that drug use is unknown to the patient, in other words, they were given something by someone else without their knowledge? I'm just trying to offer alternatives because you said your statement very factually with finality.

She's hawt...in a dorky sort of way.

If it reads RBCs, not Hg, how does it know when you're low on O2? Hypoxia doesn't mean low RBC count... I think the light wavelength/intensity change is due to O2-bound Hg. I'm honestly not sure. So, no other takers to original post? The only things I can think of are problems with air exchange at the cellular level...getting O2 from blood vessel to the tissues, thus cells are still hypoxic but blood O2 sat is good...but not sure what would cause that... So, is EMTs blindly following the O2 sat THAT big of a worry if it's really just anemia, hypovolemia, and CO poisoning...all of which can semi-confidently be ruled out...your opinions?

I use NyQuil...

How about just post them for all.

Really good explanation.... though, I kind of regret missing out on that stage...I should have found EMTCity a year from now

Also, let's keep in mind that a lot of the posts by newbies could also be by people who aren't very familiar with the internet and even less familiar with the concept of message boards and search functions. They should at least be applauded for finding their way onto this site and TRYING to participate.

I know we moved on from this, but for educational clarification did you mean she'd need K+ even if she's hyperkalemic? Or did you mean only after receiving bicarb? ALSO: How does DKA lead to cerebral edema? High sugar in cranial circulation (is that a correct term?) leads to water uptake?to

Maybe it's my sleep deprivation and reading this thread all in one sitting, but wasn't the point of the scenario that you did NOT want to give that IV wide open, because there was cerebral edema going on? Thus your #7 was actually what would be killing your patient....and thus an example of why basic's are limited...the less training/education to recognize events like these (not that most did anyway)... BTW, what tx does #8?

Why would it take less O2 with a simple mask to be considered high flow? It seems counterintuitive (you don't have the reserve of pure O2, wouldn't you want to keep small O2 mask constantly flowing with O2?).

In reply to original posts, I would at least do monthly ride-alongs with your closest big city.

When a nurse disagrees with something I've done for the patient, I usually ask why. If she seems like she'd take my question as confrontational, I'll add "so I know next time". The conversation that follows usually leads to a finding a miscommunication earlier in the report and it works out OR I learn something new and know for next time OR it ends up being a problem with a protocol I had to follow and not an actual mistake. But at least next time you come in, they at least (hopefully) remember you're not a moron even if you make mistakes and are interested in patient discussions.

I'll bet that it's not an intentional ploy. That's very conspiracy theory-ish. I won't, though, bet on the result. Glendale FD is a decent sized agency and a known city in the LA area. It's very possible they could lead the way for other like agencies in the area... I'm personally interested to hear what the plan is....makes sense so far, though...if majority of calls are EMS, downsize fire component.

One of the reasons this is true, particularly in EMS, at least in SoCal, is both the high turnover rate and that it's a secondary job task add-on to people's true goal of being firefighters. In Los Angeles, this is also the case. I've been told FF/Medic who goes crazy with OT can rake in close to $200,000/yr until burning out...but that's almost as much as some accomplished surgeons who also teach medical school (read: two incomes). As for the $10/call FF, I don't think he should feel guilty for putting his life on the line. In the end someone has to do it, whether they make $10 bucks per call or $100,000 per year. Why else would you do any job than for the love of the job? Money I guess...but nothing wrong for doing it for the love. BTW, Dust, most of the FF applicants who work for my company are going to school for or have already gotten an AA. Albeit, it's a Fire Sciences degree, but it's still two years-ish. Few get hired without it that I know of.

This has come up in oximetry discussions before, but for clarity's sake I want to specifically ask: Other than CO poisoning and hypovolemia, what would provide a false high spO2 reading? We commonly remind people not to rely on the reading and to provide O2 if you see other signs of hypoxia or that you might get a false low (ex: hypothermia), but not much on HIGH READINGS. I know you can get a highlighter pen to get a sat in the 80s...but if your patient were lower than the 80s 1) You be seeing other obvious signs of hypoxia and 2)With a sat in the 80's, they'd be getting O2 anyways. So, what I'm looking for are cases were a patient would have a sat in the 90s range high enough to to receive O2, but in reality be hypoxic.

I found an EMT school handout lying around the station that described high flow O2 as 8lpm by nasal cannula or 12lpm by mask but often written as 10-15 lpm because many O2 regulators settings go from 8 to 10 to 15. Is this definition and explanation consistent with what everyone else learned?

None of those studies posted were very promising....overall theme seemed to be that hypothermia for neuro injuries is NOT working...though that doesn't mean they can't perfect the technique eventually.

Here's another pic of the ones we have: http://www.secondchance.com/products/ems.asp And a different pic of one that would look good for us: http://www.secondchance.com/products/uniform.asp (It matches our uniforms...yes, I know black's not good for EMS, but since that's what we wear, it would be more concealed and still on the outside.

No, our are like these: http://hsarmor.com/images/ems.jpg I found this during my search...if they want outside vests, these seem pretty professional: http://www.chiefsupply.com/Law_Enforcement...y_Armor/MEDVEST I would add the words: MEDICAL or AMBULANCE or PARAMEDIC on the front and back, though...But really, I'd prefer ones worn under the shirt.

Eh, I've been with a few organizations that start their own journals, but it rarely ends up being a respected one. We need an organized body, research entities, and people with PhDs and MDs to get any respect. What we could do is work on training updates of sorts....like the kinds people post here sometimes....

Basically. There's so many medics who don't truly care about the job because they were sent there or went to medic school in order to get hired as a FF though they hated medicine, that a lot just do the very basics on every call. No critical thinking required. When I asked a medic instructor why the protocols were so basic, he sighed and answered "competence". The less they have to do and think, the less they can fuck up. And with the number of medics and large call volume they have, they're bound to have a lot of screw ups...aka lawsuits. Also, Los Angeles City FD can do a bit more without making base contact than Los Angeles County FD can...tells you a bit about level of competence expected from them. There are a few good medics out there, though. Some you can tell do real well within the limited system they were trained in...and others you can actually see they either went to a fabulous medic school or do a lot of off-duty self-educating. I was blown away on an OT shift last week where a medic would actually stop to explain to us why he was doing everything and what led him to that decision. He even went to into dosages! He spoke of albuterol in terms of 5.0 and 2.5, not as "two things" or "one thing" like everyone else! Then, on an abd. pain I caught him checking to see if palpation would affect patient's inhale/exhale (forget what that test is called)...but I've NEVER seen anyone else do that....so at least there's some hope! I know where I'm going to pick up OT from now on....

Redcell, our companies must have obtained the vests from the same place. You described ours perfectly. I can't even find out what threat level they are because you can't get to the actual vest.

Respectfully, those certs don't really mean much as far as experience...or even newness level on the board.

I agree with Eydawn