AnthonyM83

$8 x 24 hours=$192 $192 x 10 shifts=$1920 $1920 x 52 = $23,040 Of course there is some OT Minimum wage is $7.25 now I believe. Wooot. How am I supposed to save up $8,500 for medic school again?

So, whenever we get a major trauma and go to our level 1 trauma centers, we get surrounded by residents, attendings, nurses, techs, and registration, as they all rush to do their thing. I always find myself a corner and stay for as long as I can...almost had a doctor let me to up to the OR, but someone else told him it was against policy. Anyway, I love watching ::wink:: and seeing how they assess the patient. Their method usually reminds me of steps I could do to have a better assessment before ER arrival. Does anyone have any good articles or explanations of the processes they do at the trauma centers? It'd be nice to have more to think about while I'm watching...maybe different protocols you do for different calltypes? Things your checking for with different tests and what they would tell you? I'm trying to get more out of my ER visits in general for all patients. On a GSW, I was able to do cardiac massage along with the residents for training purposes and got a good anatomy lesson. The other day a peds doctor explained how to better assess lung sounds on children. This type of stuff isn't common in my area with the EMTs, so I really have to try get a conversation going with the docs. Any tips on this would be appreciated, too.

Why does this thread ask me for a username and password in a pop-up when I load it?

I think the original question was for burns that you will be irrigating, plain water versus NaCl, whether from bottle or IV...

Exactly why I believed there should have been an intermediate study before giving it to the public at large for ('involuntary') testing... http://www.defrance.org/artman/publish/article_1819.shtml Evanston-based Northfield Laboratories Inc. said more patients who were on its experimental blood substitute died within 30 days after transfusions than those who didn't get the product. Shares fell by almost half in early trading. The product, PolyHeme, is in the last of three stages of tests generally required for U.S. regulatory approval, the company said today in a statement on Business Wire. Northfield hasn't submitted its blood substitute to the Food and Drug Administration for review. Northfield's experimental product, a solution of chemically modified human hemoglobin, could compete with a cow-derived blood substitute being tested by Biopure Corp. The FDA last year rejected Biopure's proposed trials for its product, Hemopure, because of ethical concerns that patients wouldn't be able to give informed consent to receive it. The shares of Northfield fell 43 percent to $2.40 at 9:01 a.m. in early Nasdaq stock market composite trading. "We continue to believe there is a potential benefit to using PolyHeme in patients with delayed access to blood," said Steven Gould, chairman and chief executive officer, in the statement. The Northfield study compared survival rates of trauma patients who received PolyHeme at the accident scene and in ambulances to those who got donated blood after arrival at the hospital. PolyHeme is designed to offer an alternative treatment when donated blood isn't immediately available. More died More patients given PolyHeme died, compared with the control group. In one comparison, 11.1 percent of the 279 patients given PolyHeme died, versus 9.1 percent of the 307 people who didn't get the blood substitute. Serious adverse events, such as shock, pneumonia and respiratory failure, occurred in 40 percent of patients who received PolyHeme, compared with 35 percent for those who didn't. A spokesman for Northfield didn't immediately return calls or emails seeking comment on the study. The U.S. Navy last year asked the FDA to clear tests of Biopure's blood substitute in a trial that could include civilian trauma patients. The Navy wanted to see if Hemopure can prevent trauma victims from bleeding to death in an ambulance before they reach the hospital. Hemopure is a purified and processed form of hemoglobin, the carrier of oxygen in the blood, extracted from cows' blood cells. Researchers have long tried to find a substitute for human blood to address severe blood loss, which accounts for a third of trauma deaths. Paramedics usually substitute saline solution for blood, which must be type-matched and kept cold.

Assuming you've put in some more time now, I would consider writing a detailed incident report asking for the write-up to be removed from your file. Explain the different options you had and why you chose the ones you did. It's worth a shot.

Speaking of pocket masks...I'm assuming you mean a cloth face mask rather than a CPR mask. Anyone know a good way to keep these in good condition on your person. I tried keeping one in my pocket (in case I walk into a room and at that moment find out there's isolation precautions), but it gets worn away fast. I don't want to be wearing an ineffective mask. Might not be a bad idea to put on a facemask when breaking glass as well. It tends to get in the air and it's not the greatest material to inhale...

I'm not supporting giving too much O2, but as far as this specific issue, you're not worried about what the lawyer sides with. Whoever is suing you will find a lawyer that sides opposite of you. It's the jury you're most likely going to need to convince. Deviating from protocols is against state law in CA, so IF it came down to it, you might be moving the liabiity from the EMS/health office (who created protocols) to yourself (b/c you freelanced without permission).

Careful not to smash your entire hand through the glass, cutting yourself. Do it from the side, so your wrist/arm gets caught by the window frame.

Transported to where?

Careful not to smash your entire hand through the glass, cutting yourself. Do it from the side, so your wrist/arm gets caught by the window frame.

I rather love paradigm busters... Thanks for the paper. Still reading through it.

http://ladhs.org/ems/Manuals/medprotocols/ALS-12LeadEKG.pdf

Why would that matter? If you already believe the CP to be cardiac in nature based on asking all those questions, why would non-radiating get low flow and radiating high flow? Obviously any SOB/resp. distress would make you reevaluate your low flow decision, but for purposes of this discussion we're assuming non SOB so it doesn't taint the cardiac discussion.

To those who spoke about case by case basis, so what factors/hx would influence your decision. Remember, this is simply for CP that you BELIEVE to be cardiac in nature (based on hx and case by case). No SOB or signs of resp. distress. ccmedoc, I appreciate your answer. So, you'd feel comfortable with a low O2 level that is keeping sats at 92%? The reasoning being that heart would get more O2 this way than if there was a higher O2 sat in blood because the high O2 volume would lead to vasoconstriction and decreased cardiac output? Now my next question would be is that decreased cardiac output going to be that bad? Decreased CO be okay (if no other medical hx like CHF)? Wouldn't it decrease workload of the heart even more (and thus decrease tissue damage), provided the patient was calm? I'm just working things out in my head. Thanks for the comments.

Everyone bringse up transporting to another facility...wouldn't the most accessible receiving facility be that same hospital? Though to be fair, that would have at least gotten them out of the walk-in lobby and into the ER hallway with the other patients on gurney waiting to be seen. Though if she was in custody...PD usually doesn't wait in the walk-in lobby. They usually wait in the actual ER with the medics and their patients...so I guess literally it would not have done much good.

I know we've discussed O2 rates variosu times, but I couldn't find any that relate to chest pain. For CP, which you believe to be cardiac in nature, what flow rate do you use? I have always been taught high-flow with NRB both in EMT class and that's what medics tell us to do on-scene, with the concern the if heart is ischemic you want to give it more O2 to compensate. I was recently told that other areas of the country give NC only and one of the benefits would be keeping the patient calm, thus reducing HR and workload of heart. Is that what you guys are doing out there? Also, is 4-6lpm NC really enough if there's cardiac ischemia happening?

Holy *******

Those protocols coincide with what I was taught as an EMT (not a significant MOI, A/O, no pain, no visible injury, no distracting injuries, not stressed/anxious) ... though in the field all the medics seem to cspine for everything. Even the ones who do take the time to do a good assessment will cspine if there's any non-midline neck OR back pain (even from less than 5MPH accident, no vehicle damage), seatbelt use. I'm too new to decide if that's valid or not....what's the rate of neck fx in low speed accidents from non-midline neck/back pain? If it's 1 in 10,000 is that chance low enough? We go on accidents almost everyday...0 to 5 of them, usually. I don't have a set opinion...just looking for input. I just know what makes intuitive logical sense to me, but only based on the limited info I have.

I'm not familiar with this abbreviation...at least not in this context.

This is one example: http://fire.lacounty.gov/ProgramsEvents/PEShiftCalendar.asp 24 Hour Shifts 1 Day On, 1 Off, 1 On, 2 Off, 1 On, 1 Off, 1 On, 4 Off, Rinse/Repeat If you work in a busy area and are awake the entire shift, you're just a zombie on your day off. Bunch more examples: Some have 1 On, 1 Off, 1 On, 1 Off, 1 On, 4 Off Some are MWF, every other Sun 12p - 12a...a T,Th, Sa version too M-F 6am - 2pm Sun-Wed 4pm - 2am MWF every other Sun, 6am-6pm I've heard of 15 hour on-call shifts, too...but those might not be on a set schedule.

No, the assumed risk is for us. We're risking being injured by the child. As for parents, if they're young children I personally prefer them in the back with the child, as it cuts back on the crying and squirming significantly. Whether in front or back, every non-patient has always been restrained witout exception. I'd definitely prefer having some method to restrain a child supine on gurney, though.

Some of our rigs have a built in carseat in the captain/jump seat in the back. You remove the back cusion and there's a carseat. If it's a non-emergency transfer, the hospital lets us know and we send that rig. Otherwise, in emergencies child in parent's arms or in severe emergencies (prolonged seizure / rep. arrest) child just laid on gurney, no straps, parents in front to make room, EMT kneeling at side to hold child still and assist...risk of patient flying around is hitting us is assumed risk...like with going code 3.

Dust, I think you (and others here) would get along great with the instructors at the paramedic school where I'm taking my 'paramedic prep' class right now. Unfortunately, I won't be able to afford actually going there...but least I'm getting a good basis/outlook on paramedicine from them...usually don't see that in the field around here...have to come to the message boards for it.

That'd be an interesting experience...it'd beat my $8/hour