AnthonyM83

You should come ride out in Los Angeles County, nothing other than a femure fracture will get you morphine...and even then only SOMETIMES, even with stable VS. All non-trauma abd pain with normal vitals, skin signs, and no signs of blood are BLS'ed by the FFMedics where I work.

You get points for actually stopping and not just honking and zooming around her.

Maybe not backside, but side of the building might be a common one in apartment complexes, businesses with many entrances. Also, all the fire rigs really block a lot of your view, so you may not be able to see everything clearly. We'll usually stage in the ambulance and if not, we'll leave all equipment inside and stand across the street to watch the fire (not the healthiest, lung-wise) until they get us on the radio that a victim has been pulled out.

I don't know stats, but I know while at the station, one of the most common TV shows that ends up being watched are those World's Craziest Videos...and there seems to be at least one police car getting hit on the side of the road per episode...combine that with YouTube and links from other forums, I've probably watched dozens of cruisers being hit...Ambulance videos are probably more rare, because most don't have cameras.

We only have, I believe, 2-inch tape...but it actually has lines on it, already, by coincidence (that's the way it was made...this is the tape we use for splinting)

Well thank you AZCEP and the rest for your help! Sorry it took so much back and forth...message boards can be a difficult medium!

So, it's okay to have predominantly negative R waves in 'normal' rhythms...without violating the definition that an R wave is a the first positive deflection after the Q... everything seems so contradictory. But okay, if that dip in V1 after the spike is an R wave, then it now makes sense how the R waves in V1 and V6 are measuring the same thing.

Ohhhkay. I was thinking the V1s normally had short R waves and that the following dip was an S wave. I'm looking up "normal sinus" ekgs online and looking at Fiznat's picture, though, and V1 seems to regularly have a little spike after the P and right before the dip. What's that from? Also, the text said "The left side of the septum depolarises first, and the impulse then spreads toward the right. Lead V1 lies immediate to the right of the septum and thus registers an initial small positive deflection (R wave) as the depolarisation travels ward the lead. " So, I just assumed that little spike was the small positive deflection they were talking about. But you guys are saying that's not what I'm seeing when I look at the V1 examples...

That I certainly am...sigh, it's always been a recurring theme and I often end up missing the big picture, b/c I get stuck on something like this. So, my question comes down to this: If the R wave is always representing depolarization of the ventricles (rather than septum) in normal physiology AND depolarization toward a lead creates a wave with a positive amplitude, then why does the lead V1 which is is on the RIGHT side of the heart (thus impulse travelling AWAY from it) have a positive amplitude?

Okay...then I'm trying to make sense of this section: " The left side of the septum depolarises first, and the impulse then spreads toward the right. Lead V1 lies immediate to the right of the septum and thus registers an initial small positive deflection (R wave) as the depolarisation travels ward the lead. When the wave of septal depolarisation travels away from the recording electrode, the first deflection inscribed is negative. Thus small "septal" Q waves are often present in the lateral leads, usually leads I, aVL, V5, and V6." I read that and then looked at a sample V1 QRS given. It had a small R wave. Then I looked at a sample V5 QRS given. It had a tall R wave. I understand that R waves get larger as leads go farther left, but if V1 is to the right of the septum, what physiological event is it getting its R wave from? It must be that small septal deflection toward V1 (described in first quoted paragraph), because that's the only impulse going toward V1 (which is needed to create a positive wave). Now, when they explain the Q waves in the left leads (second paragraph of quoted text), it seems like they're talking about about that same septal depolarization from left to right, but since the leads are on the opposite side, they register negatively on the EKG as Q waves. The only way I can make sense of those two paragraphs is that depending on electrode placement and if impulse is going toward/away from it, the septal depolarization reads as either pos. R or neg. Q. Where else would V1 get a positve R wave...it can't be the ventricles depolarizing, because that would create a negative wave (such as the S wave). Now, I'll totally believe that I'm wrong, but I don't understand how else to make sense of what the text is saying. I appreciate the help guys...I really want to have a conceptual understanding of this and not just memorize each thing.

We had a day toward the end of class where the San Francisco Paramedics Association came in to talk to our class, basically recruiting. All their classes seemed way out of my price range, so I didn't sign up, though a lot of students jumped on it mainly so it would look good on their records when applying to FDs and nursing programs. I didn't really see the benefit or me...now that I'm working full-time I might reconsider, though. That was about it as far as talking about outside classes and associations (other than NREMT).

Gotcha. That's making sense now, guys. Last thing I want to be sure about: Are the R waves in V1 and V6 from different sources? The text said V1 registers a small positive deflection as the charge moves from left to right across the septum. As the charge moves through the ventricles, that would create a V1 S-wave...so basically that "small positive deflection" is all the R wave you'll see in V1. And that same left to right across the septum is what produces a Q wave in the left leads like V4. Whereas the R wave in the left leads are from the ventricles depolarizing (not the septum). Would this be an accurate explanation? And yes, right now I'm just talking about normal physiological waves, not pathological...that's NEXT chapter 8)

Having seen how reluctant a lot of the staff of nursing homes are in initiating even BLS assistance to patients, I'm thinking AEDs replacing ACLS is probabaly an A+ idea...in most places.

So, you're saying what the Q wave is representing isn't actually the impulse itself traveling left to right, but rather the difference (in voltage) from the left to the right side. Since left gets impulse first, then right get impulse, it reads AS IF an impulse were travelling in left to right direction (when in reality, both septum impulses are travelling downward and slightly to left). Would this be correct? Also, depending on whether lead is looking at the heart from left or right, it's either a Q wave or small R wave. (PS I'm also referencing this picture: http://health.yahoo.com/media/healthwise/nr551740.jpg) Then, as the lower septum and apex get depolarized, it creates either a tall R wave (if leads are looking from the left) or S wave (if looking from right). Then, as it travels up the sides of the ventricle, upwards, shouldn't you get a negative wave in V4-6? (these are the ones to the left of septum, right...) but instead they show a continuation of the R wave...only VF, II, and III show an S wave.

In addition: My text is kind of vague on S-waves. I want to be sure S-waves are in effect the "opposite" of R waves, in that the leads are detecting the ventricular depolarization going toward the opposite side of the heart.

I'm doing a little self-study on EKGs, but stuck on a little point. The way I'm understanding it is Q-waves in lateral leads (I, III, aVL, V5, V6) are there b/c of depolarization from the septum toward the right side (thus away from lateral leads, thus negative wave). But the text also says left side depolarization happens first. Soo, when reading the strip how does the Q wave end up coming BEFORE the R wave in the lateral leads??? My only conclusion is that I'm misunderstanding how Q and R waves are formed or where the leads actually are in relation to parts of the heart. (BTW, to whoever responds, mentally, I'm thinking of everything as a movie and seeing electrical currents passing through the heart toward and away each lead...rather than thinking in terms of "R wave equals ventricular depolarization"...I'm trying to visualize exactly where in the heart current is going in relation to the various leads.)

...if both you and your partners have had shooters come back to the ("safe") scene right next to your head and emptied their gun into your patients head while you held their c-spine. ...you literally get over 200 people crowding around your shooting scenes ...you have critical stab patients arrive by ambulance at trauma centers with no prior notice b/c their base lines were busy

Not gonna help ya much when they're ALOC and clenching their teeth. I would only carry stuff if you find yourself having the need for it in your area, rather than "just in case". I started carrying it after two times in a month that I couldn't get the teeth apart (on a motorycle TC) without sticking my fingers way in there (which some medic actually wanted me to do, yeah right!)...cases were the basic cross-finger open technique isn't enough. A couple weeks later, I used it on a shooting victim, when medic couldn't get jaw open. Only problem so far is that my hands are usually bloody by that point and I don't want to reach into my shirt pocket for it. I've never checked for gag reflex with it, though...we just start sticking the OPA in and if they fight it, we don't use it.

Edit/Addition: -A tongue depressor for opening mouth/teeth on ALOC traumas in order to insert OPA.

We have nights were the admins roll in a supervisor van and buy the crews dinner in the field...if things aren't too busy, they'll gather a few crews at In & Out, so they can eat as a big group, which otherwise never happens. You can also have gifts like $10 gift cards to stores for catching good behavior, like having a washed rig after a rain (most people won't was their after a rain, but rig still looks dirty)...or for helping out around the stations, cleaning and such...it's a little harder to catch going above/beyond at scenes, but you could do it for that, too. We have one supervisor here who really like looking after her crews and will go out and buy dinners all the time (BBQ or sandwhiches or fresh cookies/brownies) and then gets comped by the company.

So, I just got a phone from one of our supervisors saying a guy we transported last week had TB and to come down to get tested, today. If it takes two weeks to come up in tests, I guess I"ll have to take another one in a week. Anyone know if I get to know exactly which patient it was and if their TB was active/latent? How much info do I have the right to know about? How effective are the TB medications?

Other than the shears and sharpie, what's are the things on your vest for?

We were taught that's actually a pretty valid legal defense. Standard of care is defined by many things, DOT Guidelines, Local Protocols, Classroom Instruction, and your EMT Text, too. So, you do have the "according to my training" defense... which probably wouldn't work if it were a ridiculous guideline like tourniquet the neck for uncontrolled head hemmorhage....but I'd imagine something like removing impaled objects from the cheek would okay.

So, what's a short acting drug that is found in a white powder form that knocks you completely out for a bit? Are the patients completely alert and oriented or are there any residual effects, like wooziness or possible hallucinations or visual problems or headache? Date rape type drugs come to mind, but I from what I've heard there's usually residual effects. It doesn't just stop acting. Narcan didn't work, right? So, it's not an opiate...

I'm just an EMTB, but to kick it off, how about: -General Impression -BP/Pulse/Resp/Pupils/Skin -O2 Sat/Monitor -Neurological assessment: Level of conciousness/Circ-Motor-Sensory/Behaving Normal? -SAMPLE (what will she tell you about the event?) -Any chief complaint? -Confer with parents/nurses/other kids..have they learned anything new and has anything more been done medically for her since your last dispatch update? Do they have intermediate VS since the first ones you got, but before now? How did she come around?