DwayneEMTP

I can only laugh at WSBP because I spend no time on them...I have to revel in his agony....

Dolphengirl, captain and I sometimes don't agree on things, but life is full of choices. Sometimes I choose to accept his point of view, sometimes I don't. But should you choose to ignore the advice he's offered here, just understand that you are now, at this moment, making the choice, to short change your future. Quit fighting will silly people girl. Become the medical professional you want to be! You are stuck fighting with these boneheads because you have no other options allowing you to do what you really want to do. Give yourself options. There are no good shortcuts. Good luck on whatever you decide. Dwayne

I would think that to have a second P with a similar morphology would require a significant portion of the atria to be existing as well wouldn't it? On that same note, and I'm pulling this out of my rear as I heard it 'somewhere' a million years ago, don't they leave a large part of the posterior portion of the heart when doing a replacement? I'm not sure of course, but might this make sense for the second P wave? And lastly, is there an easy answer for why the SA node is left with a replacement? Maybe it's relationship to the Vagus nerve? Hell, I don't know...this just caught my attention... Thanks for the post Doc..pretty interesting! Dwayne

I dig tattoos...I grew up in the 'biker' culture, I like mine and will probably get more... But unless you happen to have need of my services while I'm in the shower (And I promise you, none of us wants that...) you'll never see them....(upper arms where even a shorter short sleeved shirt won't expose them, shoulders, etc) If you're thinking of entering a "profession" that is not body art based, and want to be taken seriously, keep 'em where others don't have to look at them...It's simply the adult thing to do... Dwayne

I think we get carried away a bit with wondering what happens to these guys until we define "sexual assault." I know it's not the politically correct thing to ask, or do, but the rest of the conversation is simply scatter gun advice...as well as some things here don't seem to make sense. If we're talking rape, obviously there are serious issues that need to be dealt with, for this ladies protection as well as those of the surrounding female population. If the assault was an off colored joke? We could be off in the ditch here. I'm not asking for the above description, simply stating that it will be necessary to give it to someone you trust if you're goal is accurate, productive advice. If this was a humiliating, traumatic event, I suggest you take it to a professional...But you already knew that... What I can tell you, having two family members that were violently raped, is this is not the way to cope, heal, or bring closure. Good luck to you. Dwayne

Becksdad might be a good one to ask. After a seizure brought on by meds (the only one he's had in his long, long, long, life) I believe he told me he was barred from "ambulance work" for a period of 5 years seizure free... I might have misunderstood, or be remembering incorrectly, but I think that's what he told me. I'm afraid I don't know if it will effect you getting your education. I don't remember being asked about these types of medical issues when applying, just the standard background checks, drug or alcohol abuse questions, etc. I can't imagine it would be a barrier to a medic education. Good luck. Dwayne

I was just reading this in our local protocols... If called to a Dr.'s office, they are the highest level of care (Assuming an RN or Dr.) and control the patient until released to EMS. They can release, or not, or ride in with the ambulance, if I remember right. If there's an issue we're to call med control and let the Docs sort it out. Dwayne

Going through preceptorship as we speak, I can say it's divided me on this issue. I now wish that I'd had previous basic experience for a few reasons. First, not having it leaves me at the mercy of my preceptors opinions of my knowledge and skill level. Is what they are teaching the 'right' way, or simply their way? Many times the examples used to show me how 'stupid' I am, seem to be simply different ways of doing the same thing. The way I was taught, and the way they have always done it. Second, and it's not really supposed to work this way, it is difficult to work as a medic while trying to perfect my basic skills. Even things a simple as taping the collar to the board properly while trying to evaluate the patient at the same time...not impossible, it would just be easier if my hands would do the basic tasks while allowing my brain to focus on the medic tasks. But then, what are the options? Wait years for a basic position to open? In the Denver, Springs,Pueblo area AMR is king. My instructor told me that they have somewhere between 10-30 basic positions open yearly, yet the schools in these areas produce between 500-800 basics/yr. Not a realistic waiting list for a pre-req for medic school in my book. Volunteer, with all that entails? I can't see any benefit here really. If a basic position had been realistically available, I believe I would have taken it. But this is the real world, and we must make do with what we have. Can I get there from here? Yeah, I think so, if I can manage to expose myself to some preceptors that want to help me understand the things I've missed (as best they can). Would I mind it being easier than it is. No. Do I believe that this is a good road to take for the feint of heart, with the preceptor that I've started with? Absolutely not. Everything I've been exposed to so far has been designed to teach me that I'm a failure. If I was less certain (as I might have been 15-20 years ago) with who I am and what I'm capable of, this might have been crushing. Keep in mind here though, that those much smarter than I, with tons of years in this business tell me this is not necessarily the norm, so take my comments with a grain of salt and listen to those that have seen much more than my tiny slice of this issue. Good luck with your studies!

Yikes, that is awsome! Thanks fiznat!

Hey all, I'm creating a Power Point presentation on Cushing's disease for class and have a question I can't seem to answer on my own. I am clear on how and why the cortisol levels rise, and maintain their high levels. What I can't seem to figure out (after about 7 hours of rubbing both brain cells together) is why the weight gain is localized to the face and trunk? I have formulated a theory, but have a low level of confidence in it, and haven't been able to strengthen or weaken it with info I have found on the net. It goes a little something like this... The higher levels of cortisol have several effects, but a couple of the main ones are to increase vascular sensitivity to catecholamines, and behave as an insulin antagonist...which has to side effect of raising circulating blood glucose levels. I've wondered if perhaps the increased vasoconstriction from the catecholamine sensitivity could cause poorer circulation in the extremities, causing a higher availability of the circulating glucose to the trunk and head/face, increasing fat storage to those areas. The descriptions I've discovered state “weight gain”, though I don't remember them being described a fat storage specifically. It seems as though the poor circulation theory might also work well with the poor skin condition found in these patients, as well as it's retarded ability to heal and sweat. What seems to torpedo the circulation theory is the lack of significant tissue necrosis, and edema, (as in advanced diabetes) that I would expect to see in these chronic patients...Also, I can't imagine, (though I don't know) that the vascular system could maintain such constriction for a length of time necessary to cause these symptoms before becoming exhausted and simply failing. Though the catecholamine sensitivity is sufficient to cause chronic hypertension I believe? So perhaps the vascular system is more macho then I've been led to believe. (The majority of my exposure to vascular stamina stems from our studies of hypovolemic compensation.) It seems as though every theory I invent, immediately has an evil twin... So, there you have it. My best attempt to appear smart, that will probably end up making me look like an ass. I'm just not sure what direction to go in next. Any help I could get would be greatly appreciated! Have a great day all! Thanks for all you do for us here at the City. Dwayne

I don't think I remember any silly question.... Congrats! Now jump into the forums and flex your mental muscles! Let's see what you've learned! On the expanded scope...I believe that is actually a class that will remove things from your scope of practice. ( A friend of mine took the class, and said that it basically told him things that were not allowed in LA county, but were most elsewhere in CA, sort of a reduced protocol refresher...But perhaps I'm confusing that with something else) Good for you for sticking in there! Dwayne

Sure, in fact if you chose a good product to begin with, it will pay YOU when you become tired of it! Just be sure that if you made any videos "for insurance purposes" that you have them all accounted for before putting the product back on the shelf...(or so AK tells me....I'm not sure what he's talking about... :wink: ) Dwayne

At 17 I'm not sure what level of education you're at. High school or college? Though for me it doesn't really matter. Your teacher is responsible for much more than what comes out of their mouths. They are responsible to set a professional example for students. I don't care what level of education that falls under. When I started one of my college level courses, our syllabus was full of errors, things that were crossed out before copying and had lines drawn through them. This teacher was famous for failing people based on lengthy papers that were required for class. I had read many of those failing papers, and found some of them to be outstanding! (She was not very smart, but very much a bully). Though I had encourages these people to challenge her judgments at higher levels, very few, if any did so unfortunately. At the beginning of class I approached her and said "I take my grades very serious. If You should find my papers lacking, I will expect that you can justify your impressions to others. If we should disagree about your impressions, I will be taking my syllabus with me as the example you've set for academic standards in your class, when I challenge them." She said "It's just a syllabus! Things change constantly, with what I'm paid here I don't have time to retype it for every semester!" I said "I'm not challenging that, I'm simply trying to be fair by letting you know my intentions." The next class we had clean, rewritten papers, as were all others I received in her class. If my teacher talked on their cell phone more than once or twice a semester (I've never had it happen), I would simply pack up my books and leave the class. The next time it was an issue, I would request from the administration that I be allowed to change classes to a teacher that valued my education. There is NO acceptable reason your teacher should be more focused on their phone than on their students. I prep hard for my classes, so there is little new information to be learned from lecture. I expect them to be for clarification, not introduction. It's important that you don't tie your good education to your instructors competence, you will fail if you do so. But if things are to change, we must expect a higher level of conduct than you appear to be seeing now. For two years I've gotten my son ready for school every morning, and as I've put him on the bus heard him say "Bye daddy! See you tomorrow!" The time I spend in class is not free. It's comes at a very high personal cost. My teachers had better be prepared to fill every minute with their undivided attention. But that's just me... Dwayne

In Pueblo, it seems almost everything is responded to Code 3, but I've never been on a call that was transported that way. Here (so I was told by the Medical Director) Every Code 3 return must be reviewed and justified by the medic, in person, with the medical director and the "Code 3 committee." I don't know what happens at the committee...But I've heard it can be rough if you can't justify your rationale for a "hot" transport. I can see good and bad to that...But mostly it seems to be a good thing... Dwayne

And before we go any further...can someone define "child"? 5y/o or 18y/o...perhaps it makes a difference? My 18y/o nephew, to me, is still a child. But he's also a Marine. would I take him? sure... See what I mean? Dwayne

Yeah, same here. No matter what I put, I got them all wrong...somethings tweaked... Dwayne

Ooops again. Hopefully it was obvious I meant "can" instead of "can't." :oops: Thanks all! Dwayne

Thanks all...as well as to those of you that wrote to her but didn't post here...You didn't slip by! Your messages are amazing...gentle, happy, positive, loving messages...Next time I get the flu I'm going to start a blog for me! You are inspiring... Have a great day all! Dwayne

You don't want to buy them FG, you need to make them! You can get about a gazillion index cards for 5 bucks or so...a lot of the learning is in the making...don't cheat yourself out of it. Dwayne

Meds gave me fits as well, as we studied pharm separate from physiology, which doesn't work well for those of us that need to relate items to remember them... This worked (works) for me pretty well... I read the drug info, imagine the physiological effects it has on the body, and then imagine running a call where that drug is needed. I imagine the patient, the presentation, the clinical findings I would want before I could justify using this intervention, then imagine tracking the changes I would expect to occur after. It seems to make a more complete picture for me, as well as I hope it will begin to form chains of logic and behavior in my mind...helping me to remember important things when time is short. For example: Albuterol. What kind of patient would need this intervention? After the med is delivered, what happens in the body? (Primarily the bronchi and heart, but also the vascular system). How would you track the effects of this med? (Lung sounds, Pulse rate, BP, amongst others). If your imaginary patient gets better, why? What are some reasons your imaginary patient might get worse (I just had a call like this)? Obviously that's not a complete picture...just meant to be an example. For me it simply helps to keep focused on the patient as a complete physiologic machine, as opposed to simply trying to memorize each drug attached to a symptom. On the drugs I feel more comfortable with, I then rationalize why I would choose NOT to use them on a given patient. Why is albuterol good for asthma but not for an MI with difficulty breathing? See what I mean? Anyway...I hope this helps. It's not as easy as memorizing sometimes...but I believe it will leave you (us) with a more concrete working knowledge of meds. Good luck in your studies! Dwayne

Thanks Kaisu, Pretty cool you're willing to take the time to do that... Dwayne

Sorry all...I'm not sure what happened! The link above worked for me when I tested it, but it sure doesn't work now! Try here... http://www.caringbridge.org/visit/alyssageske Thanks for doing this...Pretty cool...

Hey all, My niece Alyssa has been diagnosed with an inoperable malignant brain tumor. She's 15 and has to have radiation therapy five times a week for the next 6 months (min) as well as Kemo for the next 9 months? (I might be getting them screwed up, this is still kind of new) Her prognosis is bleak (I believe about 30% @ 2 years), but she's an amazing girl...strong, funny, very religious...she's just a peach. I was hoping that maybe some of you would sign her guest book? Maybe tell her who you are, where you're from...just wish her well. Anything you want really. I just thought that when I was her age it would be amazing to get notes from people around the county, and around the world! And maybe even third world countries like Australia! ( ) There is a web page set up for kids with cancer...her's is http://www.caringbridge.org/cb/viewMyStory...hod=executeInit You can read about her if you want, you have to register...just name and email I think (I just did it but can't remember) and then you can leave your note... If Christianity is your way...she'd love to hear about it! If not, she'd just love to hear from you...and I'm hoping responding to notes will give her a way to fill her days now that she's not feeling so hot. I will ask one thing. Please don't send advice on cures, herbals, going to Mexico or Sweden for treatment...etc. I don't mean to be offensive...her parents are still coming to terms with the thought of possibly losing their daughter...that's just too much to digest at this point. I've met some of the most amazing people here. If you can find time for a note...I'll be grateful. If not, I know everyone is busy.. Have a great day all! Dwayne

Any chance of getting that in english?