DwayneEMTP

With the skill stations during NR testing thinking is absolutely counterproductive! The scenarios are set up to run EXACTLY the way your skill sheets do. Recognize which sheet matches the scenario, run down the sheet like an automaton, pause when you're finished to make sure you didn't miss any critical fails, announce that you're finished and move on. (Know your critical fails) It seems to me that the people that had issues attempted to analyze the situation and apply logic. NR skill testing abhors logic!! They want to know if you memorized the sheet and if you can regurgitate it while someone is staring at/timing you...that's all. Probably more important is to remember that 10 minutes might as well be all day! There is no hurry, they don't judge you on efficiency, grace, economy of motion, they just want you to pass or fail so they can go home. You start out passing, it's up to you to give them a PROVEN reason to fail you. Listen to emsbrian. I left there thinking "what an idiot! I got all lathered up about this and I could teach my son to pass it in a week" I was nervous I was going to miss the 'trick' they slipped in. No tricks, nothing complicated, recite your skill sheets and go home. The real test, if the 'counsel of elders' is to be believed, is when you decide if being good enough to pass NR is as good as you want to be. I'm hoping not.... Good luck! Dwayne

This seems to make the argument for those wanting training instead of education, but I was curious about your thoughts... http://www.ftimes.com/main.asp?SectionID=8...ArticleID=38131 Paramedics Left Out of County EMS Picture For EMT-I's in the field, new certification guidelines leave them almost as valuable as a paramedic, according to Ham. There are only three or four skills a paramedic can do that an EMT-I cannot, Ham said. Ninety to 95 percent of ambulance calls can be handled by an EMT-I, he said. Michael Garvey, state EMS director, concurs. "There's no exact percentage, but it's near that 90 percent," he said. What can't be handled by EMT-I's, Garvey said, are patient transports. EMT-I's can't administer "piggy-back medications," those that are added to an intravenous line during a transport. Also, EMT-I's are not equipped to handle rare heart conditions. However, most of the medications used to treat a heart attack, called advanced cardiac life support, an EMT-I would have and be able to administer, Garvey said. NOTE: Most of the article left out for the sake of argument, and to isolate this question. Dwayne

Thanks AZ, I knew I was wrong headed somewhere. I makes much more sense if you think of them as overlapping processes instead of linear. Does it make sense now where I was getting stuck on the terminology? I was so sure I was clear on the physiology of each concept at the molecular level. But it seems every time I start feeling over confident I find I've been waving at the crowd with my zipper down. Thanks for your help everyone! That was like a misquito buzzing around my head...It just had me in vapor lock. Life, as I know it, can now continue on a normal basis.... Have a great day! Dwayne

So, is contraction and repolarization happening in the same myocytes at the same time? Maybe that's where I'm going wrong, I believed them to be mutually exclusice acts. Depolarization occurs, triggering contraction, depolarization ends, contraction continues, repolarization begins, contraction continues, repolarization and contraction end...Some thing like that? Dwayne

Edit: Oh hell...is it possible that what you are saying is that though systole/diastole are happening physically, they are not exactly in concert with the electrical impulses shown on the EKG so that perhaps is why the terms don't match up? Though the ventricles are in systole (physical) the wave of depolarization has completed (electrical) so though the EKG shows the end of depolarization, contraction is still occuring? Is there a lag between impulse-->EKG-->physical response maybe? Crap...I'm just making myself look dumber aren't I....?

Yeah, thanks Doc, I guess I understood the difference, but with them being so closely related (normaly) I tended to think of them together. But I still have the issue with this sentence: "So ventricular contraction (systole) spans depolarization and repolarization of the ventricles." Wouldn't contraction (systole) cease to be present upon repolarization? Or maybe repolarization is normaly considered part of the systolic cycle? Though I couldn't find any reference to systole that referenced this. Thanks for your help Doc... Dwayne

So perhaps it's just the terminology that's giving me fits. I think I'm pretty comfortable with the physiology, though I didn't express it very well... I'm still confused as to how repolarizaton, on the EKG, can be any part of systole? Let's say, in gross terms, that the QRS complex is showing ventricular contraction (systole). Then the ST segment and T wave are showing relaxation (diastole). The statement that ventricular systole lasts from the begining of the QRS complex to the end of the T wave seems to be a contradiction in terms, doesn't it? Shouldn't there be a different term to describe the systole/diastole combination? Doesn't systole end (in gross terms) when diastole begins (assuming as dust stated, that we are dealing with the majority of the myocardium being represented on the EKG)? I guess I'm just not understanding from a terminology perspective, (perhaps it's still a physiology perspective, but I can't see it yet) how a systolic cycle can include any part of diastole and still be called systole. Again, I'm speaking in gross terms, I understand that the de/repolorization happens in waves, so the whole muscle is not completely in either state at any given time. I'm sorry if I'm just being a complete bonehead...but isn't this as simple as the terminology being strange? Perhaps we call it ventricular systole from QRS to the end of the T wave because of tradition? (like EKG instead of ECG)? I know I'm missing something obvious as I can't seem to even make the question clear and have not heard it asked from other, smarter people...I just don't know what it is.... Thanks for your help...Have a great day! Dwayne

From “Rapid interpretation of EKG's”, Dale Dubin, MD, 6th edition, pg. 27. “Ventricular systole (contraction) begins with the QRS and persists until the end of the T wave. So ventricular contraction (systole) spans depolarization and repolarization of the ventricles. This is a convenient physiological marker.” I know I'm going to look like a dork when someone explains this to me, but I just can't seem to get it right in my head. Depolarization, in my mind would by synonymous with contraction would be synonymous with systole? Right? So it would seem to follow that repolarization is synonymous with relaxation is synonymous with diastole? At least in general terms. Perhaps there is a small difference in the exact moment of activation with each? For example, I understand that repolarization happens on the cellular level, but maybe relaxation only happens on the muscular level. So 'relaxation' wouldn't happen until all myocytes in that muscle had depolarized? My point being that reploarization and relaxation might not be exactly synonymous, but maybe close enough for this question...Maybe not...but maybe. Where I get confused is why ventricular systole is considered to persist from the beginning of the Q wave through the T wave. Why doesn't it, by definition, terminate at the beginning of the ST segment? Wouldn't the end of the S wave to the end of the T wave be ventricular diastole? In fact, I'm reading here that “ST segment through T wave is repolarization.”, so how do I reconcile that with the statement above? I thought perhaps it was a typo in the above mentioned book so I looked it up in my A&P book and ventricular systole is defined the same way. How can systole and repolarization be used together unless your comparing opposites? Gosh, I wish I was better at expressing some things. I'm hoping you can figure out what I mean. I'm quite a ways through this amazing book and can honestly say I understand each concept presented so far completely (as complete as I can without using it) but the above paragraph is making me crazy!! What am I missing? Thanks all, Have a great day!! Dwayne

Hell, I always wondered what akroeze stood for. It never even occured to me it was your name!! I thought it was that freaky Canadian spelling for "ambulance" of something....No...wait....surely ambulance has an 'ou' in it somehow.... Dwayne

I've often wondered about that. I once had a bad reaction to medication. In 6 weeks I went from 200lbs to 290lbs! Never in my life had I been above 200lbs! My wife swears I ate less, or at most the same while I was sick, the weight just piled on.... Once I quite the meds, I lost 40lbs in the next 3 weeks, and another 40lbs in the 4 weeks that followed. In the last 4 months I've had my big ass planted in this chair, eating and studying and eating, constantly...I couldn't even spell exercise...Yet my weight changed by only 8lbs. 4 Months of sitting and eating!! Why arent I as big as a house? I guess my point is that I don't believe, that if I dedicated my life to the task, that I could manage to even get back to 300lbs, much less 500,800, or 1000! The calories in - calories burned = weight change, just doesn't always seem to hold true. I'm no expert, so if you're fat, I'm not saying you're not to blame, and if you're skinny, perhaps you deserve all of the credit...It just doesn't seem to be a constant equation for everyone. Anyway...what becksdad said.... Dwayne

When you call people stupid Timmy, you are, by default, claiming to be so smart as to be worthy of judging their "stupidness". You should then have no issues explaining the logic involved in making that judgement. So I'm calling you on it sport. Who was dumb? And why? Time to put up or shut up big guy.... Dwayne

So....what's got you on the naughty list? I promise not to tell!

Admin, I'm curious. Other than "meet and greet" what would have been a worse forum? I can't really see the issue. If it was meant to be educational, the BLS, ALS, Education, Instructors, Student forums seem acceptable. I keep waiting for someone to answer me as to why it was funny? Are there things to be learned from the vid? Sure. And if learning had been his intent, he would have put it in a learning forum. What's funny about this, on second thought, is that he got just what he wanted...a bunch of attention and conflict. Perhaps this was the right forum after all! Dwayne

Amen Dwayne

Yikes...he'll do a lot of stuff! Don't forget his elf!

Not really a matter of "if you don't like it don't watch it", it is in the FUNNY STUFF forum! Same question as above. What is funny about it? Post it if you want, just use your head and put it in an appropriate forum. If you're intent was truly to educate, instead of grandstanding, (Which appears to be your true motive, as you posted another one after learning they way the forum readers felt about this one) wouldn't it have made some sense to put it in the EMS or Student forum?? MAGIC, it's not like you just stumbled in here...C'mon man. Ok...can we all go back to looking at funny stuff now? Dwayne

If by arbitrary you mean impusive (I didn't find a real clear definition) I disagree! Earning a +1 from the 'counsel of elders' is a pretty big deal I think! And becksdad's post certainly qualifies... Sorry, if your post went over my head, I couldn't tell if you knew I was joking or not.... Dwayne

It would seem to certainly be snoring resperations...but why is it funny? Dwayne

-1 for continuing to use the word 'we' when describing people who get erect nipples at the thought of doing the 'sexy' things beyond the scope of their education! You've been an advocate of education and common sense in all of your posts...Quit saying we when you should say they...Don't make me come over there... Besides, why should you get all the points, I just posted a dancing elf thingy, and, you guessed it...not a single point awarded! What does a guy have to do to get taken seriously around here?? Dwayne

Someone sent this to me and I thought it might be fun here! (ok, maybe not, but maybe) This is my son Dylan...I look forward to see you! http://www.elfyourself.com/?userid=9641501...457554G06122122 Dwayne

Growing up I happened to know the kinds of people that sleep in the living room on a mattress on the floor, and have a pitbull and ferret for pets...I'm thinking there is very little chance the tox screen is coming back negative. Also, to you parents out there, when you had a new baby, what were the odds it could burp without waking you up...much less scream? It frosts my boys that anyone with half a brain could catergorize this as "a terrible accident"... That's it...not real point I guess...this just got under my skin... Dwayne

Maybe a foolish question, but I notice we keep refering to the hands and/condition as cyanotic. Would this still be the correct terminology when the coloration is restricted to the flexor region (do I understand this to be the tops of the hands, following/near the tendons?) and fingertips? Or would this term refer to a more generalized coloring issue. The colorization seems too specific to be a general circulation issue involving the whole hand(s). Are the hands a normal shape? Left and right appear equal in all respects? Do they function fully and normally? He doesn't complain of pain, but is there any loss or change of normal sensation? Is he a new user of albuterol? Did he use it during or after his ball game? How long since the end of the ball game? I don't suppose kneeling in the ready position could have pinched the dorsal arteries distal to his wrists? My apologies Doc if you've answered these questions and I missed them...and to everyone else if these are silly questions...I don't mean to muddy up the thread. Have a great night all... Dwayne

Ahhh...I get it! So a code is partially what you are getting (full cardiac, respiratory arrest) and part how you'll work it (all out, meds only, DNR)...Makes sense now! Thanks all! Dwayne

I thought I knew what a 'code' was. Lack of hear beat and respiration. It made perfect sense in context with 'pedi code' 'geriatric code' etc. Then I saw on here somewhere, "dispatched to a nursing home for a code (not a full code)" and all of my 'code' clarity became a little murky. So what is a code? Are there different types and levels? It's ok to tell me I'm an idiot...I've heard this term since I was about...well...young....watching Emergency, and I should probably know the answer...but...well...there you have it. Have a great day all! Dwayne

She says "This is obviously a difference of opinion" Oh...MY...God...That was painful and I only listened to about 5 mins here and there.... Dwayne