DwayneEMTP

I was just reading this to my wife and said...."This seems like a good idea" And she said "But then you have all those people on a list the bad guys can use" I really don't want to think that my wife and Dust have ANYTHING in common....sheesh We can pretty much end this discussion here....my wife is always right... Dwayne

Guys....no offense...but after you've been here a while you'll understand not to snipe at Rid until you know what he's talking about. You'll notice that no one with over 20 posts have taken offense to what he said...Read a few more threads and you'll see what he means.. He's not slamming Medics....it's just "I'm a medic, why can't I do a nurse's job?" Is a pretty common thread...often asked and answered. Have a great day all! Dwayne

Dust...looking at the pic of your cubicle...Are those Little Mermaid sheets I see? I'm not saying that's a bad thing..... Dwayne

Pretty cool pics Dust....Thanks for keeping us up to date! I think this has gone on long enough....you should all come home now....spread the word...everyone should grab the first thing flying and come home... If Bush asks tell him I said it was OK....that should smooth things over. (nope...not a Bush hater...trying to be funny) Stay safe...send more pics...come home when you can... Dwayne

Welcome Kevo! As a new student I can promise you will learn more here in a month....if you pay attention....then you will learn in your Basic class! Work through the old scenario threads....ask smart questions.....and you will be miles ahead of your classmates. The things I've learned here have completely changed the course of my personal education! Good luck! Dwayne

When carbon dioxide diffuses into the blood plasma and then into the red blood cells (erythrocytes) in the presence of the catalyst carbonic anhydrase most CO2 reacts with water in the erythrocytes and the following dynamic equilibrium is established H2O + CO2 <-> H2CO3 Carbonic acid, H2CO3, dissociates to form hydrogen ions and hydrogencarbonate ions. This is also a reversible reaction and undissociated carbonic acid, hydrogen ions and hydrogencarbonate ions exist in dynamic equilibrium with one another H2CO3 <-> H+ + HCO3- Inside the erythrocytes negatively charged HCO3- ions diffuse from the cytoplasm to the plasma. This is balanced by diffusion of chloride ions, Cl-, in the opposite direction, maintaining the balance of negative and positive ions either side. This is called the 'chloride shift'. The dissociation of carbonic acid increases the acidity of the blood (decreases its pH). Hydrogen ions, H+, then react with oxyhaemoglobin to release bound oxygen and reduce the acidity of the blood. This buffering action allows large quantities of carbonic acid to be carried in the blood without major changes in blood pH. Hb.4O2 + H+ <-> HHb+ + 4O2 (Hb.4O2 is sometimes written HbO8.) It is this reversible reaction that accounts for the Bohr effect. Carbon dioxide is a waste product of respiration and its concentration is high in the respiring cell and so it is here that haemoglobin releases oxygen. Now the haemoglobin is strongly attracted to carbon dioxide molecules. Carbon dioxide is removed to reduce its concentration in the cell and is transported to the lungs were its concentration is lower. This process is continuous since the oxygen concentration is always higher than the carbon dioxide concentration in the lungs. The opposite is true in respiring cells. Pretty cool thread chbare! Is it ok to cut and paste or do you want summaries? (man I hate bio-chem) "The Krebs Cycle" Dwayne

Hell...20 The advantage of being older than I think? The perks behind knowing why drive-ins were so important! Dwayne

I've read the posts about lights and sirens on POVs not helping you get where you're going...but saw it yesterday... I was the third or fourth car back at an intersection that has two lanes going each direction, just as the lights are about to change. Suddenly there is an ambulance right on top of me! Siren blaring! So I'm trying to find it, so I can get out of the way....but it's not in any of my mirrors....but..he's somewhere! The traffic that was turning in the intersection mostly comes to a stop, some people facing the red light attempt to go through to try and clear the road. Of course this puts them in the way of the people going through the green light trying to clear the road.... I'm still sitting still like an idiot...because I still can't find the ambulance! Finally the intersection is a mess (It's still amazing to me that no one was hurt)....People are backing up, going forward, sitting still....just trying to figure out who needs to do what to clear the road... Then I notice a little brown, muddy Toyota pickup with a camper shell threading it's way through the traffic...one little flashing light just visible through the tinting on his camper shell window.....That Little Prick!!! He goes on his way while the rest of us continue to try and get untangled.... He was only one or two cars back at the light that was going to turn green....He easily caused himself 2 minutes delay by turning on the siren....Pretty crazy... druidman227, When others here tell you you don't want to be this guy....It's not because they have nothing better to do than beat up on people....They've been there...done that....This is the first time I've seen it firsthand (though I didn't doubt those that have posted in the past) and I'll have a hard time not beating up "what kind of lights do you use" posters in the future....(Ok...well that's not my way...but I may be thinking it) You're 17....try not to be offended, but instead by grateful you were given opinions by a caliber of people you are not likely to be fortunate enough to meet by chance elsewhere.... Good luck to you....don't get mad and go away....We're happy to have you here!!! Dwayne

I don't claim to be the brightest bulb in the box...perhaps I did miss the joke...but I don't see any humor in that post... I don't know what you mean by the rest of your post... Dwayne

Windsong, I can almost never tell what the hell you're talking about.... You go on about stupid Americans, prayer in school, flag burning! (two issues near and dear to many American hearts) But wasn't it an American that posted these trivia points? I didn't notice him asking about wood huts or igloos..??? What in the hell is the matter with you? If you have a beef...come out with it.... If you don't know that/why flag burning and prayer in schools are vital issues for defining what it means to be American then you shouldn't talk about anyone being ignorant of Canada. I've spent quite a bit of time in Canada...love it...I'm glad you are not a good representation of it's people.... Sorry for the rant all...I usually don't respond to these type of statements...but this one got under my skin....I must be burnt out. Dwayne

One thing that always strikes me when vs-eh? posts on the topic of God is that he is always careful to capitalize God and He when appropriate. He may not have respect for my God, but by doing this he seems to show respect for my opinions. When did we decide that disagreement equaled disrespect? I have faith in a higher power, that has no basis in logic, that I can't represent to him with even the shakiest scientific evidence.... I have evolved to the point of having faith. If he didn't follow a similar evolution then his believing in my God is certainly equivalent to my worshiping his car keys. (I might be able to fake faith in his car keys because everyone else seemed to have it...but would also refuse to do so) I believe you learn faith, you don't choose faith. I appreciate his opinions and his logic, though I wish spirituality for him...it just doesn't compute for everyone.... (sorry vs-eh?, I was going to capitalize "car keys" to make the point but couldn't bring myself to do it) Dwayne Dwayne

But on the other hand...if God loves me why do I only have 1.5 reputation points? (Sorry...that thought just cracked my up)

I only answer because I respect your opinions mostly vs-eh?, and think maybe you're going somewhere with this....Plus I love to watch these arguments unfold... I believe in a higher being. I don't believe my definition of a higher being fits everyone or even anyone else. And nope, I'm not here to sell this to you. This works for me, I hope your way works for you..... Dwayne

A good friend of mine went to work in L.A. right out of basic class and had to take the expanded scope class before being hired. According to him the class does not add anything to your scope of practice, it is two days explaining what is removed from your scope of practice. I believe....and it's been a bit....that they allow oxygen, splinting etc....but remove almost everything else. Put on oxygen, call for an intercept....that's pretty much the job I think....I'll try and get him to post here. Dwayne

Jack Nicholson in One Flew Over the Cuckoo's Nest One of my favorites: Quote = "I tell you Sid, that one of these days we'll look in to our microscope and find ourselves staring right into God's eyes, and the first one who blinks is going to lose his testicles."

What! They don't all..... Hell....Now I need to make another appointment with my guidance counselor... Maybe I'll be a nurse...surely they all sleep together..... Dwayne

Hi all, I caught an episode of "Paramedic" the other night and had a question. I will post it the best I remember.. Call was for an 80ish female, leg pain after a fall. No loc, not other pain, no other history relevent to the injury ( I believe ) They find a very thin lady on her bed with severe pain, mid femer. She screams in pain with any attempt to move her. These are my questions: The paramedic did not remove her pajama bottoms....when he palped her leg, pain seemed to be nearly dead center of her femur. Was there some reason not to cut away her pajamas to expose her leg? I reviewed my basic manual and didn't see any contraindications for a traction splint relevant to geriatrics (Though it seems that you would need to expose it to reveal joint issues etc.) Yet with the little that was seen on the episode they didn't seem to consider using a traction splint. Are there age contraindications that I'm unaware of? Pain meds were given and she was transported on her rt side (I believe it was position of comfort) I will hope that it is obvious that the spirit of this post is not armchair quarterbacking...(I promise I've read those posts and know it's evil) and would not judge the paramedics based on my little bit of knowledge even if I thought I knew the whole story.... I was just curious about these two things. P.S. Follow up at hospital confirmed mid-shaft femur fracture. Thanks all! Dwayne

I don't pretend to understand this completely, but I wanted to play! I cut out what I believe to be a brief summary, the complete text can be found at the link below... http://www.emedicine.com/ped/topic16.htm Respiratory acidosis occurs when the arterial partial pressure of carbon dioxide (PaCO2) is elevated above the normal range (>44 mm Hg) leading to a blood pH less than 7.35. Respiratory acidosis is not a specific disease. Instead, it is an abnormality resulting from an imbalance between carbon dioxide (CO2) production by the body and excretion by the lungs. This imbalance occurs in severe pulmonary disease, respiratory muscle fatigue, or depressed breathing. Respiratory acidosis may result from an acute or chronic process. An acute respiratory acidosis can be life-threatening when a sudden and sharp increase in PaCO2 is associated with severe hypoxemia and acidemia. In contrast, chronic respiratory acidosis (>24 h) is characterized by a gradual and sustained increase in PaCO2. By definition, the diagnosis of respiratory acidosis requires measurement of the arterial PaCO2 and pH. When the diagnosis is made, the cause should be thoroughly investigated. History: Does the patient have a history of headaches? With chronic hypercapnia, headaches typically occur at nighttime or when the patient awakens in the morning. Does the patient have disturbed sleep patterns? Chronic hypercapnia can disturb sleep patterns, leading to a reversed sleep-wake cycle. Is the patient irritable or anxious, or is he or she having trouble concentrating? Does the patient have a possible or known exposure to sedatives (eg, narcotics, benzodiazepines, tricyclic antidepressants)? Is the patient recovering from a procedure in which general anesthesia was used? Does the patient have symptoms of neuromuscular weakness or paralysis? Bulbar dysfunction suggesting myasthenia gravis Proximal or distal weakness suggesting a myopathy or Guillain-Barré Apnea associated with a traumatic injury suggesting an injury to the cervical spinal cord Does the patient have a long-standing pulmonary disease, such as bronchopulmonary dysplasia, cystic fibrosis, asthma or emphysema? Does the patient have an acute change in mental status (eg, signs of stroke, postictal state)? Is the change in mental status associated with a fever, which may suggest encephalitis or meningitis? Does the patient have signs of increased intracranial pressure (eg, headaches, visual changes, emesis)? Does the patient have a potential for an anaphylactic reaction? Does the patient have a potential traumatic mechanism leading to brain injury? Physical: Neurologic findings Early signs are anxiety, disorientation, confusion, and lethargy Somnolence or coma when PaCO2 greater than 70 mm Hg Tremor, myoclonus, or asterixis occasionally seen Brisk deep tendon reflexes (mild–to-moderate respiratory acidosis) Depressed deep tendon reflexes (severe respiratory acidosis) Papilledema or blurring of the optic disc Cardiovascular findings Tachycardia Bounding arterial pulses Hypotension (severe respiratory acidosis or acidemia and hypoxemia) Skin findings Warm, flushed, or mottled Diaphoretic Respiratory findings Acute hypercapnia in association with increase work of breathing Tachypnea, dyspnea, or deep labored breaths Accessory muscle use and nasal flaring (usually present) With CNS or peripheral nervous system disease, respiratory distress may not be present Decreased aeration, crackles, wheezes, or other signs of airway disease Clubbing, a sign of chronic respiratory disease Causes: Extrathoracic airway lesions Infections - Ludwig angina, laryngotracheobronchitis (croup) Congenital lesions - Subglottic stenosis, laryngomalacia, craniofacial abnormalities Thermal airway burns Tonsillar and adenoidal hypertrophy Intrathoracic airway obstruction - Asthma, vascular ring Depression of central respiratory control Drug induced - Opiates, sedatives, anesthetics, alcohol Infection - Meningitis, encephalitis Stroke Hypoxic encephalopathy Increased dead space - Wasted ventilation Pulmonary embolism Pulmonary vascular disease Low cardiac output Acute lung injury Pneumonia Pulmonary edema Lung contusion Bronchiolitis Chronic lung disease Bronchopulmonary dysplasia Cystic fibrosis Chronic bronchitis Chronic obstructive pulmonary disease Respiratory muscle weakness leading to hypoventilation Poliomyelitis Guillain-Barré syndrome Myasthenia gravis Muscular dystrophy Spinal cord injury Chest wall restriction Flail chest Pneumothorax Pleural effusions Kyphoscoliosis Increased CO2 production Malignant hyperthermia Extensive burns I hope this applies..... " Brown-Sequard syndrome"

Good science? Ehhh....who cares.... http://www.thatsweird.net/Pictures/eyeful.jpg

Hey Beach Bum, Welcome to the City! I can't speak to all of your questions as I'm not law enforcement but perhaps I can help a little where the class is concerned. Where are you on the Central Coast? I went through the EMS academy at Allen Hancock in Santa Maria. The EMS course is pretty much advanced first aid. I had nothing going in except my 25 year old boy scout first aid. I found the 8 week course to be pretty challenging. We went 4hrs/day Tues, Thurs, Friday and all day on Sat. with a voluntary 4 hour lab on Weds. Class was fun. We had many students that took the EMS course along with other classes or worked full time jobs at the same time, though many of those people did poorly for lack of study time. I think it cost me about $800 or so for the class after books, boots, and uniforms. I can't imagine that you would find anything but a benefit having your Basic cert going into law enforcement, but finding a job as a basic will be difficult to impossible. I interviewed twice with AMR for Santa Barbara county and I think...I don't remember for sure..there were about 15 applicants/position. They tend to interview on a regular basis but are rarely hiring. (They don't let you know until after the process that they have no jobs to fill) I'm not sure if this helps, but If I can do anything for you don't hesitate to let me know! Dwayne

Driven

Wow...this doesn't seem this difficult to me.... Dust, Rid, Ace, etc... seems to believe that we shouldn't STRIVE to create basic/basic squads when we know there will always be a need for ALS. How does this not make sense? I don't see where you find that they hates basics? I don't want a basic if I can be treated by a paramedic. If I'm at the hospital, I don't want to be treated by a paramedic if I can see the ER doc. If I need surgery I don't want to see the ER doc if I can see the surgeon. Does this mean I hate basics, paramedics, and ER docs? That I only see value in surgeons? Nope...I don't think so. CHOOSING to create BLS only systems seems more or less the same as choosing to create a hospital without ER docs and surgeons. I've heard that it happens, but is that the goal we want for our communities? God bless volunteers. But to pretend that they provide the same service as 24/7 professional squads (in most cases) just doesn't seem to wash. And I know the logic that volunteers enable communities to avoid paying professional ALS crews can't be lost on most of you...I read your post, I know you can make the leap. I also hate the ALS v BLS threads, but mostly because they usually start with BLS screaming "FOUL" when an ALS provider points out the limitations of our BLS cert. It makes us look like boneheads when I know most of us can see the limitations ourselves. I worked hard for my cert. I was in the top 2 of 35 in my class. But if I'm what you hope for as the standard of care in your community....well...I'm glad we're not neighbors.... When I have my MI, I want a paramedic, sitting in his ambulance, fresh out of his continuing education to come do his committed, ALS, best. Disclaimer : Dust and others, I don't mean to speak for you. Feel free to correct me if I've misunderstood some of your points. Dwayne

Wow...even as a basic the inaccuracies were distracting.... But put those aside for a sec...Haven't we seen the young, rebellious medic, doctor, student, fireman, cop ad nauseum ? Was there an original thought in the entire episode? Pretty poor acting, the storyline so predictable that I got impatient waiting for what I already know was going to happen next. And the best I can tell (with the exception of the woman at the end) if you're a paramedic, just showing up will cure you...no patient contact seems necessary beyond "you're gonna be fine" Pretty poor showing....maybe they need time to grow... Dwayne

Ace, point taken. I assume from the way the question was written that he is a Basic. Perhaps I am mistaken. And as such was looking for an answer such as the one from kevkei: It seemed to go directly to what I believed to be his question. I do know additional education is important to you and many of the other anchors on this board, so perhaps your approach was better suited to his growth in EMS, whether he wants it or not (I'm not implying that he doesn't). I don't know enough about many things to know if he will learn from your posts or just be turned off of posting in the future? Either way, I learned from the info...thanks Dwayne

Not going to get into a pee pee contest with you here ace, Because I know you will dedicate days to this silly issue. I'm not the sharpest knife in the drawer. Could you please re post your quotes and highlight the parts that describe how to visually assess and auscultate the neck and throat as it relates to determining the severity of the effects of an allergic reaction on these areas? I saw several bold areas that addressed a diagnosis and even some general symptoms but still did not answer his questions. If you can find all this crap in your searches, how can you not find his questions in his post??? I didn't see it. (It may have been there, but if so, at a level beyond my understanding) And if I was SpongeDude I would not have read dozens of posts to answer a question unlikely to be asked in this specific manner. Do a search for SpungeDude's posts, he doesn't ask a lot of redundant question....he doesn't need to be spanked and sent on a wild goose chase... I truly do believe you are a smart person, I hope someday to be able to talk EMS at your level....why do you need to use your intellect to be a bully....I don't get it... Dwayne