Ridryder 911

HA !....HA!... Actually, the problem is I know that my hearing in my right ear is decreased some, I go about every 2 years to an audiologist to have it checked.. the scary thought is in comparrison to other newbies and medics, my reading's more closer than some others!... This scares me! of the differential .. yes, I am cautious of this. I believe some medics are getting sloppy in auscultating skills or never really learned them to begin with. Yes, I looked into electronic stethoscopes, not so much for my hearing but I really auscultate and listen to lung sounds, heart tones... and gasp! .. bowel sounds. Although, all I am listening for if they are present or not at the time. With the number of medics, not just getting older, but staying in the field longer and exposed to noise pollution more, this is something to consider. I know we are meeting next week with our board for hearing protection .. (we want the headset/intercom type) to reduce our exposures... Be safe.. R/R 911

Wow .. that makes me scared.. I see at least one or two a week.. sometimes s shift!. This is a small rural metro town as well. Of course we run on all "person down".calls..... First death exposure was hen I was 15 working in ER... didn't realize, the code had stopped.. Be safe, R/R 911

That was my main point as well. My boss still refuses to allow machine B/P... the old I want to be sure it is accurate. I will tell you after 38 years of siren... 6 years of helicopter I can assure you my hearing is off.. The other point is how many times I see repeat blood pressure actually taken in the rig... every 15 minutes. At least after the first initial auscultated BP, you have a base line. If they use a machine, at least you know it will be done by the print out. Be safe, R/R 911

Here is some links, with interesting findings of ETCo2 in the field. www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11339734&dopt=Abstract www.jpgmonline.com/article.asp?issn=0022-year=2001;volume=47;issue=2;spage=153;epage=6;aulast=Bhende www.enw.org/ETCO2inCPR.htm www.medscape.com/viewarticle/464505 www.medtronic-ers.com/documents/Capno_It's_a_Gas.pdf Journals: Gravenstein JHS, Paulus DA, Hayes TJ. Clinical indications. In: Gravenstein JS, Paulus DA, Hayes TJ, editors. Capnography in clinical practice. Stoneham, MA: Butterworth; 1989, pp 43-49. 2. Bhende MS. Capnography in the pediatric emergency department. Pediatr Emerg Care 1999; 15:64-69. 3. Sanders AB. Capnometry in emergency medicine. Ann Emerg Med 1989; 18:1287-1290. 4. Santos LJ, Varon J, Pic-Aluas L, Combs AH. Practical uses of end-tidal carbon-dioxide monitoring in the emergency department. J Emerg Med 1994; 12:633-644. 5. Ward KR, Yealy DM. End-tidal CO2 monitoring in emergency medicine. Part I: Basic principles. Acad Emerg Med 1998; 5:628-636. 6. Falk JL. End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation. Advances in Anesthesia 1993; 10:275-285. 7. Gonzalez del Ray JA. End tidal CO2 monitoring. In: Henretig FM, King C, editors. Textbook of pediatric emergency procedures. Baltimore: Williams & Wilkins; 1997, pp 829-837. 8. Bhende MS, LaCovey D. End-tidal carbon dioxide monitoring in the prehospital setting. Prehospital Emerg Care 2001; 5:208-213. 9. Bhavani-Shankar K, Moseley H, Kumar AY, Delph Y. Capnometry and anaesthesia. Can J Anaesth 1992; 39:617-632. 10. Nobel JJ. Carbon dioxide monitors: exhaled gas, capnographs, capnometers, end-tidal CO2 monitors. Pediatr Emerg Care 1993; 9:244-246. 11. Microstream Technology, Oridion Medical, Danville, CA. 12. Singh S, Venkataraman ST, Saville A, Bhende MS. NPB-75â„¢: a portable quantitative microstream capnometer. Am J Emerg Med 2001; 19:208-210. 13. Bhende MS. End-tidal carbon dioxide detectors: are they useful in children? J Postgrad Med 1994; 40:78-82. 14. Aziz HF, Martin JB, Moore JJ. The pediatric disposable end-tidal carbon dioxide detector role in endotracheal intubation in newborns. J Perinatol 1999; 19:110-113. 15. Gonzalez del Ray JA, Poirier MP, Digiulio GA. Evaluation of an ambu-bag valve with a self-contained, colorimetric CO2 system in the detection of airway mishaps: an animal trial. Pediatr Emerg Care 2000; 16:121-123. 16. Bhende MS, Allen WD. Utility of a Capnoflo resuscitator during transport of critically ill children. Pediatr Emerg Care (In press). 17. Cummins RO, Hazinski MF. New guidelines on tracheal tube confirmation and prevention of dislodgement. Circulation 2000; 102(Suppl 2):I-380-I-384. FYI... Be safe, R/R 911

Apparently Harvard and Duke, Yale, etc.. has done substantial research showing it is one of the few tools that is absolute. Yes, there is some equipment failure occasional like any other equipment, but you can detect that easy by blowing into the monitor yourself & check variation. The cost is nominal in comparrisonto other equipment we use. I personally believe this tool will be an asset, once we learn it, in comparison to an ECG. This definitely does not replace clinical skills but really enhances, them on things either your are unable to detect or will display before clinical findings can occur. For example tube displacement within 2 seconds .. showing either into posterior pharynx or totally out. I have developed a power point presentation, and trying to up-date it with more factual points. For thos interested. In the days of controversy of percentage intubation per Paramedics.. this would solve it. If you show ETCo2 wave form appropriate there is no dispute... short & simple. You cannot fake it or have false readings.... this is why anesthesiologist use this so much. For TQI purposes this really will justify our skills percentage, if you do not have a wave form alternate airway should be tried if intubation techniques have failed. I will try to post links for journal research later... The colormetric is really non-valuable due to high percentage of poor readings and only use is to detect either tube confirmation or not, unfortunately you have nothing to place in documentation. Be safe, R/R

Agreed, mainly is it is going to be Hx.. hx.. hx... 12 lead will determine initial treatment. STEMI from Non-STEMI enough hopefully I can either get them thrombolyzed or straight to cath lab... Most of this is done simultaneously, maybe not in this format though.. I am surprised they are so interested in Tropin I.. yes, it is the best lab marker, it has hx of delay marker up to 6 hrs. ... Thanks Ace... Be safe, R/R 911

geez.. folks.. how hard is to remember how to take a blood prssure... this is not rocket science here...automated blood pressure cuffs have been out for over 30 years.. they have proven their point, better than judging someones hearing sometimes. Be safe, R/R 911

Yeah, the old 2 man.. (non-folding legs) that you actually both had to lift and lower.. however when you got good, you could drop the legs/wheels while the patient on the stretcher in the air... you also noticed that the medics was not as "scrawny" then as well.. most could lift at least 150-200 pounds easily.. yes even the small women. Also did not have the Fire Squads there either, so actually most medics were in better shape... had to be... Be safe, R/R 911

Yeah, I find it ironic with all the talk of missed ETI , using this would reduce the number immediately. Using it would determine 100% your in proper place or not.... no guessing, estimating. It also can tell you if you have displaced into oropharynx, as well. No waveform... no intubation short and simple ... waveform drops within 2 seconds, not like SpO2 which can be continuous u to 4-6 minutes. Also, you should not use SpO2 for determination for intubation. Remembering ventilation and tissue oxygenation are totally separate issues. The process of ventilation is just as important as tissue perfusion. This is something we can assist or even control, the other we can't... I believe within 5 years, we will understand capnography will be just as important in respiratory as the EKG is in cardiac care. the neat thing is can be used on any age from neonate to adult. . Once you have mastered understanding it, you can determine many things. Co2 entrapment. Those nasty asthmatics, is your up-drafts really working?.. determination way before lung sounds change, also we all know that intubating asthmatics is not the best thing since they don't really have airway obstruction more it is an entrapment. You can tell how much... Ironically, many EMS is looking at the new device to determine if CPR is effective, when you can also determine this with ETCo2 as well, immediately, the same is true on capturing with pacemaker, with those patients that pulse is hard to determine. Like I said, this device is not being utilized in its full range it has so many uses and many are not using it, which is a shame. It is one of the few if any device that is an absolute.. Be safe, R/R 911

Afer watching a 2 hour video that Dr Krauss, (Harvard Emergency Professor) produced for Medtronics. A very informative lecture. I had used ETC[sub:14b60c3322]o[/sub:14b60c3322]2, for a period of time, but it was a good review. My question how often do you use ETC[sub:14b60c3322]o[/sub:14b60c3322]2 ?... And to what degree do you use them ? Do you use them to verify endotracheal intubations, determine CPR is effective, check for capturing of pacemaker, or to cease or not to perform codes, etc... ? Does your medics fully understand capnography waveforms ? As well do you use side stream... to determine depth of bronchial spasms? Be safe, R/R 911

Having self confidence is one of those qualities that is not included in the job description or can be taught in school, or tested. I agree, as you describes it comes with experience. From what I understand from your post is that your supervisor doubts your confidence level, because of lack of experience?.. This sounds like a double edge sword... I suggest maybe practicing skills, talking to other crew members to help make suggestions. This business, requires one to develop a "thick-skin".. and to be appreciate of constructive criticism. With this saying you will also need to develop a mental satisfaction that you provide the best care, when you do deliver care. That is all that is expected from you. I forewarn you there is a fine line from confidence and cockiness, in which no one likes. I wonder from the discussion of your supervisor, that this is the true problem. The "lack of self confidence" appears to be a broad statement. I hope he can give you more examples and specifics to work upon. Is the "lack of self confidence" in client care or performance in the field? again, specifics to work upon... I wish you the best of luck... Be safe, R/R 911

First of all, doesn't sound like your business was not very "business" smart. You should had a attorney review all policy and procedures and make you sure you had the cities blessing form either the commission or business administration. As far as "they receive funding" and should not charge... is an asinine statement. Subsided services are not definitely, not subsided enough to make it, EMS has to charge.. if not, it won't be an EMS very long. Go through the proper channels... get the permit or whatever is needed, and hire an attorney if you truly have a right to operate a business. Be safe, R/R 911

I think one needs to really look and explore before making a choice. I went back into the field full time about a year ago, making about 1/2 what I was making an hour. The reason was I becoming very disgruntled nurse, and hated getting up every day. Whenever you become apathetic towards people it is either time to take some time off or change careers... I love the working in the field, but realistically the pay sucks. I am fortunate, my EMS is one of the highest paid in the state and since I had so much experience and with guaranteed overtime, I make more than I did as a RN due to the number of hours I work. I am also fortunate, I do not have the financial responsibilities as well as some do. But, one needs to look and explore all options as Dust describes. Yes, you need to be happy at work .... very true as I described, but you also need to remember ...will you be happy after a period time, if you have to work several jobs, not being able to pay bills, or neglect your family ? So many get in EMS or return because the love of the job, only to really learn to hate the job because of poor finances. We can all describe how this job is like a drug.. once it gets into your system it is hard to get out. But, we also need to realize the need of financial responsibilities as well. One cannot "always follow your heart".. one sometimes needs to follow your head and pocket book as well. I never fault anyone leaving the field for better paying job. I do understand it. Please don't give me the " money isn't everything " and "one knows when you enter the field it doesn't pay much.. and we don't do it for the pay" speeches. It is because EMT's will work for minimum wage or volunteer the reason we get paid as we do. Yes, other factors are accounted as well. Education level, and again supply and demand. Hmm there we go again.. there are a line of EMT's wanting the fix of working in the field. It is a shame that this is even an issue.. So hopefully, EMS will start paying accordingly and bring the pay to be able to provide its workers a decent salary so decisions doesn't have to be made. But I doubt I see this in my career. Definitely not the way we are proceeding. Be safe, R/R 911

I am a PEPP & PALS instructor, & I was informed that new standards was to be out this spring. Studies have shown not to hyperventiallte head injuries patients.. due to it does cause constriction of cerebral ateries. Yes it does reduce ICP by reducing bleeding but, also prevents cereberal tissue from recieving adequate perfusion. Here is a link with the pathophysiology and treatment of why pupillary response is asociated with oxygenation. http://www.aic.cuhk.edu.hk/web8/severe_blunt_head_injury.htm Be safe, R/R 911

We do not have certifications, we have a license. However; Oklahoma accepts the NREMT exams.. F.R. , Basic, and Intermediate (however must have intubation modules), and Paramedic. Be safe, R/R 911

oh... you mean Junctional tach...the same thing.. True you cannot diagnose in 3 leads.. not that you can not diagnose with a 3 lead monitor.. such as using multiple lead placing.. even MCL[sub:955ea64636]1[/sub:955ea64636] etc.. Be safe, R/R 911

The "QRS" are regular, until mid-way. Also appears to be a prominent "P" wave although the morphology is different and appears to come from different foci. This may be contributed from movement or poor electrical conduction. Be safe, R/R 911

Okay.. here is some more... dirty linen and turned out gloves in the side compartment.. also, we have a lot of smokeless users, where i work at.. spit cups.. c'mon, you have the habit clean up after yourself. I don't mind a dirty unit so much, if you have been up all night ... and beat ass tired. Just be sure the rig has gas, some O's.. and please replace the med's you use as well as batteries and some ECG paper.. Be safe, R/R 911

Well that is better than..Pantophobia ... fear of everything. be safe, R/R 911

I stand by my point that those with suicidal tendencies and history of unstable mental health should stay away from this profession. That is why many EMS services require psychological evaluation before employment. I wished there was a mental health check as well a regular physical examination. Maybe we could detect problems before they had escalated before an incidence. The nature and demeanor of our business can cause some major stress on even the stable ones. In the event of a crisis or emergency is not the time for an occurrence to occur to the medic performing care. This is true even with high stress level in physicians as well.. again, that is why some physician groups also require psyhc. testing as well. I worked with a great physician and a professor of emergency medicine that turned out to be manic-depressive. We did not know that he was until a very stressful event that caused a major disturbance. Since for some reason his med level had decreased, he acted & performed wrong which could had caused permanent damage to a patient if a nurse had not intervened. This is the hard part of mental illness, there are no physical signs usually. No I do not mean to "stigma" by any means, but there our some professions that are better suited and definitely less stressful. PTSD is a common aliment to our profession. JUst like having chronic back problems limit employment, and inability to lift as well, so I consder this a medical ailment as well. Be safe, R/R 911

Do we get mad at the Diabetic with low blood glucose that gets violent, or the head bleed because they keep asking the same repetitive question and rip out their I.V.'s , or geriatric patient that accidentally over dosed on their Digoxin, because they could not remember how many pills they took?...... then, why do we criticize people with an illness so severe that cannot rationally see clear enough make rationale decisions ? There are different suicides. Ones that are out of spite, or accidental (though they would injure, but not be fatal), and ones that are so depressed they see no other choice. Depression is disease. EMT's have a hard time dealing with these because we cannot see or treat it. These patients do not see alight at the end of the tunnel... they don't even see the tunnel. The cloud that over hangs them makes it where they cannot see an option, they have attempted to rationale each part... albeit not appropriately. How many have you seen where, they did not truly gave some thoughts prior. Sometimes this can be caused by chemical imbalance in the brain, electrolyte imbalances... etc. or just overwhelming situations that was too much for them to digest. Who knows when your last straw will be ?.... I used to get mad and very angered at them too, but; then after having several major critical events in my life, I have learned to develop an understanding. I now think how sad to live with the cloud of depression over them where life appears so bleak and doomed that it hurts so bad that the only option appears to remove the life. It was a shame, we in the health care field could not treat and help this person. I am sure they would had loved to be healthy, and enjoy life, like any other person... So let us remember they are ill like other patients ... Be safe, R/R911

Okay... here is some more.. anal retention..literally. Those who purposefully, feel they have to expel and share their methane with every one. Okay, I know it is a bodily function.. Clean your damn mess in tthe bathroom.. I don't care most of us are men!... and please hit the toilet ! The other is an occasional cell phone is okay.. but I had a partner that talked to 8 people within 15 miles... and yes he was driving.. sorry, doubt that they could not wait for at least 20 minutes.. The other is flirting on duty..in great detail., especially those who think they have to also have conjugal visits.. c'mon surely you can hold out for 24 hrs... I know some of you new ones may find it hard to believe, but Paramedic programs really have been out there for a while. You did not invent EMS when you just graduated. One of my most pitpeeves.. okay you ran a code.. congrats..That is what you are trained & hired to do. Just think, they couldn't had got worse.. no matter what you did to them.. dead is dead! ... Didn't realize I was so anal.. but yet again, a lot of people have reffered to me in those terms..LOL

Ditto.. this profession is too stressful for unstable people. This profession has lead some very stable and damn good Paramedics to their grave. What we see and deal wiht occasionally, as well as trying to be "emotionally ready" for teh "big one" can lead to major problems. Please seek professional help before contiuing... Be safe & good luck, R/R 911

Basics that either believe they actually have more education than Paramedics, and especially those that failed the Paramedic test or never took it. Basics second guessing that it is time to transport.. just because we got the patient in the unit. Duh.. we need to really assess them & tx. them.. let's take care of the patient... okay. Like Dust, lazy ass partners that like to shoot the feces instead of getting the unit in-service. Paramedics that are STUPID.. .. not ignorant which is a total different story. Those that do not understand there is a mixture of the field way and book way. Not just one or the other. Any EMS perosnal that refuses to learn or increase thier knowledge and are satisfied with status quo... Those with < 12 years in EMS your still a rookie to me... come and see me after 18 to 20 yrs. then you have some experience, after 25+ and you still are active and kept up... I will really respect you and what you say. Instructors that read from the book.... Just a few, R/R 911

Sure it was not Dead Meat?...LOL :evil: R/R 911