Ridryder 911

I thought this portion of the articles was interesting ..." Unilateral or bilateral decompression? Not a single case report exists of bilateral tension pneumothorax in awake patients".....Apparently the authors did not investigate very well, I personally seen two this last year. One documented in a response I made and one in a level 1 trauma center, as per radiology report. Unusual maybe, but not that it did not occur. Remember, not all injuries are reported in trauma studies... As well it is a known fact that when one exhibits the classic symptomology of tension pneumothorax such as tracheal deviation, it is usually found in post mortem. Mediastinal shift to move the trachea has to be so severe it has to move the great vessels. Again, refer to ATLS, IHTLS, PHTLS current standards. R/r 911

I am sure it is not as interesting to some as it is to us whom were part of the history of EMS. It does bring back much nostalgia of seeing equipment, people, ideas and thoughts that some of us (Dust, Richard, and others) had at the time. Although there are a few inaccuracies in the time lines, I hope those that view it realize the desire and dedication that was made to make things better today. No, we were not martyrs but I have to say there was many that made many sacrifices to make things as good as they are (even though it is not all great), just think how bad it would be without them. Carrying 60 pound monitors, arguing with LPN's in the ER that you can actually establish an IV and yes, even read EKG's. Fighting with staff members that oxygen is really the first treatment of choice over Lidocaine, and yes even ambulance drivers can actually take ACLS and pass, then later teach it. Yes, we definitely have a long way to go, but definitely better in many ways than it was before. I do wish we would those that have the dedication and visionary that we had seen in some of the earlier pioneers. Many pursue this as alternative job (after failing fries or awaiting for a FD position), rather than a potential career and profession, which harms the future. R/r 911

It is obvious you have limited trauma experience and training. Lower airway obstruction and blood pressure may have no commonality, unless one is hemmorraging or has potentially compromised vessels. As according to current educational training courses such as sponsored by American College of Surgeons, the American College of Emergency Physicians and many other sponsored trauma care, delay of care to await signs of impending shock, V/q ratio can and may lead to death. This is why, even a chest x-ray should not even be awaited for before a decompression is made in an ER or Trauma Center, if they do they are incompetent. Obviously as well, you have a misconception that a large pulmonary contusion is made every time a decompression is performed. As well, an understanding about pulmonary contusions. They are not considered an immediate life threatening injury in comparison to a tension pneumothorax. As far as barbaric, I much rather decompress a conscious patient (if one has time a Lidocaine 2% can be administered) than to have the patient die. Tension pneumothorax is anImmediate Life Threatening injury that should be treated immediately, and any delay (as awaiting for drop in blood pressure, cyanosis, poor sat, tracheal deviation) is and has been proven to be negligent, according to the current standards. These are late and ominous signs. Treatment should have had been performed prior to the development of them. If one awaits for their patient to "be unresponsive" then it has been too late, and should be held accountable for gross negligent care. Good assessment techniques along with mechanism of injury should be the indicator of immediate treatment. Remember, this is considered an lower airway obstruction and even awaiting a few minutes can be detrimental to the patient. No, I am not endorsing chest decompression on every simple pneumo and again understanding the differential is why it is important to have in-depth knowledge of trauma care. Prophylactic decompression is made when there is NOT a tension pneumo, again this has nothing to do with vital signs or detectors. Rather it was made upon inaccurate physical findings and assessment. Although, it is not routinely endorced to be productive; many surgeons agree a simple pnuemo produced by a decompression is much better than having a undetected tension that was not treated. Again, we need to be careful on recommendations. Especially when they are in direct conflict of current medical recommendations made by such organizations I described. Instead of having argumentative discussion, and if one lacks an understanding I am sure there are plenty that can offer literature recommendations as well as references to course texts. Again, this is not an personal issue rather poor and misguided advice that was given. R/r 911 R/r 911

If the program is sending you out before you have completed objectives or portion(s) of the program it is missing the whole point of rotations. Clinicals are about obtaining clinical experience in the areas you have covered and applying didactic knowledge to clinical performance, to basically see how it is applicable. Shame on your program of attempting to "push" or "rush" you through before students are prepared to perform. Sorry, just obtaining clinical time is not the purpose nor will it produce well educated Paramedics. Being able to apply the knowledge in a clinical setting, while being monitored is the sole reason for clnical exposures. It makes no sense to send students out not knowing their objectives (since they have not covered or learned them yet). R/r 911

Sorry Dwayne but this is not a clawful event. The information given to await a drop in oxygen saturation, and for the patient to be hypotensive before decompression is a gross and erroneous statement. If one did such as recommended could be found grossly negligent in patient care. Nothing personal; rather such statements should not had been made. Such actions and recommendations may lead to confusion for those studying EMT programs. Let's keep the forums and posts as medically accurate as possible. R/r 911

Let me say this, I highly suggest that you either : A) Attend courses such as PHTLS/ITLS/ ATLS to further your education before making grossly and erroneous and harmful statements as you just did without any merit. Re-attend Paramedic school or possibly a refresher, so you understand that clinically significant tension pneumothorax can still have saturation's above 90 and as well maybe normotensive to even hypertensive. If one awaits for the symptomology of decreased saturation rates, tracheal deviation, and blood pressure to fall before taking action, then one will either not have to take any action at all or will be performing resuscitation measure. Please refrain from posting erroneous information and attempt to make sure statements are up to current medical standards. R/r 911

Hang in there... glad to see to see a positive change. Just like life, it sucks some times and sometimes it's great. Appears, you are getting some real life lessons and are learning to apply your knowledge to the workings of EMS. Good luck! R/r 911

I find it strange that any neonatal would run "hot", especially returning. Research has demonstrated that time is not the element. Even the existence of neonatal flight teams are questioned due to as Vent described the infant is treated at the hospital. R/r 911

If you review ped.'s, you will find that they are not as susceptible to v-fib like adults as others have described. The usual pattern is bradycardia to aystole. Hence, the reason for initiating compressions <60 rate, and rare defibrillation. R/r 911

I believe the intent was to "think" outside the box. I personally never heard or recommend Tetanus injections in the field as routine care. Again, hopefully to educate and expand on wound care and the possible illnesses associated. R/r 911

The respiratory pattern described in Cushings reflex or triad (in which the triad is usually the late sign, causing the full pattern) is usually central neurogenic hyperventillation or Biott's respiratory pattern. Deep, irregular breathing pattern (not to be confused with Kussmaul's) respiration's. R/r 911

Several of our employees just finished the CBT Paramedic test last week, and described that majority of the test was in fact over medications, and on their test (5 total) there was no scenarios as they had predicted. The medications they described that was on the test were administration of Lopressor, Calcium Channel Blockers, and ACE inhibitors. Like others described, there were medication dosage calculations (usually Dopamine), ironically there were no pediatric medication dosage as one would predict. There were questions on administration techniques such as sub-q, etc... Good luck ! R/r 911

I have written thesis based upon family and cardiac arrest. Personally, I have always utilized anyone help that would participate. Those that usually feel uncomfortable will let you know soon as possible. As you described, much research has been performed and very little ill effects or occurrences have been documented, even on pediatric arrest. I have in my (30 yrs) experience have found it to be a good closure as well as many feel they were able to "do something". Ironically, most cultures honor death and family members in the home. North America is one of the few that feel it is "taboo". Until the last fifty years, many deaths occurred in the home and even the body was placed for view at the home. In regards to your call, many people tend to be "overwhelmed" and unable to give details due to being overwhelmed at the time. Chances are, they would not even be able to identify you (out of uniform) and only give portions of what occurred during the code. One can only attempt to do the best they can at the time. Hopefully, since it appeared the family was spiritual, interaction with their pastor could help. R/r 911

Wow! After all those years, one would expect them to come up with something new to study! Same old B.S. different verse! Really, why did they not study why they are still performing thoracotomies in the ER? They have been proven worthless with little results.. Wow ! A determination or even a paper written with a study of 192 patients. Hmmm in most scientific research, that would not be enough models to determine Jack Sh*t, especially regards in the different variables and varied injuries. So in other words a very flawed study but, it made the headlines... where in other parts of the medicine, it would never been able to be published or considered seriously. We see the same crap every ten years, when the same old professors have to be published to keep up tenure for professor. Shame, they are not really studying and research methods to lower mortality and morbidity within their own department. Everyone in EMS (or at least should know) procrastination increases mortality. Now, what everyone including surgeons, physicians, researchers, and EMS should understand, there are trauma cases, no matter how long or how short of transport times they will die. Even if that glorious trauma surgeon was standing there when homeboy got shot.. sorry, multiple .357 to the thorax, will have the same results. I do have a solution, let's place those trauma, research physicians in the back of the box for a while, and see what their "save" rate would be? ... R/r 911

Here are some more humorous tee shirts for EMS, healthcare.. http://www.cafepress.com/buy/medical?CMP=K...b5720pi11ai1815 R/r911

I wished Cadillacs would come back It would be nice to have a smooth ride again. Actually, I see far more Levoped drips than Epi, Vasopressor, and even Dobutamine drips. It is far more effective as a alpha agent. I agree, I was hesitant at first, but if used properly I see it works great (especially cold sepsis shock). With I.V. pumps being used routinely in the field, it is now safer to use. I am wondering, how many EMS has balloon pumps for critical care transports? R/r 911

We carry the usual Dopamine and Epi, Vasopressin, and Dobutrex as well. We are considering Levophed. Personally, I like the Dobutamine and Dopamine (preload and afterload factor). I realize Levophed used to be considered a last ditch effort (Levophed leaves them dead) but, early use appears to be promising. What is lacking is early use of IABP with use of vasopressors. It is much easier to wean them off and as well decrease permanent renal damage as well. R/r 911

This sounds familiar of a poster that was on EMS forums about a year ago, and after multiple discussions was banned from some sites because of their attitude. If it is the same one, apparently they still have not learned anything as of yet. I agree with Spenac, if it appears that it is everyone else then you one should look at their ownself. One can have bad luck, but with that many people hmmm....? R/r 911

We could sum it up briefly. These are children. Yes, some may or may not have seen problems, may or may not handle things appropriately. We know scientifically many are impressionable, they are still developing. This is the reason we are to be discreet what movies they watch, videos that are played, lyrics that is listened. We allow those that make life mistakes, and crimes to use their age as justification as making those mistakes as well. Why? Because, it is well known they are still growing up, yes they are not adults. Healthcare is a profession that sole job is to be responsible for others. Again, it is generally understood that most of the of those of not of age is not only not able to be responsible for themselves, but why would they be able to be responsible for others? Yes, there is always exceptions, but again that is why it is called exceptions. Healthcare and specifically EMS is not that in dire need to have to recruit children. Rather, this program should be used as a education tool program only. It as any other program should be closely monitored on the amount and what extent they are exposed to. EMS should not be dependent on juveniles providing the care. Again, the adults, the city leaders, should be responsible enough to know that and as well make sure professionals that are mature, are educated are the ones that provide emergency medical care to their citizens. R/r 911

Just in: recent pictures of posts 53 president and vice president

Better understand there is no such thing as BLS care, or ALS care.. rather patient care. In the real realm of medicine there is no separation. We need to be educated that patient care albeit BLS requiring a band aid or thoracostomy is part of our job. We should be educating Paramedics delivering care may require psychosocial such as getting Granny some food to eat or discussing about her cat, or performing a sternal I/O both has its weight and neither one is more important than another. To us it may be a significant difference, but to the patients it may all be the same. We need to remove the stigma and labels of ALS vs. BLS. Rather, to provide the best care no matter what level it might be. R/r 911

Anyone that has really studied EMS systems realize that rural area could utilize Paramedics much better and actually is more beneficial than in metro areas. Then really all patients should be initially examined by a Paramedic. The reason one will not see many Paramedics in the rural area is lack of funding and benefits that are offered at larger services. Sorry, although the interest may be there, when it comes time to paying bills and food for the family, one is going to work where they can make double to triple an hour with benefits. It is the same problem all small communities have attracting any health care provider. R/r 911

Additional points to Dust's comments. Be sure to check that the state you want to work in "honors" their program. Just because you have the RN license in one state does not automatically allow one to obtain one in an another state. Each State Board, review where one graduates from so yes, education and school does count. Last, I had read approximately 4 states no longer accept RN's that graduated through Excelsior, many more State Boards are reviewing to change as well. Unlike EMS, most state boards want longer and better programs. Also, if one is considering going upward such as graduate level (nurse anesthetist, practitioner, CNS) most of their nursing will not transfer. My recommendation is to go to a real nursing school. R/r 911

I no longer work in the aeronautical EMS industry but did for several year. Nor have I worked for Mediflight and I too worked for a competitor but; have several friends that are Medi-Flight, EagleMed and Air Evac Lifeteam. I do agree Marti is great and as a important structure there. I am now working for REACT, while I am in NP school. R/r 911

You will have to be more specific in asking. Are you wanting a company to provide air coverage, or are you asking for those that do? R/r 911