Ridryder 911

Welcome to medicine... I always thought it was interesting for many EMT's and Medics to assume they actually know medicine, having never worked in a hospital environment. The EMT curriculum was developed in assumption that most students have either worked previously as an EMT or have hospital experience. I get amused for those that assume that they have taken an 8 week class and then become an expert in emergency medicine, as well never really being exposed to a multitude of treatment regime and philosophies. Good luck in your new career and learning aspects... R/r 911

I would agree Morphine is the most safest and one that has the best all around desired effects that we should be aiming for. Fentyl, is a great analgesic but as AZCEP described a drip should be instituted for pain control. Personally, I have not seen much use for Nubain for trauma or cardiac, rather more used for migraine and obstetric type pain. R/r 911

You need to review local policies, personally I like 800/250 yielding a higher concentration and less fluid in which most of these patients need in cardiogenic shock.. etc. But one must forewarn others the concentration strength. Here is a nice link a paramedic professor has describing different techniques for dopamine... http://gaems.net/download/drugcalc.pdf

This might help: http://content.nejm.org/cgi/content/abstract/338/6/362 R/r 911

I can't believe this is even debatable! One should had been taught back in basic EMT that manual b/p's are given in even numbers, even nurses aides know this much! This is due to the dial is only in even numbers, and I do really doubt that one could really hear and correlate the difference. Refer to manufacture and even the teaching of how to document and auscultate blood pressures. Whenever someone reports an odd number, one would assume it would be electronic, otherwise all credibility would be questioned that one could not read the dial increments. R/r 911

Show me an odd number not from a digital B/P and I will usually show you someone whom does not know how to do take a blood pressure. As well, most do not usually listen for the initial Korotkoff sounds, furthermore the numbers are only posted in even numbers, detecting a sound in-between numbers would be so minute, choose one or another. It has been a traditional charting and record method to always chart vital signs in even numbers, including pulses and respiratory rate. It was only recently with the invention of digital read outs that even numbers have been accepted to chart as such, the theory was they were to be more accurate. R/r 911

And come to think after all those years you carried those hemostats, and you thought they would never come in handy... 8) Go to the sup.. R/r 911

.... There you go .. R/r 911

Actually, ER Doc AHA still allows Lido in lieu of Cordorone, they do prefer Cordorone however; but still discuss that is the providers choice. (We had a big pow-wow of Instructors, attempting to clear this misconception up). As well, ever heard of pre-mixed Lidocaine? It only has been out about 18 years. Personally, I have little success of Cordorone over Lido nor have I ever seen seizures r/t Lido as well. I do believe Corodorone is a better antiarrhythmic medication, but in V-fib, no difference. This was even in pre-hospital, ER, & ICU/CCU settings. Yet again proper dosage and all drips should be on a IV pump. The problem I have with Cordorone is if the patient is on anticoagulants (especially Coumadin) it can screw up their PTT/INR.. I believe Cordorone within time will be the same as Bretylium hype was to replace Lido etc.. and we seen were that went. R/r 911

Congrat's.. You are probably are making a wise decision. Good luck in your new career and thanks for the years you did out into EMS. R/r 911

Faulty, and shotty study. Not enough scientific data and details to warrant a concern and changes to occur. Not specific enough to describe if those patients had enough damage that mortality would had been high already or not. Interesting since all other literature is describing we are not giving enough Morphine dosages. NTG is good, but it only works to a point. It is not an analgesic and we only want and can dilate vessels to a point, then it can become dangerous. R/r 911

Okay I will describe as one of my favorite character "Dr. Perry Cox", on the television show "Scrubs": Okay, newbie! .. Listen up! You are supposed to be scared!... That is why they have a FTO with you.. for god's sake, we don't expect you to be a Roy DeSoto out there on your first week! Now what we do expect is for you listen, watch and learn..and yes asks appropriate questions. We want you to be scared.. it helps for you not to be so cocky and confident that you thought you already knew all the stuff just because you passed a few tests.(Your not the 1'st newbie) Now, the real learning begins on how you will apply all that goop that they taught you! In the book House of God; one of the ten commandments is to "take your own pulse on a cardiac arrest." There is a actual reason for this.. think about it. So yes Newbie, we will pick on you, we will laugh at you at times, and we will quiz and question you... uh, that is because that we are supposed to do and expected to do. It is our mission to teach you, be sure you don't kill someone and by-god actually do some treatment and maybe with luck actually help someone... so that later, maybe by chance you will do the same in return to another newbie someday. Now good luck, things will get better with time... give yourself a chance.. R/r 911

I had thought of this as well, but the reason I posted was hopefully, for the other 100 or so that would be asking the same question, would not post the question again or bother us on flightweb... Just a thought, if one has to ask... "What does it take to be a Flight Medic/Nurse ?" etc.. Then it is obvious you do not have enough experience to be one..!

First welcome to the site.. You might to want to perform a search, there are many re---re----re--posts on this subject. Basically, be a critical paramedic for at the least 5 year minimum with all the vowel courses. Very competitive job, everyone thinks they want to be one .. very, very few ever become one. It is a good idea to work in a urban area, (preferred not large metro or too rural) that is progressive. Good luck ! R/r 911

Actually this post should be moved to either the "professionalism" or the "what would you change in EMS education" posts... Sorry, to new poster.. but you just proved many things... R/r 911

My guess is that a fragment or bullet tumbled down into sinus- post-pharynx area. This route could had lead into the esophageal puncture, upper lung. Remember, those bullets (especially in head wounds) may travel into several areas. I agree V.S, most of the time one will see tracheal deviation, mediastinal shift to occur to move internal organs such as the heart, and trachea.. which is a lot of pressure. I have seen very many tracheal deviation on dead people... I do attempt to check for tympani sounds to differentiate between hemo vs. pneumo, this will make my treatment regime from placing decompression from MCL to mid-ax. Air can escape upper, but with a hemo, I prefer mid-ax to allow to drain if possible. R/r 911

Maybe working in a taxi service might be a better option for you. Then again, I don't want to slam taxi drivers As others suggested, you want to be treated as a professional, then act and communicate as one! R/r 911

I highly encourage and recommend attending accredited Paramedic programs, If you are in a paramedic program enquire if they are in attempt to become accredited through programs such as CoEMSP, Accredited Health Careers Association, etc. Rumors in my state that all programs must be accredited by 2010. I hope so, but I doubt it. By being accredited requires your instructors to be proficient not only in EMS but teaching as well. Appropriate clinical agreements and contracts with administrative staff and instructors to monitor student development. Plus, a continuous development program to ensure the student is taught well. Mainly, mandating the educational institution to have the EMS as a program not just a class. The old saying those that.. "can't do, teach".... should never occur in EMS. As well, being competent in their profession, knowledge and skill proficient. Instructors should have at the least a demonstration of general education by either passing proficient exams or degree status. We cannot or will never become a true profession, until we have recognized level of instructors teaching the programs. R/r 91

Whose to say their even medically trained? ... R/r 911

As usual, news and journalist thinks and believes that they are above all. The same when our local news helo's fly into tornadoes.. etc.. R/r 911

I have worked with Thermal Angels and like them, they are somewhat expensive. I would not microwave an fluid.. I attended a hearing against a nurse anesthetist whom microwaved fluids and they removed her license, citing references of endangerment. R/r 911

NEVER USE A MICROWAVE!!!!!!!!!! Either have an approved fluid warmer for IV fluids (tubing warming device) or the fluids in an warm device before administration. There has been successful lawsuits against hospitals that have used microwave, it can change osmolarity, and as well have "hot spots"... R/r 911

If you compare the number of hours per week and usually most are now on year contracts instead of the 9 month contract., that is not that much money. Remember, one must have at the least a master degree level to teach "RN" at a university setting. They also usually require at least the minimal 5 years clinical experience. Most require to be at the "professor" level to either be a Doctoral candidate or have received their Doctoral level in education, or Nursing Science. Furthermore; most universities may require them to still maintain clinical experience and additionally to be published in some professional journal. So in comparison, it is not really a whopping salary, especially if one realize most regular nurse can make that salary either in management or travel, without all the B.S...or go into sales representative or computer systems... etc.. VS-Eh? I am wondering if the PhD' are not our M.D.'s that we have on the forum? I do see many medics on "MySpace" etc.. that describe themselves as having a professional degree as a Paramedic. Then, when reviewing their educational experience, they only have attended Vocational/Trade school or a Junior College. This is shameful, that they do not even know what a professional degree is!...(hint.. it is really not trade school!) Maybe we should have a post on what private, trade/vocational, undergrad, grad, and post/professional requires and is composed of. So many (including EMS instructors) do not have a clue on educational systems. Again, part of multiple problems we have as a system. How are we ever going to progress, if those that teach are uneducated? Again, we require kindergarten teachers to have at least an undergraduate level to teach.. But, it is okay to learn to make an incision on someones neck from a GED level instructor. hmmmm..... does this make sense? R/r 911

Dust, stated my opinion exactly. When we and if we ever are able to bring our level of education up to par, then a lot of changes can occur. I am too against national standard protocols. Whenever this occurs, you will remove autotomy and the medical community participation and needs. There are some areas that need aggressive protocols, where some that do not and will not ever need such. It should be based on several factors. As well, most "blanket" protocols, will only allow minimal treatment. Let's treat patient problems first.. For as national standard certification/ license, that would be great if we had a true national standard of educational standards. As for right now, many states will allow anyone, anywhere to conduct about any level of EMS programs. The reason behind this multicomplex. But it is simple at the same time. (Read Dust's post) At this time there is no reason to progress. With over a half a million to possible million EMS personnel, we could change the current level rapidly. There itself lacks the problem .. apathy. Why change something, that many do not feel the need in changing ? For example, look at the participation of forums of EMS... the same folks, of course with predominally the same opinions. Still this is less 5.000 people out of ???? certified and licensed EMS personnel. Again, one can get the jest and feel how interested EMT's are in changing the system. Predominally, from my experience EMT's are whiners and cry babies !.. They much rather complain, and be pissed off than to ever create changes. When approached how are aware of local, state, and national committees or development very few ever participate. Again, they may want changes as long as someone else will do it for them. Usually most organization have the 80/20 rule. Twenty percent is active to cause change and be creative, and eight percent are not active.... I bet our rule would be 98/2. Like Dust described ... "The problem is that a much too large percentage of providers in EMS do not want change." Many feel it is better than their last job... Yes, it would be nice to see EMS become mature and actually become a profession with associated responsibilities and benefits. However; I would not make any bets on it. It appears we are regressing instead of moving forward. R/r 911

Partly true. If one can reduce work load, and increase vasodilation you might decrease potential infarct size, by allowing some blood perfusion. Yes, PCI does increase improvement and survivor rates, as well as thrombolytics in specific conditions. However; more and more research is gearing towards door to cath lab rather in lieu of thrombolytics. You did point out some significant points that many AMI's are not caused by arterial spasms, and even obstruction in the lumen of the coronary artery, rather releasing of plaque from lining of the arterial walls. R/r 911