Ridryder 911

I just taught at an instructor retreat and here are some of my suggestions on adult education. Be happy! Truthfully, how many of us want to see an instructor that appears that they rather be doing something else ? Skip the "Why are you here?" introduction, waste of time and really nobody cares, but themselves. Everyone is there to take the course and it does not matter.... period DON'T lecture.. Notice how all AHA, and others have went to video tape/DVD teaching in lieu of lectures. Studies have shown performing and seeing is much more comprehensive than lectures alone. Skip the war stories.. they are paying or attending classes to learn on their time..not to hear how YOU did something. This class is about them not you ... they will develop their own war stories later. Anecdotal stories in a very minimum that is associated with a specific task/skill to help clarify something is allowable, but be careful. Allow your students to make mistakes: allow them to make errors then give positive correction. Many will correct on their own and learn and retain more by doing this. Get Involved! Get down on the floor with them.. Use the 3 points of demonstration, when teaching a skill. 1) Demonstrate entire skill without lecture 2) Slowly teach skill with demonstration of each step 3) Demonstrate skill entirely without interruption. Then have students return demo to you.... Skip the games.. Only apply games when you know they are successful, or the subject is complex. Many adults learners feel intimidated by games.. and feel that they are foolish and immature. Be careful and apply when applicable Use humor cautiously, and appropriately. Follow standards and keep to curriculum as much as possible, but allow exceptions and discuss application outside the class room. Positive reaffirmation! Give praise... and often, every one likes a pat on the back.. but, be sincere! Finally have confidence in your self, all the students want to succeed and at the same time want to see you succeed as well! Good luck,

First, welcome to the site, we are truly are glad you are here! There are many of us on this site that do not believe in having any identity, lights, or even carrying personal jump kits..... even myself do not believe in stopping at an accident. There as well many of us that believe that having lights, sirens, radios is very unprofessional and demeans the professional attitude of EMS. We call those that demonstrate this behavior .. "Whackers" as a slang... Please do not take this as a personal insult, rather as education. Many on this site, believe in promoting education (not training), having a quick response by professional EMS responders to do-respond from volunteer 1'st responders. I suggest in lieu of whacker toys, place it in education.... again welcome to the site! R/r 911

Actually reading all the posts is quite humorous... the fact is we are missing the whole point. Others are trying to point it out to us, other professions have started and we as usual follow behind...... that is ................ Prevention is the key. If we were truly professional, educated, and really even caring we would do more on prevention medicine. We would work closely with MADD, seat belt enforcement, fall prevention and home safety groups. Other professional groups have made that move. Did you report or make notes on how safe or un safe the house was, on your last call? Did you remove that slip rug? Did you contact the social worker to notify that grandma had fallen twice this week and needs rails in her bath tub?... What else could you had done..? Do you feel bad, after the third time you have to respond on someone due to extreme heat, poor living condition, the child that was ejected from not being restrained? Are we really wrapped up so much into our profession or is it insecure that we actually believe it is someone else's job? By punting it off to someone else ... how professional is this... how lazy would you consider a health care professional to turn an eye to to a hazard? Would you have the same opinion of a firefighter that seen frayed electric cords, later to work a structure fire, caused by that electrical short? All that was stated in other posts are good points.. but, that is still treating the symptoms not etiology. There will continue to be enough idiots, that consume the wrong food, have a sedentary life style, causes incidences that harm themselves and others.. by performing prevention we will not stop our career or run volume, just enhance it!. R/r 911

Unfortunately vs-eh? represents those that really do not understand faith, religion, or even Christian beliefs and definitely does not have any education in theology or divinity studies. Mere it is based upon anecdotal feelings. It appears, from the several posts, avatar changes that has intimidation, few remarks, that one may be confused, hurt, or have ill feelings. Although you have read it many times on bumper stickers, true Christians recognize that they are not perfect by any means, in fact humility is one of the greatest attributes that a Christian could and should have. I still do not understand the hostility against any faith that promotes moral character, education, and love to one another. Yes, many have been hurt in the name of "Christianity and Religion" (please do NOT confuse the two) which are not the same. Every one in one way can have negative thoughts from any group of people either religion, race, or even nationality.... I could definitely have ill feelings against Canadians from the ones I have known, but to do so would be simply wrong. Placing or labeling anyone would be wrong, everyone and every groups has members that makes mistakes. Even EMS has several members that misrepresent us daily. I find it ironic on this EMS forum the negativity to Christians, while on other sites it is quite the opposite. In nursing one is taught spirituality, and recognize the need of it as well. Recognizing that science and beliefs can compliment each other, not having to have a choice between the two. In fact we have prayer before each class, and even before shifts at the Trauma Center (yes, it is not a Catholic or Christian hospital) and usually led by one of our surgeons. I find it very disturbing of those that criticize or have no recognition of a high power, thinking that this life is really all there is.... wow, how sad and could be considered self egotistical. I do realize as one becomes older in life, and matures with life experiences, opinions change as one sees more and more life events. What I do not tolerate, is belittling of any faith, view, or even forcing or coercing onto another. The same is true to categorize that Christians have a lower I.Q., or education level, when in fact the opposite is true. Many Nobel prize winners, scientists, artists have been of those with deep faith. Most colleges/universities were started by and are continuously funded by Christian denominations. I believe many people have a fear of faith, due to their own personal choices or have a history of poor choices or have uncertainty feelings... There is right and wrong. No matter what faith, denomination you have or do not have. Life is not easy for anyone, no one ever said it would be. However for those of faith, those that have an avenue and ability to believe of a higher power, received spiritual peace and mind, attempt to follow positive discipline have scientifically proven to heal faster, have a better prognosis, and live longer. They usually appear to be more optimistic, deal with crisis better. Each day I see miracles occur, the humming bird that technically should not fly, the train-auto accident that no one was injured & there should be no survivors, the healing and cures that science has no answer to and definitely we know that it was not the sole powers of a Paramedic, physician or surgeon. Yes, having spiritual development is an asset to this profession, when and those times there is no answer, when things do not make sense, when we question life itself.... it does not remove those thoughts; however allows us to cope better. Peace, R/r 911

23 y.o. get a good H & P with pin point assessment of abd pain. Is it @ Mcburney's point.. last menses, ectopic pregnancy, PID, associated N & V (if so how many, description (food/blood/fecal) last time) last meal (what?) , last B.M. (normal), change in weight >10 lbs if so how much and how long, description of pain - cramping, dull, sharp, intermittent... ? PMHX- surgeries, birth control (if so type, adhere. missed, IUD, past pregnancies, abortions) anyone else ill lately? Examination- where and location of pain, have patient point with one finger specific area. Examine abdominal wall, (obese, flat, distended, bruising)?, listen for bowel sounds (RLQ usually hear loudest) all quads, palpate usin pads of fingers, opposite corner where c/c location, checking for grimacing, enlargement of organs, rigidity. That's it for starters, R/r911

Ditto.. R/r911

That's correct, in fact even maybe longer (some studies describe up to 4 minutes, dependent on perfusion level). That is why I am such a proponent of EtC02 monitoring. I do believe next to ECG, this is one of the most bio monitoring devices we have. Any Paramedic that values their license, certification and does not use this or does not demand access to this is asking for problems. What is so surprising to me, is after attending a couple of EMS conferences recently, on the number of EMS that does not offer or Paramedics that refuse to utilize this. Either this is from ignorance and poor understanding of the equipment, or plain stupidity. One thing is for sure, attorneys are beginning to understand the value of the device...... I would highly reconsider knowing all my equipment offered to me in EMS. R/r 911

Dopamine was never designed as a vasopressor or to raise pressure. It was just the side effects of overdosage that causes the alpha effects. True there is not much research, however be sure to carefully watch pressure when using lower to mid range Dopamine. Mesenteric dilatation and increasing renal perfusion, (even little) will cause a shift in fluid good or bad ... decrease afterload however can cause increased inotropic effects as well increases myocardial oxygen consumption. Like all was discussed, a double edge sword effect. This patient needs a pacemaker, and if that does not cause enough ejection fraction, then placement of IABP until the mycocardium is healed, or decision for placement of possible intraventricular assist device (IVAD), or even a possible transplant candidate. R/r 911

Do I remember the EOA, EGTA hell we still carry them in our bags as back up... actually used one the other day... projectile vomiting.. sealed her up.... For basics remember the basics... yes, it cannot be over emphasized, MJT, chin lift on non-trauma. Unfortunately, cross finger, or scissor finger technique on how to open a patients mouth safely and properly is not being taught much these days. SO man medics come in informing they "were unable to open the mouth" a little cross finger, opens it up.. no problem. I have yet been bit, when performing this properly (hint : properly). R/r 911

Couple of things, Nitrates are NOT contraindicated in Right sided AMI, they should be closely monitored and it is discouraged to use, but technically it can be used, and does great on some patients. (No, I would not use on this particular patient) Second, cardiogenic shock usually has either a tachydysrhythmia or high degree block, as well a low dose Dopamine may actually cause a reduction in blood pressure, but will increase renal perfusion and thus have potential diuretic effects. Dopamine at the alpha range (which produces > B/P) usually will damage the kidneys in the long run...

I use the "Open Mike" rule... don't say anything, you would not broad-casted out loud..... R/r 911

Part of the problem, is Paramedics are not usually taught airway procedures in-depth enough. Yes, patients in severe respiratory distress, the use of the Mallampati scale will be excused; however, ALL Paramedics should know it in detail and be very familiar with it. Yes, there are times that one can properly evaluate the tongue, thyroid, etc.. especially patients with COPD, etc.. a few extra seconds will be far beneficial in the long run, as your partner prepares equipment. Let's not excuse ourselves from proper knowledge and procedures, albeit there are times one has to expedite and eliminate steps, in lieu of the patients status. R/r 911

Hmmm... I do believe reading in the NHTSA Basic EMT curriculum ..." nasopharyngeal airways should not be inserted in facial trauma, potential trauma involving the cranial vault"...., oh yeah, head injuries..... You honor I rest my case. R/r 911

Hey Ace, it's restricted to subscribers only..... can't read it. R/r 911

[quote="SSaint Oh, I'm not saying my municipal service doesnt bill. We bill at just a hair above cost, to pay the professional portion of our staff, and other expenses (insurance, etc) I've heard of agencies that bill as much as $1,000 if a 'medic even RESPONDS to a call. That's just for showing up. Let's not even get into the expenses behind procedures, and transport mileage.

I guess GAMedic never heard of pulmonary hypertension as well. Although, that may be an indicator of CHF, not all CHF patients has hypertension when in failure, in fact most patients in sever distress presents hypotension (shift from right side to left side) and decreases the work load for about 10 minutes. Remember the true etiology of CHF is caused by poor pump failure such as in an AMI, poor ejection fraction, which the patient may not have hypertension. Dependent on just those findings is asking to eliminate other clinical symptoms as well. R/r 911

This had nothing to do with money. Even companies that are ran private and want as much revenue as they can, know how to bill for initial care, and transfer of care to another organization. All our municipilaties bill, no matter private, city or volunteer, without the funding EMS is doomed. One that is financial savvy also performs risk management knowing the best care for the patient decreases liability. R/r 911

As the infamous Dr. Krauss ( Jems several articles on EtC02) calls it the....."the tail, wagging the dog syndrome"...... In one of his lectures, he describes EMS is more educated on the use of EtC02, than possibly 95% of ER physicians. This is very true even in my area. Even though I spec. every ER cardiac rooms (21 beds) with EtC02 (side stream even) they have used 10 times .... 9 of those times I was the one. We have had a problem of the ER physician "pulling the tube" announcing it was not in place, even though we had a nice wave form and lung sounds... I politely discussed with our new Medical Director, which so happens to be the new ER director as well. I informed him of the accuracy of EtC02 and how foolish, and problematic this could be as well as potential litigation ( the former physician pulled an ETT and was unable to re-intubate). Ironically, this "problem physician, now asks if we have lung sounds and wave form..no longer an argument. We need to educate the Doc's slowly an professionally, they will come around. R/r 911

We use a virex type solution, strong enough to melt gloves if not careful... the answer to your question is if it was to permit me to breathe.. heck yes! R/r 911

You are quite aware of the situation that no-one causes suicide. Depression, mental-illness and even addiction to medication is an illness. You are aware you did not cause the problem, and apparently you only seen the tip of the iceberg. These situation is lengthy and much complicated. You actually helped... whom knows, what might had occurred if he had continued. This is tragic situation, and unfortunately it occurs way to often. You had no choice, he caused the situation, and he was responsible for his actions... not you. R/r 911

This sounds very remotely strange, I have flown to so many ATV, all resulting with bad results. I totally disagree with awaiting for helo... remember..."olden Hours starts with the incidence, not our response or arrival. Why wait? That is asinine, and delays further treatment and transport. One can always cancel, I do it routinely.. with incidences of high speed ATV, injuries are usually associated TBI, Neuro/Spinal Injuries, etc.. This is not like a simple residential MVC scene. Tell your Supv., next time if it is his kid or him, you will be sure evaluate then call the helo..... p.s. one can still bill, even if they don't transport... they might want to investigate this. R/r 911

For one thing, check the the "thrill " of the shunt. Bolus her with 250 ml of NSS, and watch for impending s/s of overload. Monitor her because of her baseline hypovelemia and underlying medical conditions needs to be. If this patient was not a CRF and did not have a major underlying medical problems, then yes maybe a basic call because the body could compensate and there would be no problems. Since this patient already has a major illness, one needs to assess in detail. It is irrelevant what the initial vitals were, she is symptomatic with tilt and obvious hemorrhage on the ground. Look at the PMHX, medication's, etc.. this is the differential in making a BLS versus an ALS. R/r 911

I agree the 5 minute emergenc medicine consultant is another good one. It does appear at first to be like a "cook-book" but; one has to have a good H & P tool to use it... R/r 911

Be careful of the Boussignac device. I just listened to a CPAP lecture yesterday discussing it. It is true it is reasonable, and does not use oxygen like the determined type set; however your oxygen set must be able to deliver 25 lpm to deliver the appropiate level of pressure. One needs to purchase a manometer as well to measure the amount of pressure ( I heard it was approx $10.00 for disposable and about $100.00 for a permanent one. The other disadvantages was the mask was not as form fitting, (which is important for high pressure) and it is very noisy!.... Like I said, it is economical and it does work.... R/r 911

Geez, Just to show you ... "stupid is stupid does". you might have discussed with your physician, partner, etc... on what status this was, and I truly doubt that they described that it was not an emergency, of the scenario was like you described. If you become offended so be it. If you did do a research as you stated, then you found out as well the dangers as other has so pointed out. One should be able to defend themselves when making such statements and allowing the continuation of such, to be determined not by ignorance but refusing facts. It is unreasonable and just simply poor that you are unable to interpret what an emergency is. Surf other forums, they will inform you as well. If your partner or even your physician(s) needs to educated and informed, there are plenty, including myself that could present facts, research, literature and web links, but I really do doubt that is the case. Now, what does scare me, is what do you think an emergency is? As far as helo, one needs to be extremely careful in a chopper. The noise level, and the " flickering" effect the blades produce a strobe effect (which could increase seizures). Placing a an eye mask to reduce the light, etc.. which will help. R/r 911