Ridryder 911

Noooooooo problem that is why we are here... to learn of each other...glad you are participating! R/r 911

Remember NTG is NOT contraindicated in inferior wall AMI's however should be used CAUTIOUSLY....I too would not probably use it though on this scenario. For the thrombolytics, I would not consider it since it is an inferior wall, if it was anterior yes...Yeah, if you can the posterior wall that would be helpful too.... not many monitors allow that though, and changing leads around (forgive me Bob Page) is a booger, when your patient is going down the tubes... R/r 911

Yeah, me too because the new test has not been "officially" written as of yet. So whomever tested you, tested you using the old test with approved modifications, or has an inside deal with the National Committee. :wink: R/r 911

I understand your point and respect it as well. Remember"sudden death" syndromes, has no pre-cursor of arrhythmia's, as well more prominent in younger females, and ventricular fibrillation threshold decreases with each conversion. R/r 911

I have not used the Nipride with the Dopamex, and Dopamine, same effect as I described earlier. However, I am VERY cautious with Nipride drips.. 3 drops too many and bam...... R/r 911

So basically an expander, with isovolaemic haemodilution and real no effects except of that.... hmm sounds like a fancy Dextran , interesting but why? I agree rob Peter and pay Paul situation. R/r 911

No hx of LOC, orientated X 4, I would not had called for helo and she was informed of risk, have LEO witness that risks was informed ( death, CHI, unknown injuries, you highly suggest further evaluation and treatment), contact medical control if protocol (most anymore has quit this, they can't force anyone to go either) and out of there. Patient made an informed and conscious decision. We only can make strong suggestions, and recommendations. R/r 911

This type of patients makes one sphincter pucker... I agree I would probably either revert to pacing or Atropine. I agree with Azcep, I am thinking this is actually entering cardiogenic shock too or will be using the last of his heart up. The reason to shy away from pacing is I like a little sedation before hand... ever been shocked 60 times a minute?.. One would have to be cautious on sedation. Yet, a live heart is better than a dead one. Sounds like a typical transmural infarct, and we really don't know if Dopamine would even do any good since there is no ejection fraction left. With this as well, we know we might be increasing the oxygen demand and increasing the infarct size.too I have sometimes used the pre-load : afterload trick . The effect of using Dobutamime and Dopamine together. This teeter totter effect appears to decrease the work load, until you can get the patient a transvenous or implanted pacemaker placed in them or place them on IABP if that does not correct the problem. Like others stated it's a difficult case. R/r 911

ER's can earn hospitals revenue with ambulance deliveries U.S. hospital emergency rooms, frequently beset by too many patients and too few beds, can take in more money if they stop diverting arriving ambulances to other hospitals, a study on Wednesday said. By putting in more beds and avoiding so-called ambulance diversion, a hospital could boost emergency-room revenues by 10 percent, according to the study of a 400-bed Oregon teaching hospital published in the Annals of Emergency Medicine. "It's important that hospitals understand that decreasing ambulance diversion can translate into higher revenues," said John McConnell, who led the two-year study of his hospital's emergency room at Oregon Health and Sciences University. Most emergency rooms are understaffed and overwhelmed with patients and unprepared to cope with a crisis such as a natural disaster or terrorist attack, the nonprofit Institute of Medicine said in a recent report. It also said diverting ambulances inevitably leads to unnecessary deaths. But hospitals have been hesitant to add capacity because many emergency-room patients are among the ranks of the 46 million people who lack health insurance and may be unable to pay. The new study is one of the first attempts to show the potential financial benefits to hospitals if they change course, the authors said. U.S. hospital emergency room visits have risen steadily, jumping 26 percent between 1993 and 2003 to 114 million visits, according to the Institute of Medicine, which advises the government on health matters. The Oregon study also found patients entering an emergency room by ambulance are less likely to be uninsured and more likely to be admitted to the hospital, than patients who walk in. "That was a surprise to us," McConnell said. "The patients where a hospital makes a lot of money is the heart-attack (patient) who is then admitted," he said. The Oregon hospital treats about 43,000 emergency-room patients each year, and midway through the studied increased bed capacity. When beds were added and ambulance diversion dropped, the hospital gained about $175,000 in extra revenue per month. A major limitation is the study didn't quantify the revenue lost from inpatient beds being used for emergency patients, Robert Williams of the University of Michigan School of Public Health said in an editorial in the journal. "In simple economic terms, one patient is a sure thing and the other, a roll of the dice," Williams said. Wow! It doesn't look like that study was too scientific, as well I don't know abut you guys, but most of my patients don't have insurance with or without ambulances, and most are NOT admitted into the hospital! R/r 911

Has anyone have more information on this? HSD can help accident victims survive Imagine yourself trapped in a car on Interstate 5 after a head-on collision. You are unconscious and have lost a significant amount of blood. You may have a severe brain injury. When paramedics arrive, they start intravenous fluids, critical to keeping you alive on the way to the hospital. The intravenous fluids currently used have been unchanged since their development in the 1960s. University of Washington physicians based at Harborview Medical Center believe that a new intravenous fluid has the potential to improve your chances of survival. The fluid is a concentrated salt solution with or without a sugar component called Hypertonic Saline/Dextran (HSD). It will soon be tested in Seattle and nine other communities in the U.S. and Canada as part of a research study sponsored by the Resuscitation Outcomes Consortium, with funding from the National Institutes of Health. Hypertonic fluids are expected to help accident victims survive by resulting in more rapid improvement of blood pressure, improved blood flow to the injured brain and decreased likelihood of high pressure in the brain. They may also decrease the risk of infection and lung injury by altering the immune response. HSD is already approved for use in 14 European countries, including the United Kingdom, France, Germany, Sweden, Norway and Denmark. It has been tested previously in eight clinical trials in the U.S. and shown to improve survival. Potential side effects include allergic reaction to dextran, seizures due to very high salt levels in the blood and rapid increase in blood pressure leading to more bleeding. None of those side effects has been seen in the previous clinical trials. Would you want paramedics to give you HSD for life-threatening injuries following an accident? When asked this question in a recent telephone survey, more than 78 percent of Seattle area respondents said they would welcome the treatment. The Food and Drug Administration and the UW Human Subjects Review Committee have given researchers permission to do this study and enroll patients without their consent because HSD must be administered shortly after injury when patients may be unconscious and family members not immediately available. Once it is possible to do so, all participants or family members will be asked to give their informed consent to continue in the study. During the three-year study period, HSD fluid will be carried by paramedics in Seattle and King County and by Airlift Northwest. It will be given to approximately 400 patients ages 15 and over with severe blood loss due to either blunt trauma (e.g., injuries caused by motor vehicle crashes) or penetrating trauma (e.g., bullet or stab wounds). It will also be given to patients with evidence of severe traumatic brain injury. In 1970, Seattle became a model for emergency care in the field with the creation of Medic One at Harborview. We're confident the new study will contribute to our continued leadership role in setting the best medical standards worldwide for pre-hospital emergency care. Dr. Eileen Bulger is an attending physician at Harborview Medical Center and a UW associate professor of surgery. For more information, go to the study's Web site at http://www.roctrauma.org/ or call 1-800-607-1879. Public comment is welcome.

I too agree that airway book is great and every instructor and EMS facility should have a copy in their library. My second revue and recent EMS book I read is interesting as well. Name: Critical Care Paramedic Author: Bryan Bledose, D.O., Randal Benner, et. al Publisher: Brady ISBN: 0-13-119271-X Description: Text, Hardbound; pages- 1142. Discussion:This is the current bible for serious EMS providers. Unfortunately this text is not mandated and incorporated into the national curriculum for Paramedics. As an experienced provider that has always worked in the hospital setting, it is difficult for me to realize that most Paramedics has little to no medical experience, other than the brief exposure to clinical, and dropping off patients. This text helps bridge that gap. I believe a lot of hard work, thought and insight was placed in developing this book. I foresee possibly programs developing after Paramedic education utilizing this text. This text is way overdue in this profession, thank goodness, especially with the insight and knowledge these authors have stepped to the task. Pros's and Con's: Part of the con is not the books fault. It is a text had to be designed to actually teach Paramedics, what should had been taught in the beginning. If EMS programs were truly educational, this text would not had to be designed. The pro's. there is not enough time, space to discuss the great aspects that Dr. Bledsoe has placed into this. The graphics, art, pics, are superb. The outline is good too, with a design similar to most Paramedic text. This text I would believe is written at a lower college level. Some of the problems I see, is that it is assumed that you have a full understanding of basic EMT through Paramedic level. This may be difficult for those who has not mastered the basics or logistics of these yet. For those that have this is a nice documentation of picking up where Paramedic school stopped. The text unfortunately is somewhat shy in detail of certain conditions, etiology, etc.. but, there is no way possible without individual texts on these certain subjects to make this possible. I was impressed with RSI pharmacology portion, as well labs that the Paramedic needs to know. Cardiovascular emergencies was detailed enough, that even this text would help inexperienced critical care nurse to help them understand hemodynamics. Summary This should be a required reading for every Paramedic in the U.S. (also Canada, but your programs probably already cover most this p.s. I have heard Bledsoe is authoring one for Canada's level). If one is really considering becoming a Flight Paramedic, career Paramedic, they should have read and fully understood its objectives. This is text that no Paramedic should be without. Ranking I rank this text a high 10/10 stars of life !

You know Frankie, this is one vision I could had done without!... R/r 911

We just recieved a new Medical Director and was hoping he would increase our analgesic protocol to include Fentyl, but declined stating studies show too much associated chest wall restrictions ?... Maybe later... R/r 911

I agree with GAmedic. It has been proved over and over money is only a short term solution. Yes, comparable and competitive wages should be definitely expected, but everyone uses fiances as an excuse to gripe. As GA describes, safe and working equipment, participating in decision making for the company, having a company that involves participation from employees in policy making, and growth. Benefits, and career ladder options. Unfortunately most medics are not financially savvy and only see short term solutions. I was talking to some EMT students and we were discussing career options. I asked which would rather have an higher payed EMT position, with little or no benefits or one that was moderate pay and loads of benefits, you guessed it higher pay!...? Again, usually because of lack life experience and maturity, as well most have only short term goals. I suggest a doing a good comparison of other EMS services, with potential benefits such as career ladder movements, education reimbursement, promotions, etc. Stay away from sign on bonuses! It has been proved they do not attract the type of personnel that is serious in career retainment, that is why more and more nursing jobs have eliminated these promotions. Place that money on retainment funding and reward those that stay. Introduce mentoring strategies, where employees that mentor new people and help retain these people are rewarded, everyone wins. R/r 911

Perhaps since this was initially posted over 6 months ago, I bet she moved on one way or another. Let's stick to recent posts if pertaining to personal time issues. R/r 911

I actually have read that book. Very interesting indeed. Some parts at first I thought was dry, (description of diagnosis and a lot of psychobabble) but over all an interesting read. I agree it is an upper level reading, and usually associated with an upper level psych cl assess required reading list. The title was an interesting eye grabber and its' later explanation is interesting. I would rate it a 5-6, stars of life, definitely worth reading especially if you are into psychiatric disorders... R/r 911

Okay, if Oprah can do it so can we! Have you read a EMS, medical, text, fictional book lately? As most are aware this site promotes growth and expanding the mind and knowledge. One of the best ways to do that is to read. I am going to suggest a lay out, please be honest, frank with discussion of the book, what your likes and dislikes as well. How and if this changed you current practice, treatment or ideas. Okay let the fun begin! Book:Text type : 12 Lead ECG for Acute Care ans Critical Care Providers Author: Bob Page Publisher: Brady Costs: approx. $45.00 (U.S.) ISBN Number: 0-13-022460-X Discussion : This text is authored by the renowned ECG Guru, Bob Page. Bob, is a veteran Paramedic and has teaching and promoting advanced cardiac care for Paramedics for several years. His lectures of "Multi Lead Medic" has been a popular lecture and classes for years. Bob is an health educator with St. John's in Missouri. Anyone that knows or have met Bob soon finds out his love, enthusiasm and sincerity to improve quality care in EMS. Here is a link to his website for more information of classes: http://www.multileadmedics.com/ This text follows Bob's lecture on twelve leads. The text is designed so that one does not have to be from the EMS arena to understand it. Health care workers such as ICU, CCU, and ER can use this book for educational purposes as well. It does have an EMS flair through out the text though, and is written so one is not required to have formal ECG education prior. With that saying I would highly recommend though to make it more understandable, and clear, one should have a well understanding of Basic ECG interpretation skills, and as well a more than basic knowledge of cardiology. Many EMS veterans will recognize his famous "Multi lead Medic" methods, before the introduction of 12 lead monitors, many aggressive Paramedics would physically move leads around to obtain better insight of ths ECG. These being the infamous MCL[sub:db743a3462]1[/sub:db743a3462]. etc.. As well it demonstrates, that one does not have to have a 12 lead monitor to obtain a better diagnosing an obtaining a better ECG. I would describe the text to be written at an upper high school or lower college reading level. With chapters that is well designed and flow that is easy to understand. This text reminds me of Dubins' "Understanding ECG's", in the way it is presented with immediate recall, and testing after each chapter. This method has been proven to increase comprehension level, which is nice. Pro and Con's" The text is straight forward, and very little anecdotal discussion is made. The graphics and artwork is excelled and Brady has outdone themselves on this. The 12 lead ECG's is very clear and not blurry like so many other EKG texts. The book is full of practice strips to immediately practice and entice readers to learn more. I do wish that was an accompany CD, but Bob still performs this lecture and class, which I highly recommend. There is not much discussion of treatment modalities, which also can be good or bad. Bad, not understanding the treatment, the good of it will not be outdated by protocol changes. Summary: Over-all I enjoyed reading 12 Lead ECG for acute and Critical Care Providers. It is not a thick book, approximately 300 pages with many of those being practice ECG's It is paper back which has its' advantages and disadvantages as well. I would definitely recommend one to read and keep this book as a reference book, material. One could read easily read this in one to two days. Ranking 1-poor 10 -excellent : I rank this textbook 8/10 Stars of Life Be sure to link to Amazon.com for EMT City to get credit for purchase.. remember to support our site!

Yes, that is true. For as not being insured to work prehospital, I believe is a crap excuse. I really doubt that is true, I do believe they told that but was not being honest. I am sure, that insurance company much rather cover the staff on a person that injured themselves on the hospital grounds, than to have to wait for EMS to arrive to deliver care in the parking lot of even walk way to ER. Yeah, let's worry about licensed health care workers providing emergency care, and not someone in full arrest or fell and bleeding, etc... hmmm don't think so. Far as special people .. why? Surely, all the ER nurses are required to attend ENA trauma nurse core curriculum class (TNCC) and advanced ATNCC. This class certifies, to place patients on LSB, CID, KED, and traction splinting, as well as removal of patients in an auto. Most ER requires this to be hired or employed as an ER nurse or should. Basically this is a 3 day mini-EMT course, that reviews and familiarizes nurses with most prehospital equipment to allow them to know how, why it used and works. As well of course the basics of trauma, patient assessment, treatment and spinal immobilization skills. R/r 911

So let me understand this, the service has a EMT "rookie" school, is this an EMT class, that the service has and pays you while you attend? or do they hire you and do OJT with some classes?...or are you an EMT already and the have an rookie academy, to fine tune new EMT's? R/r 911

As other noted of course spinal precautions, pay close attention to abdominal pain (LUQ), and as well not bolus him with to much fluid. Since this is really more of multiple fall and not a direct 20' fall, I would as well be monitoring a detail neuro assessment. Transport destination. it all depends what is the closet rated and what services that hey can provide, Level II can perform about as much as Level I. Rendezvous with helo possibly if closest does not have surgical suite availability. Remember, not all trauma patients require a Level I... R/r 911

That is why I stress treat appropriately, not so much accordingly. I disagree, that here in the U.S. I have seen more labs, med.'s ordered, and changed to new med.'s without ever seeing or getting a history of the patient. Internal medicine orders, to be changed by consult, cardiologist to be changed by pulmonolgists, to be changed by endocrinologist.. and on. Now, remind you there are test that accompany each as well. Far as inappropriate care, I believe it is important to justify anything you do... even from placing a splint to LSB, each could cause damage and maybe not needed. Med.'s as well, but at the same time not to ever withhold or second guess if they are needed. R/r 911

FYI for those that not aware.. Corodorone can increase the Digoxin, Lanoxin levels by 70%, as well as patients on Coumadin, Corodorone can increase their INR (clotting time) by 100%...........something to consider! R/r 911

Do realize Cordorone side effects? As well many studies are now defending that Cordorone works well as reducing ectopic beats, but in V-fib it has no higher benefits than Lidocaine. As well there is no"special study" to detect an irritable foci, unless we are checking electrolytes, checking hypoxia, observing ischemic changes...meanwhile. hoping she does not have another episode sudden death. Again, many are getting the knee jerk effect of giving Lidocaine. Please read the studies of the amount that was studied and what even is considered to be therapeutic level. A bolus of 100 mg, and even a drip 2 mg would not be considered enough to produce toxicity. Let's be reasonable. Again, if one is not able to obtain specific history on this individual, I would lean of administering an antiarrhythmic even if prophetically to reduce sudden V-fib. It would be hard to justify a "post arrest" and knowing she had a course of V-Fib, if had a re-current V-Fib and was unable to convert the rhythm again. Be safe, R/r 911

Cute..... R/r 911

I agree, I am not a big fan of M.S. on trauma, but remember you should have Narcan on hand just in case. Fentyl is a much wiser analgesic to use. I always find it amusing, to see old "war movies" where they administer M.S. then watch them die... well, that part may be true... R/r 911