Ridryder 911

Whit, might want to call a statistician as well... find out what the definition of "skewed" is as well.. it is a normal part of standard deviation, and usually is encompassed in normal findings... :wink: R/r 911

Have not seen it YET... in the south midwest.. but give us a few days...they love cutting and diluting stuff down with any thing they can... R/r 911

Damn no porn! But weight loss products in German .. would'nt you know... :?

Just like many ways of education this can be an asset. However; never to replace some of the traditional way of one on one teaching. Used as an alternative yes, it is definitely helpful. My EMS is considering placing such a program for it ease to use, the availability and as well it keeps track of CEU hours etc.. now the downside. The hospital I work for has it.. spent hundreds of thousands of dollars to designing such etc.. Yes, people use them (they have to) but they fast forward the videos, someone writes or copies the answers down so one can literally skip thorough it... main point, no one benefited, wasted time, money and effort if not used properly. Like I described used as an adjunct to traditional CEU's, a great alternative and tool..... R/r 911

A lot of EMS are city divisions, this allows for open for public records. I know of many communities that immediately disclose if there is a LEO, firefighter, or EMS that has been charged. This is public record if you work for the public. Again, even if it is just charges they can publish discuss that charges or investigation is taking place. I have even seen them publish salaries, this is one of the disadvantages of working for a local governmental employer. Most cities as well have "moral" and "public image" clauses written in their policies. Describing if an event occurred that would cause embarrassment or shame to the city, one can be discharged as well. For as med.'s missing, most have an immediate UDS and testing. If there is enough suspicion of behavior and physical attributes to cause suspicion this may grounds enough for immediate dismissal. I have never seen a service, place administrative leave on narc problems.. usually they have already built a case when they bust someone... the removal of license and certification, usually comes later. R/r 911

Well its official ...............this site has just went to the dogs! :wink:

Okay.. common sense time .... kiddies. So you are going to pay > $100 for a stethoscope huh?.. maybe I should start selling them... (lol) So can you identify S[sub:f423b3e98b]3[/sub:f423b3e98b] S[sub:f423b3e98b]4[/sub:f423b3e98b], atrial kick, crescendo -decrescendo murmurs or clicks with split clicks?.. You guys understand this right and can identify these in < minute auscultation and of course you know where tricuspid is louder etc...... Point being, having a cardio scope, doppler, etc.. and not knowing the substance is the same comparrision of having red lights and a 100 pound personal Randy Rescue Kit.. in your car.. it's still the whacker syndrome.. Be wise, learn auscultation techniques, know what each specific etiology and area means and accordant treatment ... then purchase the biggest stethoscope you can!... Good luck ! R/r 911

I still say it is not what you put in your ear, it is what is betweeen them that counts..... R/r 911

The only problems I now have is new state dooper.. uh I mean troopers. For some reason they want to maintain an open lane next to the bird and sometimes refuse to close a lane for the helo.. They already had 2 medics killed and 2 firefighters killed for their new "brown shirt' attitudes. Hopefully, we won't have any more needless deaths. For as refusing.. it is stupid to refuse extra hands, but as a flight/nurse/medic I can assure... more than 4 is too many near a rotating blade. Too many people to control and have a safe scene... R/r911

Great posts Spock... I just did a clinical presentation on pain management and the perception of health care workers. Basically, they studied the ratings patients gave and then the ratings triage nurses and in-house ER nurses gave. Remarkably, there were times that the nurse underrated the pain by as much as 48% of the time. This as well as on the 1- 10 scale, being up to 4 points off .... ( I can cite literature if you request...) The most closes were orthopedic injuries and the farthest away form being accurate were abdominal pain. The most closest nurses to giving pain med.s were burn center nurses... Short and simple, if our patient is in pain... give them med.'s .. if they are drug seeking treat accordingly.. notify physician for deviation or more appropriate orders. Use common sense... (wow ..new concept) We way under-medicate pain control... the tuff cowboy era is over... R/r 911

With the price of Diesel increasing we have converted over to Mentos and Diet Coke.... increased speed... just hard to have your partner keep feeding those damn candies.... :wink:

That is nice you care so much for your spouse and I do understand the feeling of absence. For a 2 week rotation that is not too bad. Most healthcare professionals are routinely assigned night shifts until they have reached seniority, to get a day time position. I know at some places this may take several years, or even work 24 hr shifts. In the nursing world it is not unusual to work night shifts more than 5 ears before even being considered for a daytime position. Some helpful, hints from one whom worked nights for a while. Let him have some peace time.. and sleep. Try to have activities at night, when he is awake. It is hard for the circadian cycle to change to adapt to family life. Be patient.. he might be more moody than usual.. deep down he may not like it much too but aware there is not much he can do about it. Hang in there.. goo luck ! R/r 911

The Doc's got it.. SSS Something I don't like patient's to have ... R/r 911

Here is one last more, this one drinking & driving ... wow !.pretty impressive. Maybe this is something NAEMT should produce and distribute, in to maintain our professional image & promote injury prevention. http://www.youtube.com/watch?v=RPjNxAgOaUM...earch=Paramedic Be safe, R/r 911

Here are some excellent sites for EMS and capnography.. my mentor on capnography Dr. Krauss 1'st is ppt presentations ... http://www.tdh.state.tx.us/hcqs/ems/Krauss...Capnography.pdf http://www2.us.elsevierhealth.com/inst/ser...;id=ajem0301028 http://emscapnography.blogspot.com/2006/05...hould-know.html http://www.oridion.com/english/capnography...vironments/ems/ http://www.enw.org/ETCO2inCPR.htm I thought this was interesting as well. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Silvestri S, Ralls GA, Krauss B, Thundiyil J, Rothrock SG, Senn A, Carter E, Falk J. Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA. ems.medicaldirector@ocfl.net STUDY OBJECTIVE: We evaluate the association between out-of-hospital use of continuous end-tidal carbon dioxide (ETCO2) monitoring and unrecognized misplaced intubations within a regional emergency medical services (EMS) system. METHODS: This was a prospective, observational study, conducted during a 10-month period, on all patients arriving at a regional Level I trauma center emergency department who underwent out-of-hospital endotracheal intubation. The regional EMS system that serves the trauma service area is composed of multiple countywide systems containing numerous EMS agencies. Some of the EMS agencies had independently implemented continuous ETCO2 monitoring before the start of the study. The main outcome measure was the unrecognized misplaced intubation rate with and without use of continuous ETCO2 monitoring. RESULTS: Two hundred forty-eight patients received out-of-hospital airway management, of whom 153 received intubation. Of the 153 patients, 93 (61%) had continuous ETCO2 monitoring, and 60 (39%) did not. Forty-nine (32%) were medical patients, 104 (68%) were trauma patients, and 51 (33%) were in cardiac arrest. The overall incidence of unrecognized misplaced intubations was 9%. The rate of unrecognized misplaced intubations in the group for whom continuous ETCO2 monitoring was used was zero, and the rate in the group for whom continuous ETCO2 monitoring was not used was 23.3% (95% confidence interval 13.4% to 36.0%). CONCLUSION: No unrecognized misplaced intubations were found in patients for whom paramedics used continuous ETCO2 monitoring. Failure to use continuous ETCO2 monitoring was associated with a 23% unrecognized misplaced intubation rate and another point WASHINGTON, DC—Emergency medicine researchers have found that paramedics are more likely to recognize a patient’s breathing tube was placed incorrectly if they monitor end-tidal (exhaled) CO2 continuously. However, the study’s authors note that not all out-of-hospital personnel use this method of treatment. The study will be published online today as an early release by Annals of Emergency Medicine and will appear in the journal’s May 2005 print edition (The Effectiveness of Out-of-Hospital Use of Continuous End-tidal Carbon Dioxide Monitoring on the Rate of Unrecognized Misplaced Intubation within a Regional Emergency Medical Services System). Routinely, paramedics and other emergency medical personnel perform endotracheal intubation, an emergency medical procedure, which requires placing a flexible, clear, plastic breathing tube down into the trachea to help air pass freely to and from the lungs. When a breathing tube is unwittingly misplaced in a patient’s esophagus rather than the trachea, or becomes dislodged during patient movement and is not recognized and corrected, it can cause life-threatening complications by sending oxygen to the stomach instead of the lungs. These complications can lead not only to insufficient ventilation, but also to stomach rupture, airway trauma, irreversible damage to the heart or brain, or even death. Of the 153 patients who were intubated before arriving at a regional level I trauma center emergency department, 93 (61 percent) had received continuous end-tidal CO2 (ETCO2) monitoring and 60 (39 percent) did not. The rate of unrecognized misplaced intubations in the group who received ETCO2 monitoring was zero, and 23.3 percent in the group who did not receive it. The study, which took place over a 10-month period, involved about 45 EMS agencies from 10 different counties in Florida. Researchers were able to identify that about half (21) of the EMS agencies did not use continuous ETCO2 monitoring on intubated patients. End-tidal CO2 detectors are listed among a standardized list of equipment for ambulances jointly published by the American College of Emergency Physicians and the American College of Surgeons. However, researchers say not all ambulances meet these standards. "There have been many studies demonstrating that sole utilization of clinical confirmation of tube location is unreliable, but research is now showing us that with the right equipment paramedics can monitor tube location much more safely and effectively," said Salvatore Silvestri, MD, Medical Director of the Orange County EMS System in Orange County, Florida. "The evidence presented in our study may persuade more EMS systems to consider equipping their ambulances with continuous end-tidal CO2 detection capabilities." I agree it is ONLY a tool and does not replace assessment by any means, but should be used as an adjunct . My friend and cardiac mentor Bob Page describes :"End Tidal CO2 reading without a waveform is like a heart rate without an ECG recording.” .. R/r 911

Thanks.. yeah, I had seen it & cold not locate it... good points as well good demo of coup counter coup syndrome and M.O.I. .. (god, we are sick aren't we?) .. ... These should be played about this time of year everywhere when school is getting out... shame Mtv or similar does not play these type ...... Dr. Bledsoe liked this one : http://www.youtube.com/watch?v=HBu55k5Oc4k...search=seatbelt R/r 911

I agree with ERDOC, he is higher trained; however he cannot work at that level since he is technically off duty. Actually, since your other friend was a an EMT ? he was officially the highest trained individual. She should had released control to him... moment, she was rude or "spazzing" I would had totally removed myself from the scene. She wants to act unprofessional and poor conduct suffer the consequences then. (Of course we are hearing only one side of the story) I would discuss with her afterwards in private, if she apologized, for her behavior then I might re-consider.. although doubtful. If she did not, I would report her for unprofessional conduct and behavior.. have your other friend as a witness of this. If she cannot handle herself or her behavior on something that trivial, she has no business in rescue operations. Time to get a new job @ Wendy's... R/r 911

That is a great site.. as well as many others. I highly suggest you search for any articles written by Dr. Krauss, he is a emergency physician that is pro-EMS capnography... check JEMS and this months JEMS Capnography for triage written by him as well. CHF will produce normal wave forms however you may have a different set of Co[sub:86b0bedbc5]2[/sub:86b0bedbc5] level. Remember, CHF is not obstructive but congestive at the capillary level... R/r 911

Although I totally agree with what everyone is saying, we have a problem.... a big problem. There are so many patients that fall through the crack... For example.. granny who falls, no hip fracture, however; cannot bare weight and needs assistance has friends to check on her later.. Not a stretcher patient, but definitely if I was the ER Doc, I would not send in a cab alone, unless you want to see her again, in a few minutes & with our attorney later. This is the dilemma... and it is only going to get worse!. We are going to have more and more ambulatory with assistance and potential risks for fall patients that do not meet admission criteria, however cannot get into a vehicle or walk up flight of stairs etc.. without risks. So the solution ...more w/c vans, supplemental reimbursements for non-emergency transports, ?? Who knows... we are on the ship Titanic & we have just seen the tip of the iceberg.. R/r 911

I am waiting for the "Tele Tibbies EMS Instruction Video".... R/r 911

I think one should be pacing by now.... actually those appear to escape fusion beats trying to increase the heart rate. I disagree with AVR, too slow and there the R-R is regular as well as some discernible P" waves... Great strip... R/r 911

After viewing some of EMS videos, I noticed some straight forward awakening videos of injury prevention... unfortunately, they appear not to be any from the USA. This makes me wonder why ours is so watered down in comparison? For example spilling coffee and ramming into rear end only next clip with laughing calling insurance agent... "like a good neighbor" Now review foreign ones...quite a bit of contrast; they get the point across... http://www.youtube.com/watch?v=LYeUMkRMAts...earch=Paramedic http://www.youtube.com/watch?v=Qvht1d5GVHk...earch=Paramedic http://www.youtube.com/watch?v=pWygwnAo3zs...earch=Paramedic Think maybe it would get the hint more across? R/r 911

Bad ALS= DEAD PATIENT Good ALS= DEAD PATIENT Bad BLS= NO CHANCE IN HELL ! Good BLS= DEAD PATIENT CONCLUSION PATIENTS DIE... short and simple, there is very "few" saves out there. This is part of the problems of EMT's today, unrealistic expectations... you may get 1 or 2 saves per 50 or hundred. If you don't count them dying shortly after... really resuscitations is about 1 in 500 maybe. Even 20/20 had a repeat documentary on how the public's expectations of cardiac arrest and saves is way overrated.. so is our professions as well. Now I will admit that this job is important, even more so we do it as the best as we can. It is our JOB to attempt to resuscitate and save a life... but the chances are against you. Even though we did not create that rule, we just have to deal with it. Stabilizing for transport (within common sense) and administering BLS or ALS most of the time is not enough, people will die.. no matter what we do. The reason I am being so blunt, I have had the fortunate event to assist in teaching a Basic class this week...Wow the expectations of some is incredible ! Now, I am not pessimistic, I am a realist.. the numbers are there, facts don't lie... There are very few we save ... I don't care how good or how much ALS, med.'s . electricity, or the old "diesel medicine".. you loos a heck of a lot more than we save... thank goodness we don't get paid based on our + results... No trying to bust chops... just a little reality check.... R/r 911

Maybe, he has a "special laryngscope"... ... Apparently students.. other the cue it is a mannequin, maybe the one with the stethoscope should pointed that out.... R/r 911

Ouch... I wonder if the truck driver was hurt?... R/r 911