Ridryder 911

Never.. I will not tolerate bad behvior, but yet again I don't off duty as well, but to really use authority ?.. I think we are getting way too much of ourselves.. Like Admin described this has been discussed several times... R/r 911

Yes, way too much. Usually the bad calls, turn out worse, than they were... R/r 911

I prefer to give just enough Narcan to increase the respiratory drive.. so one has to remember if they are not inhaling ot will take a lot longer to work through mucosa membrane. The same is true that you have to be cautious of "suddenly awakening" your patient. Again, many use Narcan for a broad spand of medications.. and questionable if appropiate or not. Personally, I feel what the heck.. if it works great! Be safe, R/r 911

So true.. we just started implementing EtCo2 as a routine procedure. I have a video lecture from Dr. Krauss, when he gave a lecture locally it is about 2 hrs long. You thought it was the end of the world, when I required them to attend. Fortunately, they have seen the need and the benefits of understanding the capability of your equipment and of course good sound clinical examination and judgement. More than the .. we use it for :__________ Whenever and if EMS matures into a true profession and maybe we can recruit professional minded people. Hopefully, medical school students don't complain about learning new things and ideas ! R/r 911

Is it the citizen(s) clueless or EMS ?.. again, why should we be authorized to wear a badge ? Maybe, EMS should take a hint ... from the public, we are the ones that are clueless. R/r 911

Narcan given inhaled route has been popular for a couple of decades now. Although, the "atomizer" is a newer approach. Great idea, for those you cannot get a line on.. R/r 911

Does your state not have a EMS Registry Data Report ?.. Most states require an annual report including the average response times, number of personnel etc.. that way they to obtain Federal Funding, grants, etc... contact your state EMS agency to see, they should have everything on file. Good luck, R/r 911

WOW !.. I haven't seen EMT badges in so long.. I thought they were extinct, if it was not for the forums. If you wore a badge around here, the cops would arrest you for impersonation. Not even the F.D. wear badges anymore. Like Dust and so many others have stated.. wrong profession. I am medical, not public service. I have no authority over anyone .. so why would I need badge ? Let my actions & behavior demonstrate of what & whom I am .. R/r 911

They should had just put him in a MRI.. they would had came out!... Reminds of a suicide attempt, I worked. Where a male attempted drilling 6 holes in his head to let the pressure out... he had made depth not totally penetrating the skull, and he had his hair caught in the drill bit.. ouch... R/r 911

Very Good Ak !.. I even inform Doc's even sometimes : "Are you sure ?".. or did you see this ?... Even all of us sometimes will not see the whole picture or not hear something in the history. I don't know how many times I have Doc's, nurses etc.. thank me afterwords... the same I do for them as well. It is a team approach, yes the Medic is the Captain, but this does not mean they are the ruler. If they get upset, because you suggested or informed them something appropriately, they need an attitude adjustment. I know I rather have my EMT tell me something than to make an error... in which, later I found out they knew about & allowed to me to make.. they would held just as responsible as I would for making the error. Be safe, R/r 911

Man, this is one getting deep.. Neuro is not here yet ?.. Since, she is sedated & on a vent., I would probably try to either load her up on cerebyx or maybe after consulting with the nuero team on suggestions, possible deep heavy sedation to see if any changes of EEG ?.. Although, it will be forever to run, start the usual lab's and maybe see if toxicology comes with something I am sure I am missing something that is obvious. It's the usual 2 a.m. like in real life.. too much coffee... Hopefully, we can see something altered in her labs, order the usual CBC, CMP, BLDCLTRS., U/A.. anything remarkable on physical examination, since we have knocked her down and altered our p.e., that has not been earlier recognized ?.. I would try to get a better hx. if possible from the spouse.. unusual food (cooked or uncooked), related illness in family or those that was on the trip ?.... R/r 911

First Welcome to the City ! Second, your rule should be basics should not administering medications.. short & simple. If you are able to "push medications" as you elude, you should be at an advanced level. " Pushing the medication" is not the hard part..knowing what it is doing the moment you have it in the bloodstream, at the cellular level is more complex.. life would not be so difficult if all it involved was the skill area... I didn't know Texas allowed basics to administer IV medications ?.. hmmm p.s. we welcome you again, but it is courtesy not to use ALL CAPS... R/r 911

It should be..or at lest you would think it would be. But, I digress, I don't think it is. I just lectured some EMS Instructors on EtCo2 the other day, and they knew nothing about it other than some simple articles from JEMS etc.. Again, sometimes the blind leading the blind..... I feel like EMS is sometime like a dog chasing its own tail.... very queasy feeling and getting no where... Be safe, R/r 911

I agre with the mask & decon room.. once we can get the seizures to stop a CT would be nice, then maybe later on a LP.. after some more labs...might as well have lab, just bring everything down...LOL R/r 911

Not always..!!!! It too depends upon your location! I know many RN's with all the whiz bang titles & 10 yrs experience, that are only making $25 an hr. & that is a nighttime shift as well... Most travel nurses make between $25 -35/hr avg, but usually only have 13 week assignments & usually no benefits & usually require a minimum 2 yr experience. I went back into the field so I could make more money.. seriously.. I make the same yearly and work PRN as a RN, so my salary is much more than usual staff as PRN. In the Midwest, most RN basic rates start at $16-18/hr then yes, with shift, week-end, and cert's can add up .. not all hospitals pay for specialty certs..(the most I ever got was a $2.00 hr difference with 5 specialty certs..that is why so many do not take the test) and usually most new grads start at nighttime (until you pay your dues) or someone dies or does not like working with the brass or management. The old saying "If it looks too good... it is!" ... be cautious on every profession... R/r 911

Good points AKmedik8or; however I disagree with your action. Yes, there is a chance of hyperkelemia but, I might choose another paralytic other than Sux., that does not a high effect K+ shift .. I would highly recommend using some form of benzo or CNS agent to depress the clonic movements and secure the airway. If the sz activity continues, such as nasal versed, etc.. This is of course status occurs.. The usual neuro hx. questions, fever, trauma, illness in which you might want to re-literate. As well any "special pets".. or plants/herbs ?.. such as spiders, snakes & all those things that makes my skin craw.. since they too carry neuro toxic agents as well... Be safe, R/r 911

I thought it was quinine toxicity as well. I don't see quinine used as often as it was once used. Congrat's on the Dx. Chbare.. and the "thinker of a scenario " ERDoc as usual.. you made my brain hurt...LOL R/r 911

Again, another point for rationale of knowing what you are measuring, and what it means, more than "using the equipment. I would estimate >90% of EMS personal, does not know much about pulse oximetry, EtC02 capnography and the fundamentals of what, how and the significance of the device. If one was to really study outcome base criteria on use of equipment, very few medics (over-all) would pass the grade. R/r 911

I did a formal lit research, and could not find it. It might not be scanned. Here is some related links that discusses that same topic/article : Appearantly they revised the article and placed a continuation on it.. http://www.jems.com/jems/24-3/18408/ Good luck, R/r 911

This should be tattooed on every medic's left forearm, so when they intubate they can see this ! This is why I am such a proponent of clinically evaluating patients and using EtCo2 & Sp02 appropiately as adjunct. Unfortunatley, we have abandoned teaching oxygen-Hgb curve.. we are to worried to teach them to use of Epi pens, activiated charcoal, etc.. that they might use every 10 years ! R/r 911

The funny thing about education & instructors (notice I did not call them educators.. there really is a difference) is anyone knows one make the test whatever difficulty they like it to be. I can write one .. most could never pass or write one where no one would fail... all over the same subject(s). It has to do with test writing capabilities, presentation of material(s), need to know of in-depth's, etc... What is the difference between Harvard Medical School and all others?.. they use the same literature, probably the same texts, etc.. it is the requirements & demands they place the students.. more in-depth, extra material, and research. When evaluating schools, look at their track record of passing first time on boards and licenses. Look at the students ability to be employed immediately afterwards, and the history of the instructors. An instructor should have the minimum of at least 5-10 clinical years at the level they are teaching at. Evaluate clinical settings, mannequin situations are fine for classroom, but poor clinical sites and areas, should not be tolerated. Any institution not requiring O.R. intubations on live patients, ICU areas where exposure of chest tubes, arterial lines, arrhythmia therapy, as well as neonate and pediatrics ER settings has failed to demonstrate the needed clinical objectives. Short & simple... if your program does not have these you are getting short changed... It is your money & time more important it is your career choice..! Make a wise decision... R/r 911

Heres an idea.. 1 level.. Paramedic.. okay. 2 - EMT & Paramedic..Wow! that was hard... Heres a new one EMT- Intermediate, Defibrillation, Intravenous, Orbutrator, Technician or for short........ EMT/ I.D.I.O.T. R/r 911

SpO2 estimates the arterial hemoglobin saturation (SaO2) .. Remember, we are actually guessing what the saturation level of the arterial oxygenation is with a Sp02 monitor, true SaO2 would be performed with arterial blood gases... R/r 911

I agree Dust, there are 2 things I do when I inspect an EMS unit. I check the KED and suction unit. If the KED looks like it is brand new and the suction unit still has the original tubing .... I cringe ! R/r 911