chbare

Ruffems, I agree with your point. If you are employed as a first responder and you have the job description as a first responder, than you are a first responder. I would have no problem giving over patient care. Of course, state law and regulations come into play; however, all of that not playing a role in the transition of patient care, I would have to hand over care. It is that simple, my RN license does not come into play unless I am actually working as an RN. Even then, I transfer care over to EMT's and paramedics all day long. Patient transfers are quite common and I do not see nurses taking up arms because they have to place patient care into the hands of the EMS/transport crew. Usually, we are more than happy to get the patient out of our facility. So, the transition of care "pride" issue may be more situational. I simply do not see how letting a first responder volly squad have access to placing IV lines is of great benefit to patient care. IMHO, the time, effort, finances, and resources could be used to push for the formation of a paid professional service. I agree with you, pushing for a full time ALS service would be the best choice rather than pushing to allow specific people on specific days to provide one intervention. Even if we can perform IV therapy, what is the great benefit to patient care and how will this effect outcomes? Having a medlock or IV of NS will not help the cardiac arrest patient. In addition, look at much of the research on trauma, allot of people are no longer emphasizing aggressive fluid resuscitation and in fact fluid resuscitation may cause more harm. Many critical trauma patients seem do better we simply load their butt into the back of our car and drive like hell to the hospital. I think we had a "homeboy" EMS thread on that topic earlier, so I will not digress from the topic on hand. I know the, "it will help the ALS provider when they show up" argument will be thrown out for discussion. Come on now, how long does it take to place an IV? So, where is the great payoff? Vicki Johnson, this is not a personal attack and do not take it as such. I am looking at this as a patient care issue, and I am not finding any significant benefit to letting first responders place peripheral IV lines. Take care, chbare.

"I think this is a terrible idea. Is our field really this procedure-crazy? Separating skills from the providers capable of utilizing them is a horrible plan, and really serves no purpose other than allowing first responders to "play" before the ALS arrives. This would increase chances of infection, complicate the transfer of medical care, and potentially cause harm to patients through emphasis on the wrong treatments. I understand you are a RN, but when you are working as a firefighter you are a first responder, and that is it. On a code you should be providing CPR and ventilations, nothing more. I personally believe that - unless there is a special arrangement like in the hospital - the person responsible for the patient's care should be in charge of when/how/where procedures are done. Performing "advanced" skills prior to fully understanding the patient's condition on the ALS level is inappropriate and potentially dangerous." OWNED Take care, chbare.

Congrats! Take care, chbare.

Looks like acute injury to the inferior wall. We need rapid transport and more than one IV life line. We will of course need to monitor this patient closely and I would also get a right sided ECG. In a patient so young, we should consider drug use first in spite the above history of no drug use. We must also rule out congenital defects, Kawasaki Disease, and anomalous left coronary artery origin from the pulmonary artery. In any event, medications that reduce preload could be met with disastrous results. Take care, chbare.

AnthonyM84, that is great advice. There are several nursing scholarships, financial aid, federally subsidized low interest loans, and the military to look at. In addition, some of the programs allow you to test out for your LPN half way through your course. I was able to do this as a nursing student and work for about $18.00 an hour in a nursing home for a year. Much better than the $5.00 an hour I was making as an EMT prior to my LPN job. Take care, chbare.

We do not use it on every patient who receives Succ. Remember the physiology of Succ. It is a non-competitive depolarizing NMB. So, it essentially creates a sustained state of depolarization. Remember when a cell depolarized, potassium shifts out of the cell. In patients who are hyperkalemic, (such as renal failure, burns, specific neuromuscular disorders, and electrical injuries) this additional increase in serum potassium can be enough to cause cardiac conduction problems. High serum levels of serum potassium inhibits proper cell membrane repolarization. Calcium chloride provides a stop gap treatment that will temporarily stabilize the cardiac cell membrane. Essentially, it will help to stabilize the ionic cell membrane potential. However, you are only looking at about 45-60 minutes of bought time, so you will need to follow up with other treatments. (Insulin, dextrose, albuterol, etc.) Take care, chbare.

I have never hear of using CaCl- for premedication. The only plausible situation I can think of is using it if we inadvertently used succ on a patient with hyperkalemia or caused hyperkalemia on a patient with underlying pathology. Take care, chbare.

Per my prior post, I would hesitate to say that baroreceptor stimulation is the only mechanism of action behind the bradycardia seen in Cushing's triad. Take care, chbare.

I have seen both terms used interchangeably. The changes in breathing can be anything from Apnea to Biot's to Cheyne-Stokes. Different locations of lesions and type of herniation can effect the type of breathing pattern. For example, Biot's has an association with pontine or medullary dysfunction. -Three general concepts fall under the umbrella of Cushing's Triad. I think the confusion comes from how the three concepts are described. 1) Heart Rate -slows down 2) Respirations -changes 3) Blood pressure -elevated -widened pulse pressure Take care, chbare.

I have heard a couple of different explanations. -The stimulation of baroreceptors by elevated B/P as described above. -I have also been told that actual pressure and ischemia of the brain stem causes the changes. Some people think that the bradycardia may be independent of the blood pressure. In any case, bradycardia is most often a very late sign. Take care, chbare.

Not here, perhaps it is a helpful idea to help keep immunizations current. Not all that helpful for people with tetanus prone wounds. The immunization will take up to a couple of weeks before immunity occurs. A TIG would be needed in these patients. Take care, chbare.

http://www.cajuncreations.com/detail.aspx?ID=83 You can get a nice four pound turducken roll for $30.00, not exactly "rich mans" food. Take care, chbare.

I rather like them. Had one with shrimp and crawfish stuffing over thanksgiving. Quite tasty IMHO. Take care, chbare.

Oh brother... :roll: First, there are many different levels of medical education in the Army. You have entry level providers, to LPN's, to special operations medics, to 18D's. I would be very careful when shooting out sweeping generalizations regarding all "medics." Next, do you honestly think a line medic needs to worry about dealing with chest pain following an IED explosion with multiple causalities and an unsecured scene? Many people are coming back home alive due to improved point of wounding trauma care. ( Aggressive hemorrhage control and timely evacuation.) It only makes sense to focus on what saves lives in theater. In addition, we need to consider the demographics of these line units. Younger and generally more fit than the average Joe US citizen. So, in depth medical issues are not as emphasized. Also, seriously ill or injured people will be evaced to a MTF if the front line provider cannot care for the problem in most cases. You need to appreciate that there is a delta between the "field" we work in and the "field" that military medics work in. Remember, at the MTF, there will be nurses, docs, and support people that can deal with medical problems. Finally, I know several medics that are actually quite good with medical subjects. Their ambulatory medicine knowledge is actually top notch. Please correct my erroneous thinking if I am in fact way off base here. Take care, chbare.

That has been my experience. In nearly every case I can remember, the ground crew cancels us enroute or prior to us launching. We simply turn around and cancel the mission. No fuss, very simple. I am at a loss to see why we have so many pages of fuss. Take care, chbare.

Actually, a couple of things lead me to question the diagnosis of ventricular tachycardia. First, a down and dirty 3 lead axis determination does not indicated right shoulder deviation. It actually looks like pathologic LAD. Second, pathologic LAD is commonly associated with a left anterior fascicular hemiblock. If we look at this as something other that VT, then we can also appreciate a RBB as well. LAFHB + RBB leads us down the path of a bifascicular block. What is the patient's past and present medical history? Take care, chbare.

Where I fly, I have more freedom than I do working in the hospital; however, I still work under guidelines and a medical director. I do not know of any flight services where RN's are independent practitioners. My scope of practice is dictated by my medical director. What service uses RN's that do not work under the guidance of medical direction? On to the original topic? I have never experienced this problem and I an unaware of this being a problem with other crews I know. We have had situations were flight crews thought flying was inappropriate, but the ground wanted the patient flown. Not the other way around. :-k Take care, chbare.

If you want to play doctor, do not waste time and energy going through medic school, nursing school, and a PHRN program. Focus on your pre-med courses and make your goal medical school. You are looking at a year of medic school, then another year or more to complete nursing school if you medic credits have cross over. While the credits from these courses should count toward some of your pre-med courses, you will still need to complete upper level math and science courses in most cases. I find that it would be much better to put your time and resources into completing medical school. You should have several years of medical school and a residency to figure out how to take care of people. Take care, chbare.

Allot of mud throwing from both sides. Sometimes it is hard to appreciate the other side when all you know is your little part of the world. I agree that EMS exposure is a great thing for Nurses. In addition, with the aging population, we will only see more SNF and LTC patients in our practice and agree that a paramedic could benefit from this experience. I think the benefit would both be from an understanding of the nurses job and educational perspective. You see many kinds of modalities at these facilities. Wound care devices, invasive feeding devices, and CPAP/BIPAP devices to think of a few. In addition, these facilities are target rich in terms of different diseases and medications. This is a great area to appreciate the pulse of an A-fib patient, assess heart tone abnormalities, and see patients with chronic conditions. Take care, chbare.

5 mg of Midazolam IM to a guy in status, and the doc was yelling? It was two for one day for a** h**** in the ER. Take care, chbare.

Will do. Take care, chbare.

Yes, it looks like I will be moving on to other aspects of nursing. I have had a great year plus of flight experience, met some great people, and have had great learning opportunities. I still plan to fly part time if possible. At present I will be working as a "Nurcenary" and selling out 13 weeks of my life to the ER who pays the most. Take care, chbare.

I think AZCEP was stating the axis was normal. It was just a little to the left in the normal range. The R axis is 15. This is within the normal axis range. 0 to -30 would put you in the physiologic LAD range, so 15 is a little closer to the left. Overall, the 12 lead looks pretty unremarkable. Take care, chbare.

On an off topic serious note. NG/OG tube placement and gastric decompression can save more than a work uniform. This can actually improve ventilation and oxygenation, decrease insp. pressures, reduce aspiration risk, and score style points. Take care, chbare.

It shares many of the same pitfalls of the ETC. Yes, you can still cause damage if you cram the device into the airway. The tube is rigid much like an ETC or ETT. Some of the potential benefits over the ETC: -Only one port for inflation. So, you need not remember what blue #1 and white #2 mean. -Only one port for ventilation. Again, this leads to less confusion. -The new Kings have a built in gastric port and you would have extreme difficulty using it to ventilate. (If you were in a hurry and forget that the connector end of the tube fits the BVM.) -The king has somewhat of an elliptical shape that ensures placement into the esophagus. As I understand, people were unable to place the king into the trachea using laryngeoscopy. However, I would never say never. -A bougie can be placed through the King and you can attempt a device change out with an ETT provided you place the bougie into the trachea. -The King seems to work with lower inflation pressures. This may prevent trauma and tissue necrosis. The distal end of the King has a blunt tip that is much softer than the ETC, so this may lead to a decrease in trauma as well. -The king can provide ventilation with airway pressures over 30 cm/H20. Overall, I can see several advantages. The King does come in different sizes and you need to inflate the king with a specific amount of air depending on the size. I would not call it idiot proof, but I would say it is nearly Nurse proof. Take care, chbare.