chbare

Xnekal, this bring up a point that I have commented on in the past. It seems that people do not understand the purpose of using a LMA in the prehospital environment. The LMA is a rescue device not a primary method of airway management. True, the LMA offers little to no passive aspiration protection; however, we use the LMA as a temporary emergency method to establish some kind of airway in the patient with a failed airway. (This also includes a cannot mask ventilate situation.) In most cases we are talking about different situations when we compare OR and prehospital LMA uses. Take care, chbare.

This finding is pretty common among the clients that utilize the emergency medical services of our nation. I have seen "Professional" drinkers that have levels in the 400's, and these people are ambulatory, ao times3, and have clear speech. This topic does create some interesting discussion on the effects of acute alcohol intoxication. In the "alcohol naive" patient you need to worry about a couple of things. First, we all know about the depressant effects of alcohol on the CNS and the danger of hypoventilation, loss of airway reflexes, and aspiration risk. In addition, we need to worry about another problem. High levels of alcohol in the body can also prevent our hemoglobin from properly loading, transporting, and offloading oxygen. This is known as histotoxic hypoxia. The red blood cells are essentially poisoned and unable to effectively function in the transport of oxygen. We usually associate histotoxic hypoxia with other problems such as cyanide exposure; however, it is possible with alcohol intoxication. This can result in continued hypoxia even after an airway is secured and the patient is on a vent. So, we can see how long term problems such as, cerebral hypoxia can still occur even with adequate airway management techniques. Take care, chbare.

Off topic; however, a little pearl related to the discussion. Heart transplant patients will not have a response to atropine as well. This too is related to the separation of the heart from the nervous system. In addition, heart transplant patients will not experience typical symptoms of AMI. Often, a chief complaint of dyspnea or CHF like S/S are seen in the heart transplant patient experiencing acute cardiac problems. Take care, chbare.

LR, D5W, & NS. Take care, chbare.

Good topic to debate. Let us ask this qustion. How much are we really helping a patient when we give nitro spray? Does the benefit in fact outweigh the risk of giving this med without a way of treating for side effects?( Well documented and well known side effects.) Are we actually helping our patients and does the evidence back up the practice of giving nitro without IV access? In addition, we must also consider the patient that will receive the nito. True, people take nitro all of the time, however, we must consider the reason our patient calls EMS. We will most likely be dealing with an acute change in the patient's base line condition. Even our chronic angina pt can have acute changes and will call EMS because something is different. We must consider this and never take lightly the fact that we are giving a patient without IV access 400 micrograms of a substance that will interact with our patient's physiology. (nitric oxide in the case of nitro) Remember, if you drop your pressure from nitro, you are most likely looking at a loss of preload. I would not bet my patient's perfusion status on elevating the legs to compensate for a loss of preload. The best treatment will be fluids. (Well known in the case of a right ventricular infarct ) Let's take an objective look at this debate and do what is going to led to the best possible patient outcome. Take care, chbare.

Cfaulknor, depends on the patient and the situation. In an acutely ill or injured patient I focus on two things. First, the primary assessment to identify immediate life threats. Second, a detailed exam to identify potential life threats. As you well know, in some cases we may not even complete a detailed exam. I.e.: a multitrauma pt with facial trauma, altered LOC, and an obstructed airway. You may not go beyond airway in this guy. However, in many cases we actually assess more than we think. For example; look at the 12 cranial nerves. By just talking with a patient and having him/her shrug, smile, and stick out their tongue, while we assess pupils and EOM's will actually test the integrity of several cranial nerves. In addition, common sense should prevail. If we are taking care of an unrestrained driver who hit the steering wheel at 60 MPH with 6' of intrusion, severe resp distress, and absent lung sounds on one side, we should be able to identify the life threat without percussion. It really comes down to situation and circumstances and using sound clinical judgment when deciding what assessment techniques and styles are appropriate for a given situation. Take care, chbare.

Shira_emt, I agree with Somedic. You provided the best care possible negotiated a very difficult call. One thing we must remember is that we are not responsible or accountable for all of the bad things that occur in this world. It may sound cold; however, I was nearly eaten alive by feelings of frustration, guilt, and extreme sarcasm as a new medical provider. In my first year as an ER RN I experienced several traumatic pedi deaths. Some of the deaths were related to abuse. (a few were horrific abuse cases) All we can hope to do is provide the best care possible and provide that care in a compassionate and therapeutic way to the best of our abilities. However, we are just human and cannot fix everything. In addition, we as individuals have the right to be happy and live a happy life. Sometimes we have to step back and take care of ourselves. I do not mean to imply that we turn off all emotions or become apathetic, however, we need to realize and accept that we cannot control every outcome and sometimes we cannot fix a bad situation. I hope that you find this helpful. This is just my philosophy on things and this is how I deal with the stress and horrible situations. Take care, chbare.

"...it would seem to indicate that the further you are from a hospital the more beneficial paramedic level care can be." If this trend could be proven in other countries, (Say the USA) the findings could be good news for paramedic level providers. Take care, chbare.

With the information given, I will have to go with ventricular tachycardia on this strip. I agree that the ECG characteristics are consistent with right shoulder deviation and this further solidifies my belief that this is ventricular tachycardia unless proven otherwise. Have the pads handy in the event I need to cardiovert. Take care, chbare.

Mobey, there are in fact non specific findings associated with cardiac tamponade. Electrical Altrans related to the heart moving within the pericardial sack. Low voltage QRS complexes. The National Registry of EMT's is a standardized testing organization for EMT's in the USA. They test a written exam and a psychomotor exam based on the US Department of Transportation National Standard Curriculum Many states will accept NREMT credentials and allow reciprocity. This is what we talk about when we say NR test or NREMT. Check out the website for more information. www.nremt.org . Take care, chbare.

Kyle308, in addition, Buckeyedoc, gave you the link you needed to find your answer. Take care, chbare.

Kyle308, it will vary according to where you live and work. Do a thread search, there are allot of topics on EMT scope of practice. Take care, chbare.

NREMT-Basic. That was a great post and I am glad you can see why the Intermediate is really detrimental to EMS and how agencies can use the Intermediate to provide cheaper ALS. However, I am sorry to hear that you lost your job. I urge you to go on to Paramedic or Nursing, you seem like a very smart person with allot of motivation and you will probably do well in whatever path you choose. While the hospital is very different than EMS field work, I think the ER will allow you to see and learn things that you may not in the field. You will also benefit from having doctors, nurses, and allied health providers around that can be great assets for learning. I wish you the best of luck in your new adventures. Take care, chbare.

Gajewel, welcome to the city. http://www.fieldmedics.com/forum/viewtopic.php?t=610 So, I do not have to repeat myself. (Yes I know, very lazy.) Thbarnes, wow paramedic in 2 weeks as long as I have my NREMT-B. I wonder if they will cut off a week because I have my NREMT-I. :roll: If that is not a slap in the face to paramedics...??? Take care, chbare.

We have an old Autovent 2000 that always seems to poop out. Take care, chbare.

Akflightmedic, take care over there and come back home safe. Take care, chbare.

I really appreciate the posts thus far. I hope I did confuse anybody on this topic. I would never expect anybody to remember all of the exact values, but having a broad understanding of what basic labs tell us about the patient and the underlying pathology will help us better understand how to treat the patient and even communicate and help the patient/family understand their condition. In addition, it helps to know a little about diagnostic studies. For example; You are going to transport a patient with a subdural bleed to the trauma center from a smaller hospital. You receive report and the doc tells you that there is a 4cm midline shift on the head CT. Understanding what this means allows you to relate this to your patients condition. Take care, chbare.

Just wanted to get a feel for how well educated people feel regarding lab tests and diagnostic studies. Did you get exposed to this in school and what was the extent of your education regarding diagnostics? Is this even important to the practice of pre hospital medicine? Take care, chbare.

I actually use Kelly forceps quite frequently. When I draw from a glass ampule and need to change the needle, I will use the forceps to unscrew the needle and throw it in the sharps container. Take care, chbare.

AZCEP, I do no see how people such as yourself could not be considered credible. Take a look at the people we consider credible. Read their posts and really analyze how they articulate (through posting) their answers and questions. You can get a feel for their intelligence, passion, and constant policy of standing against sub par ideas and actions. Take care, chbare.

Ridryder 911, you pose an interesting question. Am I credible? That is hard to answer. I absolutely strive to be the best provider possible. I am always reading and attending continuing education courses. I strive to be the most competent provider possible and I strive to provide the best patient focused care possible. I am employed in a different setting than most EMT's, so this could make me less credible than a street provider when talking about medicine outside of the hospital. My primary form of employment is not EMS, so this could hurt my credibility as it applies to EMS. I believe that both my past and present experiences coupled with my motivation to be the best provider possible make me a well rounded provider when talking about taking care of patients as a whole. I know where I am weak and I am not too proud to seek assistance when confronted with a difficult situation. I have had to deal with mass casualty situation in and out of the field and I am required to care for a variety of patients throughout the life span and health continuum. In addition, I have had to deal with dynamic situations and quickly problem solve my way through complex evolving scenarios. I have earned the respect of my colleagues and I know that this respect is difficult to maintain, and it requires that I give it my all every time I show up to work. I am also aware that I am an ambassador for my profession and I must strive to present my profession in a positive light to my fellow colleagues, patients, and family/friends. Are my statements and posts credible on this website? I leave it to the people who read my posts to make that decision. Take care, chbare.

Yep, you cannot go without the Broselow. Take care, chbare.

Chiari Malformation---> Structural malformation in the area of the cerebellum. Several types exist and signs/symptoms vary according to the severity of the malformation and pressure exerted on the cerebellum and other structures of the brain. LGL? Take care, chbare.

Becksdad, with the proliferation of IO access devices, I am not sure that this is really needed. Take care, chbare.

Becksdad, the question should be, "why would we want to consider doing this when we can give it IV?" Unless this is yet another way of allowing non ALS providers to administer medications "non invasive." Take care, chbare.