chbare

Ridryder 911, we use the LMA in our ER as a backup and I have had pretty good results with it. Disclosure statement, I have not used the LMA many times. I think dislodging would be even more of a problem in the back of an ambulance or helicopter. The LMA is pretty easy to insert and it's about as "Murse" proof as you can get. I know allot of people and the studies indicate that one of the most common problems with the LMA is the lip flipping back during insertion. The most common problem I have encountered is air leaking around the seal into the esophagus during ventilation, especially on very large people or people who require high ventilatory pressures. Otherwise I like the LMA and actually carry a size 4 and size 5 LMA unique in an airway crash bag in addition to my combitube while on duty with the National Guard. PRPGfirerescuetech, thank you for the link. This should be some good information. Take care everybody, chbare.

Does anybody have first hand experience using this airway as a backup/rescue device. My National Guard unit is looking at using this airway. We currently use the combitube. I have used the King LT on an airway simulator and found the device easy to insert and use, however, this is not even close to a real person. I have googled and found research on this device, and it seems to work pretty well in the controlled OR environment. From what I have found it seems to provide a better seal than the LMA. The manufacturer boasts a seal of 30 cm of H2O verses a seal of about 20 cm of H2O with the LMA. However, you know how the maker of a product likes to brag about their product being the latest and greatest gizmo. It looks like I will get a chance to use the King LT on cadavers next month at SLAM, but I was just curious if any one had any first hand experience with this device. A web site with allot of info about the device is, http://www.narescue.com. However, this company is also selling the device, so I tend to be a little cautious regarding the info they put out. Thank you and Take Care, chbare.

I would like to thank every body for their posts. There are many people on this site who have extensive EMS experience, (and even a few who have been in EMS longer than I have been alive) and I value your comments. I want to emphasize this is something that I am carefully considering, and may not even be an option if my employer does not get the 911 contract. I know there is a significant difference between the nursing education and Paramedic education, and I do not want to compromise prehospital patient care if my training is not considered adequate. I will not even consider working in the prehospital environment until I receive guidance from the state board of nursing, the state EMS board, and my malpractice insurance company. In addition, both my employer and physician medical director would have to develop specific protocols and competencies for prehospital nurses. A possible route I may consider is applying for reciprocity and testing out at the state EMT-I level and working as an EMT-I. A few people have told me this is a bad idea because of possible role confusion. This is also something I would consider very carefully. I do have prehospital military experience; ambulatory medicine, patient transport, tactical medicine, and evacuation experience, however, this is still quite different from civilian EMS. If after I receive guidance I feel there are any doubts about the legalities and my abilities to provide prehospital care I will decline the offer and continue to support the company by strictly sticking to patient transfers. As of now I am leaning toward holding off on any ambitions of working EMS until after paramedic school. I would like to thank everybody again for their responses. Take care, Chbare.

I work for a private ambulance company on my days off providing ALS coverage for transfers. The company is looking at providing county 911 coverage. My boss recently asked me if I would like to start providing 911 coverage. My co-workers seem pretty excited to work with me. I would be working with experienced paramedic partners and would have very specific protocols regarding the skills I would perform. Both my boss and medical director state that they feel confident in my ability to be part of the pre-hospital team. Does any one have any experience with RN's working in the field? I have limited field experience, 2 years as an EMT -B and EMT -I training, and I do not want to compromise patient care. I jut wanted to know if any of you have had to work with RN's in the field and what experiences did you have? Thank you, chbare.

Excellent! The diagnosis is peritonsillar abscess. I believe it is the most commonly seen neck abscess. The abscess can cause an upper airway obstruction and should be regarded as a priority for treatment. The patient received humidified oxygen, was placed in a position of comfort, and tolerated IV therapy. His vital signs were monitored frequently as well as frequent airway assessments. Initial treatment included; 1000ml of NS over 60 minutes, 30 mg of Toradol IVP, and 1000mg of Ceftriaxone IVPB. Within the hour an EENT doc was consulted and the patient eventually received an I&D. It was well tolerated and he was discharged home a couple of days later. He eventually had an elective T&A. I am glad everybody liked the scenario. I am with you Dirt Devil on clinicians who hand out scripts for URI's without actually putting to work all of those years of assessment skills they should have learned in school, of course when the triage nurse handed me the chart on this patient she told me this was an in and out wimp call. So, I guess the shoe fits allot of people. Thanks for the warm welcome everybody, and take care. chbare.

I will try to answer all of the questions. Eydawn: The pain was present when he saw his PCP and did get worse after starting ABO therapy. No unsusal exposure to substances or activities that would cause throat pain. No other medical problems or history. He has neved had throat pain like this. Dust Devil: You are correct about the exam, this was a once over my xray vision can see all kind of exam. No rash noted. Unknown if a rapid strep was performed, I believe not because the patient did not say anything about having a throat swab. I glad it did not take long for someont to ask about a detailed EENT exam. His oral mucosa is moist and intact however you note that his left tonsil appears pushed foreward and the patients uvula appears displaced from the unusual position of the tonsil. You do not note any exudate. ERDoc: His oral mucosa is moist and intact , however you note that his left tonsil appears pushed foreward and the patients uvula appears displaced from the unusual position of the tonsil. You do not note any exudate. No strider noted. I hope the additional information helps. Take care everybody, chbare.

Interesting case Twenty three year old male presents to the ER complaining of a very severe sore throat. He states he was seen by his family doctor about 2 days ago with a cough and sore throat. He was diagnosed with an upper respiratory infection and put on a course of Zithromax. He states his throat has become very sore and he states having difficulty swallowing since the onset of his symptoms. Vital signs are; Resp-22 non labored, Pulse- 110 strong at the radial, B/P-110/066, SAO2-97% on room air, Temp-101.3 tympanic, Pain-10/10 to his throat. His physical exam is unremarkable and his lung sounds are clear in all lobes posterior and anterior. He denies any other medical problems or past medical history. The patient has no allergies and denies taking any other medications. What else would you like to know? Take care everybody, chbare.

"Glory Hole"