chbare

Oh, pain meds were given, but the patient was pretty messed up and giving more than 100 mcg of fentanyl will apparently result in a patient's head spinning around a couple of times, falling off, rolling down the hallway and spontaneously combusting in the Pyxis room.

Man, just had a rough one in the ER. Older patient fell down and sustained multiple fractures. Screaming in pain, couldn't get orders. It sucks seeing people needlessly suffer. Rather happy my hospital shifts are limited by educational duties these days. It can be a pretty nihilistic environment as far as providers are concerned. Some days are a constant fight against people who just don't care or are really good at making up reasons not to care. Even worse not having any power to facilitate comfort. Don't take the autonomy you have to make more independant decisions out in the field lightly folks.

[Citation needed].

Pain is a pretty subjective experience and addicts also experience pain. I ended up in the hospital last year with a prostate infection, in terrible pain. Because I appeared calm and collected I was not given pain medications. I was able to convince a PA to write me a script for a few tablets of pyridium however. Don't assume you know how to weed out fakers, you may very well be incorrect. Fentanyl is certainly not a "lower level" medication than morphine. Neither is Toradol. Also remember fentanyl is an opioid analgesic like morphine. Twenty minutes of severe pain is twenty minutes of suffering. The evidence is rather weak in supporting the life saving potential of EMS, but being able to respond to pain and suffering is actually something that we have a bit of control over. If anything, managing pain is a primary indication for ALS care.

Opinions on an open forum where it's difficult to verify identity are probably not going to be very helpful if you are doing a research paper. You will need to do a literature review and probably look at working outside of the box to make connections. For example, many officers have been killed by their own guns. Could this issue have implications for EMS providers?

I'm doing medicinal chemistry this semester, but it's been manageable. My courses are taught by pharmacists and the degree is a pharmaceutical science degree but not a Pharm.D. programme.

Thanks all. Still struggling a bit. The pharmacokinetics really hurt me last semester. I ended up getting help. There are many things that certain classes assume and I had to really dig deep and dive into the quantitative aspects. There are many models that we use and selecting or finding out how to select the right model can be tough. Been doing allot of graphing, slope equations and converting data into log linear graphs to find out how many compartments to model. Unfortunately, calculus, particularly integrating to find AUC's was not a big part of my undergrad. Big learning curve. This semester has been better.

It's cool. It looks like a misunderstanding that was cleared up. Everybody appears to be on the same page now. It's cool, really.

CCEMTP is licensed by UMBC. Again, you continue to perpetuate the false assumption that the course is a CCEMTP course. It is not. The FP-C exam is completely separate from UMBC. I am not saying Creighton is bad, I'm saying your understanding of the online programme is flawed. I've attached a link in a prior thread to UMBC should you wish to explore organisations that are able to offer the actual CCEMTP course. Otherwise it's best to refer to the online course as an online critical care course as opposed to a CCEMTP course. I will also provide you with a link to a list of sites officially recognised as being able to offer the CCEMTP course: http://ehs.umbc.edu/CE/CCEMT-P/Edusites.html

Sure, knowledge in any form is never a bad thing.

CCEMTP is an official course through UMBC. Certain institutions have agreements in place to teach CCEMTP as an extension of UMBC. This online course is NOT a CCEMTP course and you will NOT be able to take the CCEMTP exam or obtain the credential upon completing the online course. Not saying the course is bad but it's completely inaccurate to say it is a CCEMTP course. Again, CCEMTP is NOT a generic term that means critical care paramedic. http://ehs.umbc.edu/CE/CCEMT-P/

There is actually a fair amount of literature about this issue. I am not sure how much physical science you have but Oxygen at "normal" levels is harmful. Mammals have evolved complex enzyme systems to deal with the consequences of Oxygen and highly reactive molecules and forms of Oxygen known as reactive Oxygen species or ROS. These are a natural consequence of normal cellular respiration. Heck, our immune system sometimes makes use of ROS as part of the inflammatory response and when attacking pathogens. While mammalian physiology is generally good at dealing with ROS, many situations can markedly increase the amount of ROS being produced. This is known as oxidative stress. Good luck looking for literature. It's certainly out there but a perfectly clear and concise picture has not been completely developed.

There are also studied that show intubation or any advanced airway procedure is associated with decreased survival.

It's called an igel in the United States. The issues you report are not unique to this style of airways. It might be interesting to go back and look at every airway inserted over the past year and identify good and bad experiences, then compare this with intubation data from past years. This would give you a better system wide appreciation as opposed to anecdote.

One of our own has just started a battle with cancer. He has frequented this site and I have personally worked with him as a flight medic. He is a good dude with a wonderful family. Stop by and maybe leave a few words of support if you want or leave them here as well: https://www.facebook.com/groups/1419066058370838/

Best thoughts for friends and family.

1) I would assume the area under the concentration/time curve would be larger as is the case for other substances that are given in a way that bypasses first pass. Ethanol already has a high bioavailability, but I would anticipate a bioavailability approaching 1.0 and a very rapid peak in plasma concentration. As far as metabolism and elimination, ethanol quickly reaches saturation kinetics and as such follows 0 order elimination kinetics even at low concentrations. I would not anticipate this to change. Ethanol is metabolised via three pathways: ADH enzyme, catalase enzymes and CYP2E1. Normally, catalase and CYP2E1 are minor pathways, but with chronic ethanol exposure, CYP2E1 is inducible. I'd expect that to occur with chronic ethanol exposure at sufficiently high enough concentrations regardless of the route. 2) Reasonably high with enough use. 3) Not sure, but I'm not surprised by the story.

Really depends on your goals and aspirations. Nearly all of the STEM degrees would likely help you understand the world and subsequently EMS better. However, perhaps you are more interested in literature and the humanities or perhaps the social sciences. It seems like you are considering an exercise physiology degree? Clearly, this would be helpful as well. Much of degree selection comes down to goals and aspirations. There are more flexible options being offered however. I know many places are offering individualised or applied studies degrees where the student has more flexibility in choosing classes. A close friend started off as a biology major but really wanted to take management and business classes. He ended up going into a BIS (Bachelor of individualised studies) programme and did a minor in biology. He is now completing his first year of graduate school as a PA student and will be starting his clinical year. We ended up going to grad school at about the same time and will graduate at about the same time and it has been fun comparing some of our courses because I am doing a pharmaceutical degree so some of the courses have rough crossover.

There is still a fair amount of data we can look at and use to determine if we should continue or expand programmes. Clearly, long term evidence will be derived from said programmes. I am not convinced that we should stop or limit things. Perhaps long term data will show something different and I will have to change my mind.

Look back at the other thread. I asked the same questions that I will ask again. Putting personal feelings and potential bias aside, what does the evidence show? Do these programmes exacerbate the problem, enable abusers, increase the risk to providers, patients and bystanders? Again, I ask where the evidence points. How are these programmes working out in states that use them?

I completed an EMT-I/85 to AEMT transition class and took the national exam and I currently teach AEMT classes. It will be roughly similar to EMT. You can expect an additional 200-300 hours of lab, lecture and clinical experience. You will dive into some concepts such as pharmacology and the human body in more detail and learn about a few new interventions, interventions you probably have a basic understanding of, being an Army medic. The registry exam is interesting, long and much more complex than the EMT exam. Good luck.

It was a semester of coursework for my state instructor/coordinator credential. A fair amount of standard curriculum and instruction work along with developing learning and teaching objectives and an emphasis of developing assessments based on Bloom's Taxonomy.

Possibly, it's hard to determine intention from online dialogue. However, most of the folks here are good dudes and duddettes that really want to help people out. Unfortunately, we've had our share of people who come here and are, shall we say, less than honest. Some people are a bit trigger shy when threads like this are started due to past experiences. I am not here to condone or condemn actions, only to illustrate some of what you may be sensing. Edit for context: At the end of the day, you screwed up. You will likely take some crap for it and you are going to have to deal with it. Show us that you are an intelligent, mature professional and accept that and move on. Some of the hard questions asked here very well may come up when you move foreword with your plans to be a provider. You will need to accept this and deal with the consequences and questions as maturely as possible. Show us you have moved beyond your past mistakes, show the others here that you are serious about being a good provider. Sometimes that means accepting that some people may question your ability to be a safe, competent and professional provider. I will leave you with the words of Maynard: "Keep your dignity, take the high road, take it like a man." Good luck as you move foreword.

Good luck. You have received some tough love from a few people here, but seemingly innocuous mistakes can have significant consequences. I will refrain from soap boxing because I have significant personal bias when it comes to ethanol consumption as I don't drink any period. You will have to be a very cautious and diligent motor vehicle operator in any event.

Island, as stated, your experiences are anecdotal and cannot be generalised without reproducible evidence. In all honesty, I've no idea what national MIP "charge" rates are. To the OP, I think you've received reasonable advice. You may encounter issues related to your driving record. It would be difficult for any of us to definitively tell you how things will eventually turn out. We all make stupid choices and some of us will face consequences while others will not. Good luck as you proceed foreword.