chbare

Of course, the OP could come back and clarify so we could give better answers.

Took me a couple of minutes to find: http://www.cdphe.state.co.us/regulations/ems/101503chapter2practiceandmedicaldirectoroversight.pdf It would behove you to spend some time reading through this site if you intend to practice EMS in Colorado.

Maybe not; the techs that I speak of have different areas of focus. Some simply gather patient information and perform ECG's all day and others are involved with direct patient care. I am not quite sure of the exact definition and responsibilities of the OP's prospective position. However, if the pay and benefits are better than what an ambulance in his/her area could offer, I would not fault the person for considering the position.

I find my self in an interesting situation as an educator. I am not spending much time in the field doing direct patient care. Over the past year I have only spent about 400 hours in the hospital doing direct patient care. It is a 255+ bed hospital with a 20+ bed ER and a 40 bed medical/surgical ICU that specialises in post cardiac (PCI & CABG) care. In addition, I did about 150 hours of community health clinical rotations for a degree that I am completing. The hospital time has me spending about half of it in the ER and about half in the ICU working with paramedic students. We are able to perform to the full scope of practice allowed in the state and we also get to work with ventilators, balloon pumps and invasive lines along with medication infusions in the ICU (I know several of the RT's and several of the nurses quite well, so we are able to do allot.). My point being, how little clinical experience is too little? I feel fairly confident in my patient care abilities and still perform patient assessment and care including placing IV's and so on; however, I worry about loosing my ability to be an effective provider. While I assume there is no magic number, are you guys aware of any evidence on the optimal amount of patient contact time and performance of procedures? For example, I was doing several IV's a day during my full time ER days and now I am only doing 3-4 per week. So, what do you all think?

ER tech pay can be quite good and pay much better than the field. Also, the hospital benefits packages may be better. Several street medics work as ER techs in my area and are pretty much working at an EMT-I level within the hospital but they make bank and work well with the nurses and physicians due to the rapport that has been established from their transfers of care.

Another potential consideration: Re-evaluate the need to place EMS stickers all over your vehicle?

Another question to ask is how many true tension pneumothoracies have you seen on a spontaneously breathing individual? I am not talking about a patient with thoracic trauma who complains of dyspnea or has a sucking chest wound, but an actual life threatening tension pneumothorax where the patient's condition rapidly improves following intervention. I have never seen one with a non-intubated patient. Therefore, one has to question the need to have pleural decompression equipment readily available. Particularly in a non-permissive environment where the role of invasive procedures is generally limited.

Your institution should have policies in place to deal with these issues. As an instructor, I strongly advise that you refrain from discussing these kinds of issues on an open forum and work within your institutional framework. Good luck.

They are all different; however, you must do two stations. A and B are simply the terms registry used to designate one station from another.

Unfortunately, the oral stations and cardiology (static & dynamic) tend to give our students the hardest time. Since the registry is highly regimented and inflexible, your best bet is to take a copy of the oral skill sheet and run you through scenario after scenario. Clearly, this will take a large amount of time. Good luck.

Unfortunately not. The process of learning generally involves time and effort.

Rather that worry about various terms that change from area to area, I suggest you take time to learn proper medical terminology. As always, the importance of a two semester sequence of anatomy and physiology with labs cannot be understated.

The arguments seem to stem from certain assumptions. What process did this person go through to have this approved, did he in fact pay for it, was it integrated into a training exercise and so. I would need to have more information in order to automatically condemn this person's actions and demand sanctions/disciplinary action.

I am not sure. It seems to be a complex issue. There are very violent countries such as Mexico that have strict laws and limited "john Doe" weapons access. There are countries with high per capita gun ownership that are not violent. Of course, the reverse is true as well. Clearly, more than just access to firearms is causing issues and I suspect each country has unique social, cultural and ethical issues. It is clear that violence in the United States is an important issue. I'm not sure that myopic and radical views such as take away all guns or have everybody carry guns are the answer to this issue. Unfortunately, people often end up taking sides without admitting the complexity of this problem, and it is a problem regardless of your political views. IMHO.

Depends on the state and company. The onus will be on you to research the programme in question.

Would a "gun license" decrease the incidence of violence in the United States? I am not so sure considering how many people die from motor vehicle related incidents in spite of every state requiring a drivers license. I am not opposed to a "gun license" per se, but I would have to question it's efficacy.

Going off topic a bit but you can rig a bag mask, PEEP valve and nasal cannula to provide CPAP. Simply attach the PEEP valve to the bag valve mask and attach to at least 15 LPM of Oxygen. Then, place nasal cannula on the patient running at 15 LPM. This will provide both flow and a constant pressure (CPAP). If anything, you can use it as a pre-oxygenation method prior to intubation. This is how it's done: http://emcrit.org/misc/bvm-preoxygenation-and-reoxygenation/

Why do you disagree exactly? As I stated, pulmonary fibrosis may be a grey zone; however, non-invasive ventilation may improve oxygenation and decrease the need for intubation. NIV has been used to help patients with restrictive lung disease, therefore I would not have an issue with a pre-hospital trial. In this case, the patient improved with initial therapy and did not deteriorate until a couple of minutes prior to ER presentation. Also, we do not know if the fibrosis was the underlying cause of the patient's distress. As I stated a grey area, but still a consideration.

No worries, keep posting. We all potentially have something to bring to the discussions here.

With the two year vocational degree and two year internship push in Norway along with potential language requirements and all of the visa/work permit issues, I imagine going from the States to Norway would be more difficult than Canada.

Pulmonary fibrosis is considered restrictive for the most part. Cystic fibrosis; however, has a significant obstructive component. I believe the OP is talking about an un-intubated patient. In this case, the PEEP the OP is talking about is CPAP. There really is no difference between PEEP and CPAP except how one interprets the context in which we use the terminology. Using CPAP on this patient fits into a grey area. I see no absolute contraindications and certainly a short trial of CPAP is not outside the realm of reason.

No worries mate. It wouldn't matter if you were doing it for the hell of it. Unfortunately, all of the systems of measurement are rather arbitrary and we often run into the problem of different systems and dimensions being used. Imagine my horror when somebody stated a patient's blood sugar was 6 for the first time in front of me only to follow it after my reaction with "what, 4-8 feeling great." However "ionically" active substances are probably better off being measured in mEq/l simply because common formulae such as the anion gap take this method of measurement into consideration. Large, complex molecules that are not particularly ionically relevant such as troponin are easier to report in a weight based dimension. However, it will ultimately come down to recognising what system a particular lab uses and their normal reference ranges.

I am not sure what you are asking? H2O + CO2 is not a proper reaction. For a proper reaction, you need to identify the environment (often aqueous in biochemistry), the reactants, the products and ideally, a balanced equation with proper stoichiometry would be the proper way to write said reaction. Fundamentally, you have to change the oxidation state of an atom for an reaction to be considered a REDOX reaction. An acid-base reaction involves acids and bases, but the confusion only confounds as there are several acid-base theories. The Bronsted-Lowry, Arrhenius and Lewis are the top contenders with significant amounts of overlap and subtle differences. Additionally, some use what is called the strong acid definition. Unfortunately, it will probably not be possible for me to explain all of your questions on this thread. If you are struggling in chemistry, I would absolutely suggest you get with a tutor and your chemistry professor. I made my chemistry professor work for her money. Basically, I would not leave the class room until I had a deep understanding of the material. I find many people simply leave after lecture or lab and do not take time to have their questions explained. Not me. You will earn every cent of your pay if you are my instructor.

I am back and hopefully can clear some of this up: First, a mmol is commonly called a millimole. A millimole is 1/1000 of a mole just like a milligram is 1/1000 of a gram. In other words 1000 mmol equals one mole. If I have one mole of Carbon 12, I would have 12 grams. However, if I had one mmol of Carbon 12, I would have 12 milligrams. With that, we commonly use mmol as a concentration. The common dimensions will be mmol/litre of mmol/l. In other words, how many mmol do I have in a liter of solutions, typically water when talking about biology. Next, mEq is cammonly called milliequivalent. As you may have guessed a mEq is simply 1/1000 of an Eq. However, what exactly is an Eq? Well, if you remember mmol is simply a measure of mass. However, mEq takes something else into consideration. Specifically, Eq is a way of measuring something about the chemical reactivity of the substance you are measuring. The formal definition of an Eq is either the amount of a substance that will supply one mole of Hydrogen ions in an acid-base reaction or the amount of substance that will supply one mole of electrons in a REDOX (reduction-oxidation) reaction. Historically, different definitions have been used; however, let us simply stick with this line of thinking. Now that we have at least some sort of understanding of what these terms are looking at, let me give you a couple of conversions formulae: To convert mmol to mEq you take the amount of mmol * by the "valence" and then divide by a litre since we are typically measuring in mEq/litre. What is the deal with "valence?" Valence is simply the charge on the ion we are discussing. However, we do not care about the sign of the charge, only it's magnitude. For example Na+ and Cl- have exactly the same "valence." In this case, the valence would be one. If you had Ca++, the valence would be two and so on for all the different ions. Let us say you have 1 mmol/litre of Na+ and you wish to convert to mEq/litre. Simply plug and chug: 1 mmol of Na+ * Valence of 1 over a litre or 1 mEq/litre. That's easy, just remember when dealing with ions that have a higher valence, you will have a different conversion. For example, take 1 mmol/l of Ca++. This would convert to be 2 mEq/l because Ca++ has a valence of two. The basic answer to why we need to consider valence revolves around the fact that Eq and mEq are looking at the ability for one substance to chemically interact with another substance. An easy way to see where this becomes relevant is to take the simple case of Na+Cl-. In a perfect world, one mmol of Na+ will perfectly react with one mmol of Cl- to form one mmol of Na+Cl-. In other words, these substances ionically react on a 1:1 basis. Therefore 1 mmol/l of these substances equate to 1 Eq/l because of the 1:1 reaction. However, if you have Ca++ and Cl-, you would need two Cl- for every one Ca++. Therefore the valence of Ca++ becomes quite relevant. Does that make sense?

You are on to the right track; however, when we start talking about mEq and Eq, the concept of charge becomes critically important. Remember, nearly all of chemistry is due to electronic configuration with the exception of certain types of nuclear decay (weak interactions) versus electricity & magnetism. Particularly, valence electron structure is the most important concept as that is what determines chemical reactivity for the most part. When dealing with ions, we can expect a very differently type of chemical reactivity. A quick, rule of thumb when dealing with simple ions is to multiply moles * charge to get mEq. Remember, it's the magnitude of charge that counts not the sign. (ie Ca++ is simply 2 as CL- is simply 1) I do not have reliable internet access now, but can do a more detailed explanation tonight or possibly even a video. How about you present your problem and your solution with an explanation and we can discuss this situation in it's specific context? Edit: Also, when talking about moles of an element, the technical standard is 6.02*10E23 atoms of "ideal" Carbon 12 would weigh 12 grams. Since, we are using fairly accurate approximations with the other elements, this is typically not a big deal.