chbare

My condolences.

How prevalent or relevant is this hypoxic drive theory?

I'm not sure mate. This is something that your country should define. There may be a grandfathering or transition process. With a one year to three year jump in educational requirements I would bet all the older paramedics will need additional education to make the transition.

Restrictive disease is typically classified as pathology that involves the ability for the lungs and chest wall to expand. This is due to increased elastance or decreased compliance (one and the same). Restrictive pathology includes conditions such as ARDS, IRDS, pulmonary fibrosis, chest wall burns, abdominal compartment syndrome and obesity. Asthma is not typically thought of as restrictive pathology as the actual compliance of the lung parenchyma is not a problem but rather inflammation, spasm and mucus production leading to airway obstruction.

Most people are born with CF as it is a genetic disorder.

It's a combination of two medications and it probably wouldn't be my first choice for treatment or prophylaxis. It has been black boxed due to a high risk of blood dyscrasia development and SJS.

I understand his issues and past history, and perhaps I look like a gullible sap, but I see no harm in asking the City community if somebody is okay.

I'm not sure you understand the concept of COPD. COPD is a constellation of issues, that means COPD is a broad term that could include a number of issues. If somebody has a history of COPD, it's your job to identify what type. Also remember COPD is not isolated to older people as certain conditions such as CF are often diagnosed during childhood. Identifying the type of COPD can be challenging as the specific pathologies cross over. Even performing pulmonary function tests may not yield an answer as airflow obstruction and gas trapping are common to most types of COPD. Sometimes you catch issues like emphysema when appreciating the Carbon monoxide diffusion test however. COPD is just a ballpark term and it is your job to put the detective hat on and try to differentiate based on a good history and exam. Asking about triggers, mucous production, history of infections and so on is helpful. Unfortunately, you may not definitively identify the problem at the end of the day, but your therapy will be based on the clinical exam. You have wheezing, increased WOB, prolonged expiratory phase and so on, you will likely administer a Beta agonist regardless of the actual diagnosis.

Actually, there exists a good argument for defining asthma as a form of COPD. COPD is a catch all phrase used to describe a constellation of chronic conditions that cause obstructive pathology. In respiratory school you would be taught COPD "traditionally" involved five conditions we call CBABE (CF, Bronchieastasis, Asthma, Bronchitis Chronic & Emphysema ). Contemporary definitions differ from person to person however.

A- is probably a catch all term for large, negatively charged molecules such as polyatomic ions and proteins.

Any of our other Kiwi mates have the ability to drop him a line?

Perhaps, but I hope he's doing okay in any event.

I just saw a post from Kiwi about leaving that is apparently locked. Just hoping he's doing okay.

You may want to consider pushing for Calcium if you truly want a fast acting, high yield therapy for hyperkalaemia. It has a very rapid onset and will quickly stabilise the membrane potential. Bicarbonate may also be an option. Beta agonists would be low on my list of front line pre-hospital interventions.

In a sense AK, your fear has been realised. While some humans are capable of change, I cannot help but appreciate how ignorant, intentionally hateful and generally non-productive philosophy permeates contemporary society. Same schyte, different century IMHO.

Yeah, a shameful embarresment. Perhaps I'll live to see the day where I can tell the children about a dark and shameful time when such things occurred.

Shock involves a constellation of issues and is not simply quantified by a blood pressure. If we can agree on this issue, then I think we can possibly move foreword.

Many would say no. Geographically and in some areas culturally, Afghanistan is probably better defined as an Asian country like India. However, Middle East can be a rather vague term.

Ultimately, the bible is rather nebulous and prone to contradict it's self. This essentially means that humans are free to interpret it in any number of ways and in essence cherry pick concepts that fit into their own personal view of the universe. I admit that I do it. Unfortunately, this leads to an inconsistent way of making sense of things and applying a logical, evidence based and consistent method of appreciating the syntax of the physical world. This leads us to how I have to look at the physical world. I have to look at it based on reproducible evidence, logic and in the United States, through the lens of a very specific legal and medical system. Going away from religion, this brings us to medical ethics. One of the most important concepts of this has been patient autonomy. Allowing a well informed patient to make their own medical decisions is a critical component of how we do things. The way I look at medicine is that my job often revolves around educating my patient in a complete, understandable and bias free way to ensure they have as complete a picture of the situation as possible. Then it is my job to support their informed decision. This must occur regardless of my personal beliefs in a divine mechanism or lack thereof.

It's probably not possible to give you a concrete answer. The concept and rudimentary practice of IV therapy dates back at least as far as the European renaissance. The practice was refined and began to proliferate during the early to mid 1900's leading to our current practice.

Solid post mate. Mental illness is much like any other chronic disease. If we could see it for what it is, I believe many of us could better appreciate and understand these patients for the most part. Unfortunately, mental illness is hard to quantify and like you stated, attempting to confront a person with logic and reason may not work in some cases.

You are a paramedic with a degree. Clearly, a science degree will be nothing but helpful for your career in health care. I have no doubt that at least one person will post an in-depth review of how their county goes about educating their EMS professionals. With that, I am a little confused about your question. Taken at face value, the answer would be no. You do not have an undergraduate degree in paramedic science, paramedic studies or whatever said degree may be titled. However, I suspect what you want to know goes beyond a simple yes or no answer? It seems you are asking about the weight, relevance or importance of one degree over another? This will be difficult to impossible to quantify when considering a profession that does not even mandate an associate degree for entry into practice. However, most would agree a science based curriculum is important foundational material for any health related degree. This is why most professions mandate a certain number of science and lab based science courses. However, the importance of other classes such as literature, composition, public speaking, humanities and fine arts is often not appreciated. It is also the reason why even STEM majors have to take a certain number of said courses. Ultimately, your degree will no doubt be an asset.

Both have valid points and physiological assumptions; however, what does the evidence say? http://www.ncbi.nlm....pubmed/10149684 http://www.google.co...HS_FTBKaBOVpLeg Krumel, why do you believe dobutamine would be the best choice? There are a very narrow list of indications for dobutamine related to it's rather specific effects that focus mainly on enhancing myocardial contractility. In this case, the patient is suffering from a loss of preload and enhancing contractility will be of little use. In fact, one of the dobutamine isomers may have vasodilating properties.

A couple of points: Racemic is a word that is typically used in chemistry to identify a solution that has a 1:1 mixture of enantiomers. These are almost always optically active as far as I know. In that I mean you have an isomer that demonstrates levo-rotatory and an isomer that demonstrates dextro-rotatory, commonly called L & D. Basically, light will travel around the D in a clockwise fashion and around the L in a counterclockwise fashion (specifically, the plane of polarisation is rotated). Many biological molecules such as sugars and amino acids share this property where you essentially have a molecule that has two "mirror images." This also includes many medications. With that, a D and a L molecule may have very different properties. In the case of epinephrine, we typically use the highly active L form but racemic mixtures include the D form. With all that said, racemic epinephrine has numerous side effects and is typically used for it's alpha effects on subglottic mucosal layers (treating stridor). While racemic epinephrine has Beta effects and can cause bronchodilation, you are probably better off using a medication such as albuterol that has more specific Beta 2 effects and less Beta 1 crossover. While I do not totally disagree with your treatment if stridor did in fact exist, your rational for choosing a certain treatment was flawed to an extent.

Thoughts and prayers go out to the people of Colorado today.