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That may be integrated into the core curriculum of programmes in the States; however, proper biostatistics courses are often upper level undergrad or graduate courses and I'm not sure a newly minted EMT who likely has little fundamental course work would benefit from going this route. Honestly, core mathematical literacy is probably the order of the day. Honestly, if somebody is not at the precalc level, I would even suggest taking what are called developmental math classes and the look at a dosage calculation class. Mathematics is frequently an across the board weakness in many students looking at college coursework. I ended up taking a year of developmental math myself and that was well over ten or so years ago. The problem has proliferated in many areas and I would say this is one of the biggest issues students struggle with at the community college level.

Biostatistics may be a bit much. A standard undergrad statistics and probability class would be required prior to tackling biostatistics. However, pre-calculus is the highest yield because that allows you to jump off into more complex mathematics but ensures you will understand dosage calculations, conversions and simple porportions. All critical for understanding the basics of medication administration.

We have significant obstacles; however, I'm optimistic that we are moving in the right direction.

Actually, the new CCEMTP curriculum is a bit more flexible and if you do some research, it assumes providers have baseline knowledge of chemistry, pharmacology, and anatomy and physiology. In fact, the site licensing process allows teaching sites to make chemistry, pharmacology and anatomy and physiology courses pre-requisites to taking the course. In theory, this could allow a programme to make a comprehensive course that uses the CCEMTP curriculum as a backbone. My employer is working on obtaining a site license and we are looking at a course that is at a minimum of a semester long that includes a clinical rotation component. This will be in stark contrast to an older, traditional two week course consisting of 80 hours.

Look at taking college level courses such as anatomy and physiology with labs, pre-calculus college algebra, English literature and composition and general or survey chemistry classes with labs. These should greatly enhance your understanding of the physicial world and human dysfunction within the world.

DFIB, you should do some research on TB, particularly in India. Pretty scary stuff.

In addition, the upcoming new and improved organinsms such as VRE, XDR-TB and new types of STD's and TB that cannot be treated by any known antimicrobial agent.

Dwayne, it's actually a very good medication with predictable effects in most cases. My point is more about looking at the bigger picture and realising other agents have their pros and cons just like ketamine. I certainly do not think ketamine is a bad medication, only that other agents may be considered by other providers. There are many ways of going about medicine and many come down to bias and anecdotal experience. I think it's important to examine that bias and ensure we don't let it create issues when we are placed in a situation where we may manage a certain situation differently.

Perhaps you should not have mentioned procedural sedation if your bias is specific toward pre-hospital use in RSI? In addition there has been much discussion about etomidate and the adrenal suppression concern leading to increased mortality has not been validated inspite of fairly large amounts of evidence. Perhaps in the future; however, it still remains a viable option even in septic shock patients. I'm certainly not convinced by the evidence at this point.

Actually, propofol is very popular for procedures. You can administer it, monitor during the procedure and recover the patient in minutes. With ketamine, I'm stuck monitoring the patient for an extended period that is even longer because of the benzos they receive. Clearly, a suboptimal situation when I have patients lining the hallway and I'm stuck doing a 1:1 recovery on a status post dislocated shoulder. Logistics and resource utilisation are critical in the real world.

Unfortunately, it has many side effects and potential interactions. You deal with it enough and you end up appreciating it is a risk versus benefit issue as is the case with most medications and procedures. Bradycardia, dysrhythmias, hypersecretion and both hyper and hypotension are known side effects. It is generally a good medication, but not a silver bullet.

If you want it bad enough, you will find a way to make it work out. Many of us have had to make painful fiscal decisions regarding school. I have nearly paid off nursing school. Note, I graduated over a decade ago. Tough love bro, but if you want it bad enough, you need to stop making excuses and go out and make it happen.

There is a shot of the anderoid "waking" people up from stasis pods in one of the trailers so I think it's safe to say that continuity will remain intact with the overall alien universe.

Actually, it looks like a different body alltogether. Per a couple of press conferences with Scott, it is not the same planet and in fact, not a planet at all but rather a moon of a planet where the Prometheus lands. Initial reviews from Europe where Prometheus just opened appear rather positive and it has a Rottentomatoes tomatometre reading of over 80% with the critics sampled. The common statements I find are overwhelming positive reviews of the outstanding scenery, special effects, score and an incredible performance from Fassbender as the anderoid. However, there appear to be some complaints about a few plot holes and some people are saying the script is not as solid as anticipated. In any event, I plan to see it on the 8th when it hits theatres in the United States.

First, congratulations on school. Sometimes getting through nursing school requires the mouth of a politician and the endurance of a marathon runner. I wish you all the best in your upcoming career. Due to past experiences, I have a different way of looking at maintaining EMS credentials. Three events in my life after nursing school occurred at least in part because of my EMS credentials, specifically national registry. First, I remained an enlisted medic in the National Guard for several years after graduating nursing school. When the new medical occupational structure was applied, I was easily able to make the transition because of my NREMT credentials. Next, my life changing experience in Afghanistan may not have occurred without NREMT credentials. Finally, I was just hired into a full time, tenure track educator position. While the nursing and respiratory degrees were a big help, I would not have even been qualified for the position without NREMT and state EMS credentials. A somewhat unrelated point; however, my old employer is looking to make all their flight nurses obtain EMT credentials to remain flight qualified. If I was still flying, I would have saved my self from doing a five-six month class. In conclusion, I would recommend you at least do the minimum to keep your credentials active because you never know if or when they will come in handy.

Most of the EMS tattoos that I have seen are rather...whackerish IMHO. Not that I have any real aversion to consenting adults doing whatever they wish to themselves assuming the activity is legal or relatively legal. I actually had a caduceus tattooed on one of my arms after graduating from Army combat medic school when I was eighteen. Looking back, it was a rather impulsive, macismo and whackerish thing to do. At least I had the sense to put it in a place that was generally out of sight.

The 754 has a rather interesting and possibly harmful if not uncomfortable pressure support like quality when in SIMV.

Dwayne, there is a laundry list of conditions that may result in low saturations that are reasonably well tolerated. You have chronic lung disease with polycythemia and alteration of the curve being one such example.

Dwayne, it will be exceeding difficult to definitively rule in and rule out a specific disorder. The patient will need a workup. Another additional consideration is the presence of a haemoglobinopathy. Sickle cell anaemia being a fairly common one. Additionally, we need to consider equipment limitations. I wanted to wait to point this out; however, is the patient dark skinned?

I prefer the term ventilator over respirator. Unfortunately, it is quite easy to screw a person up on a ventilator. The science of ventilator management is quite complex and if you've never been through a rigorous course on ventilator management, it's truly difficult to understand what I mean. This also includes transport ventilators. Transport ventilators are becoming quite complex and many services are using graphics packages.

Have we assessed the blood sugar?

Can we appreciate heart tones? Any history of congenital heart disease? Malaria is always on the differential. Pulmonary embolism is also a differential. You say the XII lead is unremarkable, but the guy is tachycardic?

Assuming the victim survives and can overcome the physical disfigurement issues, I cannot begin to imagine what psychological trauma would result from being attacked and having somebody eat your face off. Truly a horrendous thought.

Does the patient report symptomology? Can he give a timeframe, describe how he feels, has this ever occurred in the past? Any history of insect/arachnid bites? I don't suppose you have side stream capnography? History of substance use (smoker, recreational drugs and so on).

Recent long distance flight? Hazardous substance exposure? What altitude are we at and what altitude does he normally live at? What diagnostic capabilities do we have? Can we get a baseline set of vital signs to include a temperature and a XII lead? You seem to have interesting nurses?!? Let me know if you guys need a good one who loves paramedics and I'll send her your way.