chbare

Unfortunately, that would still be anecdote and not useful when determining what the overall effectiveness of the device might be. I have not seen a large amount of literature about the device, and what little I've seen has been anecdote.

It may be a bit beyond standard paramedic student knowledge; however, Doctor Jeff Guy from Vandy does an excellent podcast series called "Surgical ICU Rounds." I highly recommend downloading the numerous podcasts free from iTunes. Additionally, he does another podcast series that is a companion to his book "Pharmacology for the Prehospital Professional."

Best wishes for you and your family bro.

Why should a single study that looks at 9 pigs make us change our current practice? I agree that additional studies are needed and would be very curious to see what happens in humans. Perhaps after we have a large amount of reproducible, peer review data, a paradigm shift will occur. However, we are not at that point now. Interesting find nonetheless.

I would say it is highly unlikely to have a false positive test; however, there will always exist a non-zero chance of false positive results.

Certain types of cancers and immune disorders can cause false positive results along with women who receive hCG injections as part of infertility treatment. I am sure there are other causes and operator error such as interpreting the test well after the recommended read time must also be condsidered.

False positives are possible and can have many causes.

Most urine pregnancy tests that are reasonably sensitive will likely be negative at the two week mark. A positive urine pregnancy test more than a full month following abortion would lead you to suspect incomplete abortion. However, your test was negative. This could mean a couple of things: 1) Interesting physiology with the patient. 2) Something may have been wrong with your tests or lot of tests. Can you find somebody who is known to be pregnant and has a verified + test? You should be able to take a random sample of your pregnancy test kits and compare their results. I would rule that out first.

Dwayne, urine pregnancy tests can be positive for several weeks following a spontaneous abortion. Unfortunately, a urine pregnancy test is rather useless at quantifying hCG levels. If you have the resources, running serial serum hCG levels over several days and noting a downward trend can be quite helpful. It's generally a good idea to st least entertain an OB/Gyn issue regardless of urine pregnancy results.

I am not sure midazolam is the wrong medication for RSI. Used in appropriate doses in patients where you've weighed risks and benefits, midazolam will work. Especially, with good premedication with fentanyl or other related agent IMHO. Unfortunately, there are no "magic bullet" agents for RSI. Every agent has benefits and every agent has pitfalls. I remain skeptical of using midazolam as a sole agent without a paralytic and possibly pre-medication however. Clearly, I have to admit personal bias with other agents such as etomidate and ketamine.

Thanks, we will see what happens. At least people are giving me serious consideration.

I took the cognitive exam two days ago and received results today. Fortunately, I passed. However, it was much more complex and involved than I anticipated. Certainly much more complex than the I/85 exam. Multiple scenarios, large amounts of terminology and basic pathophysiology questions. A rather interesting experience considering the clock hour requirements for many of the curricula out there are less than 300 hours. However, I am trying to use my experience to expand the requirements for AEMT classes where I work, including serious discussion about making college level A&P with a lab a pre-requisite for AEMT students.

Okay, so there does exist some form of "medical direction?"

Midazolam is IMHO a suboptimal medication for emergent pre-hospital intubation when used as an induction agent. It has a slow onset, long duration and is associated with haemodynamic complications. I've never used midazolam as a sole agent for medication facilitated intubation, therefore I have little anecdotal evidence to add other than the well known properties of midazolam.

Didn't you say NZ medics were completely autonomous? What is this whole supervision by medical practitioners concept discussed in the article?

Yeah, I am just a little suspicious that things appeared inevitable a day ago and now we are posting and throwing out "f" bombs? Also, I assumed an AICD was already implanted, but to be placed on an AED for management of a chronic condition that results in frequent manifestation of life threatening dysrhythmias is rather strange to say the least. I will send apologies if wrong, but anybody who has been educated in "medicine" would have to at least do a double take upon hearing this story.

I'm not sure you've really answered the question. It seems quality of life is still your opinion. Or as Dwayne already stated: "So the value of exerting the effort for CPR boils down to Kiwi's perception of one's quality of life?" Can a person with a chronic, debilitating condition that requires extensive support still have a rich and vibrant life that said person would consider "high quality?"

Thoughts and prayers.

No it does not. It is a critical care application and assumes a rudimentary level of quantitative literacy. It is quite simple to plug your volume to infuse, time and drop factor into one of the fundamental infusion formulae that we all learn. Mobey, I agree somewhat; however, I have had to deal with some critical patients who were receiving multiple infusions and being managed on multiple, complex modalities such as unconventional ventilator strategies, invasive haemodynamic monitoring and balloon pumps. A reliable guide is a great way to double check yourself and prevent mixing, dosing and administration errors. I can prove dy/dx of y=x^3 is 3x^2 all day long, but deprive me of sleep and give me a train wreck of a patient and I will be double checking myself.

This notion is not unique to EMS however. I've had many people ask me when I was going to move beyond nursing. In addition, I was ridiculed by some of my nursing colleagues when I was a respiratory therapy student for doing something "under" nursing. Of course I don't remember having chemistry and physics requirements prior to beginning nursing school. In any event, there exists pretentiousness and ignorance among all areas of human existence. We've all made pretentious and uneducated statements about somebody or a group of people based on ignorance and pre-conceived bias. True professionals strive to learn from past mistakes however. IMHO of course.

There are several applications that do this task. I use one called iResQ that calculates BSA based on a point and touch diagramme. In addition, it has ventilator, ABG, medication, lab and specialty critical care references. I imagine there exist several other capable applications out there.

That's not how it works in the United States. Certain states may have specific quantative benchmarks; however, many of the national accrediting agencies are less worried about actual clock hours and more worried about processes, systems, outcomes and overall Programme structure. This not only applies to nursing accreditation (NLNAC) but other allied programmes such as respiratory therapy (CoARC). Feel free to look up the sites and download their materials.

Nursing is somewhat of a mess in the United States (dependant upon the area, no doubt) and perhaps not the best example. Unfortunately, many programmes appear to be struggling to meet the educational needs of students. In my area of the country, clinical time has been slashed and many students struggle as colleges struggle to find qualified instructors and compete for clinical time with other allied health programmes. Asys brings up a potentially important point. There are many people with undergrad and graduate degrees who are unemployed and underemployed. However, looking at the general trends, people with degrees appear to do better on the whole.

You perform ventilations when indicated. The patient will initially not require positive pressure ventilation, but subsequently deteriorate after your primary assessment and intervention (Oxygen administeration). I presume you are testing at the NR-AEMT level?

http://circ.ahajournals.org/content/122/16_suppl_2/S325.full I teach PALS. This would not be a "critical error" if I were running a megacode station.