chbare

A function of environment perhaps? One of the first services I worked at was in a rural, farming community. Organophosphate insecticide exposure was not uncommon. I remember a particularly bad case that I was not involved with, but it made quite an impression on many of us in any event. The patient apparantly had a very complicated inpatient course. Eventually, it was realised that he had large enough concentrations of insecticide under his nails to cause ongoing problems.

I think it's a bit more complex than "whiney" parents in some cases however.

I am afraid I am not compelled to change my stance. If my physician chooses to terminate our relationship based on my refusal to vaccinate my children, all the better. I'm probably better off finding somebody who's views resonate with my own. Clearly, this contrasts to an emergency physician or on call admitting physician. Accepting patients and providing care unconditionally is part of their job description. Primary care physician on the street corner, not so much.

I can choose to go to a certain physician and a physician can choose to provide me a service. Seems to be a simple concept to me. I go to a doctor as a customer seeking a service. The physician can decide not to have me as a customer. Personally, I like being able to choose who best fits me and would appreciate a physician terminating the relationship if he/she had an issue with me. The thought of a system that would force somebody to provide this service in spite of them having personal issues with me is terrifying. The patient/physician relationship should be based on mutual trust and respect. Forcing somebody to care for me violates that basic tenant IMHO.

However, you have a well defined scope of practice and adhere to those standards as I understand?

I had my suspicion but didn't want to give it up as I had to deal with a case of P falciparum a few years back. I've often heard malaria called the great imitator and I'm a believer. Great case, much appreciated.

I worked with several SA medics and B-tech medics over in Afghanistan. A few worked in the Joburg area. They had a few stories to tell.

What is the context here? Does it have something to do with the word were?

A vector borne illness is always something that needs to be ruled out. Malaria is always at the top of the list. Edit: Obviously many others to consider or even something a bit more bizarre such as tick paralysis. You said you didn't strip the guy, did you do a detailed exam at some point?

Romazicon? You guys doing procedural sedation on benzo naive patients or something like that?

Past history of sore throat, fever, malaise or scarletina? His signs and symptoms resemble Sydenham chorea.

To add additional information: It appears this took place ten years ago, so routine Carbon Dioxide monitoring may not have been as prevalent. The protocol they had about doing a look on intubated patients seems to support my suspicion; however, It appears there were numerous errors here.

Right, atropine has been removed from the algorithm. Never said it was harmful. I would expect people to use good clinical judgement and use it in certain situations where it may be helpful. Nerve agent exposure and PEA/asystole arrest during a colonoscopy for example. With that, I see no need to use it "routinely."

http://m.jems.com/article/news/alleged-paramedic-mistakes-cost-chicago2 No mention of Carbon dioxide monitoring.

Why use something that doesn't work? Take the following scenario for example: The medicineman voodoo dance of healing doesn't appear to effect PEA/Asystole outcomes. However, PEA/Asystole survival is so low why not do the dance during a code? We don't do it because it's not effective and it adds additional cost and resource utilisation when there is no clear benefit or rational for using it. Same concept applies with atropine in most cases. We don't perform interventions because we "think" we should. We perform interventions (usually) because there exists some sort of evidence supporting the use of said interventions.

Yeah, I realised that after posting. I am a little dense today I suppose.

We also use porcine based labs. Particularly, hearts and lungs for our heart/lung labs. In addition, I was recently able to procure a television, microscope and a flex camera and have integrated formal histology labs into my teaching along with a tonicity lab where I have a student draw my blood and citrate it. Then, we take various samples under microscopy and add solutions of various tonicity and appreciate the results as you can easily view the red blood cells. It's a pretty standard first semester anatomy and physiology lab exercise, but a novelty for AEMT students. I also managed with much smooth talking and pestering to procure (borrow from a university chemical stockroom) gas emission tubes and spectroscopes. This has enabled me to integrate formal spectroscopy labs into a survey physics class that I teach. So far, I have been sticking with Hydrogen because the math can be reduced to a simple Rh/n(2) for calculating energy levels. Baby steps, I keep telling myself. We also use the standard sim man, chicken legs for IO and I use racks of ribs, inflated balloons covered in tape and an anatomical skeleton model for realistic pleural decompression. Moulage is fairly simple as well. Fake blood and cottage cheese can work wonders. Also, coffee grounds mixed with conductive gel makes for a great prop. I have even managed to attach large syringes to endo-tracheal tubes after intubating airway mannequins. The syringes were filled with foaming hand cleaner and roughly approximated excessive secretions. Edit: -Rh/n(2).

I am having a difficult time understanding how that adds anything productive to the conversation at hand? The OP mentioned the weather and originally being from the Northern United States, I understand how one can develop an aversion to winter weather. Edit: Globex corporation, you sorry sukka! I saw what you just did there, even if it was a bit too late.

I hear you bro. Moved to the Southwestern United States just over 10 years ago and I've never looked back. Love the weather down here, love the culture and love the food. Also, I can be hiking in the rugged mountains, appreciating the desert sands and enjoying the forest without ever leaving my state.

Both are roughly equivalent in their aim and scope of knowledge; however, PHTLS is a derivative of the ATLS curriculum.

Totally different story bro. You are doing the worst possible thing. You are injecting information into a scenario to make it fit what you personally think is right. Take questions at face value and do not add additional information. Consistently going against this rule of thumb will make your future testing experiences rather painful.

I understand the frustration with the instructor's answer regarding the question; however, the scenario seems very straight foreword to me unless I am missing something. Obvious gunshot wound to the head, no pulse and no respirations paints a clear picture in my mind.

Is this in the United States? That is a pretty meaty EMT curriculum compared to many in the United States. Not that I am complaining however. I'd live to discuss your curriculum if possible assuming it is based on the NSC. A couple of other EMS educators and I and pushing for significant changes to our EMT, AEMT and paramedic curriculum.

I'm not arguing about the inadequacy of EMS education in the United States; however, I'm not keen on quantifying it with a single number when significant variation exists.

The NSC has been replaced as you stated and some states are already making the transition, therefore I'd be hesitant to apply said standard across the board. The new guidelines are actually nebulous as to the clock hour requirement. This is both good and bad IMHO.