chbare

You guys saying Autism started about the time vaccines hit the scene may want to look back at your history. It doesn't appear to be anything new. Sure, we are better able to identify and classify, but the classic signs and symptoms of the various flavours of Autism are documented throughout history. In fact, some of the most brilliant individuals of the past such as Paul Dirac and others may have in fact had Autism. Dwayne brings a refreshing and dare I say objective view of the subject, especially as a parent. Take care, chbare.

Does he have a peak flow meter, can we do bedside spirometry? (I actually carry one (PEF) with me now.) Often, many people who are not well controlled may not have any complaints, only to say they never realised how bad they felt after they are stabilised. I may at least consider treating if there are no contraindications. Having before and after quantative measurements would be good, but probably not realistic in most cases of EMS transport. I'm on board with a MDI and spacer, although not because of aggressiveness or anything. It's easier to use IMHO with similar efficacy to a SVN. Also, never want to miss a teaching opportunity while I have my patient as a captive audience so to speak and MDI's are often administered incorrectly. So, I can kill a couple of birds with the same stone before even arriving at the hospital. This is a potential opportunity to make a difference with this patient. Take care, chbare.

I hope you really know why defensive medicine is prolific in the United States? Take care, chbare.

We must also remember that the American physician is fundamentally a scientist. I believe this is why the typical curriculum focuses so heavily on physical science and why a curriculum heavy in physical science is required prior to entering medical school. A physician may be involved in much more than just clinical medicine, such as research. Therefore, I believe this is why the curriculum is heavy on didactic knowledge. Of course, the physician typically spends several years following medical school, touching patients as you put it. I think your assumption that all they do in medical education is "teaching the test" is just a bit myopic. Take care, chbare.

To answer your question; yes, it is possible with some dysrhythmias. Do some research into the second degree type 1 AV block. I believe Dr. Wenkebach described this type of block initially based on auscultation and the term Wenkebach phenomena was coined. Take care, chbare.

I still work the streets in the sense that I am working in the clinical environment. I am now working as a respiratory therapist in addition to teaching. In early 2009, I was on leave from Afghanistan preparing to sign on for another year contract when I developed back pain with terrible discomfort that radiated into my right leg and gluteal area. I had apparently herniated several of my lumbar discs without ever experiencing a "traumatic, precipitating" event. It just occurred. After a MRI and discussion with my doctor, he would not medically clear me to go back to Afghanistan. I basically went from working an exciting and autonomous position that paid well and allowed me to travel the world, to... Fortunately, with good physiotherapy ( my doc basically showing me several stretching exercises and non-pharmacological pain management ) I feel more or less "normal" today. However, I've taken steps to ensure I can still make money. This has included transiting out of role where heavy lifting is required. Basically, I'm only a nurse in theory now, but respiratory therapy has allowed me to stay active as a clinician, caring for patients and I continue to develop my self as an instructor in the event I need to rely more heavily on teaching to make ends meet. Take care, chbare.

When I was told I had sustained a career ending injury... Take care, chbare.

Yep. Take care, chbare.

No single, pivotal moment in my career. I have slowly developed over the years and currently am the product of total life experience. I've had bad calls and have changed the way I think about things after certain situations; however, much of my development has been a slow process of career evolution. After much reflection over the years since I left Afghanistan, I've changed the way I view the world (for better and worse), but again, nothing drastic or sudden. Take care, chbare.

Used one on a guy who bisected his radial artery with an electric rose pruner. Used one on a guy who amputated his arm upon punching a glass window. Used one on a guy who was caught in a drug deal gone bad. They apparently attempted to shoot off his patella and ended up blowing out the popliteal artery instead. Funny, the one place (Afghanistan), I though I'd use them, I never did. Even had a patient who took a 7.62*39 through the pelvis with massive haemorrhage and failed haemostats. Quick Clot was attempted without success by onsite providers. We just packed the wound, held manual pressure and flew the guy to a CSH for damage control and initial resuscitation before taking him out of country. Take care, chbare. Edit: "taking."

Seems a rather low yield exercise in terms of patient contact and procedures. I could see a shift or two, but anything more could take away from the hospital experience, an experience that has already been cut back with newer hourly guidelines for residents. IMHI of course. Also, I've never ran into a PGY-1 who was full of themselves. Every year, my college runs a new group of PGY-1 family practice residents through a week of ACLS and PALS training in the summer, prior to starting their residency. Never ran into somebody too full of themselves. Take care, chbare.

Before I reply, I need to ask a question, a question others have asked. We need to know your role in health care or we cannot provide answers that you would intuitively understand. I'm guessing your level of understanding is rudimentary? That is okay, but you need to ket us know or I'm liable to answer with information that would be meaningless to you. If you've already introduced your self, I will apologise in advance. Take care, chbare.

We still have 4 month shake and bake paramedic camps in the United States, an Associates degree is not even required for entry into practice in most areas and most paramedic programmes require little to no mathematics or physical science education, yet this "paramedic practitioner" concept continues to come up on this site? Of course, there exist NP's with minimal physical science background who are independent practitioners, so I shouldn't be too surprised about people thinking they can be the new "diet physician." Take care, chbare.

However, the population growth has become much slower in countries with "modern" medicine and good indicators such as lower infant mortality rates. In fact, countries such as Japan are headed toward a population growth crisis where the elderly will significantly outnumber the young with the potential for near zero growth. Yet, countries without sophisticated health care or countries with lower indicators (high infant mortality et al.) are experiencing significant population growth. Take care, chbare.

If you look at the literature, surgery doesn't have a great record of success. It appears reasonably effective for neurological problems, but as a method for pain control, the results are pretty depressing. While I'm not going to give medical advice, I do suggest people consider all options, research, get the opinions of several physicians and make informed decisions. Take care, chbare.

I was thinking about the circuit attached to the tube and related equipment (cascade) that would go along with the tube relating to mechanical deadspace, but probably a moot point as stated. Take care, chbare.

It typically has a smaller diameter/radius than the airway and will add resistance to the flow of air. This can increase the work of breathing. In fluid dynamics this is explained by something known as Poiseuille's law. However, Poiseuille's law in it's standard form assumes incompressible fluid and laminar flow, so it's only a gross approximation when using compressible fluid and turbulent flow. The tube may also increase something known as deadspace, mechanical deadspace to be specific. Take care, chbare.

Unfortunately, antidysrhythmic medications have significant pro-arrhythmic effects, so "calming" the heart is probably not the best analogy. However, if you are well versed in their mechanisms of action, I would not make a big deal of it. However, some people take these sayings literally. A real common one around here is that "lidocaine numbs the heart." Unfortunately, I feel this shows a fundamental lack of knowledge regarding the mechanism of action of these medications when we distill things down to catch all statements. The evidence is rather telling in that I gather both agents are equally ineffective at having a functional member of society walk out of the hospital. Therefore, it's a crap shoot IMHO. My bias being that I really do not focus on medications that much in an arrest unless there are clear indications such as a drug overdose or electrolyte imbalance that would potentially benefit from certain treatment modalities. Anecdotally, my experiences with both agents are equivalent. Take care, chbare.

Or, if I happen to have a Ph.D. in Persian rug history, I should also be called "doctor" in the clinical setting. Also, more food for thought: The term EMT paramedic has been removed following the NSOP changes. A paramedic is no longer even considered an EMT. If only educational requirements would show said changes, yet that is a different discussion for a different day. Take care, chbare.

Let me put this back on you since you apparently have covered this in depth. What does the current evidence suggest? Does either agent lead to increased survival to discharge? Take care, chbare.

Tell the RN that is okay and I would like to speak to the charge nurse about the situation. Possibly involve the DON if needed. Also remind staff of the patient's bill of rights and the fact that the patient's POA will be in shortly to review the assessment findings with all providers involved. If needed, we may consider involving the independent patient ombudsman at some point. Take care, chbare.

Track the RN down and insist that a complete, bedside report occurs. Partner can stay at bedside while I personally find the nurse. Transfer of care and continuity of care cannot occur via the agency of a CNA, a non-licensed provider that is ultimately not responsible for the the patient's care. Also, involve the patient during this bedside report. If need be, involve medical control; however, at this point I cannot force a person who is alert and oriented and presumably (we need to verify that the patient is in fact making her own decisions) able to refuse care to go to the hospital. Take care, chbare.

Septic shock when defining it with proper criteria will likely be exceedingly difficult to diagnose by point of care EMS crews. To actually say somebody is in "septic shock," you must identify a constellation of findings to include a sepsis related SIRS response, multiple organ dysfunction and the presence of refractory hypotension. I want to stress the term "refractory. This means you need to perform initial fluid resuscitation first, and only after fluid resuscitation has failed can you think about septic shock proper. Remember, not every hypotensive patient with sepsis will be in septic shock. Take care, chbare.

http://www.anesthesia-analgesia.org/content/91/2/358.full Take care, chbare.

Not sure I follow your vagus nerve statement? If you have supratentorial haemorrhage/mass effect/swelling, the vagus nerve very well may not be involved. Take care, chbare.