chbare

Infidelity is a complex situation involving many factors potentially. While it certainly may be an indication of overall relationship issues, that's not the only factor to consider. Take a rather esoteric example, but valid nonetheless: Take a person with a personality disorder. This individual may engage in such behaviour regardless of the overall status of the relationship. Additionally, defining infidelity seems nebulous in some cases. Take the concepts of "open" relationships and the "swinger" lifestyle. Clearly, this behaviour probably falls outside many mores and norms, depending on the environment, but now we have to be very careful how we define infidelity in these cases. It's not necessarily a physical or even psychological phenomenon, or at least not using the common criteria many here would apply. It may even vary from relationship to relationship or even person to person. This further complicates the picture.

I would suggest you take a little time to get to know the people on EMT City before making sweeping generalisations about what we all want and what we are willing to do to complete our goals. This site contains a diverse group of providers with varying goals and aspirations.

Yeah, the DNP is a strange animal. Many people call it a "clinical" doctorate and do not associate it with a PhD. Anecdotally, it seems to be an add on degree that allows one to be called "doctor" and pushes an agenda of completely independent nursing practice. It's going in a concerning direction, but with the implementation of affordable health care, I'm not sure the trend will stop.

Those three courses have been a fairly standard part of most nurse practitioner core curricula (MS prepared). The DNP doesn't seem to address basic medical sciences beyond what MS prepared NP's already have. I've seen a few DNP programmes that involved 9 months of online courses.

Yeah, this is tough. Back in the dark ages as a nursing student, it was very clear who the physician was. When I went back to school in respiratory, I spent a significant amount of time in a large teaching hospital and with all the "doctor" titles it was exceptionally confusing to tell who was what. I would not want to be in a situation out in the field where somebody identified themselves as a "medic" and I understood the standard interpretation of that title only to find out the provider was not a paramedic. Perhaps this is not a problem in a system where everybody is aware of the rules, but I cannot stop thinking about those confusing experiences I had in that hospital.

I'm not so bold as to definitively state it's bad; however, the evidence (yet) is not compelling me to champion for sweeping changes of guidelines. We will see what the next couple of years bring as the 2015 guideline recommendations are right around the corner. Of course, that's not to say they always get it right.

I am not sure this study alone is enough to compel a paradigm shift in clinical practice. Many people will likely point to the COMMIT trial where larger numbers of patients in IV Beta blocker groups developed cardiogenic shock. Of course, the COMMIT trial was published back when primary PCI was less prevalent. In addition, the primary end-point of infarct size used in the METOCARD-CNIC trial is nice, but what about compelling clinical outcomes? This is certainly an interesting development and may open the floodgates for additional Beta blocker trials in contemporary times where PCI plays such an important role.

Possibly. I was probably projecting a few of my own personal experiences.

That's pretty interesting actually. Certainly not the typical story of hormonal, lust filled teenage regret and disastrous, dramatic breakups.

n=1 experiences may not be representative of the world in general...

I am not talking about global consensus when it comes to teaching. I am talking about consensus on best practices for treating problems such as acute coronary syndromes and so on. Clearly, countries will have to develop educational curricula based on their resources and needs, but a starting point for best practice is not a bad thing to have.

A crew I may or may not have known or worked with may or may not have gone into a hospital where nurses may or may not have confused vancomycin and vecuronium. OP, you should check out emcrit's series of podcasts on the "Laryngoscope as a murder weapon."

Rather than globalising training, I think the approach of developing international consensus regarding treatment is a good goal. Then, countries have a framework of treatment recommendations and can develop educational programmes that take the nation's needs and resources into account. For example, the world is roughly on the same page when it comes to emergency cardiovascular care. Of course, with consensus, compromises can occur and guidelines may neglect things that some people and experts consider important.

I'll parrot what Scuba said. We still cannot get everybody in the world using the same systems of measurement, I don't see standardising curricula globally.

My wife is still friends with an old high school ex. I have no issues with it. Of course, I have no issues with anything she wants to do. I don't have any past lovers that I'm on speaking terms with. Not so much that the break ups were terrible or anything like that, just that we were young and went our separate ways.

Kiwi, take a look at my post and you will see I addressed the work visa issue clearly, among other immigration related issues.

As a nurse, your best bet is to look at nursing reciprocity in the United States. This involves work visas, employer sponsoring and immigration. Additionally, you will have to deal with boards of nursing and exams like the CGFNS and NCLEX. Basically, it's a hassle. Additionally, there is not a big market for nurses that provide "core" EMS care. Most nurses in transport work for specialty teams, flight and critical care transport teams. With that said, the National Registry of Emergency Medical Technicians does have a formal reciprocity process for national EMT certification. You can find information at: www.nremt.org Your best bet at a job is via nursing however. Good luck.

I'm sorry for your loss. Thoughts go out to you and your family.

It makes a possible case not for aggressive cooling but for aggressive prevention of hyperpyrexia. Interesting and I wonder if this will change the AHA zeitgeist regarding hypothermia when 2015 comes around?

http://www.nejm.org/doi/full/10.1056/NEJMoa1310519?query=featured_cardiology#t=articleTop

My premiums will increase 20%, co-pays to increase by 10% and some prescriptions will not be covered. I have not been able to really look at alternative pans (ACA), but will likely not qualify for a cheaper plan...

I may be in the minority, but I am not all that convinced that cholesterol lowering agents really impact mortality. The evidence is not significantly compelling. Most of my issues are lipid based and I do not currently take statins, but I am not all that confident that Lovaza therapy decreases mortality. Certainly, the literature is not all that strong when it comes to people with CAD and their outcomes. However, providing I can afford it and the complications are minimal to none, I am going to continue to take meds. I am torn on the statins as it is likely I will be a candidate for these agents with the new guidelines that go into effect.

The guidelines are fixing to become more complicated. This will involve many people. I will likely be one as I am a consumer of lipid and cholesterol lowering medications.

They are mentioned in the information you posted, but I want to make sure everybody is clear that we have specifically stated these signs have been appreciated. We've yet to do a good physical exam and I want to make sure everybody can appreciate the cardinal signs of the proposed toxidrome.

There are a few things that we should appreciate when looking at the patient.