chbare

Just to be clear, asthma is a form of COPD. Take care, chbare.

I understand where you are coming from. This semester started out with me hitting the ground running and it's been a***s and elbows since. I will send the info by PM. Thanks. Take care, chbare.

Thank you Dwayne and everybody else, this is a great honour as I know there are many other members that have been here longer and have many more posts. I have always tried to stay active and hopefully a productive member of the city. EMS has always been my first love so to speak and I will advocate for this profession regardless of where my life takes me. There are so many people here who could be recognised and I agree we need to keep up this type of recognition process. I would be more than happy to help with purchasing prizes or anything else that is needed to ensure we can sustain this concept. Thank you again and I really am honoured and quite humbled that I have been chosen, especially because there are so many people here that have contributed to some of the best threads that I have seen on the web. Take care, chbare.

The more experienced I become, the more thoughtful I am about aggressive interventions that are associated with high risks. I am in fact more fearful in some ways than I was as a neophyte provider. Take care, chbare.

No. Many nursing programmes have a chemistry requirement, but it's still a mixed bag. Some of the allied health programmes such as respiratory therapy may have physics requirements. Take care, chbare.

I would dare say you may be a minority. I didn't even take algebra in high school let alone chemistry or physics. However, once you begin to learn, your life is changed in ways that are more profound than I can even explain. I remember studying a bit of electricity and magnetism and a brilliant flash of intuition occurred during some thoughts on Coulomb's law. It dawned on me that the force laws of gravity were nearly identical in form to the laws of electrical attraction and repulsion. Both are inverse square laws! The absolute beauty and stunning realisation that two seemingly unrelated aspects of nature share a common symmetry was incredible. Making these profound connections not only allows us to understand our jobs and the physical world better, but I think also allows us to develop tools for everyday problem solving because we are able to understand said concepts and critically think through unique problems and ultimately connect seemingly unrelated concepts. Take care, chbare.

There are three areas of study that I think are absolutely fundamental to master if you want to develop any understanding of the physical world. They include; mathematics, physics and chemistry. All understanding of our physical world is derived from these three areas. You may remember my thread on chemistry requirements for EMS. I think a survey of physics is crucial for prospective paramedics. I was actually able to do an eight hour series of lectures on introductory physics for a paramedic program that employes me as an instructor. Understanding the basics of vectors, force, work and even understanding the difference between speed and velocity are helpful in so many ways and lay the foundation for understanding trauma and injury patterns, mechanism of injury, how fluids flow and how the circulatory, musculoskeletal and respiratory systems function among many other things. I went a bit overboard and explained the basic concept of differentiation and derived F=ma from the conservation of momentum, but it's such a fundamental concept I really had no choice. We even did a basic lab on force and types of energy (primarily kinetic and potential in terms of classical physics). Demonstrating the concept of intertia was really fun and I always love looking at people respond to the old helium balloon in a car trick. Take care, chbare.

How exactly does one define "fearless" paramedicine? Assuming a very broad and ambiguous interpretation, I would have to say such a concept should not exist. Fear is a natural concept, it is something we experience that ultimately ensures our safety and helps us make better judgment calls. A certain amount of fear should always be present during the patient care experience. We should experience fear and respect regarding our patients because ultimately things do not go well. Also, we need mechanisms in place that make us ponder our proposed actions prior to going down a certain treatment pathway. RSI anybody? Take care, chbare.

That is great. I think it also speaks well of a company to have their finger on the pulse of the folks and recognise customers in such a way. They apparently care about their product and clearly care enough to find out what the folks are saying about their product. Your idea about recognising exceptional City members is also great. I am somewhat partial to a vote. Perhaps have a 24 or 48 hour nomination period where people can nominate on a thread or maybe by PM. After the nomination period ends, have the folks vote on the nominees. The top five will receive the "prize" so to speak. My thoughts, and they are certainly not definitive. Take care, chbare. EDIT: What would be kind of neat would be to profile the winners with their permission. Nothing too personal, but something about how long they have been in the field , some of their accomplishments, what they have done to improve EMS and so on. Clearly, we would need to be careful about crossing the privacy and safety lines, but it's just a thought.

As a person who suffered through nursing school, my best advise is to be careful about choosing your battles. While I absolutely agree that instructors should be obligated to teach correct information, my experiences with some nursing instructors are that you will be in for a long and exceedingly painful trip by choosing to contradict said instructors. It is not right, I disagree with it; however, there is an unwritten saying I often hear and it goes something like "cooperate to graduate." It is a sad state no doubt, but an uphill battle that will typically lead to the student loosing regardless of what is actually correct. This is a curious dichotomy, because I actually want my paramedic students to call me out and challenge anything I say that sounds suspect; however, I require that they present a compelling case. As long as you call me out respectfully and can back up your stance, I take absolutely no offense. The environment in my classes is unfortunately very different from other classes at the same college. What can make it even more difficult is I am an instructor at one moment, then immediately transition into student mode the next moment. Unfortunately, my tendency to question, debate and argue has made the last two and a half years more painful than they had to be. ( I must admit that for the most part, my instructors have been fairly patient with my behaviour.) So, I can appreciate the OP's point of view, but know that challenging instructors can make your life much harder than it needs to be in some cases. Good luck and strive to never be that type of instructor. Eyedawn, I suspect that by now you recognise that nursing school has a culture all it's own? It is exceedingly difficult to compare EMS education to the nursing school experience because nursing school really is very different from any other type of educational experience I have ever been a part of. Take care, chbare.

Does compelling evidence exist to support the use of IV adrenaline over IM adrenaline in the initial management of anaphylaxis? Take care, chbare.

Unfortunately, neither of those options will help right here, right now. The OP is currently struggling and needs help. While your suggestions are great for pro-active people and people who continue expo facto, neither will help the OP out of his/her current situation. Plus, you need a minimal level of mathematics and writing skills to take a proper chemistry course and will need to take chemistry, biology or A&P to get into the microbiology. Take care, chbare.

The officer acts professionally. If I'm speeding, give me a ticket. I am of no more importance than the next guy and breaking the law is just that. Take care, chbare.

I would have had your back doc. Take care, chbare.

There will always exist ethical dilemmas in this line of work. People may not always agree and different interpretations will always exist no matter how concrete you think a certain document is written. Take care, chbare.

Take care, chbare.

Damn Doc, I really appreciate the doc's continued involvement on the city. At this point, I'm going to have to go with no intubation as well. Take care, chbare.

No, ambulance time is not required to maintain ACLS, PALS or TNCC credentials. Some employers may have a ride requirement, but AHA and the ENA has no such requirement. Take care, chbare.

Another option is to consider respiratory therapy. If nursing theory and the doctor nurse politics are a deal breaker, respiratory therapy is an option to consider. In addition, you have a significant amount of critical care experience as a respiratory student. Take care, chbare.

Unfortunately, chemistry underpins the fundamental concepts of anatomy and physiology. One pitfall is the fact that we try to look at these science courses in a vacuum. I dare say that somebody who had already had some chemistry and is fairly well versed in rudimentary concepts of chemistry would typically do better in A&P and perhaps take home additional knowledge and understanding that would otherwise be too foreign to learn. OP, if you can give us more specific answers and answer some of the questions posed, we may be able to steer you in the proper direction. Resources such as Khan Academy are always a consideration. I am not too proud to admit I have used Khan Academy at least a time or two when confronted with a difficult problem involving trigonometric functions I was not familiar with and other concepts that I probably should have learned in high school. Take care, chbare.

Set a standard and make sure the details are spelled out clearly along with expectations and consequences, Have specific goals and benchmarks set and ensure you have your medical director back you up. Also, you will have to take the lead by setting a good example. After you set the standard and begin changing the underlying culture of the service I would also suggenst the following: 1) You should look at having a mandatory monthly meeting, perhaps two different dates to catch all your employees. This meeting should be several hours long and would cover a refresher topic. Airway, paeds, toxicology and so on could be covered. 2) you should implement a good QI/QA process and mandate 100% compliance. In addition, at least one chart review should be performed at the monthly meeting along with frank discussion that should be preferably facilitated by your medical director. 3) Look at contracting with a larger, high volume service and mandate that your employees get a day of ride time under a qualified preceptor every quarter. In addition, implement a quarterly skills verification session and if you guys do invasive procedures, quarterly clinical verification such as spending a day in the theatre for airway management is highly recommended. 4) Mandate that your employees spend some time rotating through hospital specialty clinical areas such as ICU and Labour and Delivery every six months to a year. 5) Recognise and respect the crew members and have a mechanism in place for identifying and rewarding people. Let them know that they are valued and integral components of the team. Take care, chbare.

However, some of these pre-hospital devices are able to significantly increase the flow by use of the Bernoulli principle and air entrainment. It's not the flow that concerns me so much, it's the pressure. Unfortunately, with air entrainment, it's a rob Pete to pay Paul situation. You have allot of flow, but the increased kinetic energy comes from somewhere. This somewhere happens to be in the form of decreased pressure or a decrease in potential energy. So, with inspiration, many of these devices provide flow, but I am not confident they can provide true continuous pressure during inspiration. So, you potentially get a device that provides 1/2 CPAP with inspiratory flow augmentation. Hey, that is a pretty cool, catchy phrase, I should market it as a new modality. Bet it would sell like crazy with such a fly name? Take care, chbare.

Remember, if we are talking about an intubated patient receiving controlled ventilation (let's say volume), the flow is a function of how quickly the tidal volume is delivered. So, you can increase the flow, but the amount of gas delivered will be the same assuming the volume to be delivered remains constant. The said volume would be delivered faster resulting in a decreased inspiratory time however. CPAP in a spontaneously breathing patient may be a different story. It can be confusing; however, CPAP & PEEP are physiological analogues, but can be delivered in different ways. Hopefully that makes sense. Take care, chbare.

Thanks for keeping us in the loop Doczilla! Take care, chbare.

To be fair, we do this all the time. You think that stuff you learned about orbitals from your high school chemistry class was not an over-simplified translation? So, when it comes to books about religion and so on, I'm certainly not going to make a big deal about the First National Church of Elvis writing their interpretation of the bible. Does it really matter anyway? What the governor did was wrong, nothing much else to say here. I would feel the same if he had been an atheist and remarked that only atheists could be his brothers and sisters. Take care, chbare.