chbare

I have the same problems at my service. Often, I find stopping the Diprivan and going with fentanyl and benzo boluses works well. Anecdotally, I find it difficult to make people comfortable with Diprivan outside the hospital. However, this will be less of a problem as the minimed will no longer be manufactured. Take care, chbare.

This is not a state EMS board conversation, therefore the state stuff is invalid IMO. The OP specifically asked about NREMT. In addition, three years and some change is not that long. I will continue to stand by my statements. I can see only one reason for an 85-99 transition at this point in time: "I want my 99 because it will be an easy transition to paramedic without actually going through a full programme in a few years." If this is the case, it's the path of least resistance and may not be what is best for the patient and your career. Go to medic school. Take care, chbare.

Both are going away, why bother? Get ready to transition to AEMT or look at medic school. Take care, chbare.

Do not take this wrong; however, if you are not aware of good airway resources such as the Ron Walls manual, yuo may not have had much exposure to this area. You stated it was only touched upon in school, yet you will be performing these techniques at your service? The important questions to ask yourself are: 1) Does my service have a comprehensive programme that covers RSI? 2) will I have OR time? 3) do they recommend a specific book for their course and what it is? 4) Will I have extensive, dynamic airway lab scenarios with SIM man and or cadaver exercises? 5) Is a comprehensive QA/QI programme in place? 6) Are there mandatory refresher courses every quarter or so and a minimum number of tubes required along with repeat OR time? 7) Is the proper equipment available such as back up airways, waveform capnography, bougies and so on? I hope that helps, I would hate to see you set up to fail. RSI is one of the few times where we are given a golden opportunity for a clean kill. Good luck. Take care, chbare.

ASA affects platelets, a good point to emphasise as these other labs are related to clotting factors. However, with an INR that elevated, one has to assume some sort of factor problem and altering the platelets in the pre-hospital environment may not be the best way to go. Take care, chbare.

I have to disagree. There is a big movement and in some states NP's already have completely independent practice. In addition, there is a group of NP's who want to be called doctor in the clinical setting and utilise the doctor nurse practitioner concept as a means of doing so. While we are veering off topic, it is important to realise this movement is actually worthy of a discussion on the terminology behind how we address providers in a clinical setting. Regarding the OP, I do not see how using these pet terms to describe people in casual conversation can be all that harmful. Clearly, bullying and such occurs in our profession; however, these terms are far from the worst problems we encounter regarding terminology, respect, professionalism and bullying. Take care, chbare.

Agreed with the above. If you really want to discuss the nursing name game, you should take a look at all the drama the DNP movement is causing. Take care, chbare.

I cannot see how the statement in question applies to CPR pulse checks per se? It was based on electrical versus mechanical capture in the setting of TCP. I think he was simply saying you can have electrical capture without the presence of mechanical capture or a pulse. Take care, chbare.

A blog post of somebodies opinion is not really the best method for deciding for or against the efficacy of any given intervention. I do like the fact that you are looking for additional information. The truth being there is limited pre-hospital data regarding the King. However, the data regarding the use of other supraglottic airways such as the Combitube is fairly positive IMHO. An argument pitting the King against the Combitube is inane at this point with the limited data; however, from what I can see thus far the efficacy of the two devices is pretty similar. Regarding an arrest situation; good bag mask technique ~ ETT ~ Combitube ~ LMA. The emphasis on advanced airway modalities has been removed in recent years in favour of quality, uninterrupted CPR. Take care, chbare.

Did you happen to read "Pride and Prejudice and Zombies.". It was written by the same author and I would highly recommend it. You basically have the original story with the same old stuffy Brits, ninjas, Kung Fu and zombies. Take care, chbare.

I hope everyone enjoyed this case study. Somewhat of an atypical presentation of a condition that is not all that uncommon. Take care, chbare.

Yep, he was eventually diagnosed with variant angina. Take care, chbare.

Unremarkable. Take care, chbare.

Possibly, think about a few key points; 1) The signs and symptoms started suddenly while at rest. 2) The signs and symptoms resolved suddenly with treatment. 3) Substitute the LBBB with ST elevation and would you consider other differentials? Take care, chbare.

Had his appendix removed. This is actually not a zebra case. Take care, chbare.

A great question and one the receiving facility asked us. They initially thought there was a problem with the paper speed; however, the repeat XII lead was totally unremarkable. Take care, chbare.

No stimulants or illicit substances on board. So, you are looking at a Medevac? Take care, chbare.

He would go to Dubai; about three hours if you manage to get a leer or hawker, 5-6 hours with a possible refuel stop in Kandahar by way of a King air 200 if you cannot get a jet. You have CT, CMP is a complete metabolic panel or chem 12, echo is unremarkable. Not really a zebra, but perhaps somewhat of an atypical XII lead when considering the problem. Take, chbare.

Absolutely, a consideration to place on the list of differentials. I included a totally unremarkable coag profile and D-dimer to give people working with this differential more to go on. Take care, chbare.

You can always try to evac out of country. Repeat XII lead: Take care, chbare.

Cardiac enzymes are negative, coags are normal, d-dimer is negative, AP chest is unremarkable, CMP is normal. Patient remains symptom free. Take care, chbare. Edit: WTF, two posts in one?

So, we did the following; 1) oxygen 2 LPM NC 2) ASA 325 mg crushed 3) nitroglycerine 400 mcg Sl 4) metoprolol 5 mg slow IV 5) Get him the hell out En route his pain improves to a 0/10 and you arrive safely at your destination about an hour later. What do you want at the military hospital? Take care, chbare.

So, we have a new onset or presumably new onset LBBB with his signs and symptoms. What do you want to do about it? Take, chbare.

Pressure in right arm ~ pressure in left arm. No military experience works a desk job for a logistics company. No radiation, does c/o "moderate dyspnea." BGL is 150 mg/dl. XII lead: No xray at the clinic. You can send labs out with a local and have them back in the afternoon, about 6 hours from now. Taking an ambulance trip to the military hospital is always a safety risk. Take care, chbare.

He is alert, awake, and oriented with a patent airway. Pmhx: appy about 5 years ago No allergies/intolerances, no meds, smoker about 10 pack years, 2-3 drinks a night, dad has DM HPI: Sudden onset chest pressure about 10 minutes ago while entering data on his computer, first time he's ever felt this way, no C/O stress or anxiety, "just started all the sudden." ROS: anxious, complains of chest pressure at about 7/10, otherwise unremarkable VS: p-94 rrr, 22 non laboured, 160/88, 97% RA, PE: Fairly unremarkable, lungs clear, S1S2, no JVD or edema, belly soft and non tender, neuro status intact, obese with a BMI ~ 30 Take care, chbare.