chbare

You survived mate, enjoy this thanksgiving with friends and family. Take care, chbare.

Why would you want to go to New Zealand and attempt to obtain work as a Basic Life Support provider when you will have a degree in nursing? No offense to New Zealand providers; however, things do not add up in my mind. True, I worked over seas as an Intermediate Life Support Paramedic; however, the pay was just a bit better. Take care, chbare.

Good old Thomason, or UMC now. Been to that hospital a time or two. Take care, chbare.

The Voyager's may end up being the first objects to leave the solar system; however, this has yet to occur. Take care, chbare.

I find it rather interesting that many people actually believe we can create micro black holes and open and destabilize other dimensions. We are talking about smashing particles smaller than the smallest known atom (hydrogen). In fact we are essentially talking about smashing protons (hydrogen nuclei). Assuming humans could actually create a micro black holes (insert allot of imagination) with LHC technology, I can only assume these objects would be so small and unstable, they would emit more Hawking radiation than the energy they could possible acquire and promptly "fizzle" away. The reality being, we cannot safely transport a human to our moon and we have yet to shoot an object out of our own solar system. I have a very hard time thinking we could actually create objects we cannot even explore beyond indirect observation and mathematical assumptions. Please correct my statements as I am not exactly a physicist. Take care, chbare.

Any wannabe physicists on this site will appreciate the newest update from CERN. The large Hadron Collider is up and running again. After only a couple of days, proton beams are focused and colliding at relatively low energy levels. Hopefully, levels of around seven trillion electron volts can be reached. Hopefully, the next year will be exciting and I would love to hear in the near future that the Higgs Boson has been identified. Take care, chbare.

Take care, chbare. Edited for color coordination.

I am not sure I would call somebody an idiot without definitive supporting evidence. Unfortunately, I find many paramedics are taught the exact phrase quoted. Stable = drugs and unstable = electricity. While it is partially true, many providers are not educated to look at the big picture and try to connect dots. Take care, chbare.

However acting without considering the big picture or causes that can be corrected or treated is myopic and potentially harmful IMHO. If this were a post resus renal failure patient who missed dialysis for a week, would your treatment modalities be different? Treating patients with blanket statements in a vacuum should be avoided if at all possible. This is why I continue to question patient history. A simple cardiovert/no cardiovert scenario is meaningless without history and additional considerations. Take care, chbare.

However, we are still discussing the question about who benefits from oxygen therapy? I think we can say, yes some patients will benefit from supplemental oxygen. However, how much they benefit from the said therapy may be a better concept to discuss. Going back to an anemic patient; There is little doubt that increasing the partial pressure of oxygen will in fact increase the content of arterial oxygen in these patients (assuming no diffusion or oxygen movement problems exist). However, as pointed out earlier the actual impact on content of arterial oxygen is rather small. In addition, we must also appreciate the difference between hypoxemia and hypoxia. There exist very important considerations and implications associated with these two concepts. Take care, chbare.

Good, so glucose has multiple forms; however, nature tends to favor the D form of glucose. This form is what we commonly call dextrose. You are correct in that dextrose is the D enantiomer of glucose. An enantiomer is a type of stereoisomer that has a "mirror image" characteristic. Additionally, there are profound optical differences between D & L. Passing polarized light over a D enantiomer will cause the light to move clockwise in what we call dextrorotary. Likewise, a L will cause the light to move in a counterclock wise direction called levorortory. Is there an easy way to tell D from L? Does the difference between D and L potentially effect humans? Take care, chbare.

Do you ever wonder why things are called what they are? Simple, every day concepts we often discuss have deeper meaning behind their name. So, why not dedicate a thread to these concepts? So, let's start off with a very common one. Why do we call glucose, dextrose? Is there in fact something special about dextrose? Is all glucose the same? What is a primary difference? Trust me, understanding this concept will go a long way in helping you understand how it applies to other medications. Take care, chbare.

As stated earlier, we need to seriously consider the cause of the arrest. The differential for PEA includes multiple considerations. Getting crazy with amiodarone will not be helpful if we are dealing with an overdose of a med known to increase the QTc. Additionally, we need to consider other medical and trauma causes. I alway consider electrolyte imbalances. We can actually do something about hyperkalemia in the field. The key is index of suspicion and identification. Take care, chbare.

Looking at literature used by AHA, airway type does not appear to make any difference. Bag mask versus ETT versus supraglottic are all options. However, advanced airways do not appear to effect outcomes. Take care, chbare.

Why, a "good" paramedic school should prepare a person for practice regardless of prior experience. EMS continues to be one of the few areas in medicine that mandate working at a lower level prior to moving up. To the OP, good luck with your searching, a good school can be hard to find. Look for degree programs that mandate college level courses such as anatomy and physiology. Take care, chbare.

It seems, many countries outside of the United States have physicians who are much more involved in the practical aspects of EMS. I worked with South African casualty physicians who were rather adept in the practical aspects of patient care. As an American, it was rather strange having a physician help you package a critical patient for transport. I remember caring for a hypertensive emergency somewhere over Iraq in a Russian cargo plane. While I was monitoring the patients ICP via an IVC system, my doc mixed and hung a labetalol infusion. Something that is rather foreign in my experience as a nurse. Take care, chbare.

You are correct; however, we must keep this in perspective. I will will use the content of arterial oxygen formula to illustrate the point: The CaO2 is calculated with the following: CaO2 = (1.34 * Hemoglobin * SaO2) + (PaO2 * 0.003) Let's say you have a Hb of 13, SaO2 of 96% and a PaO2 of 100 mm/Hg CaO2 = (1,34 * 13 * 0.96) + (100 * 0.003) 16.7 + 0.3 = ~17 ml/O2/100 ml blood So, you can see, even with a PaO2 of 100 mm/Hg, you are only adding 0.3 ml/O2/100 ml blood to your total CaO2 Let's say in the land of Oz we are able to have a 100% oxygen atmosphere and by an act of God we are able to increase the PaO2 to 760 mm/Hg This would only come to 2.28. This is why to have meaningful increases in oxygen via dissolved oxygen content, we typically look to hyperbaric therapy to significantly increase the partial pressure and thus dissolved pressure of oxygen in the body. Of course, such concentrations are rather toxic. Take care, chbare.

Interestingly enough, HR contacted my wife and stated my wife's comments would be placed in the crew's employee records. So, points for professionalism, follow up, and employee support. I was wondering how this company is in general. Take care, chbare.

Oh no, it was quite good. She was very impressed with their professional conduct. So much, she contacted their HR department. My wife has pretty high expectations, so I was curious about this company. Take care, chbare.

Anybody know anything about MedStar in Fort Worth Texas? My wife had an encounter with a MedStar crew a couple of days ago. Take care, chbare.

I often see people quote this classic foramen magnum herniation pattern. While it can occur, and you may hear the term tonsillar herniation to describe the effect of the cerebellar mass moving in a general downward direction causing the cerebellar tonsils to compress the brain stem and upper cord, this is far from the only thing that can occur. In fact, we are neglecting a major portion of mass effect pathophysiology as it relates to this often misunderstood concept of herniation. If you recall, an invagination of the meninges exists, known as the tentorium cerebelli. In essence, the tentorium separates the cerebellar area from the superior aspects of the brain. Therefore, if you develop a supratentorial mass effect (space occupying lesion) or edema above the tentorium resulting in herniation, the herniation will in fact occur through the tentorial area. Two basic types of supratentorial or transtentorial herniations can occur. 1) Central; when the temporal lobes of the cerebrum and parts of the temporal lobes push downward through the tentorial notch. 2) Uncal; often associated with a lateral mass on one side such as an epidural hematoma, where the uncus of the temporal lobs is pushed over the tentorial shelf. Each type can has associated signs and symptoms. In addition, the exact cause of Cushing's triad seems to have many causes when looking at the literature. I have seen reflex changes, to ischemic changes, to pressure on the vagus nerve used as explanations for some or all of the exact findings. I suspect, multiple types of pathophysiology lead to these changes and perhaps attempting to identify one clear culprit is a bit myopic IMHO. Take care, chbare.

Actually, he stated "seems" in his first post prior to saying "Point is." Additionally, he clarified his statement in a third post where he stated "seems" for a second time. I have to disagree with the notion that his statement was anything other than anecdotal observation. Take care, chbare.

Thanks for the link, cheers. Take care, chbare.

I do not make a habit of giving medical advice, and this post is not medical advice per se. With that, if you never have had flashes and this is a new experience that just occurred while sitting and reading, you many want to consider talking to somebody with more important initials after their name than most of the people on this site when it comes to medical knowledge and the subject at hand. Posterior vitreous detachment, retinal tear, and retinal detachment can be characterized by flashes and a wide variety of other visual changes, most of which are painless. Just food for thought. Take care, chbare.

Lay is typically defined as a present tense verb. Additionally, there is a difference between lay and lie. Lay referes to the subject actually putting something down, where lie is more of a "to be" type of verb where the subject is the one doing the action. For example: I lay the computer down. For example: I will lie down for a nap. With that, the past tense for lay is laid and the past tense for lie is lay. What a confusing conundrum, hu? So, Dwayne, you are in fact correct on this one. Don't let it go to your head. Take care, chbare.