chbare

Welcome back, how's life treating you? Same old stuff over here in the land of entrapment. Take care, chbare.

Also note that a two year PA program is different from other two year degrees. PA students are typically in class most days of the week, have very limited breaks, and do not have summer vacation like other college degrees. The typical PA program is in the neighborhood of 27 straight months long. Also remember, virtually all PA programs in the United States are graduate level programs. (Master Degree programs.) There are a couple of BS programs still around; however, this is rapidly changing. In fact, UNM in New Mexico had one of the few BS PA programs; however, as of this year it is now a MS program requiring an undergraduate (Four Year) degree prior to entry. Take care, chbare. Edit: "the"

It looks as though vasopressin may cause cerebral vessel dilation and theoretically increase cerebral perfusion. Regarding the beta 1 stimulation: we do not give epinephrine based on beta 1 effects. Epinephrine's primary theoretical action is vasoconstriction and shunting of blood volume. In fact, beta 1 effects may theoretically increase post arrest myocardial oxygen consumption and post arrest arrhythmias. Therefore, in theory, vasopressin's lack of beta effects creates a better profile. Note my extensive use of the word theoretical. This is because studies are all over the place. However, in human patients, survival to discharge does not seem to change with either agent. Take care, chbare.

[quote name='crotchitymedic1986' date='01 It is unethical to inflict that kind of wound on a diabetic unless they are in cardiac arrest, especially when it is not necessary.

In my anecdotal experience, either biology or chemistry is required for entry into A&P. The problem being, you need to have at least a rudimentary understanding of basic biological and chemical processes going into A&P. As A&P is not a chemistry class, you need to understand the concepts of atomic structure, ion formation and electron loss versus gain, ionic versus covalent bonds, and important concepts such as hydrogen bonding. Likewise, basic biological concepts such the particulars of eukaryotic cells and classification of organisms such as viruses and bacteria need to be fairly well cemented prior to entering A&P. With that, I suspect people who do well in high school chemistry and biology need not take a general biology class in order to gain entry into a college level A&P course. However, the face of education has changed so drastically in this country, many high school graduates are in fact barely literate when it comes to rudimentary understanding of the sciences, let alone calculating how many protons and electrons an atom has by looking at the atomic number. ( An incredibly simple concept by most standards.) Therefore, I find many people in fact spend a couple of semesters in college filling in gaps that should have been sorted during high school. Furthermore, Dust I would agree with your assessment in the years past; however, the sad reality of modern life in the United States, is that current high school graduates are entering college woefully underprepared for academic adventures beyond tenth grade. Take care, chbare.

You need to take some of what you read on Allnurses with a grain of salt. Yes, jobs are harder to find. Surprise, our country is in a bad way economically, therefore I am perplexed why so many nurses seem to have a sense of entitlement regarding obtaining instant employment at their local hospital immediatly upon graduation. Is this the cool aid they drink in nursing school? The truth being, the job market is tighter across the board and no profession is absolutely recession proof. With that, many nursing jobs exist; however, you may have to entertain commuting, moving, or working a less than ideal job to gain experience so you can nab your "dream" job. Good luck and remember school is like a marathon and you need to be in it for the long haul. Take care, chbare.

You may have a very difficult time transitioning into an RN program with "mini" versions of courses. If your credits cannot transfer, getting into a college based nursing program will be nearly impossible. Then, you will find your self taking a year out of your life obtaining the pre-requisites. Best knock out your science, English, and humanities courses now, as any degree will require these core classes. Take care, chbare.

It's actually even more complicated. All those molecules they talked about in A&P and molecular biology come back to haunt. (cAMP, Adenyl Cyclase, cGMP, MAO, COMP, and so on...) GTN is just as complex if you really want to dive into how it works. It seems EMT students are still taught the primary mechanism of action revolves around dilating coronary arteries. When, significant action is based around preload reduction. Then, comes the actual process of how GTN works. Many people do not know that nitric oxide plays a significant role in how nitrates work in general. Not trying to be a smart ass; however, at the EMT level I think the best paper to write should be based around challenging these general misconceptions by writing an expository essay. Then, feelings and fragile egos remain intact while the point can be delivered. Take care, chbare.

You can make a statement and still have an expository paper. Take the beta agonist for example. Your thesis could be something like "The importance of understanding intracellular physiology when administering inhaled beta 2 agonist medications." I do not think EMT-I students will be out setting up research projects and having their research published in the the New England Journal of Medicine. Therefore, it is safe to say your thesis will not be based around proving a concept that requires extensive research. You are simply making a statement based on current evidence available and not making a statement based on the evidence you personally produced/gathered. Take care, chbare.

The condolence book is open at flightweb. http://www.flightweb.com/condolences/index.php?cid=50 Thought and prayers for the families and friends of my fallen colleagues. Take care, chbare.

Try not to become overwhelmed. Assuming you are required to write a proper paper in an approved format, (APA in most cases) ten pages is not that long. You have a cover page, a table of contents, an abstract, and a works cited page. Therefore, you have whittled the ten page requirement down a bit. Any number of topics will be interesting and challenging. One thing to consider, is getting away from the standard "I think we should do this, and here is the evidence to prove my point" type of paper. At your level, I think you may get more out of an informative or expository type of paper. Take the adrenergic response and bronchodilation situation for example. Most EMT's I know simply think you give albuterol, activate a beta receptor, and bronchioles magically dilate. You could push this concept much further by explaining the adenyl cyclase and cAMP involvement within the cell. Not only will you learn much more than the few hours spent on A&P in typical programs, your class mates will learn when you go to present your paper. Assuming you are required to present your paper. (A concept I would suggest.) Take care, chbare.

My condolences...to the good people of Texas. Take care, chbare.

There are only about ten confirmed cases in the literature. Most cases occurred within one to three weeks of the original conception. I am unaware of any human cases where there was a great disparity between the different conceptions. Take care, chbare.

Highly unlikely, following the delivery of the first child, an unstoppable cascade of events including the release of large amounts of endogenous oxytocin to stimulate uterine contractions and achieve hemostasis would occur. I could only assume this would adversely effect the other uterus. Take care, chbare.

Unfortunately, we have been giving a medication with profound alpha effects without much improvement in M&M. (Epinephrine) We are even giving a newer modality that attaches to its own receptors and supposedly acts in a very similar way to an alpha agonist. (Vasopressin and V1 & V2 receptors.) Not much in the way of improvement with vasopression either. Dwayne, from a pure physiological perspective, some of the retrograde flow studies do make sense. (At least in the larger veins that do not have valves.) Even in a person with a beating heart, it is quite easy to increase intra-thoracic pressure to the point of decreasing venous return. (A pseudo back flow if you will) This is easily accomplished with poor ventilatory strategies that lead to the development of auto PEEP and air trapping. Remember, the "normal" CVP is only 2-6 mm/Hg in a healthy adult. In fact, the mechanics of normal breathing and intra-thoracic pressure changes actually assist with venous return. Therefore, it is safe to assume (in a purely physiological sense) that the loss of a normally functioning system and the loss of a true driving pressure for the vascular network can lead to retrograde flow of the venous circulation is possible. This appears especially likely in the setting of CPR. Take care, chbare.

Sorry bro; however, if we are talking life and death, I can easily obtain access with the current IO technology in a matter of seconds. Additionally, ACLS is not a skills class. ACLS is nothing more than a review of ECC guidelines. You learn skills in school and keep current through continuing education and an employer con/ed program. Maintenance of skills such as vascular access has no real place in ACLS. Why do people still think ACLS courses should be responsible for teaching people cardiology and skills. Even the two or three day horror classes taught nothing but intimidation. Sure, they were difficult and full of machismo. If you want some challenge, you can always look at ACLS-EP where you will discuss more advanced clinical topics such as electrolyte abnormalities. Take care, chbare.

A good thought, and I would take that even further by saying we should be teaching people about risk reduction and prevention. However, this is not the point of the thread. In fact, we are not even discussing outcomes. Take care, chbare.

I do not suppose you have a good peer reviewed study to back up your claim? Take care, chbare.

It is essentially blood flowing in the opposite direction. In this case, he is talking about blood essentially flowing away from the heart in the venous system as a potential explanation for the presence of femoral pulsatile sensations during CPR. I agree, there exists no conclusive evidence to my knowledge that says the presence of pulses during compressions means much of anything. I have never relied on pulses during CPR unless we had a rhythm change and were assessing for ROSC. Even then, waveform capnography can be quite helpful for detecting the presence of ROSC. However, we really do not understand what is occurring hemodynamically during CPR. I have pasted an abstract of a small but relatively new study that finds the presence of both anterograde and retrograde circulation components during CPR. In addition, some people suspect that the heart is nothing more than a conduit for blood and that circulation occurs as a result of intra-thoracic pressure gradient changes. "Direction of blood flow from the left ventricle during cardiopulmonary resuscitation in humans-its implications for mechanism of blood flow. Clinical Investigation American Heart Journal. 156(6):1222e1-1222e7, December 2008. Kim, Hyun MD a; Hwang, Sung Oh MD a; Lee, Christopher C. MD b; Lee, Kang Hyun MD a; Kim, Jang Young MD c; Yoo, Byung Su MD c; Lee, Seung Hwan MD c; Yoon, Jung Han MD c; Choe, Kyung Hoon MD c; Singer, Adam J. MD b Abstract: Background: Common mechanisms proposed to explain forward blood flow during cardiopulmonary resuscitation (CPR) include the cardiac and thoracic pumps. However, the exact role of the left ventricle in promoting forward blood flow during standard CPR in humans is mostly unknown. The aim of this study was to explore the role of the left ventricle in generating forward blood flow during standard CPR in humans by observing the direction of blood flow during CPR. Methods: Ten patients with non-traumatic cardiac arrest were enrolled in this study. During CPR, contrast echocardiography with agitated saline was performed in the left ventricle and the aorta, and the direction of contrast flow was assessed using transesophageal echocardiography. Results: On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. No aortic regurgitation was present. Retrograde blood flow from the left ventricle into the left atrium as well as anterograde blood flow from the left ventricle into the aorta during the compression phase of CPR was observed in all cases. On injecting the contrast in the aortic root, anterograde flow from the aorta during the compression phase was observed. During each cycle of chest compression, the mitral valve closed during compression and opened during relaxation, and the aortic valve opened during compression and closed during relaxation. Conclusions: Retrograde flow to the left atrium and forward blood flow onto the aorta on left ventricular contrast echocardiography during the compression phase suggests that extrinsic compression of the left ventricle by external chest compression acts as a pump in generating blood flow during standard CPR in humans. © Mosby-Year Book Inc. 2008. All Rights Reserved." Take care, chbare.

Come on now, where is your sense of adventure? I worked one of the slowest shifts of my career a couple weeks ago. Actually wrote a ten page paper on gas diffusion in full APA format. Take care, chbare.

I think you could argue STEMI; however, the XII lead does not demonstrate the "typical" types of findings seen with STEMI, if we are considering going down a full fibrinolytic path. Pericarditis is a good consideration; however, we typically see global elevation from the inflamed pericardium. Look at all of the findings: + We have flat and depressed ST segments in contiguous leads + We have rather atypical signs and symptoms Lets say that this is in fact an acute coronary syndrome. How many types of ACS exist? Generally speaking, we have three types. 1) STEMI 2) Non STEMI 3) Unstable Angina (USA) For the sake of continuing with the scenario, lets say this is not a STEMI. What do you guys think? Take care, chbare.

No problems with ulcers, bleeding, AVM's or any complications related to his surgeries. No history of stroke or head trauma. His blood pressure is 130/78. So, you are looking for the presence of STEMI? Does this ECG meet the criteria for a STEMI? It may be somewhat debatable. However, does this really look like the "typical" STEMI? What two criteria must be met in most cases for ECG evidence of STEMI? You were nearly there on one of the criteria. Edit: No cardiologist yet and the ER doc says it's your call. Take care, chbare.

Lap chole= Laproscopic removal of the gall bladder. 6 LPM Via NC may be a bit uncomfortable. So, you have your IV, you gave your ASA, and you do beta blockade with style and grace. -No Chest Pain -No dyspnea -Generalized malaise Ok, so lets talk about fibrinolytics in the field: +What are the indications? Does this patient meet criteria based on our findings? This is where critical thinking comes into play guys. Serious decisions here and perhaps a humbling reminder of the real implications of doing these advanced procedures in the field. +What about contraindications? Cath lab team has been activated; however, they are 90 minutes out. Take care, chbare.

Vital Signs: P- 60 strong & regular, RR- 19 & unlabored, SPO2- 94% RA, Pain-0/10, "I just don't feel right," Temp- 37 C, B/P- 150/100. No recent medication changes, no exposure to any known illness, no one in the hose is sick, nothing unusual or of particular interest in his life. XII Lead: Take care, chbare.

Scene appears safe without overt hazards. You note a 54 year old male sitting up in a chair without any obvious distress. He has a history of HTN and takes Toprol XL 50 mg PO Q 24. Surgical history is significant for an appy and lap chole. The patient is well dressed with good hygiene and appears to be slightly overweight. Take care, chbare.