chbare

Depends on the provider. Midazolam is fairly popular with some of the more invasive procedures. Take care, chbare.

Congrats. Take care, chbare.

Actually, somewhat opposite of a reflex. Lack of reflex activity. Take care, chbare.

As stated, we are talking about different physiology. Blocking sodium channels versus noncompetitive or competitively acting on ACh receptor sites. In addition, Novocaine (Procaine) is known as an ester. Unfortunately, serious problems such as anaphylaxis, toxicity, and prolonged duration of Procaine related to atypical plasma pseudocholinesterase in about 1 in every few thousand people. For these reasons, Procaine has fallen out of favor and Xylocaine an amide, is commonly used as a local anesthetic for dental procedures. Take care, chbare.

Neuromuscular blockade occurs at the site of the neuro-muscular junction. This does not include the optic nerve, optic chiasma, optic tract, or associated CNS structures. The retinal conversion of photons, impulse transmission, and nervous integration of visual stimuli is not effected. Obviously, eyelid movement can be effected; however, the underlying visual physiology is not involved. Take care, chbare.

Congrats, I know you have been working at this for a while! Take care, chbare.

Did you take a look at her blog? She describes a patient's birth using very colorful language. I am not sure the patient would pass this off as Army medic talk. In addition, the student talks about filming the birth? I am unsure if permission was granted? The blogger also talks about how worthless clinicals are, and how she is posting these blogs during her nursing classes. I suspect we have potential HIPPA issues and academic issues. If I found out you were posting myspace blogs in one of my classes, I would want to send your butt packing. Take care, chbare.

You can look her blog up on myspace. No membership required in fact. Obviously, the constitution argument is already out; however, we have yet another example of the post ghost returning to haunt. Even if she sues, wins, and completes school, I am not sure people will be lining up to hire her. The damage is done. Take care, chbare.

This is a rather popular topic on another site I frequent. It essentially boils down to repercussions related to information you post on the web. http://www.courier-journal.com/article/200...0393/1008/rss01 Take care, chbare.

Somewhat similar to an incident I had outside of Kabul. I was pulling temporary clinic duty for a company that provides logistical support to the military. The camp dog was hit by a car and sustained serious orthopedic trauma. We had to hold the dog for about 24 hours while arrangements for surgery were completed at Bagram. My peers were quite surprised when they received a detailed, several page long medical report titled; "Diesel the dog." I was not quite sure how to handle the bureaucracy, and simply wrote it up as I would any medical case. The dog was eventually evacuated the next day, and had an ORIF of the leg. Ultimately, he ended up making a good recovery. Take care, chbare.

I am a nurse. While involved in transport and teaching, my role is not strictly EMS. Take care, chbare.

I would be more than happy to help. I am not a real EMT however. If this is specific to EMT's, I understand. Take care, chbare.

I am not arguing against opiates. I prefer to give 2-3 mcg/kg of Fentanyl IV in addition to benzos post intubation. I was just stating the fact that some providers may shy away from properly dosing or perhaps considering a proper does of an alternative agent. On topic however, I think it is appropriate to simply go with Etomidate and sux if time is of the essence. However, liberal sedation and analgesia status post intubation should be a priority. If you have a little time to pre-medicate, 2-3 mcg/kg of fentanyl IV can make your patient more comfortable and may blunt some of the pain and sympathetic response to pain. Laryngoscopy is in fact a very painful procedure. Take care, chbare.

One thing I see with Midazolam is frequent under-dosing. A good RSI dose should be around 0.1 mg/kg IV. You are looking at about 10 mg for many adults. I find providers are uncomfortable with these higher doses, and the hemodynamic complications with higher doses can be problematic. Take care, chbare.

http://findarticles.com/p/articles/mi_qa39...06/ai_n9413350/ This describes the two cases I knew of. It also appears, there is a case study of intracranial NPA placement in 2007. Apparently, a person sustained extensive trauma from a GSW to the face in Iraq and the medical provider inadvertently placed a NPA into the cranial cavity. So, now we have three cases since the 1970's. Funny, we tell people to absolutely not place a NPA for any head trauma based on a few cases, yet refuse to admit we may have real problems with it comes to procedures such as ETI. Even though we have significantly more data on these other topics. Take care, chbare.

Obviously, this is a judgment call; however, this NPA argument appears to be somewhat of a sacred cow that EMT instructors seem to pass off on students. Obviously, it could be a problem with a severe enough injury; however, has anybody ever really looked at the literature? How many VERIFIED cases of intracranial NPA placement could you find? I have been able to find two cases. Two cases of something that is considered unusual and rare at best, is some how debated several times a year on various EMS forums. Take care, chbare.

Too much oxygen while on room air is not the primary concern. The associated respiratory alkalosis and acid base/electrolyte disturbance along with a left shift are primary concerns. Somebody else mentioned shallow breathing. It is possible to breath so shallow that you are either moving dead space or you do not have adequate minute volume. This question does not address any of these variables and is quite useless IMHO. Take care, chbare.

You could argue that there is not much justification for pediatric intubation. Unfortunately, the burden is now on us to provide evidence that we can safely and effectively intubate, while contributing to positive outcomes. Take care, chbare.

Actually, we are saying the opposite. Why add more skills when it appears that we may be contributing to bad outcomes when we utilize our current skill set? How can we advocate for more skills when people still do not even understand basic concepts? I see EMT-B's going through intubation classes who can tube patient's all day long; however, these providers cannot even explain simple concepts such as explain how carbon dioxide is transported or how PH changes effect hemoglobin/oxygen affinity. Take care, chbare.

You would not use an angiocath, you could simply use a standard 18 or 20 ga needle. A spinal needle may be used as well. Take care, chbare.

If the patient has addiction/dependancy issues with narcotics giving naloxone could in fact exacerbate his already violent behavior in addition to causing other problems such as seizures. Take care, chbare.

So, we prophylactically turn our patient's into chemistry experiments every time they act strange? Do we have a blood sugar? Take care, chbare.

http://www.nationalpost.com/news/story.html?id=1419824 Take care, chbare.

Not sure I can agree with you on that point. Nothing to suggest she was "stupid." The incident occurred and she initially felt fine, had no noticeable problems, and refused. I dare say many of us would do the same thing. What are we to do, demand a CT with every injury? As Doczilla stated, there are pitfalls to having CT's. Even one CT may potentially increase your cancer risk. While it is common technology, it is a diagnostic procedure with potential risks. Take care, chbare.

Yep, the officer really did act inappropriately. Not to say he didn't feel threatened or anxious; however, his actions were not what I would consider appropriate. I agree with Dust on this, he will loose his job. Take care, chbare.