chbare

The officer actually initiated the stop before the driver reached the hospital. However, the driver continued to drive to the hospital. Take care, chbare.

She died actually. Reports say it was from an epidural hematoma. This whole "talk and die" stuff is something new to me. Seems like another way of saying, "guess you were not well after all." This is not uncommon and regrettable ( thoughts go out to friends and family); however, we simply cannot rule out every problem. How many of us have taken a knock to the noggin, only to brush it off and develop no long term sequela? Then, there are people who do develop problems. My wife's brother had a fall while doing house work recently. Bumped his head, but had no other complaints and went about his day without any problems. A few hours later he started vomiting and was taken to the ER. He had developed a SAH and was flown to a trauma center. He has since recovered with no known deficits; however, it just shows that you can never be really sure. However, are we going to rush to the ER and demand a CT every time we hit our head? Take care, chbare.

What about the posterior wall and right ventricle? Take care, chbare.

Thanks Spock. The funny thing being, after reading this thread, both parties appear to have similar points of view. Take care, chbare.

The Hatch chili festival is a true event however. It is neat to drive through the town during the fall and see houses that have the roof full of chili peppers drying in the sun. The smell of roasting chili peppers is an experience as well. Only one point of contention however. For all of the hype regarding "Hatch" chili, they do not actually process and can the chili in Hatch. That occurs at border foods in Deming, about an hour drive from Hatch. Useless knowledge, I know. Take care, chbare.

LOL, Yeah, I would steer clear of any of the Corollas from the 1980's. Especially ones with bad yellow paint jobs and Kam/Safi air stickers on the back window. Take care, chbare.

Depends, you can have fuel or other fire hazards depending on the scene. So, the threat of fire is possible well after the accident. Another overlooked threat is airbags. This is actually a big problem with newer vehicles that have air bags placed in every possible location. No longer can you simply disconnect the battery to deactivate these devices. Fire is a potential threat; however, I have yet to see a car explode during the last 13 years. Actually, the only exploding cars I have seen were Kabul taxi cabs. Take care, chbare.

During depolarization, sodium enters the cell rather quickly. During repolarization, sodium is actively pumped out of the cell, while potassium enters. Obviously, many other things are occurring during depolarization and repolarization as well. Remember, positive deflection of waves has nothing to do with the positive or negative ion flow through cells. A complex (QRS, T, or other wave) is positive on the ECG when the electrical activity is moving toward the positive electrode. If it moves toward the negative electrode, the waves will have negative deflection. Hope this clears things up. Take care, chbare.

Agreed, who really uses DCAP-BTLS after leaving the NREMT psychomotor skill station? In addition, everybody has some funny phrase for remembering things. Any nurse who has taken TNCC is familiar with ABCDEFG. In reality, phrases like this mean nothing as long as the provider delivers proper care. As for the "accelerated EMT" classes: In all honesty, it makes no difference to me. Basic EMT is essentially advanced first aid with a few skills. There is not much in the way of foundational knowledge or advanced concepts taught at this level, so I do not think it makes much of a difference. Take care, chbare.

It is interesting; however, physicians in the United States are not as involved in EMS as many other countries. In countries such as South Africa and Australia, physicians work extensively in the pre-hospital environment and are quite involved with the pre-hospital providers. This is something that is unique in the United States. So, I see this as a potentially good move for physicians in the United States. Take care, chbare.

I am not sure. The unfortunate truth is that unrecognized esophageal intubation is most likely more common; however, it may not be talked about as much. The trend is becoming much more popular in the hospital however. I occasionally work in a tiny rural ER that has 5 beds. Their intubation kit comes complete with LMA's and a monitor that has waveform capnography capabilities. In addition, capnography has been used every time I have been on an intubation. In fact, I remember one night a patient went into respiratory arrest on their tiny medical/surgical floor. I responded along with a paramedic from the ambulance service (hospital based). The patients doc (Family Specialty), had intubated the patient and taken all the reasonable steps to stabilize the patient. One of the first things he asked was to place the patient on capnography and note the findings. It is becoming more popular and many places at least have colometric technology. Baby steps. I do not expect ICU's to use this technology as frequent ABG monitoring and chest x-rays on vented patient are fairly standard. In the ER and with code response teams involved with the initial intubation; however, capnography should be standard. Take care, chbare.

Wow. Well, if I understand you correctly, you are using your providers error as an excuse to justify our problems as EMS providers? So what? Your provider blew an EJ or subclavian. While that is potentially bad for you, it has nothing to do with the current topic. In addition, did you take the time to read my comment about pointing to the bad behavior of other professions? Take care, chbare.

Currently use the MRX over here. No complaints actually. The battery life is especially impressive. I have completed flights that were just over five hours long with continuous pulse oximetry, cardiac monitoring, and Q 15 minute vital signs on one battery. Take care, chbare.

A few thoughts to consider: 1) As stated, we need to check our ego at the door. This is not a war against taking skills away from paramedics. Obviously, a fair amount of research exists that points to the possibility that the status quo is not helping patients as much as we like to think, and in fact may be causing harm. Nothing personal, at least consider the evidence, and deal with it. 2) I am so tired of the typical kindergartner argument. When you moan and say, "oh yeah, well what about the physicians, what are their actual intubation rates," you sound like a child making a childish argument. I did this to justify my behavior as a kindergartner; however, we are all grown up now. Do not justify bad behavior by looking at somebody else's bad behavior. At least consider the evidence without pointing the finger at somebody else. It's a hard pill to swallow sometimes. 3) Consider the data as a whole. It is easy to focus on special situations such as prolonged transport times. Yes, looking at solutions for some of these problems is important; however, look at the bigger picture before focusing on every detail. 4) In line with number three, it is easy to become overwhelmed in the details. For example, I could potentially justify every little possible scenario. What about tamponade, pneumothorax, and epidural bleeds. Obviously, we many not be able to perform the interventions to correct some of these problems in the field. Again, we need to look at the big picture. What really should be our emphasis as pre-hospital professionals? Having the ability to perform every skill for every conceivable situation, or having a clear understanding of our role and how it fits in with the big picture? We need to identify key modalities that are crucial to good patient outcomes, and have strong evidence to support our decisions. 5) While I am not saying pulling ETI completely out of the pre-hospital arena, we must at least realize there may be less emphasis on this procedure, and in fact many of our patients may not really need a tube in their trachea. Take care, chbare.

No worries. I think your medical director has taken a good stance. Absolutely nothing wrong with advocating for etomidate. It is an excellent agent for nearly all RSI scenarios. (For now that is.) Take care, chbare.

Again, adrenal suppression has been noted after a single RSI dose of etomidate. While this is rather transient, it does occur. Again, the possibility of harm or evidence of poor outcomes based on this fact is still up for debate. To date, I would say, definitive evidence does not exist. Yes, adrenal suppression is definately associated with continous infusions of etomidate. You are also correct, that some people may consider "stress" dosing specific patients with hydrocortisone after they receive etomidate. As I stated earlier, I am not pushing to change my current practice; however, I will continue to keep an eye on the current literature. A viable alternative agent could be Ketamine. Ketamine has some great effects regarding bronchoconstriction and hemodynamic compromise. However, one must be aware of the potential side effects associated with the use of Ketamine. I know in the US, we tend to say Ketamine is the evil enemy of all things head injured; however, some of the studies that demonstrated this had limitations/flaws. In fact, some people argue Ketamine may have neuro-protective benefits. All in all, I plan to continue using etomidate for it's fast onset (essentially one arm to brain circulation time), hemodynamic stability, and overall safety profile. In spite of the adrenal suppression issues, I have yet to see definitive evidence that proves etomidate harms people or causes bad outcomes (even patients in septic shock). Take care, chbare.

If you think there are discernible P waves for the QRS complexes. This is my take on the rhythm, you can agree or disagree. Obviously, we disagree. As the OP stated, three docs gave three different impressions. Take care, chbare.

P waves all over the place, irregular rhythm, possible digoxin effect (characteristic "ice cream scoop" pattern), atrial fibrillation until proven otherwise. IMHO. Take care, chbare.

Again, adrenal suppression is well documented and well known after a single dose of etomidate. Yes, it is transient however. Obviously, the septic shock scenario is of particular importance because these patients may already have pre-existing underlying adrenal problems. In addition, the conclusion left the loop hole of "Pending the results of prospective trials..." wide open should additional evidence materialize. While, I am still using etomidate, I plan to keep an eye on the evidence as this debate is still ongoing. Take care, chbare.

Thank you for the discussion Krumel. I have to admit, I am always a little embarrassed when I explain our EMS system (especially educational standards) to my South African and Australian colleagues. Take care, chbare.

It is well documented that a single dose of etomidate will cause adrenal suppression. However, equating that to poor outcomes in patients is an ongoing debate. http://emergency-medicine.jwatch.org/cgi/c...full/2008/201/5 Take care, chbare.

Great scenario! Why do you have visual changes with digoxin overdose? It is nice to have the docs involved as well. It is nice to take a break from they typical us versus the world mentality of other places and have good interaction with the docs. Take care, chbare.

Who knows. Again, these people claimed to be nurses. In addition, it is unclear if they in fact caused the bleeding. Take care, chbare.

It is hard to say from this story if they truly acted poorly or unprofessionally. It is possible the providers were truly unprofessional; however, people can interpret things in many different ways, especially people who lack formal medical education. For example, I worked with a nurse who was an absolute cool customer in emergencies. We had a critical patient, and he calmly assessed the situation and started managing the airway. Throughout the process, he was calm, collected, and provided excellent patient care. Unfortunately, somebody in another bed herd the event. Obviously, the beds were separated by a curtain. This person and their family went on to complain. While this nurse was nothing but professional and in control of a bad situation, the other people complained stating that the said nurse did not sound "excited" or "stressed." The people complaining said this person was unprofessional because they "should have been more excited and anxious" during the situation. Again, people on different sides of an emergency can interpret actions and statements in very different ways. Take care, chbare. One of the "nurses" took the nail file from a bystander. Agree with your point. It is important to present your self professionally. In addition, you may say something or act in a way you consider appropriate; however, somebody else could interpret the statement or action differently. However I agree that we must try to present ourselves as professionally as possible. Take care, chbare.

Meh, who knows the real story. I am not sure how this author a self described "attorney" assumed the providers made any assumptions based on the patients general appearance. In addition, the author was basically standing there gawking while the EMT's were no doubt attempting to access the patient. I am not sure what this person was expecting. Some health care miracle like the movies perhaps? Like the war movies she watched where people received morphine for their war wounds? Obviously, this person, like many people of the general public has no clue how health care works. This does emphasize the fact that people's (health care providers) behavior and communication techniques can leave a lasting impression on other individuals. Oh, and I love the nurses jamming a nail file into the patients mouth. They get extra points for style from me. Take care, chbare.