chbare

Or, what about steroids and septic shock patients? Why even consider doing this? Take care, chbare.

UDS: Negative UA: + for ketones CBC: Leukocytosis of 17.5, slightly decreased Hbg and Hct, Plt's WNL. Chemistry: NA+: 133, K+: 3.2, CL-: 102, CO2: 17, BUN: 29, Creatinine: 1.9, Glucose: WNL per age. CT: Large left sided subdural hematoma is noted with mass effect findings (Midline shift and compression of the ventricle). You perform funduscopy and note retinal bleeding to both eyes. So, we are thinking shaken baby syndrome? Take care, chbare.

You are able to obtain IO access without incident. No "odd signs" and no specific external indications of trauma. The parents seem genuinely concerned and will try to answer any questions to the best of their abilities. Unfortunately, you are in a center with all the resources to handle this patient; however, do to budget cutbacks you will double as the ER physician or any other physician you would call for consultation today. What do you want? What will you do? Take care, chbare.

Ok, rapid transport sounds good. Let's say the patient continues to deteriorate while en-route to the hospital. You end up having to intubate while attempts at peripheral IV access are unsuccessful. Would you go IO for access? Upon arrival at the ER, you find that the current economic situation seems to be effecting the supposedly recession proof physician and nursing professions. Looks like you will be managing the patient from here on out. What do you want to do? What about the parents? Will you let them stay with the patient? Take care, chbare.

XII lead shows sinus tachycardia without any conduction abnormalities. No notable fever. Rectal temp is as noted in an earlier post. Anything potentially stand out in the history? Take care, chbare.

The parents state the patient has had a 24-48 hour history of lethargy and "not eating well." Patient was born at home and had no medical care, mother had no prenatal care as well. Parents state there were no problems with the delivery. The patient is very lethargic and responds with a weak cry to tactile stimuli. Blood sugar is WNL for age. No other history is noted. Sidestream ETCo2 is 17-20. You note sinus tachycardia at 130-140 on the monitor regular rhythm. Left pupil is dilated and non reactive at 5 mm, right pupil is 3 mm and reactive. No specific findings of trauma are noted; however, the anterior fontanelle is firm and bulging slightly. Take care, chbare.

History and ECG findings. For example, a dialysis patient who missed a few sessions with a sine wave pattern. Obviously, respiratory depression and depressed DTR's on patients who are receiving mag sulfate. Take care, chbare.

What about hyperkalemia or magnesium sulfate toxicity among other problems? "Asking around allot" should include doing some actual foot work and researching yourself, never take anything said on public forums as gospel until you can verify what is said. Take care, chbare.

No seizure activity is noted, the patient is breathing around 40-44 times a minute with periods of irregular respiration noted, skin is pale and cool, Rectal Temp is 37 C, patient is covered with one layer of clothing. Take care, chbare.

You respond to a suburban area of town and are asked to take a look at a 4 week old infant. The parents state the patient "just had a seizure." No one is sure how long it lasted exactly, the parents deny any problems or history. The house appears safe and in good repair. Take care, chbare.

Dose for what exactly? I am a little confused regarding what you are using Calcium Chloride for? When talking about giving 10% CaCl- to an acutely ill patient, you may expect to give much more than 2-4 mg. The standard concentration of your "amp" of CaCl- is typically 10%. This gives you 100 mg/ml of calcium. You are suggesting giving significantly less than 1 ml of CaCl-? I think you are getting your numbers crossed or perhaps confusing ml with mg? Take care, chbare.

You are contacted to respond to a "seizure" call. Take it from here. Take care, chbare.

Hmmm, somebody has too much time and disposable income on their hands. I thought this Zombi Hunters website was more of a funny spoof site; however, it seems some people take these concepts much too seriously. I am also rather surprised to see how much genuine support there is for people to create these bug out medical bags and post their pictures. If I had to guess, these are a bunch of people who require special forces erotica to fill some empty void in their consciousness. In addition, medical envy may play a role. From reading the posts, this guy says he designed the bag to be used by a medical provider in the event of a disaster. He also states that he is involved in the car racing industry and obtained the Blackwater patch from his BW friends. In addition, he talks about the shooting schools he has attended. Take care, chbare.

What? That kind of stuff going on in Dubai? Never! Take care, chbare.

As others have stated, most of the PM positions in the UAE are filled by lower paid individuals. There is in fact a huge population of Indians and Filipinos in the Emirates. This is also true of nursing. Most nursing positions are filled by people from other countries. My company works closely with Wellcare hospital in Dubai, because we utilize their EMS service for airport pickup and ground transport to receiving facilities in Dubai when we medevac clients into the Emirates. They seem like good guys for the most part. You may find it difficult to work as a PM because the wages and benefits may not meet your expectations. In addition, it may become more difficult in the future to move into PM positions as the Emirates is starting to push "Emiratization" in their country. In fact, foreigners vastly outnumber actual Emirates. In fact, one of my mates just took a teaching position at a college in Abu Dhabi for their new paramedic program. Other things to consider: -Dubai is very expensive. -Public transport is a PIA and becomes expensive. -Driving in Dubai is different and many different rules apply, some will not favor you if you are involved in an accident. -UAE is an islamic country, in that I mean a state endorsed religion. As such, you will need to live a bit differently even though UAE is fairly liberal depending on where you live. -There are rules for everything and living/working in the Emirates is a complicated process. -The climate actually sucks in the summer which is about 9 months of the year (Temps well above 40 with very high humidity). -Not as culturally divers as you initially think. UAE is a nice place to visit; however, like many other places, you really need to reasearch and get a feel for what living there will be like. Remember, the tourist scene and everyday life is usually profoundly different in most places. My companies coorporate office is in Dubai, so we spend quite a bit of time flying in and out of Dubai. This is especially true when we have several evac missions and need flight crew handy in Dubai. In fact, I spent nearly the last three weeks living in Dubai. I can tell you the glitzy tourism aspect wears off rather quickly. Dubai has good things to offer; however, be well informed and have realistic expectations before making any decisions. Take care, cbare.

Spenac, you must get with an RT or provider who is well versed with this ventilator. Setting this ventilator up can be quite tricky and I urge you to find somebody who can spend a significant amount of time teaching you how to use this device. You will need understand and know what some of the settings do and implication of these settings. As you may know, you will be calculating an actual inspiratory time and flow rate. These settings along with the rate and tidal volume will effect the I:E ratio. This is a bit different from some of the other transport ventilators. This is quite different from the CV4 and Oxylog 2000 that I currently use. Trust me, get with an expert on this one bro. Take care, chbare.

Not really the NREMT making these changes. If you have been keeping up with the National SOP changes, you would know that this is being implemented at the national level. NREMT is simply changing their levels to reflect the new changes. These changes are also covered in the following thread: http://www.emtcity.com/index.php?showtopic=13921&hl= Take care, chbare.

I am with Doc on this one. The cases of true meningitis I have seen were so acutely ill, the emphasis was on stabilizing measures. Seems like these make great test questions however.

Interesting choice of words Dustdevil. However, I agree. When approaching this topic we need to realize, regardless of how, when, and where we perform an abortion, we are killing a human being. There really is no way around this fact IMHO. Take care, chbare.

http://www.nremt.org/nremt/downloads/2007_Annual_Report.pdf Not state specific however, you can safely say that a majority of people who take the NREMT will pass on the first attempt. Take care, chbare.

You must also keep this in perspective. Regardless of how "exciting" our jobs may seem to others, we will inevitably have days where we can take things for granted or even hate what we do. I expect, even you have days where you would rather do something else? Even if you absolutely love your job, you will face difficult problems and experience periods of time where you are less than thrilled to be at work. Another concept to consider is that many patients will receive similar management in the pre-hospital setting. We are far from "God like" and in fact are quite limited in the overall scheme of the spectrum of health care. I understand if people take offense; however, we play a small part in this movie. So, what you may interpret as "going through motions" may in fact be the proper way to manage patients. As a novice provider, it is easy to become wrapped up in "skills" and having to perform all kinds of interventions. In fact, I find my self taking more conservative actions when approaching patient care as I mature. However, you will always run into providers who, for many reasons simply show up for a paycheck. Debating the ethics or morality of this is complicated and may be beyond the original point of this thread; however, these people exist. In conclusion, some days I live a miserable existence and truly hate what I do, other days I absolutely love my job. Most days, I am somewhere in between. It is a dynamic concept. Try to be flexible as you look at how other people view their job on any given day, and understand that having different opinions regarding the same job may not be a bad thing. Take care, chbare.

Not all that hard. We are talking about civil court in the US after all. Have even a slightly sympathetic jury and an autopsy report could be meaningless. Take care, chbare.

I am using the term rather loosely to describe people who essentially live west of Afghanistan. Mainly, European and American. It is not uncommon for us to develop severe GI illness within the first few weeks of entering the country. Unfortunately, about seven months ago, when I first came in to country, I learned just how "uncomfortable" these conditions can be. Obviously, Cipro and Flagyl can be quite useful. Not to say you take Cipro every time you have loose stool; however, for severe diarrheal illness... Take care, chbare.

Nothing wrong with sharing thoughts and ideas. Even the most experienced person may learn something new when people throw out their thoughts. Take care, chbare.

Depends on the specific environment and the intelligence you can gather prior to deployment. For example, Cipro and Flagyl are two very important medications where I live and work. However, when dealing with "non westerners," I find other agents such as mebendazole are important. You will be operating in the US or will you be deployed in an international setting? The problems will vary according to geographic location, logistical availability, current world events, and level of pre-existing infrastructure. For example, I had fairly good logistical support and intelligence regarding the medical situation when I deployed following Katrina. However, our level of support is somewhat limited in Afghanistan and we go through many local channels to obtain supplies and equipment. Obviously, some of this is because I no longer have military supply/logistical channels open as a civilian. Spend some time researching and create a list of "mission essential" equipment that you would utilize on every deployment. Then, have a modular "kit." Allow for flexibility and never forget the importance of planning and preventative medicine. Simple concepts such as up to date vaccinations and a malaria control/prevention program may in fact reduce morbidity and mortality much more than a pile of cardiac medications. Take care, chbare.