chbare

I do not follow? Rheumatic fever is an autoimmune inflammatory disorder associated with Group A strep infection. Guillan Barret like signs and symptoms are not typically found with Rheumatic Fever. Take care, chbare.

Many links to the cause of GBS exist. Nothing absolutely definitive however. Organisms commonly associated with GBS include; CMV, Campylobacter jejuni, EBV, and HIV. In addition, many substances and conditions such as lupus are associated with GBS. The typical course involves a patient who develops GBS following a respiratory or GI infection. Take care, chbare.

Possible Guillan Barret status post a viral illness? Take care, chbare.

Diploma programs have gone the way of MAST pants in the USA. Please, do yourself a favor and go through an AD or BS nursing program. In addition, ensure the program is NLN credentialed or you could have serious problems with reciprocity and military service. Take care, chbare.

One of the most likely diagnoses would be electrical storm. Take care, chbare.

I have to go with the docs as well. I have seen many pulmonary embolism patients. True, many had central cyanosis; however, central cyanosis is not exclusive to PE. I have never seen the classic nipple line up cyanosis however. Take care, chbare.

So, now we must ask what can we do for this guy? Massive PE with a massive V/Q mismatch. Do we code him or call him? How do we manage his airway. Will traditional laryngeoscope likely produce good results? Will BLS techniques work? What about a supraglottic airway or fiber optic technology? How will this neoplasm complicate going for a surgical airway? Take care, chbare.

Yes, IO access would have been a great asset in this situation. Yes, you can push IV medications to include dextrose 50%, colloids, and blood products through a patent IO site. Take care, chbare.

You are talking about lidocaine jelly and the use of topical lidocaine? I agree that using lidocaine jelly and neo for nasal intubation is quite helpful. However, no strong evidence exists supporting the use of lidocaine to blunt ICP changes in the head injured patient. Then again, nothing saying it is harmful. Take care, chbare.

I think much will depend on the service and mission profile. When we eliminate specific therapies we can limit our ability to intervene when conditions such as true allergies and medication interactions arise. However, letting providers run amuck with unlimited access to interventions can result in massive acts of commission. A balance is needed. This will require allot of physician involvement with the service and hopefully customized guidelines that will meet the needs of the providers and the mission profile. Some information to consider regarding lidocaine. I can find no solid evidence that lidocaine actually benefits the head injured patient. Of course, no real evidence exists that says lidocaine is harmful. So, like many things in medicine, something becomes a standard of care with no real evidence to support it's use. High flow oxygen for every patient for example? In addition, if you look at many of the guidelines, many people recommend that you need to give the lidocaine several minutes prior to laryngoscopy for it to be of any benefit. Pretty hard to do in many cases of RSI. Then, what about services who do not use RSI? The use of Toradol may be a good idea; however, Toradol is a very powerful NSAID, and we should not take lightly the risks associated with using Toradol. Several black box warning exist for Toradol. Problems such as GI bleed, adverse cardiac and neurologic events, coagulation disorders, and renal damage are all serious problems associated with the use of Toradol. Take care, chbare.

Still, why do most nurses you know take CEN, CFRN, CCEMTP and the like? Most I know of do this to improve themselves, to show that they have obtained a base or core level of knowlede in their specialty, however, I do not see them doing this so they can be entitled to more skills. Too many of us, these credentials are simply part of professional development and not an excuse to do cool skillz. That is the difference I am trying to emphasize. I do think we are on the same page however. Take care, chbare.

I stand by my statement. I took both CEN and CFRN. Neither certification changed my responsibilities as a nurse in the ER or in the transport environment. Just like taking ACLS, my responsibilities as a provider do not change. This is my point. However, I find other people think they are entitled to have intubation privileges after watching somebody do it at an ACLS class. Take care, chbare.

Hmm, cannot say I have a problem putting credentials after your name. It seems that in EMS, having a new credential should entitle you to new skills while many other providers see this as simply a way of obtaining additional knowledge and experience. If this attitude was not as common, this thread would not exist. For example, I just helped teach an ACLS class for several people who had never taken it before. Upon completion, the nurses were asking us about the best ECG and airway books so they could self study and learn more. A few EMT-B's wanted to approach their medical director about adding intubation and defibrillation because they now knew how to perform these skills. Take care, chbare.

What kind of ventilator education program does your company have? Are you able to contract with a respiratory therapist? A good RT can come in and help your service evaluate your ventilator needs and perhaps develop an educational program. I have no experience with the HT50 and limited experience with the Univent 750. I have used the 750 at a small ER where I have been pulling PRN shifts. I believe the Eagle is the Univent 754? Take care, chbare.

You never know. :wink: However, I must say that the older Windows XP was a much smoother and more stable OS than Vista. It is a crying shame that you cannot buy XP anymore. With that, does anybody have any experience with the Linux based operating systems? Take care, chbare.

Not exactly. Unless you are giving bicarb to treat a specific condition, (Hyperkalemia, overdose to enhance protein binding, and the such) bicarb can actually complicate the cardiac arrest situation. Altered serum osmolality, increased Co2 levels and electrolyte alterations have been noted with bicarb administration. Take care, chbare.

Hehehe, yeah, I think we are on the same page. Take care, chbare.

Ok, still not the same IMHO. Take the old PM, chop 100-200 hours off of it, and call it the new intermediate. The argument is really not as important as is the fact that people with 300 hours of training can provide paramedic level care. In fact, the 300-400 is only a recommendation, so in theory, you could see how low you can go. Take care, chbare.

http://www.apple.com/mac/ Take care, chbare.

Hmm, well a couple of points if I may? First, I would not say the I/99 is the old paramedic curriculum. Perhaps this is true in specific sates; however, the I/99 was developed by the DOT. The model is similar to a paramedic model; however, I see a significant difference between the I/99 and the older PM courses. Back in the late 1990's when I was looking into paramedic schools, many of the core programs were in the 700-1000 hour range. Note: this was prior to 1999. However, the current I/99 curriculum can be taught in as little as 300 hours total. Look up the DOT NSC, you will find a direct quote stating average students will have average results with 300-400 hours of instruction. This is significantly less than even the older PM courses that I know of. Not that 700 hours is anything to brag about. However, I can agree on one point. The I/99 with 300 hours of training can perform similar skills to many paramedic providers. I have to disagree with the intermediate not being utilized comment. Intermediate level providers are quite popular. Why spend time and resources on paramedics when intermediates can have a similar skill set with significantly less education and pay? Take care, chbare.

Thanks for the heads up. I will only take the Cipro and Flagyl as I have an actual script for those meds. Take care, chbare.

Thank you again everybody: I was talking to a surgeon who pulls ER shifts occasionally. He told me to stop by his office. I stopped by a few days ago, and he had a nice care package for me. 1) Levaquin 500 mg tablets times 20 2) Levaquin tablets 750 mg times 15 3) Script for Cipro 500 mg tablets times 20 4) Script for Flagyl 500 mg tablets times 30 5) Nexium 40 mg tablets times 60 Looks like I have the old TD problem covered, in addition to a few of the eukaryotic goodies as well. I may even have enough to make a few friends if other people start to have problems. :pottytrain5: A side note: I received a call yesterday. It looks like I will be hanging out with DwayneEMTP in Afghanistan instead of Iraq. At least for the first two months or so. Take care, chbare.

Need a bit more to go on. What was the situation, patient condition, history, and outcome of the call? Why did the provider in question feel that BVM ventilation was not required? Why do you feel the procedure was required? Take care, chbare.

Are you sure the above cardioversion guidelines are correct? For example, the monophasic guidelines you stated are in fact what ACLS at one time advocated for monophasic stacked defibrillation shocks. In addition, starting cardioversion at 200 joules monophasic is a bit high especially if you have a stable SVT or new onset A-Flutter. Take care, chbare.

Good job, glad to know you plan on attending paramedic school. If you are not going through a degree program that requires a background of science courses, I too strongly suggest taking a year of Anatomy and Physiology along with the A&P lab. If you have the opportunity, I strongly suggest a semester of molecular or microbiology and lab. You will obtain in depth knowledge of many molecular and physiologic pathways. These courses should provide you with a strong foundation for you future educational pursuits. Take care, chbare.