treaux

Many good points in this thread and as someone already said, initial studies like this are going to be put through the washer several times before any type of conclusion can really be made. I agree that the current options for c-collars make it very difficult to size properly for many of our patients and I have been known to either forgo the collar and use manual stabilization or create some type of modified c-spine protection in cases where I feel the collar would be detrimental. The same can be said for long boards in many cases. I also agree that the extrication factor makes collars worth their weight in gold when it comes to messy situations. firefly, I find it odd that you said the STA blocks to work better than the big Ferno blocks. We use the STA blocks as well (to clarify, they have the blue pad that sticks to the board and two triangle like wedges that velcro to it) and I think they do a terrible job. In my experience the Ferno blocks do a much better job of staying put and reminding the patients not to turn their head, where the STA blocks just seem to twist away (yes, even with the blue "mean" tape).

Unfortunately I can't get past the first word when it's in capslock.

In Cali of course. I read an article stating that there are McDs in 30% of children's hospitals alone. Get em while they're young!

I can't even begin to comprehend what shark here posted, but I feel it's safe to say his caps lock key is on.

When you are considering giving IV fluids, medications or whatever, the question should be "Why am I giving this medication?" instead of "Why not give this medication?" There's the old saying I also received in medic school which is "Everyone can use a cup," but I think times have changed and a fluid bolus requires a reason just as oxygen does. I start saline locks on my stroke pts since if I hang a bag it will simply be removed upon my arrival at the hospital and I can start two saline locks in the time it takes for me to set up one 1000cc bag (don't ask why this is so because you'll just get my rant about employers buying cheap equipment).

But it's got 'lectrolytes! Makes me think of the hospital I visited that had a McDonalds in the cafeteria about two halls down from the cath lab.

This one is pretty simple. Considering a stroke pt is either having a blockage or a bleed, why would you want to raise the pressure in the blocked or bleeding vessels by adding fluids? Sounds like the call was a good learning experience and an inadvertent discovery with the MI. What was the cause of the acute ALOC then?

Just don't eat the penguins!!!! unless they're really really tasty

Welcome. Get ready for one of the most difficult yet rewarding times of your life. In the end you will look back on it with a smile.

He's already proved himself a troll. Just ignore him.

I'm with P_Instructor on this. Def perform a complete abd assessment. Possibility of GI bleed, decreased motility (possibly due to the MS) or constipation? If it's an acute onset it may be something treatable so recommend transport if the symptoms are different than her usual for hospice. You don't have the resources to just write it off as a DNR pt and leave them there.

Also to throw into the mix, does the pt have a magnet for emergency de-activation of his AICD? Try disabling it to see what the underlying rhythm is that's causing it to fire. Make base for permission (at least where I work) and apply defib pads in case you need to manually defib or cardiovert. Then treat appropriately to the pt and/or the rhythm I'm not clear on how you cannot determine the rhythm when you say you have a QRS and it's widening. Are you just missing the p-waves? Is it regular? I'd also consider a sedative if this was precluded by anxiety and due to the pacer firing.

I agree with chbare. Kinda need more info to determine the basis of his tachycardia as well. Any flu symptoms, dehydration, etc that might point you away from cardiac? His rate isn't fast enough to be causing symptoms, and there's no reason to think of conversion unless you can see a clear picture of SVT. If he's asymptomatic then treat him as so and simply transport to the appropriate facility. Oops, just saw the update.

As far as the situation was described, I understand the pulling his hands away part due to the fact that you didn't know how he would asses. However, that would be best followed up by an explanation of why you were concerned and then a demonstration of how to gently palpate the abdomen and assess for a AAA. Who knows, maybe that mass was pulsating and maybe that lowly EMT-B student could have known what that felt like so early in his new career. However he won't know and neither will you for that matter. Assessments must always be complete, though you are right to have regard for where your assessment could potentially cause harm.

Officially, we are allowed 20 minutes to drop of the pt, put the rig back together, do our PCR and leave it at the hospital. This is fairly unreasonable and often times it's the PCR that gets skipped and we just clear. We can add an extension of another 20 minutes if we have extra cleanup or a code 3 return. Our system has been so busy lately we usually just sit at the hospitals until we become available and then get another call before we can clear.

To find a some new reasons to be happy and to appreciate what I have. Most of all to make myself a better person and to accept others without resentment.

First off, kudos to Dwayne for bring up the spell check/grammar issue. Being that documentation is a large part of our business, start working immediately on being clear and concise with what you write. Take a class if you have to. I've seen patient care reports that look like a third grader wrote them and it makes me wonder if their medicine is on par with their writing. As far as "getting your hands dirty" goes you should remember that you're in an education-only mode right now. "Getting your hands dirty" right now should mean appreciating any patient you get to see (even if they're not your own) and researching their medical hx until you understand it. You have a long way to go before you can perform medical treatments that will make a difference in the lives of these patients. If BLS transport is the only way to go initially, then pride yourself on doing a good job of it. Many BLS transfer EMTs don't perform assessments due to the monotony of dragging patients back and forth from facilities on a daily basis. If you do a full assessment on these patients, you will get used to being hands on and you will also be surprised at what you find sometimes. Your curiosity and eagerness are a good value, but realize that you are on the last molecule of the tip of the iceberg and you need to direct that eagerness to the most basic of education. I say this as I feel like I'm still on the tip of iceberg myself and I've been doing this for 6 years now.

pal-treaux by the Rx Bandits "What you want is what you find out once you believe That you no longer need it"

To clarify, you can do quite well in California and we do have emergency ambulances that don't do inter-facility transfers. As for reciprocity, it is a bit of a pain as they don't have an easy way for you to challenge the EMT-P. If you were to get certified by the National Registry, you could apply for a California Paramedic license however. As far as money goes, San Diego will not provide as good of a living as the San Francisco bay area. Starting wages here are around $65k a year on the ambulance and $70-95k for a fire paramedic. I and many other medics here break the 6 figure mark with a moderate amount of overtime (usually 2-3 shifts a month extra). We have one medic who does nothing but work who hit the $250k mark last year.

Sounds like they were dispatchers from that article. However, if they have their EMT cert and are on duty, they have a duty to act. It's gonna be bad.

It works the same way as a tachymeter does on a stopwatch. The meter for pulsations is on the right side, and respirations is on the left. When one of the second hands (this is why there are four) reaches the arrow at the top, you begin counting the pulses. When you reach 15 pulses, you look at where the hand is pointing on the scale on the bezel to the right and it tells you their heart rate. The green zone shows the normal range of 60-100 bpm. For respirations, it's the same thing except that you start from the bottom arrow, count to five respirations and then use the scale on the left side of the bezel. There have been these pulsemeter watches for a long time actually and they're also known as "Doctor's watches" Another example is the Ball Watches "Doctor's Chronograph" which is a $14,000 watch. Click here for a picture of it. Also take a look at this page for some interesting antique Doctor's watches.

Having just switched to King LT-Ds from Combitubes as a backup airway, I'm very impressed. I've used them twice in difficult airways and had great results. As far as EMT-Basics using them, with proper training, it could be useful. There are many rural areas near me where it can take up to an hour for paramedics to show up and I'd much rather have an airway established during that wait. It all comes down to training. If EMT-Bs are taught to use it and have frequent refreshers on their skills, it will be fine. Just as medics who don't get to intubate a lot need to stay fresh on their skills.

Very sad to hear. I personally have never stopped at an accident while off-duty for that very reason. I know an engine and an ambulance can be there in 5 minutes, and there's hardly anything I can do in that 5 minutes to make a difference. Remember that your safety is always first. Thanks for the article Vent.

I agree on the Citizen Eco-Drive. I've had one for the past 12 years that has become my beater/work watch and has served me well. I recommend the perpetual calendar as you'll never have to set the date again! However, on the novelty side, I do have a St Gallen rescue which I wear at work regularly. It has a pulse and respiration meter on the bezel and I've actually found myself using it at work instead of the old count and multiply trick. The other benefits of the watch are that it's "Disinfectable" in that there are no hinges or joints were dirt/blood/nastiness can collect. I'll try to take some pictures of it. It's more of a collectors watch though as it has a swiss ETA movement which puts it in a higher-than-reasonable price bracket. I collect watches though, so I had to have one. Call me a "whacker" as I know you guys might, but I'm more of a watch whacker than an ems whacker

Very interesting. Just had a neonate call last night (delivered right before I got there) and had an interesting call. The fire engine was so scared of dealing with the call that they sat across the street in their engine waiting for us to show up, then flipped a U-turn and pulled in behind us. Another fun fact is that I was born at Alta Bates hospital!