Callthemedic

"Wanker, this is Callthemedic" "Radio check, over"

"Wanker, this is Callthemedic" "Radio check, over"

Dear chatroom Goddess, I think his thesis is con to the credibility of passing, not minimum standards.

BTW, I voted for "Canada sucks" You made us take back the Expos. Jeff Huson was the only good thing to ever happen to them, but mercifuly, you traded him out of there.

Education they receive, or education they seek If I speak for myself, I have sought the information that I felt was missing. I train for skills above my scope so that I can always meet the requirements within my scope. The medications which I am responsible for in my scope are completely lacking complexity, but I know more about how they work than my scope calls for. Why? "Education is not the filling of a pail, but rather, the lighting of a fire". Once the bucket (scope of practice) is full with educational requirements, my expertise is not complete, it is started. So maybe the a question to ask would be "Do you take responsibility for what you think you should know, or do you allow educational requirements to dictate your professionalism?"

If you go to the OPs record of previous posts, just like other short-lived "scenarios", you will find that they don't follow-up very often. They seem to be disenchanted with paramedics and thought they could post something that made the profession look bad. At any rate, they seem to not know how to answer the questions, or don't care. I have followed 2 other scenarios in the past week that never got a response from the OP. After they see that the medics seem to know what they're doing, off they go into cybespace.

Good point. The gases, as well as the line will be dehumidified because of the closed system.

A) Drama Queen What might he be getting through the regulator before his stunt. Helium? To wash out all gases and replace entire volume with O2? Liquid O2? The bubble would have to be pressurized. :?:

Naw, Dust is more of the instigator type. Y'a know, like the guy that always got you in trouble in school. Gotta be the guy rappin with the other people going along........and then they were all fired.

What body part was pinned? Did the machine or the truck move to pin him? Where did the lacs come from? Those are part of scene size-up. I wouldn't begin to speculate without it. BTW, I always complain of back pain

Intermediate. Can't these procedures be done by a basic under the supervision of a paramedic? No programs anywhere near me to compare, but I don't see any demand for them either.

After scene size-up ask the grader "where is my patient?" What do you do when you are walking up to the patient?

Treat it like a story board and construct the "movie" Patient Assessment skills from the "script", the skill sheet itself. You and your partner are driving up on the scene. What do you see yourself doing? You are putting on gloves What is happening outside the windows? MVA? You would look at the scene and size it up, Right? the first thing you think of is safety of course. Gas on the road,oncoming traffic, power lines Just "see" yourself there and take steps, not leaps Your grader will give you the characters, just follow the formula in blocks of "scenes". Scene #1 BSI Scene Safety What are you doing? Scene #2 Initial impression What does the patient look like? And so on

Implied consent: "Occurs when you assume the patient who is unresponsive or unable to make a rational decision, would consent to life-saving emergency care." Prehospital Emergency Care pp. 34, Mistovich 7Th ed. (Brady) Also applies to patients that initially refuse but then become unresponsive, incapacitated or irrational due to illness. Judging what I have read about this patient, I would have a duty to act regardless of what he "may" want. Where the hell is the OP?

Posted by Dustdevil "In the first situation you gave, while the symptoms point to some specific diagnostic possibilities, it does not clearly and positively point to any one specific condition. " Brilliant. This is the simple logic, but still genius. If you settle for a hunch instead of a probability, you will miss something. As for the cost of the extra procedure........Don't call my ambulance(if I had one yet) if you want ala carte medicine. I'm not going to stop doing procedures I think can tell me something until I hand you over to the nurse. No orifice is safe from my desire to either see the disease process or your signature.

So..........There really is someone who went through both basic and medic levels, got certed as a paramedic and doesn't know that oxygen has no contraindications?? Not only am I being asked to believe that, but now you are saying that they didn't go home and do some of that there fancy book learnin' after the case to review skills?? Someone that doesn't know how to use oxygen is being allowed to be a lead medic by the company and the other medics don't speak-up, the supervisor doesn't step in??? See what I'm saying here? Has anybody else EVER seen such an animal? I think the OP is having some fun at our expense.

Yes, as I understand it, the standard for the NRB is enough flow to keep the reservoir inflated opposite inspiration, not 15 lpm. Is that correct? I think this would help the claustrophobic patient tolerate it better as well. I would also have thought a lacerated bowel or liver would be more of a concern than the semantics of 02 therapy 101 class Maybe the basic would be of more use if they were putting in the 2nd line or doing a focused assessment.

From Rid's post ""Second, C'mon it is does not take a rocket scientist to know if a patient does not have respiratory drive, placing an oxygen mask (NRBM) will NOT or NEVER ventilate a patient. Sorry air floating around the orpharnyx will not cause inflation of the lungs... DUH! I did not have to go to 10 years of residency to figure that out ! "" That one really got to me too. Hoping to catch agonal breaths..........sometime? No hurry there huh? ""A woman doing CPR and talks on the phone and the guy opens his eyes... first thing I think is he probably does not need CPR ! Hmm maybe a little more investigation"" LOL!...I was thinking "It sounds like the poor guy was just trying to sleep one off while his ditzy wife was taking a whack at the 'ol cpr thing"

Chbare, Thank you for PM'ing the paper. I thought this was relevant to the case: "Experiments have shown that vascular cells and tissues that reduce endogenous O2-. availability (such as superoxide dismutase) are more prone to vascular relaxation, whereas O2-. generating compounds are inhibitory (such as xanthine oxidase) (Granger, et. al., 1986). (4) Finally, when cells are in the absence of hemoglobin or O2-. and are in oxygenated media at pH 7.4 the predominant reaction of NO is as follows: 8NO + 4O2 + 4N2O4 à 6NO2-. + 2NO3-. These reactions explain the effects of oxygen therapy during hypovolemic shock. If oxygen is able to decrease NO concentrations and ultimately inhibit the vasodilatation effects of NO then vasoconstriction will occur" The media is too alkaline to be a good comparison but still, this can only be advatageous from an NO viewpoint. I would still love to hear the medic's rationale. You never know.

I would react with: "Since his sat is 85 should we put an NRB on him now?" If I thought the patient's life was in danger I would say so right there and make them call me off with an explanation. The thing about pulling rank is that I would never do it unless I was advocating for the patient. This is not an ego thing, I must be certain. Under my breath.........*Whiskey-Tango-Foxtrot?......over* Just like I would with anybody certed above me, or in a supervisory capacity. I would act respectfully, as if it is still their idea , until I get a chance to talk to them off-line in a more relaxed atmosphere. No patients, or coworkers within earshot and it would be time for point-blank questions. Firm, confident and still respectful. Then if they were still an A-hole I would take their frigging head off :twisted:

No offense at all taken, thank you. Everything any of us say should be open to criticism, IF it is done in a respectful, thoughtful way. To tell the truth, I got target frustration on the heme and sort of forgot it was an NRB :roll: Anyhoo, it was straw-clutching. I think you should ask the paramedic in question why they thought this way in the same considerate way.

I always want to mill it over. If you have a link that would be great.

From emedicine.com "At one time, severe hyperventilation was an important component of the treatment of increased ICP. Reducing PCO2 to less than 25 mm Hg has been shown to cause enough vasoconstriction that CBF is reduced to the point at which a high probability exists of developing cerebral ischemia. Therefore, prolonged severe hyperventilation is not used routinely to treat elevated ICP. Brief periods of severe hyperventilation may be used to treat patients with transient ICP elevations due to pressure waves or in the initial treatment of patients in neurologic distress until other measures can be instituted. " As the co2 is restored a rebound effect vasodilates. Vauge, I know, but that is all I can think of.

I think there's a mechanism of hemodynamic tone in hyperventilation but I don't know of any contraindications of oxygen. Work it through. Can anybody make a connection between the heme molecule on the RBC and the fibrin cascade???? I would go with vaso dilation/constriction........but of course, in that case an NRB would suffice. Did he have any rate/rhythm/quality? Very interesting, thank you for posting

Still, I'll have to get used to pumping metabolic waste all over and not ventillating. As a former Rt, that will be hard to get used to