nypamedic43

We use the ProtectIV needles. No spring mechanism in them. They glide smoothly when you retract the needle. The only thing I dont like about them is that when you insert the needle into the vein, you have to put it in almost to the hub of the catheter. Because the needles retract, you cant push the catheter off the needle to get it where you want it. If you try to push the catheter off, it kinks it. edited for spelling

Very nice follow up. It's interesting to me to see the "why" of things. A definite learning case.

The first strip looks junctional to me, indicating that there may be a pacemaker malfunction. He is diabetic and has had vomiting and diarrhea all day which will definitely knock his potassium all out of whack. The second strip is still junctional and appears to have a RBBB along with some serious high peaked T-waves. The third strip it appears that his pacemaker is working at least some of the time, but he has depression in leads III and AVF and elevation in V leads 1-4 and it appears that the RBBB has changed to a LBBB. I would give him a 250 fluid bolus and monitor lung sounds. I would also give him some dextrose and get his BGL up a bit. I think I would be asking med control for some sodium bicarb and some calcium chloride, I would leave that decision to them after they see the 12 lead and I would send all 3 to them, which isnt something I normally do. He has a serious electrolyte imbalance and may be having an MI. Diabetics are tough to diagnose sometimes because they present so differently. It will be interesting to see what he was diagnosed with.

well we do bite...it just depends on who it is lol. Welcome to the City

oh my gosh the visual is overwhelming *giggle*

Welcome to the City Brandi! Jump right in

My take on it that her drivers license is suspended and her EMT cert is expired. How long has the cert been expired? because you may have to take the whole class over again.

I have to wonder why the leniency? Because they are firefighters? That's BS and we all know it. I dont work nights, thank goodness, but in NY we have 3 minutes to get up, dressed and out the door to a call. And response times are monitored closely. As for the dispatcher lying on the call report and noting that they were on scene and they didnt even respond, he should be fired. It amazes me the slack that is given our firefighter brethren....slack that we as medics and emt's don't get.

welcome back Tyler

Hiya Andrew! Welcome to the city! I'm in the Southern Tier of NY...where are you located?

Welcome to the city Mike!

Welcome to the city

I was unable to read the article without subscribing to the online newspaper...so I am not sure what it contains. I did a search on the NJ EMT Basic scope of practice but couldnt find anything other than proposed changes to the basic scope of practice dated in 2002 and 2004. I also found a cert revocation order for a basic that administered epi in a cardiac arrest dated 2001. I have always been of the understanding that the NJ EMS system is messed up. But since I can't read the article, I cant speak to just how messed up it really is.

I asked if he was ok and told him to PM me if he wanted...he didnt. Just posted that he was gonna bounce. Makes me sad This was his status from yesterday....I am tired of the excruciating psychoemotional pain and don't wish to remain I do hope he is alright

We can do 10cmH20 without an order, for anything higher than that we have to ask, however the setup comes straight off the main o2 tank at about 20 liters a minute, there is no way to make it less. Thats why the 5 or 10 cmH2o. With a patient that I know is a COPD patient, I am hypervigilant. I always watch them closely. If they are having too much trouble coping with 15 liters I will drop them to 12. IF thats still too much then I will put them on a cannula at 6, and I watch the SPO2 as well. I dont want them at 99%...I want them in the low 90's where they usually are and if I can achieve that, great.

As artickat has stated, we don't have COPD patients in our care long enough to interrupt the hypoxic drive. I really don't understand why pre-hospital people still believe that. If they are working hard to breath, in the short term, 12 liters by an NRM is not incorrect. If they cant tolerate a mask, then a cannula at 6 liters is not incorrect. With CPAP, we give 20 liters through the mask routinely and can inline an SVN with it. It's the long-term effects that most hospitals are concerned with, hence why they put the patient back on thier normal 2 or 3 liters by cannula almost immediately. But the 10, 20, 30 minutes of getting high flow O2 isnt going to hurt them pre-hospital. newborns that are on high flow oxygen for long periods of time can also be badly effected. Its actually blindness but its one of those million dollar words that ties my tongue up when I try to say it. :/ I always go with what the patient is comfortable with, whether it be an NRM or a cannula. But we arent allowed to titrate to effect, which really irritates me. They dont always need the highest liters to help them.

I will sponsor Dylan without a problem. I'll have to do it when I get home though. I gotta say though...how cool is it that he has already met his goal? Yay Dylan!!!

I'm with Mike on the shenanigans...Bradford county EMS agencies don't pay that much AND the one I worked at you had to pay for your own boots and uniforms. I'm in chemung county NY now and get paid $13.90 an hour but our uniforms are furnished and there is reimbursement for boots. The company also matches our 401k 100% up to 6%. Yeah I don't know where libby is...but I know that the EMS agencies in PA don't pay that well. az....I'm not sure I could work there. I'm an east coast girl that's for sure and I can feel your frustration.

What concerned me was the the fact that he said he was thrown backwards into the freezer, about 5 feet, give or take. I truly think that he was hit with the force of the lightning (how's that Mike lol) that had been lessened in force by the distance it traveled down the line and into the grounded house. I didn't even take his inability to pay into consideration. If his EKG had shown anything but a NSR, I would have insisted that he go with us and would have gotten PD involved. However, he did end up going down with his friend and was released a couple of hours later. These new protocols are a pain right in the arse. There is very little wiggle room anymore. A person that has been vomiting for 2 hours gets worked up....WITH a 12lead. I'm not sure how this is all going to pan out in the long run really. While they have expanded the protocols...they have also placed restrictions on those protocols. I'm not real keen on performing a pericardial centesis in any capacity. They have given us the skill but you have to be certified with the medical director in order to do it. Facilitated intubation is the same way and it has to be a 2 medic crew. We still are in a "mother may I" role. It's kind of frustrating.