Mateo_1387

So........While in Colorado, I got to meet the very gorgeous, intelligent, and super awesome Wendy (aka Eydawn). When I walked through the door of her apartment, I was met by a gorgeous blond....her breath was not the most plesent, but some things can be overlooked... [spoil:16529832bd][/spoil:16529832bd] I was love at first sight ! That was, until the real Wendy came out and asked me wtf I was doing feelin' up on her dog :shock: Fooled the HELL out of me ! When I got to meet the real Wendy, she was truly impressive. She is very much a strong woman, smart as a whip, and a lot of fun to be around. She truly makes me a better person for knowing her. So, now you want to know what she looks like......Well, now is your opportunity. (of course, I am in the pic too... the person on the right) [spoil:16529832bd][/spoil:16529832bd] Dwayne.......now thats another story all together. Seems he had the same problem I did, only worse. The hot blond met him at the door... and after several minutes of fondling, petting, and overall animalistic behaviors, Dwayne freaked out when he found out the hot blond....was...well....in fact...a him. :shock: :twisted: In all seriousness, Dwayne, his wife and child make a beautiful family. Barbara is a gem. It was nice to meet the woman that can live with Dwayne. Dwayne's son, I have to say is an impressive young man. He is charming, can put it on for the women (If I remember right, he caressed Wendy's hair), and he has a truly happy soul. To Dwayne and Wendy, thanks for inviting me into your homes. It means a lot to have good friends willing to house a dude who is looking for his place in life. Colorado is a beautiful state, and all the more better with you two in it.

Theme song for this thread...

What is the bolded?

WOW. All I have to say for those involved is [spoil:e3a9fa1272][marq=left:e3a9fa1272]FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL FAIL[/marq:e3a9fa1272][/spoil:e3a9fa1272]

Tell me about it bro...

Some of you may be wondering, just how did Dwayne get you into his home? Now he is loading us with beer and ice cream cake.....I think he had something planned all along, but so far, the only suspecting/paranoid one is me. :shock:

Oh yeah....So far so good...Playing Wii...soon, off to the hot tubs..which reminds me.... Wendy brought the most amazing boobs! (Of course I mean Matty and Logan). Wish you all were here...if we'd had more than two days notice we'd have invited you!

Hi there! Eydawn, Dwayne EMT-P, and Mateo are all greeting you from a party that we didn't invite anyone to. (PS, I stole Matt's computer so I'm posting under his name. We're all still mostly sober, and nobody has peed on anything yet... so the evening is just getting started. I'll let you guess who's typing this... more fun that way.) Hope everyone is having a good night! Really, Dwayne came and kidnapped Mateo and Eydawn... so send reinforcements! Please? Get us out of here... The cool kids...

Here is the protocol the Wake County EMS system uses. Good Luck.

Just a good understanding of Anatomy & Physiology alone will set you apart from all your cohorts with only 'a cert'. I can guarantee you that my school, and would almost guarantee that your school, covers much more information in two years than can be covered in a 456 hour training course. Do not sell yourself short for having a degree. You are getting it to be a cut above the rest. Maybe, after you are finished with school, and ride as a paramedic, you will see how a degree was a better choice. Good Luck with your program !

That is just awesome. Good food, sexy girls, Coca Cola in a Glass.....couldn't ask for much more....

If you like guerilla, I am sure AK would not mind filling in...he is supposed to be a great dancer.

How about for the folks who have response times that exceed 30 min. I could see it being time sensitive.

If they code in the ambulance at the doorstep, I would go on in, because there is a need for more resources. I would perform an intervention such as defibrillation or medication administration before entering the ER. A code on scene gets worked on scene, even when the house is beside the ER. I have worked a code right beside the hospital, in a Dr. Office. We worked it for 20 min, and called it on scene too.

You could move V1 and V2 to the back so one could look at the posterior walls of the heart.

This is also a great time to add that the idea that EMS does not provide definitive care is the idea that keeps us held back in the world of medicine. We should view ourselves as being a continuum within the health care system, not an entity that dumps our issues onto the hospital doorstep. We are definitive care. We bring certain aspects of the hospital to the patient. It just so happens that we begin definitive care, it just happens that the hospital finishes what we start, for the most part.

:bs: So, a paramedic gives a patient IV Dextrose, and brings said patient out of insulin shock. A very life threatening condition, that if left untreated, will be sure to lead to death. Now, and EMT Basic, who cannot give IV Dextrose must take said patient to 'definitive care'. When the patient arrives at said "definitive care" the patient will be given IV Dextrose. Lets look at the equation. IV Dextrose = Definitive Care. Paramedics administer IV Dextrose. So with the rule of substitution, we can conclude that... Paramedics administer definitive care.

My current station is located in a very small town, maybe a total of 15 roads. We ran a total of approx 375 calls. 24 hours a day, 7 days a week, there is a crew on duty, always consisting of one paramedic. I sit at the station for a 24 hour shift. It is not that bad. In fact, we have only had 2 calls within 5 workdays. The last call ran by this station was about 4 days ago. We have three shifts, so a total of six persons to "sit" at the station. I always thought EMS' goal was to be prepared to answer calls, not plan to do nothing. To me, that means having a full time crew ready to respond to time sensitive emergencies.

If you are not comfortable with NG tube placement, then do not do it. I guess you can tell your patient when they wake up that you are an ass man (I hope you realize I am just kiddin')

Interesting questions bro... First off.....I don't know :shock: :arrow: Earlier in this thread, I was under the impression the patient had a pulse rate of 170 +. Rather than just treat, I would want too try and figure out why this patient is having conducted complexes, but without a pulse. As I said earlier, listening to heart tones to establish if what is heard matches the monitor. In the case that it does not match, I don't know. If I had an extended transport time, I would like to go with medical control to figure out possibly what is going on, and maybe get some guidance on treatment. In the case that I did not have any OLMC, I probably would go ahead and give the cardiazem, as my best indication is that the heart is beating rapidly, though not producing pulses with every beat. If the patient had a pulse rate of 60, I probably would not give the cardizem. So I have a question for you, you are 3 hours from the hospital, and your patient has a pulse of 80, yet on the monitor a ventricular rate of 200. How might you treat the patient. Obviously, something just is not right. Good question.

You just flat out do not get it. First, if your monitor is showing a ventricular rate of 200 yet the pulse rate is 88, then something is wrong. For some reason, the patient is not pumping blood normally. You cannot just ignore something like that. Well...you can....the rest of us will not. You blame me for being a cook book medic for using my monitor as an assessment tool, yet you want to say just because the pulse ox says 98% that she is not oxygen deprived. Sounds like a double standard. I guess you are ignoring the fact she has lung infection/inflammation/excess mucus production/and probably edema in her lungs. But that is ok, just because your pulse ox says so, it will all be ok. Wrong, your pulse ox is only a tool that fits into the big picture. Sure, it is showing that things are 'normal' but that does not mean things are 'normal'. Sure the pulse is 'normal' but since the monitor shows a ventricular rate of 200, it is not 'normal'. You need to see the big picture. Give her a coma cocktail, and we can call it quits......

I think I would rather use an NG tube, and go through the enterance route, rather than the no go hole.

:bs: Advanced medications, electrical shock therapy, airway control, CPR, trying to treat the causing factor of arrest.....its sounds like definitive care. I guess we can take the dead guy back to the street corner so the citizens can just do CPR, since it is not definitive care. Since it is not definitive care, what do you call it? Granted, even though Paramedics cannot provide every last thing the hospital can, does not mean we do not provide some level of definitive care.

Thanks for posting the scenario. These long discussions are what the city is about ! We are fortunate to have Solu-Medrol. The first paragraph is a bit confusing. Are you saying that cardizem is indicated for a rapid ventricular rate, and then immediately contraindicated due to the possibility of clot formation within the atria? Using cardizem is a judgment call. For a patient that has strong clinical indication of becoming "unstable" I feel cardizem should be used. I understand there is the chance of conversion with Cardizem, but that is not the norm. Cardioversion usually requires premedication with anticoagulants, and then electrical cardioversion. Again, it is a judgment call. You have a patient who will most likely become unstable, so we want to prevent it the best possible way. Kind of a risk vs. benefit argument. Electrical cardioversion would be a last resort because conversion to sinus rhythm could cause a clot to enter systemic circulation. Electrical cardioversion would be used on an unstable patient. For the unstable patient, the risk vs. benefit would favor hemodynamic stability, in light of a clot being released into systemic circulation. Even better treatment would be to control rate with antiarrhythmics, if indicated. If able to use antiarrhythmics, but use electrical conversion, the cardioversion would be riskier. Clear as mud? Just some more on the point about treating the monitor vs. the patient. In cases where the pulse rate is within normal range, yet on the monitor you count a ventricular rate that is 3 times the normal limit, I would be inclined to treat with cardizem. You have to remember that all ventricular complexes may not equal the pulse rate. Although I have not been exposed to such as case, ya never know. Also, since the heart monitor does view electrical activity, and not mechanical activity, it would be important to listen to the heart and hear if the heart rate matches the number of QRS complexes. For us to see electricity being transmitted through the ventricles (a QRS complex) there is probably going to be mechanical movement of the heart, although possibly not very strong. Such as a PVC, you've heard of PVC's that produce a pulse and those that don't, does not mean that the heart is not moving. This patient will benefit for critical thinking and not cook book medicine. Out treatments need to be guided by clinical evidence. Blanket statements such as treat the patient not the monitor are bogus. Treat the clinical picture. Expect the unexpected, and be educated enough to do the best for your patient with presented with an unclear clinical picture. And to crotch, patients can exhibit multiple clinical problems with multiple etiologies. Not everything is dependent on just one medical problem, all the time. Just sayin'.