Mateo_1387

I do not get this argument :wink: Nah, you are not alone. Which one is it? Can we do something more for our patient's or not? Things you are not trained on probably are outside of your scope of practice. There are also things you were trained on that are not in your scope of practice, these things are usually limited by state or company protocols.

Until faced with the situation, I will not be able to give you an accurate answer. That being said, I have performed outside of my scope on calls before, but under the supervision of a paramedic, as well as I felt very confident and comfortable performing the action. That being said, I would apply those same rules to performing out of my scope to "save" a life. The difference would be nobody to supervise me. I like to think I would perform the intervention only if I felt confident in diagnosing the patient, and then felt confident in performing the intervention outside of my scope. I think if any of those two were not met, then I would probably not perform the action.

LOL, No, I probably do not know that trooper, but......you've lived in NC, you know how the troopers are !

LOL, a NC State Trooper thinking twice about giving a ticket? BOGUS.........JK Terri, Thats a good one !

What the man in the video is saying makes sense. I would think that slowly removing bandages of the burn victim would be better, because those procedures are usually augmented with pain management. Low levels of pain, treated with pain medication, makes sense, to me. Even with pain management, intense bandage ripping probably intensifies the pain past the level treated by the medication. But, this is just me rambling about how it may be, truth is I am not really sure. The anxiety before knowing something painful is about to be done is killer !

The famous paper by James Rachels, a philosopher of ethics. I think it is worth the read for everyone. [web:b6631ffcfd]http://www2.sunysuffolk.edu/pecorip/scccweb/etexts/deathanddying_text/Active%20and%20Passive%20Euthanasia.pdf[/web:b6631ffcfd]

Good points doc. I have to agree with you mostly. I just felt like it was barking up the wrong tree because the answer was given to us by the OP, no matter how much things do not quite line up. Thanks for calling me on this ! I could not find text to say this, but what is the onset of symptoms from OPP from time of exposure? Thanks. Mateo

The only symptoms that were consistent with sludge are Salivation and defecation. Organophosphate poisoning is barking up the wrong tree, at this point. As far as terminology, a Premature Ventricular Contraction is a Ventricular contraction that occurs before the next expected "normal" heartbeat. Think of a patient in a rhythm such as Junctional Tachycardia. They are having ventricular contractions. The person then has a PVC, the PVC is called premature because it comes before the next expected ventricular contraction in a rhythm. A Ventricular escape complex is a ventricular beat that comes after an expected ventricular complex. The name of PVC is given because its origin is from the Ventricle. A ventricular contraction may originate from the Atrioventricular Node of the heart (called the AV Junction consisting of the AV Node and Bundle of HIS). This ventricular contraction would be called Premature junctional rhythm, or junctional escape rhythm. .................................................................Escape Complex.................................... ......................................................................|......... ............................................... /__/__/__/__/__/__/__/__/__/___/_/__/__/__/__/__/__/__ ..................................................................|............. ............................................... .......................................................This is where the beat was expected.............. ....................................................Premature Ventricular Complex.......................... ......................................................|......................... ............................................... /__/__/__/__/__/__/__/_/___/__/__/__/__/__/__/__/__/__ ........................................................|....................... ............................................... ..............................................This is where the beat was expected.......................

Eydawn, congratulation on the job ! A biology background should be what makes you feel less like a hypocrite. You should have more understanding of the human body than does the regular emt. Your system also utilizes paramedics. I do not see the problem. You are not giving away your education for free, and you have accepted that you are going to be working under a paramedic's supervision. The way I am seeing it is that the brokenness of the system is that college courses are not required, even for the most basic certification. You have that education and the certification. You are working towards the solution, and not being a part of the problem. I hope this helps.....good luck !

I wonder if there is a little bit of confusion Kaisu. From reading Sir Duke's post, it appears to me that he is talking about a "medic mill" "zero to hero" medic. I think he is talking about that medic with/without prior experience. I am not 100% sure though. Kaisu, I am getting the idea that you are talking about a Paramedic with a 2 year degree, becoming a medic without the other certifications. If that is the case, then I can see the validity of both arguments. The medic mill zero to hero medic without experience would have a difficult time gaining experience to be a competent provider, they start off way behind the 8-ball. A 2 year degree paramedic may not have the experience, but they have the education, and the experience will be super easy to get. The 2 year paramedic will excell very rapidly.

Ya'll get back on track ! Ok....So we stuff his pipe with some green...put some gold/money on the card...give him some "mountain dew" to cure the symptoms...and after he gets to feeling good, we'll thrown in an ugly nurse to "take care" of him I think its the best birthday ever. (and if not, I'm stuffed if I know) Anyways, your patient lives for many more years. All is well....All you supermedics can return to your station !

Vitals are within Normal limits... (the dehydration may come later !) Past Medical Hx.......family tells you he is power hungry....some call him the administrator....some don't EKG looks something like this......./...../..../.../...hiccup..../..../.../... BTW Happy Birthday AK !

Good observation ERDoc. That is a Key symptom to the underlying cause. Has anyone figured out the underlying cause? Any more questions? To Michael....really really short he is not.....pipe smoker, I doubt, but who knows?........Paying with a gold card....hes probably like anyone else, he wants someone else to pay for it ! (I realize I have probably missed something in your post Michael :? )

You arrive on scene to find a patient. Chief Complaint : Not enough beer The patient is Male (So it seems ) He is 75 years old. The patient is Alert. Airway open Breathing labored Circulation: Skin is Warm, Moist, and Green :shock: The residence seems to be set up for some type of traditional festive event. What is going on with the patient? Anything you would like to know?

Yup. So is Spenac ( By the way, thanks for the nice drug write up ! It was easy to copy and paste ) We have it in the pulmonary edema protocol

Acetaminophen (Tylenol®)-160mg/5ml-4ounces Adenosine (Adenocard®)-6mg/2ml-2ml Albuterol (Proventil®, Ventolin®)-2.5mg/3ml-3ml Amiodarone (Cordarone®)-50mg/ml-3ml Aspirin (ASA)-81mg/tab-1tab Atropine-1mg/10ml-10ml Calcium Chloride-1g/10ml-10ml Dextrose 25%-2.5g/10ml-10ml Dextrose50%-25g/50ml-50ml Diltiazem (Cardizem®)-5mg/ml-5ml Diphenhydramine (Benadryl®)-50mg/ml-1ml Dopamine (Intropin®) Drip-400mg/250ml-250ml Enalapril (Vasotec)-1.25mg/ml-1ml Epinephrine (Adrenaline) 1:1,000-1mg/ml-1ml Epinephrine (Adrenalin®) 1:10,000-0.1mg/ml-10ml Fentanyl-0.05mg/ml-2ml Furosemide-10mg/ml-10ml Glucagon-1mg/ml-1ml Ipratropium Bromide (Atrovent®)-0.5mg/2.5ml-2.5ml Labetalol (Trandate®, Normodyne®)-5mg/ml-20ml Lidocaine (Xylocaine®)20mg/ml-5ml Magnesium Sulfate-1g/2ml-2ml Methylprednisolone (Solu-Medrol®)-125mg/2ml-2ml Midazolam (Versed)-1mg/ml-5ml Morphine Sulfate10mg/ml-1ml Naloxone (Narcan®)2mg/2ml-2ml Nitroglycerine (Nitro Stat® /NTG)-0.4mg/spray-metered dose Oral Glucose (Glutose®, Insta-glucose®)-31g/tube-1 tube Promethazine (Phenergan®)-50mg/ml-1ml Sodium Bicarbonate-50mEq/50ml-50ml Thiamine-100mg/ml-2ml Vasopressin-20u/ml-1ml Vecuronium-1mg/ml-10ml Etomidate-2mg/ml-10ml Tetracaine-0.5% Meperidine-50mg/ml-1ml Ondansetron (Zofran)-2mg/ml-4ml Haloperidol (Haldol)-5mg/ml- 10ml

Congratulations Kaisu ! Good luck with the new job. :thumbleft: Mateo

Letmesleep. Thanks for the links. They have some good information. A few things though...... A) I am posting this in the open for everyone's benefit. 1) The links are useful, but we wanted to know what information you used to make your decision, not just "useful links" for everyone. Although the links are beneficial....it still does not answer the questions. 2) I want to direct you back to Dwayne's post. Calling you (and everyone) out is the name of the game. When you or anyone posts on this site, you should expect to be judged and persecuted at most. This makes everyone stronger, especially the two or more actively debating. You my friend chose to focus on what you considered a personal attack. When Dwayne defended his position, you went on farther to say that you were in effect above Dwayne because you chose to respect this thread, and more so you chose to protect Dwayne. That there is a Load of Crap. Not only did you waste space, you still made a reply to Dwayne. 3) Most issues are fairly black and white. They are not "that complicated" to figure out. Issues such as religion are complicated, and need the "agree to disagree policy." But in reality, religion is not that complicated, it is just that a lot of people have not figured it out. :wink: But that is for another thread. Break things down for what they are, and the solution is relatively easy to figure out ! leaving it in the air to just "agree to disagree" is just another way of giving up. Mateo

Thanks. The picture clears it up. I can see the enlarged right ventricle on the picture you provided. With the right ventricular wall that size, I can "see" the RAD. The other picture is a bit misleading.

Thanks for the scenario chbare. I appreciate the chance to have a challenging review of congenital heart defects. I have two questions. Can you explain the finding of an enlarged liver? Is it due to a backup of blood in the venous system? Also, with the picture provided by streethealer, it shows space where the left ventricle should be as a large muscle mass. If the picture is accurate, why would it show RAD? I would think the large left ventricle would show LAD. Thanks Mateo

I do not see why it would be wrong to say no. I believe it to be too drastic of a measure to circumcise to help prevent STD's. There is still a great chance to contract an STD as being circumcised. Whether circumcised or not, there are always the uses of abstinence and condoms. Those are much less invasive, they have been proven to be very effective in pregnancy and STD prevention, and they do not require an operation to a helpless child who cannot fend for himself. I belive that as parents they should save the decision of circumcision for the child. Just as they would save the decision for a vasectomy. The physiological uses of the foreskin are taken away during circumcision. Both procedure have psychosocial implications. I would like to hear what psychosocial implications affect a male post vasectomy. I assume issues such as not being able to have children would be one. Is it one? are there more? I am curious. The psychosocial implications of circumcision are present too. We have harbored an environment where to have an intact penis is seen as ugly. Without conformity, the intact penis is seen as negative. I think the comparison was far. They are opposite in nature as a male with a vasectomy has many psychosocial implications with a surgery, vs a male without a surgery (Circumcision) also has psychosocial implications. Sure vasectomy may have a greater psychosocial implication, due to it not being routine, but my point I was trying to reach is that it is a decision left to the adult. Both procedures should not be taken lightly, but the sad fact is that many people take circumcision as a "light" procedure. On a side note, I do not see this as an argument, but rather a very good discussion. My position needs to be questioned, just as I feel the oposing position needs to be questioned.

The Split heart sounds would be due to pressure against the right ventricle, as well as the factor of hypertrophy. Transposition of the great arteries could cause the hypertrophy. The right ventricle would be pumping into the aorta. It would have to pump faster, and would have to increase size in order to compensate for decreased cardiac output. In the case of transposition, this is how I figure the blood flow goes. Blood from the veins go to the right atrium, to the right ventricle and into the aorta, to the body, and then back around. The blood goes from the left ventricle into the pulmonary artery, to the lungs, returns through the pulmonary veins, and into the left atrium. The blood then goes to the left ventricle, and then back through the pulmonary artery. The increased pressure of the pulmonary artery due to the size of the left ventricle forces the oxygen rich blood through the PDA and into the arterial circulation. So switching the great vessels would fix the problem, and eliminate the need for a PDA.

chbare, if I may interject... Although the studies show that circumcised men have higher risk to certain STD's, I can only see this as an expectation. I expect persons with their appendix removed to have no incidents of appendicitis. Circumcision may be an acceptable way to help fight against STD's, but there are more effective ways that do not cause mutilation to helpless children. Options include condoms and abstinence. Circumcision for hygene/STD prevention is like using a sledgehammar to drive in a small nail. Compare it to a vasectomy, there are less invasive ways to keep from having children. This procedure is not done to children because it is a decision to be made as an adult, the decision of how drastic a person want's to subject their body to modification. I do not see a difference in the comparison to circumcision.

It is not a matter of pain being felt, it is a matter of pain being remembered. Just because most people cannot remember the pain does not make the procedure right.

Thanks for the English lesson, but the first part of your definition describes circumcision. There is injury to the head of the penis, because tissue will be cut away. The penis is disfigured, it will never look the same again and it is imperfect by removing parts. Even the second definition can be disputed. The foreskin provides support with sexual intercourse, protections against chaffing, rubbing, and less sensitivity of the gland. After circumcision, you do deprive the child from these benefits of a foreskin. Circumcision is not something that should be thrown around lightly as it is in the world today. It may very well affect what they desire later in life. Even if they do not desire it, they will never regain what is missing.