Mateo_1387

Usually if they are in full arrest already, it's going to take more than D50 or Narcan to resuscitate them. They are not going to "snap" out of it as they would if they were only non-responsive. You'll have to do at least the first line of drugs. Early intubation is critical for delivering the high concentration of O2 needed for resuscitation.

I follow what you are saying, but......... If you suspect something causes the arrest and can be easily fixed (hypoglycemia, narcotic OD, tension pneumo) why push the drug/intervention to fix the problem down the line when they have a good chance to wake up in the next few minutes? I am just thinking that if I suspect they will wake up, I would not want to "come to" with a tube sticking down my throat.

With objects like broom handles, and "several other things", I can imagine these objects have imperfections that when used in a rough and unwarranted manner, could cause a laceration, and subsequent hypovolemia, especially when it perforates such a vascular area.

Position of the patient is important because other positions may cause the heart to move. Think about when you are listening to heart tones, you want your patient to sit forward so that the heart is closest to the ribs. The closeness to the ribs helps the practitioner to hear the heart tones. Just the patient sitting up in the same position you would listen to heart tones can causes reading of the EKG to change. One change can be axis deviation. Take for example a patient who does not have axis deviation. It is possible for axis deviation to show up on the EKG while the patient is sitting up or leaning forward, but would not appear when the patient is laying properly.

Justst to clarify, is the above how you used to do things or how you would do it today? The only reason I ask is that guidelines today are to push the intubation until later into the code, I would be weary of having a patient intubated if I had a strong suspicion that Narcan or D50 would reverse their cardiac arrest. If after administration they remained comatose after some time, then intubation would be warranted.

Some ideas that you may already do, but if not may consider... 1) Patient tracking, to let the EMS crew know the outcome of certain patients 2) Do statistics with how you hospital and EMS work together. For example, if the hospital pushes for quick transport times with stemi alerts, stroke alerts, traumas and the like, do the statistics showing patient outcomes, if the alerts were legit, so that not only will they help your agency/hospital to improve, it will also show the EMS service how much they are valued and their actions affect the outcome of patients. 3) Conferences and luncheons and the like with the ER/EMS to show how the quality of patient care. For example, my agency who pushes for on scene cardiac arrest, induced hypothermia, were invited to speak at a dinner/presentation within a hospital to talk about the continuum of care. 4) Within each agency, ER and EMS, make it come down from administration that each other has to show respect. Basically, just to say that the other are not idiots. 5) I really think that for long term "getting along" you need to offer paramedic students lots of time in clinical. The more exposed you are to the hospital environment, the more respect I think you have for them. When I was coming through the certification ranks, I did not have much hospital interaction, or experience within. I always heard, "that nurse is an idiot, that doctor doesn't know what he is doing, paramedics are better than nurses, we can intubate and do surgical crics/thoracentesis" and the regular bull crap. After doing clinicals in the hospital, especially in specialty areas, such as L&D, Burn unit, Pediatrics, I realized how smart these people were. The teamwork environment is different, and the mind set is different, where EMS thought those idiots, the hospital says "what can you do?" Through the interaction, they learned about EMS, and I got a whole education on the Hospital environment. I think that goes a long way, even if I never stepped foot to "work" for a hospital, I will always have the respect for them. 6) Have a system in place so that if hospital staff has a problem with a paramedic, and how they treat a patient, that the hospital needs to take it up with the medical director. Have paramedics walk away from conflicts, not to interact, and to directly contact the medical director, explain their treatment action, and "why" they did what they did. Then the medical director can go to the hospital, and in a way, speak their lingo to handle problems. This keeps the nurse/doctor/paramedic interaction non confrontational. Let the Upper people do the negative interaction, to leave things clean on the lower level, so to speak.

Raleigh NC is a fun place to work and live. Check out what Wake Co. has to offer. In NC there are also other great services in New Hanover County , which is right on the beach. Wilmington is in New Hanover Co., and there is a state university there, UNCW. In Charlotte there is Medic , they are always hiring. I have heard good things about the system, but two things about them, like everywhere they are understaffed, so you will run alot of calls, and they have system status management. All the services as far as I know do only emergency runs, except maybe New Hanover, you would have to go to their site and read. If you want any more information about NC, let me know, there are a few of us around who can help you.

I do not think the posts were meaning to be harsh. If you go back and read the post as being inquisitive instead of bashing you, they may seem better. By the way, welcome to the city ! On this site, questions are going to be asked. When you got done with the call, you realized some new things about how you will handle the call in the future. For example, you learned how parental placement is key to delivering proper patient care. Just as much as you should reflect on calls when you are finished, the people on EMTCity reflecting on your call is only helping you to get better, as well as satisfy our inquisitive nature. All questions asked were the same question many other people wondered about. Take the comments as positive. Hope you stick around, and pick up all the knowledge we have to offer. Be open-minded. Good Luck ! Mateo

considering all the pictures, facts, and everything snopes has to offer, plus the fact that the website is dedicated to finding the truth, I'll call it legit. Also, who is to say the email is not true, I do not see any so called "facts" within the email. But since were are on the subject of questioning, who is to say this reality of mine does not truly exist, but is maybe someone else's reality? :?

I was always told that there was no such thing as a stupid question, just stupid people who ask them.

To the OP, what makes you feel it is important ?

Oh, I was thinking you wanted any EMT stuff. I was not thinking just Basic. Sorry about that. The EMT program I was in as far as clinical went was to ride for 24 hrs, two twelve hour shifts. We signed up with the Training officer of the county, on days we were free. The training officer then put us with certain paramedics. Some were trained, some were not. Then we did 12 hours in the ER. We were assigned with a certain nurse.

Mine was coordinated through the college. Our program had a clinical coordinator, whose sole job was to coordinate clinical sites, and student schedules, as well as the clinical packets. No student evaluations were done to my knowledge. We did take Skills Check-off sheets. We had to do so many of each kinds of assessments (adult, ped, geriatric, trauma, resp., cardiac, general assessment.) Radio call in's, team leaders, EJ's, Chest Decompressions, Defibrillation, Cardioverts, IO's, Med Pushes, IM med admins, SQ med admins, inhalations med admins, 12 lead application/interpretation, lead II application/interpretation, intubations(oral and nasal), LMA's, Blind Insertion Airways, Ventilation with BVM, IV's, PO med admins, Sublingual med admins, NG tubes, Surgical Crics, I think that is the full list, but more than likely I missed something. The college set up contracts with companies to allow riders. We would be assigned in advanced with a rider. They did not discriminate against FTO's, trained preceptors, and just regular paramedics. Anyone could potentially be a preceptor. We did both. We had a set number of hours to complete and a set number of skills to complete. Some of the instructors still ride in the field, but I was never lucky enough to ride with one. Because we had alternate clinical days, I had a chance to ride with some of my classmates who were working in the field. My idea of an ideal system would be to have set preceptors who are dedicated to education and helping advance the paramedic to be the best possible. I believe it is realistic, but it will take a while to do. We have to have everyone in EMS on the same page for it to happen. The education standards need to raise to accomplish this. As far as resources, I wish I could spend more time in an ICU where contact with sick patients is constant. There is so much to see and learn in an ICU. I think more time at certain clinical sites for a set number of weeks with the same preceptor would be good. That way a preceptor may work with you for four - eight days and have a bit of an assessment of the student. They can then work on ways to improve the student and the student's skills. Going to different preceptors every week gets to be a hassle. Everyone has to get comfortable with each other, and by the time that happens, its time to go to a new preceptor next week.

Oh.......... :?

Why should we go further than the Firemen? The people who made the door, built the building, and the parents are not the ones who went into a building and drove a fire truck. These people also did not have to ability to keep the apparatus locked up. I thought it was crazy to just blame the guy for taking the truck when the FD did not secure their apparatus. The article stated the guy was a former firefighter. Why did they not take measures to keep him out? What if it was another fireman who gave him a key code or access? The idea that just because he put an emergency vehicle on the road endangering others I understand. The FD also allowed him to put that vehicle on the road. I am not saying liability is 50/50, but the FD is partially to blame.

Grrrrrr :?

The FD should be held accountable too for allowing the guy to take a fire truck out for a joy ride.

Amazed that you got through your first post without a dictionary? :shock:

medicv83, where are you? Where did you take the course? What level provider are you? I did a clinical rotation at the UNC Burn Center and picked up quite a bit. They are high caliber up there. I am surprised to hear that you had a bad experience with their ABLS course. They are a teaching hospital also, which surprises me they did not have a good program.

To add, if you go into nursing, after you start working, you can easily go back to school and study whatever your heart desires. I have a cousin who is planning to go to nursing school and then take a weekend position so he can go back to school and finish his sociology degree. That way he makes a nice salary, and can complete his goals. If I had known what I know now, I would have probably done nursing, and then EMS. But, I hindsight is always best.........

I wonder what the damage was. I understand that money is the best way to get back something that was lost of value, but I have not seen anything of value that was damaged. Suing for me looks like it is for another motive, her own self interest. I realize you did not say only. My point was that I think she had other interest rather than to make life difficult for the doctor. I did not mean to make it seem like a doctor should be excluded from permission. I was just answering your question about other than a doctor, and it was poor wording on my part. I was too lazy to fix it. A poor decision does not always equal a bad outcome. I wonder what Mateo's bad outcome was, besides the love child Joking aside, the intent of the physicain seems good, there appears to be no harm inflicted, and the woman sues because of the tattoos location, which still is not clear. The link did not work :?:

I was just curious if you knew. It is easy to give you the answer, but better if you know how we got the answer. Everyone should always want to be prepared for the "sick" patients. Good idea to work out bottle necks you may face when you are caring for a very sick patient! For neonates, the dosage is slightly lower than for Peds and adults.

1cc/kg d50 for > 2y/o 1cc= 500mg 2cc/kg d25 for < 2 y/o 2cc= 500mg 3cc/kg d10 for neonates 3cc= 300mg Three people gave you three different and acceptable ways make D10. I am not trying to call you out, but I must ask. Do you know how to do the calculations for drug concentrations?

Just from my limited knowledge of US technology I have some things that I think may need to be looked at, and some idea of how it may help in EMS with treatment. The issues that may need to be considered (at least in my own head). Will it delay scene time for trauma patients? How easy is it to read an US in the back of a moving ambulance? Is using an US one of those skills you need to do often to be proficient at? As far as treatment goes? I would think that US may help treatment plans by giving the medic a better idea of what is going on. Early recognition of problem could lead to shorter hospital times for patients, as well as faster treatment for life threatening emergencies. I am thinking it may help with: OB patients- finding position, size of, twins, placenta previa Vascular access- Placement of central lines Trauma Patients- Internal bleeding These are just some ideas, and again I asked the questions based on very limited knowledge about US technology.