Mateo_1387

I am all about knowing as much as you can, it definantly makes a medic more confident in his treatment. So do you get the same preceptor for a set amount of time? I know a lot of times in class our patients "die" when we do improper treatments, but I can't image that it happens every single time in the real world. I don't think it helps things, but it doesn't always "kill" them. Of course in class our scenarios are a lot of times based on the patient being on the verge of dying anyways I can't really see much in ems that is x leads to y leads to z, and so on and so forth, all I see is a bunch of grey area.

Dwayne, just me thinking out loud here too..... I would imagine that this patient is having a RCA occlusion. If he is having a massive Right sided MI I would just guess it would be his RCA with posterior involvement. But I guess we will not know unless emtgirl84 post the 12 leads that she has. The fluids provided for this MI is the keep the patient perfusing the brain. Ultimately, he needs PCI. We give the Nitro so that it reduces workload of the heart, and give the fluids to keep the patient perfusing. As far as his blockage it will most likely be due to "junk" building up on the walls of his coronaries. From everything I have read and learned in school nitroglycerin has minimal effects on coronary dilation. Its main effect is on peripheral veins thus reducing preload and afterload. I have also been taught in school that the nitroglycerin increases collateral blood flow thus helping with the ischemia. As far as giving nitro without an IV, I have seen and heard different things. I have had a medic while at clinical go ahead and give the nitro to a patient with an inferior MI without an IV. I asked later why she did this and she told me that the drug was very beneficial and that there was no reason to prolong giving it since his blood pressure was good. It made sense to me. The patient did become hypotensive, if I remember correctly in the high 80's low 90's but we later established the IV, but most importantly took him to get his PCI. Then on the other side I know medics that would withold nitro until an IV is established. I guess this will be a call on experience. How comfortable someone feels giving the med based on what they have seen and experienced.

Thanks, great information !

What reeks of "cookbook" providers? Who exactly is the ECC? How does giving an epi three minutes after a round of vasopressin not allow it to work? Vasopressin is used to cause vasoconstriction. As far as I know there is nothing that epi does to stop vasopressin from working. Two different MOAs between epi and vasopressin. Yes this is in our protocols. Yes this is what our medical director signed us off to do. Our success rates in Wake County for Vfib/Vtach cardiac arrest is 34%. This is of course in conjunction with induced hypothermia for ROSC.

And since when is it illegal to leave keys in a vehicle?

In my system we just started using AVL (Automatic Vehicle locator). This is so they can dispatch the closest ambulance to a call. Ambulances still have stations, but they do post in certain areas when other trucks are out. Ambulances do not move after 2300 to post. Paramedics are allowed to mark out of service at shift change if they ran a late call and want to get home. That is so they do not get stuck at a call near the hospital when they are ready to go home. But they can answer the call if they want to, and administration encourages us to answer if it seems like a priority call. I can't say that this system is the best system, but I think it is a good system overall. They response times would also improve if we had medics to fill spots. Daily we have numerous trucks mark out of service due to staffing.

In my agency everything goes in. This includes first in bag, monitor, and oxygen. Depending on the nature of the call LSB equipment is taken in. The only time this policy does not apply is if the patient is seen from the ambulance and is in close proximity.

The text says he is 30 years old. The video says hes been doing emergency services for 30 years. So he probably is 50, with 30 years experience.

Sorry for the confusion. Here we give a dose of vasopressin just like it was an epi. It is either the first or second dose followed three to five minutes later by an epi. Some texts say that vasopressin can be given and then ten minutes later start pushing epi.

Well you should follow your protocols for one on use of the medications. Anyone tell you why they are reluctant to use vasopressin? As far as how we use them here the epi is usually given first because it is easily given via bristojet. Vasopressin here is supplied in vials, so it is usually the second medication pushed. We just replace the vasopressin with either the first or second round of epi. We also give it within 3-5 minutes or an epi, we don't wait a full ten minutes. What do you mean by a suggestion of each?

I'm working on a college degree, and overall I will spend about $3,000. This figure was including books.

Ever consider the East Coast? Wake County EMS may be somewhere for you to consider. It is the county that Raleigh is located. They are aggressive, high volume, and seem to treat their people well. Just PM me if you have any questions.

No EMS stickers, but I got out of a ticket by having my paramedic book in my back seat. The Officer looked at it, asked me if I was and emt. (yada yada yada), and let me go with just a verbal warning.

Wow, I think it is funny they will not allow comments for the video !! I guess they don't want their propaganda slandered

Where exactly on his neck is he shot? are there clear enterance and exit wounds? If airways is obstructed I want to clear it and possibly intubate. What about lung sounds? Also would want to do a trauma exam to look for other gsw's. will want to control bleeding by at least direct pressure and possibly an occlusive dressing. Start an IV. Backboard the patient. Give high flow O2.

I think that is what is left of the FF ! Goo= Innards, outards, and everything else left over after a human roller gets ya.

How about this uniform, no polo, no badges, and I think everyone can get over the patch.....

James Maietta should be charged with endangerment of public safety officers. The man should have moved down to a bottom floor when he realized he was going to be immobile. Can you imagine 500 lps of human rolling over you if you were the firefighter at the end of the feet??

0 % wacker. I have some tones on my phone but no siren, the tones and pager noises get me up in the morning ! 8)

I agree ACLS is the same in and out of the hospital. Plus it never really made sense to me to risk yourself running emergency traffic to the hospital with a dead person. I don't see how one person can do CPR in the back of an Ambulance and still complete ALS skills and expect a recusitation. If it were me in that case I would work the code onscene untill back up arrives, even if that means you and your partner just doing CPR untill other hands can arrive.

Something like a tranquilizer gun might do the trick.......

I think it is funny that they say you don't get a lot of serious calls, yet almost everyone here had a serious first call..... My first call was a mutual aid out of county call to an MVC where our patient had an open femur fracture.

http://www.wakegov.com/ems/default.htm I suggest Wake County EMS in NC. Raleigh is in Wake County. Great place to live and work. The EMS system is top notch !

certainly not my intention........just a little comedy !

I got a pulse ox reading of 86 on my ambulance antenna once..........