mobey

Reference?

Easy there DFib, finished the scenario without even meeting your patient OK Gown and mask on. BTW is that N95 or surgical? The staff member leads you into a room down the hall where you find an elderly although not frail looking lady whom is sitting in a chair with her head tilted back (lookoing at ceiling). There is vomit free flowing out of her mouth, and she is coughing/gagging/snoring/vomiting. Staff states she has no PmHx, and only a bottle of Prednisone and eye drops are found in the room. She was out for a meal one hour ago, and was just found like this.

Arrive to a local care home. Worker meets you outside and says "We are on lockdown because we have Norovirus infected tenants inside".

Health Sciences Association

I will admit our pay is condusive with raising a family, however, when you consider Tim Hortons workers make $18-$25/hr it is not HUGE money. Not that getting jellie into those little Timbits is not a challenge Don't forget you are pretty hard pressed to rent a decent place for less than $1000/month here, and vehicle insurance will run a young guy a couple hundred a month. Jug of milk will be $6, and a box of good cereal can be close to $10. It is all relative

Shirley you can't be serious? Welcome to the site. Thank you for the punctuation, spelling, and grammar!

runswithneedles - Don't be so quick to take one person's word for it. Indeed 2 large bore I.V's are indicated here and i'll tell you why. 1) The need for massive fluid infusion (yes... 2 i.v's wide open to maintain peripheral pulses OR systolic 80-90 OR my favorite a MAP of 60-65. 2) CYA.... what if 1 comes out when the patient crashes? 3) Med administration concurrent with blood products Of course, as always I work remote 911 so I may practice a little different.

Ya, I had a similar experience. Finally after my 5th tour and my preceptor forgetting my name yet again, I had a chat with my school that went like this: Me: There is no opportunity to learn here, and I need to leave School: If you leave your practicum, you may be considered as a fail. Me: If this is the best the school can provide, than this course was indeed a fail, i'll transfer my credits to a private school whom I am sure will provide a better practicum for a little $$ School: Let us see what we can do Me: OK, but I am leaving this station tonight. 3 days later I had a new placement and had a great experience. It is huge risky, but you create your own experience in this profession, but I for one was not willing to settle. Are you?

Perfect answer... Not to be too big of an ass, but OP if we could get back to the scenario instead of centering yet another thread around kiwi and australian speech antics I would be very appreciative. So we have a stable patient being transported on thier Left side, with pain controlled and 2X I.V. fluid restricted. Is that the end?

I choose Fentanyl in patients when I am concerned there is going to be a BP problem in the near future or if nausea is going to be an issue. Morphine is a dirty drug IMO and I really only give it in people with extremity trauma, or abd pain. The 100mcg is just my standard starting point. It is a good start point to judge response to the drug. The only other drug I would give this guy is Ketamine.... But it just does not fit right now.

I don't really get where this pole is at... lateral chest? Either way it has to be secured in place, yet allowed to vent. If we can't board him, then so be it. Vitals are good for now. Is there bubbling around the pole? Allergies? Medications? Lets get a couple I.V.'s TKVO, and get some pain control on board. Start with fentanyl 100mcg (asuming this is an average size adult.

Spinal him and load. Start moving to closest trauma centre. Helo available? Vitals? Air entry sounds? Skin colour?

Funny how that works sometimes. I consider myself an expert at keeping emotions at an arms length. I rarely attatch any emotion to any call. I just approach it as a clinical job, and fake the genuine concern. My patients know no different, and I carry on without losing sleep. Every once in a while though, I really get hit hard by a patient. I remember recently a young redhead girl giving birth, and going into a life threatening post partum hemmorage. Over the next few days I caught myself holding back tears as I recalled her lying there asking how her baby was, all the while making a speedy trip to the grim reaper herself. Other people can code right in front of me, and I don't bat an eye. I can't explain it either, but as always, if you stop eating/sleeping it is badness. Sorrow is natural.

Is this scientific? or just you're experience? What was the negative outcome for the patient? I agree.... You are NOT a whacker I don't wanna bust you're perverbial balls here, but just a reality check for ya: A sternal rub is barbaric yet you are advocating dropping a 7lb (adult) piece of bone and meat on thier face while they lye there completely defenseless and entrusting thier well-being and dignity to you?

How do you explain the epistaxis running into thier unprotected airway? First do no harm! An NPA insertion will sort out the fakers..... If it is that important to you that you are the one to expose thier fakeness.

So I aquired a couple pigs legs from the local butcher and practiced IO's last week. It was a great experience for the EMT's here to see them in action first hand in real bone, as well as a good refresher for me. Anyone else have lab ideas that utilize this same type of realism?

Quoted for truth factor

I wonder if "holding" it stretches the bladder, and increases it's volume capacity?

Second

I do love playing devils advocate! How can you be so sure that what she is doing is not totally right? You assume some day she will make an ass of herself, yet we do that all the time with things like toilet paper stuck to the shoe, buttons done up wong... etc etc. I am personally extremely uncomfortable around these pushy religious types. I find it very hard to carry on a conversation with someone who has a glazed over look in thier eyes, and a painted on indefinite smile, telling me how great everything is because it is god's plan. I am actually embarrased to be around them. But I will tell you right now it is because I think they are full of shit, and wasting thier lives with this "wait and see" attitude. Does that mean they are wrong? No Does that give me the right to interviene? No I think if you feel she hurts your profession, then you should take steps to influence her. But I gotta say, my partner is an alternate-minister for his church, and alot of patients buy into having a prayer and a blessing on a call, especially for the family when a loved one is obvioustly on death's door. An EMT I used to work with used hypnotism with patients to treat thier pain/nausea/anxiety during interfacility-transfers. Again.... I don't buy it, but hey, if it works for some and does not hurt any, than why not?

You have all the advice you need here. I will just point out a few things as I know of the urban company you are talking about. 1) You sure you want to be available all the time just to keep your seniority? 2) The "big-boys" only applies to Sask. By that I mean, when you are in Sask, that city is viewed as a coveted job that only the best can do.... cough, choke. Leave the province for a weekend and that theory dissolves pretty fast. 3) If you want to truly be educated to a ACP level, you should broaden your borders. Sk just will not give you the education that other provinces will. Perhaps if urban experience is what you want, you should look west? 4) You know damn well the burnout rate on the west side, just where do you think noOb's start out? Good luck

First off: Very nice post. Spelling & format is very professional, nice to see from a forum noOb! Now to the meat: Correct, this will manifest itself in dropped beats. Dissect the term Sino-Atrial block. That is a pathway.... not a node! The node is a Sinus node. http://www.merckmanuals.com/professional/cardiovascular_disorders/arrhythmias_and_conduction_disorders/sinus_node_dysfunction.html Right, a pause in the pathway between the P-cells of the Sinus node, and the T-cells or the "highway" to the atria. http://www.uptodate.com/contents/anatomy-and-electrophysiology-of-the-sinoatrial-node This is a block within the AV-Node. On the ECG, the block is seen between the P-wave and QRS. Therefore the QRS (if present) is not initiated from the AV-node. This is 3rd degree "complete" heart block. Partial or 2nd degree Type 1 are partial blocks, where the AV node fails to conduct to the bundle branches periodically, can be 1:1, 2:1, 3:1 etc.

http://www.annemergmed.com/article/S0196-0644(95)70234-2/abstract Although from '95, this one shows efficacy for padding to prevent pressure sores. Kind of a crappy one, but does speak to the damage we do. A good question to ask is "Why did they start putting mattress pads on operating tables?" Always gets the juices flowing in the right direction.

This is just oh-so-true. One of my biggest struggles is switching in and out of this mentality, to provide well rounded care. I usually get into it, and dehumanize my patient in my mind for the entire call. I always have... but I am working to switch on and off. Pretty cool to see it written down like this. Back to the thread....

I see this is your first post, so firstly WELCOME! Secondly: This is a forum of prehospital and in-hospital professionals. When you ask a well written and articulated question, I guarantee you to get multiple answers from very credible sources with years in the buisness. The problem you will face on this preticular forum, is no one makes time to try and decipher poorly written posts. Please check your spelling and grammar, and ask your question in the same format you would ask us face to face in a professional setting. Look forward to what you have to contribute Majormech!