mobey

You just need to find an instructor. Come on out to the eastern border and i'd be happy to get ya trained up!

Doc: I appreciate your input. I do agree with your opinion in the hospital/ICU setting (analgesia aside). FM37: Don't take the chicken shit way out, Doc chimed in with his general opinion of my post and intentionally did not answer my questions directly using sources. I asked you direct questions, don't hang on doc's coat tails to carry you through critical thinking. You state your protocol/standard of care is "Great", if you can't back it up with logic and science, you should not be touting it as superior.

Oh my..... That was 100% sheer hilarious! I will say one thing, as much as I miss one of my greatest mentors, it is really nice to see some ol'faces (well... screenames) around here. Hope you all stick around so we can carry on Rob's quest to teach these "pup's" how to be professional prehospital healthcare providers. Asys, I am glad I am not the only one who didn't sleep much last night. I was attempting (teary-eyed) to explain to my wife at 1am how, because I am in the middle of nowhere surrounded by idiots, I do not have a mentor. Dust and a few others fufilled that role for me, and I am filled with huge regret that I did not get a chance to shake his hand and tell him that in person. I would like to tell you to "not beat yourself up" or "just remember all the good times", but I doubt that is what you are looking for. As Dust has said to me in the past "Time will heal" Thank you for posting this thread bro, no use in pretending we aren't real people.

Logic fail! (that may be my new favorite term) *Rewrote* If you have failed to provide a safe RSI/RSS for your patient, you may as well butcher thier airway to save thier life, and hand them off to someone more competent.

Etomidate and a long lasting paralytic? That is all? What about Succ? What if you miss the tube and cannot ventilate? Painful like having a steel blade inserted into your vallecula, or directly onto your delicate epiglottis, applying 8lbs+ of pressure, then placing a rigid tube in your airway and "choking" you from the inside with a air filled cuff? Cite? You mean there are times when it is not necessary to keep them safe? That is the poorest excuse not to paralyze a intubated patient I have ever heard. That is as bad as not treating abd pain so the Dr can assess. Just how exactly do you check the neuro status on a patient sedated to the point of intubation and manual ventilation? Are they just assessing reflex's? Isn't that something you can report? Do you have to restrain these "neurologically intact" intubated patients?

Rest in peace Rob. I am truly greatful for all you have done ..... A sad day

Logic fail!

Actually, I recently had to stop eating grapefruit due to numb lips after eating them. Didn't put much thought into it.... just chalked it up to a allergic reaction of some sort.

That ain't just a cold sore dude.....

Dwayne I have seen that after starting a new antibiotic. I for one am not going to diagnose this an ACE-I angioedema and hold off treatment in the prehospital setting. I would treat as I suggested above as a proactive measure, if I am wrong in calling this an allergic reaction, I would not have done any harm.

Susan: Take this opportunity to help us understand what it feels like to become addicted? As a Paramedic with degenerating Arthritis, Narcs are in my future I am sure. How will I know when it has become a problem? What does it feel like to "come off" them?

Good question Akroeze! Assuming her lwr airways are not involved, and there is no stridor... Lemme throw this by you... The pt is obviously having an allergic reaction. At this point the swelling (although slow) is becoming an airway problem. We need to do what we can to reduce the swelling and manage the airway. The pt got 50mg PO of benadryl, remember all drugs thet go enteral are subject to first pass metabolism. The dose was also 3hrs ago. so really, as far as bloodserum levels are concerned, she is not "maxed out" as far as therapeutic index goes. In fact, she is probably below. I would give 50IV myself. That aside though I tend to agree with the IM Epi being a little risky with this pt who at this point.... is pretty stable. I would have no problem trialing a local epi via nebulizer to vasoconstrict and somewhat make her more comfortable. Also, getting a little epi into the system is always a good thing during allergic reactions with airway comprimise as it does in fact stabilize the MAST cell, therefore inhibiting the release of more histamine. I also may hit her with a Dexamethosone, or prednisone. It will help with the swelling somewhat, but moreso, we will be one step ahead in case this does go for shit later.

I tend to agree with Doc here. In a situation like this, load and go. Take heroic actions and pass the buck, you can't go wrong IMO.

Anyone out there on them? My rhumatologist wants me to start them right away to try get ahead of my arthritis, however I am a little sheepish as they have (in some studies) been linked to lymphoma. One study showed 1 of 1450 people treated with TNF-Antagonists are diagnosed with lymphoma. Just wondering if anyone here uses them, and what kind of success they have had in pain relief and mobility.

I use Midazolam, but since we started with Diazepam, lets give another dose! Also... just prior to that 2nd diaz, lets slip in an NPA (just want to be sure this is not a pseudoseizure)

If you have the AHS MCP's, the ACoP will recognize them in leiu of a ACLS card. If you are a practicing Ab emt-p you no longer need ACLS as long as you have completed your MCP training.

Thx for the support guys. Kate: I am definatly looking into Glucosamine, fish oil, massage, even hot rock treatments. Personally I think it is all witchcraft but my Dr is suggesting pain control through western medicine (Narcotics) since the pain is refractory to NSAIDS. I refuse to start Narcs at 30 years old. Dwayne: As far as the ol' career goes, so far it is suggested that I keep doing what I can, while I can. The day will come very soon (within the year) that I will have to stop lifting. Strength training and range of motion exercise is important as is regular rest periods. So EMS fits good. The problem is, once I start Immunosuppressants working EMS is pretty risky. So I got some hard decisions to make there. Might try to find a job in teaching.....

I'll be honest, I didn't really wanna post this, but for the most part I really hate talking face to face about my health with people. This is a little more impersonal, as well as I may get some solid advice. So a win-win. Over the last few years I have been battling chronic pain in my lower back, hips, shoulders, and knees. The pain in my hips has become so severe my now max adult dose of Arthrotec (prescribed for spondiloarthritis back when I was 20) has no effect on it. I finally went in and was diagnosed with suspected tendonitis, given steroid shots and sent for an MRI. The results came in today: The MRI showed severe degeneration in conective tissues of both hips, most notably the right. Edema was present in both joints. Significant degeneration was noted to the Acetabulum bilaterally, and mildly to the femoral head. these findings are consistant with Rhumatoid arthritis and further assessment will be needed for a final diagnosis. Soooo....... I guess bilateral hip replacements and immunosuppressants are in my near future Damn PS: sorry I have been so quiet here, been working away from home which has changed the priorities a little.

Would also like to point out to Dwayne, that a tube placed below the cords and open to the atmosphere is a great "highway" for pathogens to get directly to the fragile airways.

So we have a elderly person who does not feel well and has strong smelling urine. Sounds like a urinary infection? I too, am missing why we are even discussing pacing/drugs. BTW: For the love of gawd, please stop trying to measure the specifics of a 3 lead. We need a 12 lead to properly diagnose a rhythm on this individual.

Low dose Vec? What does that mean? No analgesic? Sounds like baddness all around.

I absolutly hate these types of questions so I will answer yours then leave one of my own. Why are you asking the above 3 questions?

I had a pulm edema pt once that I was sure was going to code enroute. I had the family call his hometown doc and have his DNR faxed to my Med Control. I then called my med control and told him what he should expect via fax. He called me back 5min later and instructed me not to work the pt if he does code as the DNR had arrived. Pretty outta the box if you ask me. This happened in Calgary too. A Police dog was administered Morphine. Awesome story, and the Medics had no reprecussions.

Don't dogs lick thier e-coli infested arses? Just as an FYI: I used to treat and distribute tap (potable) water. There is a tolerence for chlorine levels in the water that must be followed to legaly distribute it. In simple terms, after all pathogens/bacteria are killed there MUSt be a certain level of chlorine "left over" to kill bacteria in waterlines/taps etc. So tap water in fact will kill any bacteria that is suseptible to chlorine straight out of the tap.

Unfortunatly Byron was found deceased, no details are being released at this time. RIP brother.