mobey

I have no idea what is around there for schools, but I know here in Canada there are fire schools that do not include medical education. Perhaps if you wanna be a FF, you should just go to fire school. Unless I am misunderstanding you? I know when I wanted to be a plumber in my past, I did not go to electrician school.

Please don't remind me that this is someones daughter. As a father myself, it totally ruins the fantasy.

Hmmm... The pic shows up about 2" by 2" It looks to be V-Tach.... but like I say it is VERY small and when I ctrl+ it gets too fuzzy. Anyone wanna help out, is the QRS narrow?

I just want to touch on this, just as Dwayne did. The pt recieved an injury to the body, be it traumatic or medical. The body has HUGE compensitory mechanisms to deal with injury that automatically kick in, (Tachypnia, clotting cascade, shunting, colladeral circulation etc etc) If these mechanisms are not sufficiant the body begins shutting down. My point is this: The patient "didn't make it" before you were dispatched. You were attempting to reverse death. I had trouble dealing with my first couple cardiac arrests, until I accepted this fact. But to answer your question, YES... even now, I think about my arrests for at least 48hrs.

Do you routinely call helocopters without an assessment? It is hard for me to justify a helo at the point that you called it... we had no info yet. Perhaps you were joking?

I think we are splittin hairs. Let me be more specific. You are assessing a pt who is in a stable V-Tach. You can: A) Treat the symptoms based on assessment and do nothing Treat the monitor and follow your V-Tach protocol When I hear "Treat the patient not the monitor" I interpret that to mean "If the pt is asymptomatic don't go throwing the drug box at em" How do you interpret it?

Is she lethargic? Need a 12 lead STAT.... Love that term, STAT We need a count of her meds, make sure we are not dealing with a ..... well, Ill wait to start throwing out DD's. Any Hx of SVT's? O2, IV please. Start bolusing fluid (as long as the lungs are clear)

What is the scene like? Smelly? clean? dirty? etc Initial impression... Skin Alertness Personal hygene? Chief complaint? Would like a BGL and ETC02 if she will let us.

How do you handle a stable V-Tach? How do you handle a silent MI? Do you put O2 on a anemic pt with no current symptoms? How about a pt c/o mild SOB, an Sp02 of 99%RA but a abnormal CO reading? Nasal cannula for the minor SOB? "Treat the patient, not the monitor" is often repeated because that is what EMS people do..... repeat shit without thinking about it. How bout this: "Use your monitors as part of your assessment, and treat accordingly" Proactive medicine vs reactive medicine, perhaps we are on different wavelengths in our practice.

Anytime we can discuss treatment it can only be good. I don't need a assessment to discuss treatment modalities on a cardiac issue. I am not saying how I would treat this individual, I am stating how 3rd degree blocks are treated. To be fair, we have no access to assess any patients online, that is why we talk in hypothetics.

Oh good, we get to disagree! Firstly... you knew I was going to pick up on the bolded words above, as with ECG's we are not looking at "muscle activity" at all, just electrical. *One for mobey* Anywhoo. I disagree with your assessment of lack of atrial depolarization. Although hard to see, there are definatly P waves present, and they are regular. The Ventricular beats are tricky though.... IF they are indeed regular... even at 20BPM this will be called a 3rd Degree. Unfortunatly we cannot determine that since the strips are so short. However, if the QRS are irregular, it would be fair to label this maybe "Ventricular standstill with occasional PVC's or Agonal ventricular beats". Gotta say though... That is quite a stretch. So I think it really undeterminable by these 3 strips alone, however, I will anecdotaly say, I have a stronger belief that people can go in and out of a 3rd degree way more commonly than a ventricular standstill. I suppose because I have experience with multiple people who have self converted 3rd degrees, and a Ventricular standstill seems like a more lethal rythm from a really sick heart. Dunno

Now that I look at those with my good screen, I can see what looks like regular P waves. Need a 12 lead, but looks to be 3rd Degree. Treatment the same either way for me. We can debate Atropine in a 3rd Degree all day (and we have) but my previous Tx is what I will stand by.

I dunno if your looking for treatments or not, but here is mine. First line would be 0.5mg Atropine I.V. Second line would definatly be paced ASAP. If needed, Fentanyl could be used for immediate pain control. However once the BP is stabilized, I may add in Versed and switch to morphine since I have transport times greater than 3hrs to Cardiac unit. I dunno if your looking for treatments or not, but here is mine. First line would be 0.5mg Atropine I.V. Second line would definatly be paced ASAP. If needed, Fentanyl could be used for immediate pain control. However once the BP is stabilized, I may add in Versed and switch to morphine since I have transport times greater than 3hrs to Cardiac unit.

I have only seen this once before. I called it Sinus arrest. The Gal I saw was having multiple syncopal episodes. I was pretty close to startin CPR a few times. Hard to tell bt the 3 strips if this is a regular rythm since they are short with only 1-2 beats. If they are regular, it can be called a sinus brad. Otherwise Sinus arrest fits good enough for me.

Annie, Aussie, I love where this is going (as long as tempers stay low). This is actually an issue me and my wife of 8yrs delt with in the past. It seems as though women are more or less taught that sex is leverage. It is always the man chasing it, and if he is a "good boy" he will get it. IMO, couples do not put nearly enough emphasis on the correlation between a healthy sex life and a happy relationship. I think sex is commonly used as a tool of negotiation by women, not too often you hear of a man "punishing" his wifes behavior by refusing to have sex with her, but just watch TV for an hour and you will see just how common it is the other way around. I feel a sexist accusation headed my way....

Can you explain this? Makes no sense too me.

I am not a fan of armchair quarterbacking, so I will just say this. With 3 small kids at home, personal safety has become a HUGE focus of mine these past few years. You won't find me without a seatbelt on in the back of the rig very often, everything is always secured down... and even on the sweet old lady long distance transfers - gloves are a must. These days, some combative person whether drunk, hypoglycemic, or psycosis, is not getting any physical restraint from me. Our local cops love to help out in these situations, and heck... they are trained for it. Someone else tackle him, and I will administer IM Versed, Haldol, Glucagon, whatever. BTW: OP, you mention up to 30min for IM Versed to take effect. Do you have much experience with that? I have used 10mg Versed IM a few times with much quicker response times.

Sooo.... do you have a link to online bidding or something?

When you get your training you will see how it is constructed. Aside from that, a Google search should answer your questions better than my trying to type out a description. If you can insert an OPA, you can insert a King IMO. They go in pretty well the same way.. just deeper. One cuff to inflate with a color coded syringe, and presto. I myself have used 7 now. I got so I was no longer using OPA's during codes. They are quick to put in, and even Paramedic proof.

Welcome! I hope you have lots of information and insight to share, as well as an open mind to learn! Unfortunatly, first posts and screenames are the "first impression" that you are judged on here. Not so good so far, as this is a forum that prides itself on being professional, and relaying that professionalism to the public and peers through our posts. Your screename kinda goes against what we are trying to do here. Fortunatly, we are professional enough to give you a break, and look forward to your imput. If you wanted to re-enter with a different screename however, it would not surprise me.

<--------- OMG: I love it... new job title right there!

That is the beauty of the whole thing wendy. The strike did not effect him, as he Failed school prior to the strike. Check out his 1st posting on this subject: He failed class because he failed to learn the material, then tried to attack the school & licensing board. This is what makes him such a troll. Twisting facts, and attacking any who do not agree with him. Ya.... I have a mental problem.... Mhmm, that is why I have completed 4 yrs of prehospital medical education and you couldent get through 1? I am done getting angry at this loser

Sorry guys, I ain't buying it. This is where I wish we had some psycological educated members on this forum. There is noo way, by any stretch of my imagination, that a slide show of this nature can do any good to a room full of EMT students. Please remember, this is technical school. These students are not in the mindframe of looking at patients as a "series of complicated systems" like some of us are. For the most part, they are still looking at them as "people", AKA, someones daughter, mother etc. You want to be a pro-active school, have the students do a tour into the morgue to see lividity, rigor etc. But to show pictures of partial decapitation, dead babies, etc etc.... Gimme a fricken break. Lets be realistic here.... I have had one experience with SIDS, it screwed up my mind and sleep for quite a while, my female partner had to take off 2 days, and seek coulsiling. Are you guys really advocating for a school that bombards brand new students with pic after pic of these mentally traumatizing images? As prehopital professionals we can do better guys. I don't see anyone here who states a petition should be started INSTEAD of counselling. Why other alternatives? I really do not see a petition as a "big" step... I suppose you could have a personal letter first, but to have it notarized by the profession demands a little more attention. What does that have to do with anything? HERBIE1 Really?? So you fail to recognize mental trauma? Or are you saying you EXPECT that reaction... thereby saying you expect this type of slideshow to cause mental trauma?

Lecture meaning you are still in school? (yes i know this is under students) As most know, I am not great at consoling... or the emotional stuff, but I do wanna say this: If your school put you through this damaging gore fest, they should be held accountable! Yes... at times we in EMS do get subjected to decapitation, deadly bleeds, abused children, SIDS, etc etc. We see these things in small doses, and sometimes need time off imediatly after to seek counsil to learn how to deal with the emotions attatched to these experiences. There is no goddam reason to present a "slide show" of picture after picture, of dismembered or deceased patients in some mindless attempt to "teach" students. Shame on your school, and shame on the coroner. What a frickin outrage! You have all the grounds in the world to do whatever you like about this. but at the very least, you MUST get a petition going to end this behavior. I for one as a professional educator, and student of 2 colleges, and 2 universities with 4 years prehospital education, would LOVE to write a letter in support of any action you would like to take. Someone else here will help you deal with the emotional trauma you have encurred, since i suck at that Man this got me fired up for some reason...... Bullshit

Thanks Buddy!