mobey

Are you meaning the Powerpoint presentation, that's all I can find. (Although I've only had one cup of coffee so far!!

http://en.wikipedia.org/wiki/Wanker I can't believe it either!!

OK lets run with that. Are we just going to train EMT-B to put stick them in? Or are we going to educate them on how and when to use them? Shall thier education include acid - base balance of the respiratory system? I mean after all if they are tubing they better have access to ETCo2. Not to mention the education to understand the numbers. Believe me that is difficult $hit to understand, I don't know how long we spent on the PH of the human ody but I am pretty sure it was a few months! What about all the anatomy involved with the resiratory system? So my question to you is how long of a "training course" would it be for Combitubes alone?

Or take a really deep breath.. then bag yourself!! you gotta be careful with this stuff, ever blown up a balloon till it popped?

What is your story?? Why are you asking this question??

Paramedics may save lives....EMT's may save Paramedics But Firefighters save dogs!! I hope he gets a medal of some sort for his heroic efforts. Boy no wonder FF's are paid such substantial salaries. *End sarcasm*

Or you could click on Resources, scroll down to photos and post them there!

Thank you VentMedic I was hoping you would chime in on this one. (Thank you also to ERDoc and AZCEP). Yes this is the sort of thing I was thinking, I thought due to bronchoconstriction, narrowed airways, increase mucus production, the patient was able to suck air through using acc muscles but unable to "Push" it back out. Therefor the air was "Trapped" in the lower airways and aveoli, hyperinflating the lungs till there was basically no gas exchange occuring at all. Mix up some COPD with Pulmonary HTN causing right ventricle hypertrophy, and an MI 3 weeks ago, I guess it was only a matter of time. I guess i still wonder if i had of walked in there and slapped on a salbutomol neb if this would have turned out different. but i highly doubt it. My indications for ventolin is wheezes. That is it. There must be wheezes or I am breaking protocol. I am all for flexing protocol when nessesary, but this happened soo fast there was no time. I was assessing air entry when she quit breathing.

Hey all! I am wondering if ya'll can shed some light on this. I had a 72 y/o female with CHF and COPD last night that coded about a minute after we arrived at her house. Here is the call: Called @ 2100 72 y/o female Difficulty breathing PMHx MI x 3 weeks ago, Hypertension, IDDM, Possible COPD (that's all I got) Asessment, Patient answers door, slightly overweight, obvious distress. 2-3 word sentences, purse lip breathing, decrease tidal volumes, acc muscle use, you get the picture. SpO2 68 on room air (no home O2) BP 184/80 Pulse 112 Denies chest pain, or any other symptoms, Sudden onset approx 10 min ago. Air entry (here is where I get confused) Inspiration clear in Apex bilateraly. Expiration completly silent and I mean SILENT. I listened in multiple spots front and back with a Littman Master Classic 2. Believe me there was nothing to ausiltate. Suddenly tidal volumes decrease till there are none. Setup BVM w/OPA Check pulse.....Nope begin CPR Apply pads....Asystole. *Frick* Off to the hospital (BLS CREW) Drop in a King on the way. Work her at the hospital for about 20 min and call it. So I am stuck between Exacerbation of COPD (which she was unsure of in the first place), or some sort of CHF episode (which I have been studying harder and harder to understand). I know "All that wheezes is not asthma" but what if there are no wheezes?? Sorry if this is confusing been a long week already, let me know any more info you may want.

I am known to post things that are completly freeking WRONG!! And yes this may be one of those things. :oops: I am going to look into this further to find out exactly what I am dealing with, but yes we do have a similar system.

Just wondering if anyone knows the latest on this. Can we transfer 2 patients, unrelated in the same ambulance without breeching HIPAA? I have researched it and cannot find much info. We are buying a new ambulance and it "Must" be dual cot for double transfers, but I think that they are highly inapropriate.

OK I will write my assesment and Treatments just because I want them to be ripped apart and spit on so I can learn from my superiors. As much Hx as possible. How much alcohol?, What kind?, any other drug use?, when last seen normal? Past med history?, current medications?, trauma?, any complaints of headache tonight? Seizures? etc etc. Head tilt chin lift/OPA, (not too worried about tubing right now) Pulse Ox, BP, Resp count, Pulse, Responce to pain stimuli, Oxygen 10lpm NRB, BGL(consider D50), , Air entry auciltation, Physical exam. *Take a moment for public education for friends* All done on scene. Load to unit I.V, NaCl TKVO (unless hypotensive), Cardiac monitor, Suction as needed. Reasess Reasess Reasess

But then how will you fill in the second hole??

How many calls do we actually see where "Seconds count". I mean really, blowing a red light to save 50-70 seconds? How many patients have you had that coded just outside the hospital door, whereas if you were driving faster the arrest could have happened in the hallway in the hospital? BTW I hated Recue 911

brock I have experienced these exact same problems time and time again. I find the only way is persistance. On the way to a call go through the DD's for the dispatch info. Make it a game if you can. challenge him all the time, and ask him to challenge you. I do this all the time with perscription drugs, and definitive treatments. But there are people who just want the cheq and don't really want to learn.

Does anyone have a link to any studies that have been done on running "Hot"? I did a search but coulden't find any. I have had a bad experience one night while running to a call for an out of town MS Pt. who was experiencing lower extremity numness, call came in as an "Alpha" which is the lowest priority our dispatch centre has. Half way there cruising at stupid speeds with lights and sirens (as per local protocol), we came upon an intersection which had the stop sign knocked down. I ended up finding myself in a field with poop in my pants. I have always wondered what the statistics are. No matter what the dispatch info is we Always respond "Hot" and I hate it!

Push her eyelids shut and call her a three lol Actually the eye portion is graded on Eye opening from a closed position. Since her eyes are open and fixed that will put her at 1.

Neesie I can agree with you on the CISD thing, there is NO PROOF that it actually helps at all. I for one support one on one therapy. Time is the only thing that will make this easier to deal with. This was a HUGE call, the one everyone fears.... and it may be a career ender if it is not dealt with appropriatly. This may mean years of therapy or just a few PM's with someone you can trust over the net. But I believe if you keep it bottled up, it will eat you alive. feel free to PM me if you like.

Yet when you complete the program the certificate says "Advanced Care Paramedic" not "EMT-P" hmmm But the ACoP calls you an EMT-P. So what is your credential?? What the plaque says or what the ACoP and instructor calls you? If you took a course in cooking recognized canada wide as a "Chef" course, but the school and local gov't called you a "cook" so they could keep your wage low, what would your credentials be? Your school issued cert says Chef but your nametag says Cook. hmmm I can see how difficult this must be for those who have been fed a load of $hit for so many years by ACoP. I guess they are good at one thing after all!!

Welcome to the site Vein-T. The usual questions... Overall was the course laid out well? Was the material up to date? During the monkey skills parts was the equipment in good working order, or did you have to "Pretend" to intubate the doll because the blades were missing? Also did you work ALS before starting? or did you go into the course cold? Thanks for takin the time!!

Now that is funny

Hmmm... this one is hard to give a straight answer to. I believe if it is a standard granny run with no significant event occuring - Yes (e.g. I just feel a little dizzy and it burns to pee, hyperventilation, etc). i believer FR can make all the difference in these people. However if it is a significant call like an MI , Anaphylaxis, CVA, There may be some brief anxiety reduction until the Pt figures out that holding hands does not break clots or reduce swelling. Yes this mild relief is a positive thing....temporarily.

I do not use soap at all. In fact I'd never heared of it till I came to the city. I have my own format: HxCc (history of chief complaint) PmHx (Past med history) O/A (On arrival, includes scene info and first impression) O/E (On exam - Broke into systems as below) LOC, A&O, A,B,C, Skin, CNS, CVS, Resp, Gi, Gu, Extremeties, MSK. If it is a trauma LOC, A&O, A,B,C, Head, Neck, Chest, Abd....and so on. This way I can write what I don't find as well as what I find. Ya It's alot of writing but I got used to it.

Ya looks like min wage was around $3.39 in '89, so you were paid about 2 dollars more/hr. Pretty sad. A house in Alberta is gonna run around $200,000 for a family sized decent home. Rent will be around $800-$1000/month. So ya the $20/hr does not go far but you can make a living on it.