fiznat

yeap: http://www.emtcity.com/index.php?showtopic=14379

Can you guys explain your reasoning? I'm not saying I agree or disagree with you, but if you post the "why" as well it might help stimulate some discussion.

Alright folks. I showed this rhythm to 3 separate ER docs and got 3 different answers. Let's see what EMT City thinks... Here's links to higher res versions: 3 lead 12 lead

Great find, I watched the whole thing and it was pretty interesting!

Thank you! Sure I can, although I think just because of the nature of the material most of the value will be in the class discussion. Still, I can definitely upload whatever powerpoint and example strips I come up with.

I don't understand why there is "no getting around" sending firefighters to medical calls. ...Especially sending them lights + sirens while the ambulance moves with the flow of traffic, that really makes no sense to me. I would cut firefighter response to all medical calls except those for which fire might actually be useful- MVAs, gas odor, extrication scenarios, MCIs, etc. That would also help cut down on that ridiculous (imo) four tier response system. A response is either hot (lights + sirens) or it is cold (no lights + sirens). I think playing with intermediate levels just confuses things. I think EMS ought to be city run as a true third service. If you want to put ambulances at fire houses for financial and response reasons, that is fine, but keep the crews separate. You are either a firefighter or an EMT/Medic. The service should have it's own transport trucks and be capable of handling the majority of the 911 volume in the service area on it's own. I don't think there is any point in running a third service if you rely on private ambulances to transport or to provide coverage on a regular basis. This means no medics on engines and there needs to be enough crews/ambulances to get the job done. Think Boston EMS. Pay WELL. This isn't just a selfish thing. Good pay (even if only a few bucks an hour over the average) brings competition for jobs and quality applicants. It gives the city the opportunity to pick the best instead of just whatever comes their way. City jobs should come with pensions and all the other benefits fire and police receive. Your distribution of 24/12 hour shifts seems fine to me. That should really be area-specific and it is always something you can work on and tailor to your needs as the system gets up and running.

Maybe the doc meant that the ischemia/injury was demand related and not the typical arteriosclerosis/clotting that we usually see? Not that it wasn't an MI, but just that it wasn't the normal cath-able kind...?

Thanks for your honesty guys. I wasn't sure whether I was going to get replies like I did, or replies like "oh I check all those AND (insert extremely obscure syndrome here)." In the same spirit I have to say that I am guilty of many of the same things. Someone said that they sometimes look at the "cool stuff" before looking at rate and rhythm. I freakin' ALWAYS do that and I keep promising myself to change but it's been hard going. All of the 12 lead big wigs and books say that in order to do this well we ought to develop a systematic way of interpreting and do it every single time. That interpretation in my opinion should always include (in addition to the basics): Axis, because it can help with identification of the tough rhythms (VT versus SVT with abbarrancy!) Hypertrophy, because this is a big confounder with STEMI. LVH produces ST elevations and we don't want false STEMI calls. Also tells us about health condition, output, and potential issues. Other STEMI mimickers like left bundles (remembering Sgarbossa), Benign Early Repolarization, Pericarditis, etc. A quick check for syndromes as mentioned above. I feel this is important because many of them change the treatment plan or are otherwise remarkable. Would you agree that those 4 things would more or less sum up the "extracurricular" stuff that we don't often do, but maybe should? Would you attend a class that focused on those things and a systematic interpretation? Anything else? Btw here's the wikipedia on Wellen's: http://en.wikipedia.org/wiki/Wellens%27_syndrome

Okay I'll be more specific: 1. Do you routinely determine the mean QRS Axis and can you apply that information practically? 2. Are you aware of the Sgarbossa Criteria and have you used it before? 3. Do you routinely check for Cor (or P) Pulmonale? 4. Do you look for LVH, BER, and BBB on every STEMI? 5. Do you systematically interpret every 12 lead you read in the same order every time? 6. How familiar are you with syndromes like Brugada, Pericarditis, Wellen's, WPW, hyper/hypo K, and long QT? Others....?

I'm thinking about doing an "advanced 12 lead" class at my service, and I was hoping I could get some information from you all to get me started. How in depth do you get when you read a 12 lead? Do you look at just the STEMI signs, or do you go as far as axis, rotation, hypertrophy, and the syndromes? How about electrolyte disorders, pulmonary complications and strain patterns? Please be honest: how deep is your 12 lead knowledge, how often do you use it on routine patients, and how comfortable do you feel with your understanding? What would you like to know more about, or get more practice with? Thanks guys!

You should probably be "pro" something rather than "anti" something, by the way. It makes for a better argument I think and there are some PR issues as well. Third service EMS, anyone?

Anyways, Tim- how'd you do?

Yeah I get rejected also. I'd really like to see it though if you'd be willing to make it possible...

I don't know any off the top of my head, and the reason is probably exactly what you stated: fear of losing firefighter-based membership. It probably also doesn't help that a large majority of EMS workers have no interest in staying in this job as a career and - when it comes down to it - really could care less what happens after they leave.

The HEMS people I know seem to be less upset about this than I might have thought. The MSP program, it's safety record aside (which I don't know much about), has some problems that I think a lot of HEMS people raise their eyebrows at. First of all, it is a single-provider ALS service that does not do critical care. That is way outside of the standard for HEMS in this country, which usually runs critical care-capable teams of RN/Medic or RT/RN. The lack of critical care has necessitated that a number of private services supplement the system so that critical care IFT can get done (which really is the big deal in HEMS). MSP has gone to extraordinary lengths to limit these private services from doing scene flights even though they are a higher level of care, which has resulted in some turf battles that is likely a disservice to the patients. MSP could probably do well to cut the amount of helicopters they have out there and reinvest that money into their people. Two providers. Critical care. Meet the CAMTS standards (from which they now exempt themselves). Figure out a system that works and provides the best service possible rather than A. trying to save money with drastic cuts or B. selfishly protecting turf. That said, I can't say I blame Maryland for their interest in cutting this (medically) sub-standard, expensive service and trading it out for a higher level of care that won't cost the taxpayer a dime.

For what condition are you talking about giving Calcium for?

ahhhh you gotta go longer than 3 seconds! haha it gets worse!

Welcome to the internets! http://www.drugs.com/pro/solu-medrol.html

Okay before you click on this URL, I want to express that the video contained inside really and truly cannot be un-watched. It is most definitely not safe for work (NSFW!), children, or the squeamish. If you feel you can handle it, though, please do go ahead: www.glassass.com

I use it routinely on asthma and bad allergic rxns. The spinal dose is so huge that we don't carry enough of the stuff even if we wanted to give it for that. Note the onset of solumedrol is on the order of hours, but I always get thanks from the ED staff for giving it to my asthma patients. Apparently it makes a big difference down the road.

You're not alone. We are going through contract negotiations right now as well and the company has offered us similarly paltry wage increases (that amount to cuts when you consider other takeaways and cost of living increases). Our managers haven't had the gall to say out loud that they think we are actually worth less than firefighters, though. Those kinds of words tend to incite a lot of anger, which I hope is helping your cause over in BC. For whatever its worth, you have my full support. Good luck!

I'm sure! The website kinda tries to make it so you can only print the thing once, but there are of course ways around it so that you can get multiple free sammiches. It also works if you have a few email addresses you can send to, just collect a few different coupons using each one.

Wow. I wonder if the irony has struck him yet that come whatever disaster he is preparing for, all the equipment in the world won't be worth squat if nobody knows how to use it!

No this isn't spam. I just thought I'd share because everyone loves free sammiches. http://www.millionsubs.com/Reg.php?x=1 Be advised the coupon says "ID required" on it, so don't use a fake name if you can help it. Also no doubt Quiznos will want to send you "special offers" etc (AKA spam) to the email address you provide. I have a "junk mail" address that I use specifically for these purposes. Now, to make this a legit "EMS Discussion" thread, how about we discuss our favorite foods to eat while at work? What kind of stuff is easy to eat while driving/sitting in a moving vehicle but is also tasty??

Yeah. I'm not sure how I feel about it but here are the new levels: First Responder will become "Emergency Medical Responder" (EMR). I guess these will be trained in AED, BP measurement, oxygen therapy, some splinting stuff etc in addition to the current skills. EMT-Basic will now be called just "Emergency Medical Technician" (EMT). There are minor changes here including adding ASA, pulse ox, transport vents, and a few other small things. EMT-Intermediate/85 will become "Advanced EMT" (AEMT). I guess if you want to start at this level it is going to be about 150-250 hours of training. It looks like this group will maintain the same skills that the I/85s already have, except now those skills will be specifically tested by the NREMT. EMT-Intermediate/99 is now "Paramedic." My understanding is that the NREMT wants to bridge these providers over to the Paramedic level by authorizing classroom instruction to cover the missing material. NREMT says this transition may be made without clinicals or field internships, although it says in the newsletter that "the gap of material between the I/99 and Paramedic levels hasn't yet been identified." It doesn't seem like this idea is completely fleshed out yet. Paramedics will now be called simply "Paramedics" instead of "EMT-Paramedics" Meh.