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It would be my hope that through education the this sterotyped stigma be replaced with intelligence over misinformation. Vent medic I WILL WORK WITH YOU ANYDAY I would be HONOURED. Perhaps an introduction of yet another controversy in this thread. "What are the Rights of the Infected Health Care Provider"

Dont get hung up on one type of situation, in industry, shipyards, oilpatch (climbing the stick) painters, window washers, paragliders, arbourists (sp) .... and the list is long. Look under Reflow Syndrome, I have a power point prodution I believe I found it with a google search but have lost the link.... happy un climbing. cheers

Ok I will bite here: Can anyone really PROVE that pads are safer is there a study out ... maybe by a company that manufactures these "rather expensive devices" ?? Anecdotally, I have never seen an error with Paddles, (I have been at a few arrests too ) One is directly over the patient and has a great view of procedings very easily, to observe if anyone has any contact with the patient, and a FLAG is raised in my little beany when the paddles come out of their cradles, a physical sign of impending electrity! The pads are far more inert looking, more akin to opening an MRE...(in itself that can be terrifing j/k) I have witnessed 3 occassions where someone has hit the floor with pads. 1- A Student RT of mine was holding on to BVM when a goof stated "clear" but was looking at the monitor button. (in Hospital ER crash cart mounted) student wilted like a head of lettuce. 2- A "past" supervisor in car, (no center mount cot) slipped on vomit on the floor, inadvertantly while reaching over and hit the "weld button" and made contact in more ways than one .... this would not have been physically possible with paddles. (no longer a super btw) 3- A darwin deal when one finger on the flash button, one on the bed frame.... so guess what ... yup a cocky ER Resident. ps all survived with minor motor funtions disability (for a day) yet tremours next time the pads were charged ... does that qualify as PTSD ? aka PDefibSD ? I take mild offence with the introduced concept that paddles are somehow a wanker/ ego deal, sorry really don't understand that concept at all. Sure may look like a wanker if someone "forgot" to include a spare set in the kit, O that NEVER happens in a busy service does it ? AND this single use device can be very difficult to restock where one is in the boonies or back order has not been filled, so what does one do put the truck out of service because some stocks guy fergot ? Just speaking for myself: GIVE ME PADDLES OR GIVE ME DEATH .... because that is just what it may boil down to! I like a solid proven back up for the what ifs ... but then I am crusty and old as dust. cheers

Just think, If the guy in the joke quoted United's slogan ? SLAP !

ZACTLY!

The college allows these skills in EMT scope of practice, thats if your registered, and correct your Medical Director aka "local medical authority" remember we are still under the guidelines of HDA, yes approves or disaproves based on need, and s/he malpractic insurance, (a biggy) again for clearity PCP is not a recognised title in alberta EMS EDU is absolutly correct, well as of yet, calling oneself that is very open to a huge debate in itself, pist : It imay be percieved "to a lay person" some thing that you are not, one complaint and yor looking a ACR or ... a C+C investigation. Can your ego or future job security really take that ? I digress.

NOT exactly, Dust nothing of any value comes easily, well at least for me, there is no magic answer for anything just hard work, for those provinces that do have some form of regulation....just look to who actually runs THEM? ps try next door, and looking down from where I sit...um to the right, oopsy outside voice again. 1- In fact ACoP it is a legislated requirement, a government deal the Conservative government legislated under HDA and that membership must pay dues .... yet in actuality the College has yet to be accepted under the Health Professions Act .... its only been 7 years after all, it is government, legally it is still not an approved by government,funny thing is they act like they are. That said with the right leadership .... read on don't skip down right away. 2- ACoP was previously called APPA (Alberta Pre-hospital Professions Association) it was in part set up with the amalgamation of REPA and REMTA (no point going there) APPA AND AOAA set very high standards as goals from inception ... as a result Alberta CAN boast some of the highest levels of Training in the WORLD .... PERIOD! as without this anyone, I mean any Tom Dick or Hairy Jane could call themselves a Paramedic/ EMT of this I am truely pleased, if your not as a member happy then there are options to change things .... called VOTING on ISSUES @ the AGM. (stay tuned for those that "may qualify" for reciprocity ... maybe very soon) its called the turd way ... don't you just love a good mystery ? 3- Both titles are protected ... if one is a registered member they are subject to fines and investigation for false reprentation it they use these titles .... much the same as a COP. 4- Don't dare go negative about PAC, even Bledsoe monitors what those boys and girls are up too. 5-Gap, was intended to improve the care to Albertans, and yes drag the EMT level up to come near the Ontario PCP (previously called EMCA) what a hick up there, but we are past that hurdle .... move forward. If you want to call yourself PCP go to BC they have lots, but just a few ACP .... hmm why is that again? 6- Frustration with day to day operations ? Oh me 3, but all one needs a good leader to set the right tenor, think the office staff does't repeat the same story(s)at nauseum ? 7- So was anyone present "those spewing crap in EMT city" when we laid Mike Jolin to rest last year? I stood with great PRIDE beside President T. Jalenka and that this college did the moral correct thing (in passing for those that bitch about thier fees) there are 2 little boys out there that will grow up knowing ACOP CARED and showed the respect due, hey if it was you, we would do the same thing again, let try not ok? In closing YES Alberta EMRs EMTs and PARAMEDICS are concerned with their futures this is one of the reasons we are so critical with our governing body, its NOT a social club, never was, never will be, not a union, period. A regulatory body plain and simple (well accept for when we let our hair down at the End of the AGM) its a hoot. Point is without a viable opposition any democracy fails ! Those members that spew shyt really need to ask before leaping to conclusions.... education in the history of the college is huge to understanding the "WHY" AND SOME OF the ISSUES we disagree upon, are subject to change that's Democracy for you ! cheers ps Vote for me @ the next AGM (the man with the yellow hat) YES a shameless plug.

[ Did you read the logical approach presented before? Just why would EMS be summoned if caregiver was @ bedside that was experianced enough to do an exchange, cart comes after the horse. First off, sorry not good to hear about a loved one with a tube and your correctamundo! "No one knows it All" but the more you learn, the more you find out how much you really don't know. The more I learn the more questions I have to ask, and some so stupid i embaress myself ps (thats why a wear a mask) tee hee. Damn I am so happy that someone else can't spell bougie MAN it took me 3 years to get that right! Ok an idea but in a pinch, but just about all Trach's have an inner obturator, there is reason for this, just look at the bedside back/up that you have with your family member, look at the distal end please. Look back to ventmedics first post, GREAT Teaching INFO ! OK I CALL ! Put the cards on the table: (politely) can anyone in EMT city post a trach exchange protocol/ procedure/policy in their company/state/provincial cook books for EMS applications re: Trach exchanges ... I so could use a copy for my Guidelines. cheers

ok ok firedoc 5: A guy sitting at a bar at Heathrow Airport noticed a really beautiful woman sitting next to him. He thought to himself: "Wow, she's so gorgeous she must be an off duty flight attendant. But which airline does she work for”? Hoping to make her acquaintance, he leaned towards her and uttered the Delta slogan: "Love to fly and it shows?" She gave him a blank, confused stare and he immediately thought to himself "Damn, she doesn't work for Delta". A moment later, another slogan popped into his head. He leaned towards her again and said "Something special in the air”? She gave him the same confused look. He mentally kicked himself, and scratched Singapore Airlines off the list. Next he tried the Thai Airways slogan: "Smooth as silk"? This time the woman turned on him and said "what the f *** do you want?" The man smiled, then slumped back in his chair, and said "Ahhhhh . . . . . Air Canada.”

As a card carrying active registry as an RRT (better yet excessively overpaying registration and membership dues) One I believe, can be there own judge in this decanulation of trach "emergent" senario, Ventmedic has posed a volume of good advice on this topic and I believe it has become a very good venue in this area for discussion, both the aggressive pro, and conseravative con. Just personally we are DANG lucky that we have her trapped in EMT CITY .... lol. Point being with all these valuable excange of ideas, one must ask oneself "should I do no harm ?" as in most cases the REMP-P "even if it states in protocol, guidelines, or even legislated should one arbitrarily yank this airway, this is a true specialty area and should be highly respected, as is ventmedics astute advice and her well spent time in posting ALL this good advice. On average the RRT programs are degree level (not associate) but Bachelors degrees, minimum of 2 years and a bit of a grinder and oddly enough one thing they (RRT) have in common is national registrys, national and some international reciprocity .... factually. Funny thing is that on my old ICU unit the ER MD does do a rotation, yet under NO circumstances are the R 4/5/6 even allowed to touch the VENTS, (or take serious risk of drawing back the bleeding stumps of fingers on my old unit) heck or even allowed do trach changes ... even electively. Bottom line what am I suggesting is if you don't FULLY understand that widgit/have training/or experiance in this area, no brainer dude SIMPLy fall back on to what the Paramedic does/knows best and is an expert in ... the ETT. I too would invite shannon back to have more input regarding her patient as it could be fun to continue this senario, but I think we scared her off ? I sure hope not ! cheers

Ok I like the way you think, but .. um ... let me think NO! In a public washroom the size of a NYC locker in Grand Central station .... eeeuuuwww. I WAS trying to TRIPLE my Airmiles ! :oops:

One can now clearly see that many and most abbreviations are not clearly defined, cross borders, called LTC here. In my Hood, well unless one has a couple of registrys, a Paramedic would be practicing beyond scope, if this trach exchange was performed. I have done many of these in fact I suspect more than most MD (even those practicing in ICUs) honestly speaking from experiance you can be in a world of hurt if one is not experianced, pneumo medistinum comes to mind immediately, most inexperianced providers will forcefully ventilate resulting in ... well immediate disaster. My humble advice would be ... well if this was the senario to visualise the cords, pass the ETT, then deflate the trach cuff, remove it, then advance the ETT. Just the reverse procedure if on is doing an elective Surgical Tracheostomy in a controlled enviroment. The type of TRACH or manufacture is really signifigant query here, as most as in fresh trachs the Portex cuffed unfenstrated is used to decrease possible infection complications, later on Shileys are used, fenstrated, cuffed with replaceable inner cannula, not only for easy of cleaning but for improved weaning outcomes. Off the vent, agreed, suction yes, but ETT via tracheostomy unless it is 2 sizes to small, one is begging for more problems ETTs are not rigid enough, and leave the stoma for an expert like ENT, (or a senior RRT) ps that's Ear/Nose/Throat and Wallet, sorry inside joke. Doczilla are you advocating on an international forum that one should follow your rather aggressive suggestion ? hmmm ? Ok like a real RN? in a long term care facility? Man, ones lucky if you have an LPN on duty, besides most RN's here would cower, besides in this e-senario if you had an RN worth her/his salt there would be no dispatch, thats why they called EMS in the first dang place and not a logical thought process. If the patient is still living ? Yuppers first look at the screen first for SVT .... hypotension from a reversable cause or maybe just order a serum cortisol, hey it "could" be addisons crisis too, but then hypoglycemia as opposed to hyperglycemia could be a dif dx. Can an REMT-P do CBC or Ca/vO2 or even bedside troponin ? meh get the going to ER I say Paramedics in this senario are way over their heads. Do you see why I am countering with these points , we are all shooting in the dark with this senario, simple. cheers happy fishing. edited for atrocous spelling errors

Hold yer HORSES there doc ! Ok AIRWAY FIRST but Are you suggesting go way beyond scope of practice and re cannulate with a Trach? (good grief man) even if this is an ALS provider in EMS, that they should pull a trach (a fresh one at that ???) My docs in the ICU would kill me slowly or hand me over to ENT for a nice Lynching, a cooks stylet may save yer bacon. Ok I would personally pull the Tube as a Paramedic/RRT IF it was not patent but I would stand a huge chance of getting my "you know what" slapped by my Medical Director, if I did not just use an ETT. Again my point in this senario, it is NOT clear if the patient is frank respiratory comprimise other than sats low .... again my pet peive is the machine really working ? The last post by shannon was lung sounds CLEAR and RR = 20, upper body pink, lower body blue but this tachycardia of 160 is a bit disconcerting , You Think ?

Just a stupid question, whats an ALF just to be certian I suspect are you infering Amyotrophic Lateral Sclerosis, therefore death from Respiratory Failure is the most likely senario just based on my presumtion, its an insideous, nasty diease process and those with the dx of this, typically have 3 to 5 years left of continuing degeneration. I would hazard a leap of faith that this patient's post -op complication for a trach was failure to wean or chronic aspitation pnemonias resulting from loss of swallow control. Secondly, an no intent to bust chops but Shannon an very open ended senario is very open to tons of conjecture and (just my 2 cents) presentation in a teaching senario is huge but please just for me just include a tad more info than what you have initally started .. again I think serarios are a blast but we are shooting in the dark right now well accept for blood sugars off the richter scale and recent onset of polydipsia, or is this the diffinitive dx in. I suspect this patient has urinary cath in situ, so ins and OUTs are a huge diagnostic feature as well, no mention in the onset of PMHx or Meds or type of trach ? cuffed ? non cuffed, was patient ventilated and on what mode ? or just a hi flow "T" piece or humidivent ? My rational in asking these questions is that very unlikely on most Ambulances (if the patient is breathing without ventilatory assistance) that a trach cradle is available to administer higher levels of O2 OR a even if 'T" piece is compatable with on board kit. So lets assume that we have placed this possibly "Hyper Glycemic" patient on a BVM, so what am I feeling when I assist with ventilation, are we observing Kussmaul type respiratory pattern ... that would be my guess ? I guess I am saying that Paramedics and EMTs should be painting a thoughout picture, the hands/eyes/ and toys of the ER MD! If I were an MD recieving an info patch or questions in how to treat ... hope your getting my point, it is intended as constructive critasism only. Ok so an IV is established, so where do we go from here ? cheers

The provisions of air cargo (air transportation of dangerous goods) and on board use of medical oxygen are under a different catagory, all pressurised even some unpressurised aircraft do carry oxygen, the flow rate you can get max out of their on-board systems is about 4 lpm. Hence the approval for emergency in flight of use of O2, if you have ver done a medical evacuation on a commercial airliner this is a huge pain in the ***. Kinda Funny though as dedicated fixed wing aircraft carry it every day. I have The Kanukistanian MOT regs but it would break the site if I tried to upload, its crazy big. ps it still pisses me off I can't take a regular size toothpaste .... damn those terrorists!

Bottom line start shooting out resumes, its a big world out there if you feel that strongly.

Well this concept has been discussed on many websites, and listservers for that matter, as much as I would like to believe that this could happen the hurdles to overcome are HUGE. The international medical community at large can not come to a consesis ... well on damn near anything let alone we lowly "Paramedics" and whatever level, until Paramedicine is a stand alone entity we stand a snowballs chance in hell. We are really in our infancy as a recognised profession compared to the Nursing profession (for example) I truely hope some day that this could become a reality, realistically it just aint going to happen in my lifetime, not trying to me a neigh sayer but let face it there will be NO yellow brick road their Dorothy . If those that are interested a UK remote group is trying very hard to get the DIPROM program recognised "Diploma For Remote and Off Shore Medicine" it is based out of Scotland I believe, but just getting into this specialty area requires a vast number of courses and background prior and past experiance a huge deciding factor in employment in this specalised area. In passing the majority are ex Royal Navy RNs with Paramedical training as well with vast experiance in many humanitarian aid and war zones. cheers and greetings to nuzzy, you isreal's sure have wierd names ...

On my passport my occupation is in big print but the picture is of an alien life form. Quote : Scara Great comeback, I think I wet myself !

I have had an opportunity ? to use one, I found it well laid out and everythink was quite visual (they are a bit light on syringes) the "C" O2 tank and regulator was quite cheezy but far better than a typical first aid kit that I was expecting. On international flights there is no narcotics (fact is some airlines actually do carry M/S) I found that a bit of a shocker in fact but there is Nalbuphine in some of those kits, in a pinch not a bad option to have at your disposal. cheers ps I worked with an a DR. T. a great doc, who was the medical director for Air Cabbage and CAMATA.

I think that only "buzzard airlines" carries the 700.

Many of the Airlines have gone to this "TYPE" of kit: http://www.statkit.com/index.cfm?fuseactio...amp;itemnum=700 Its not like your on a bus or something, one really can't get off at the next stop .... ok just the way I read this tickled me funny bone is all. Ok a story: I am sitting in the back of a continental jet, getting the safety briefing ... like I haven't done them myself ... so the attendent after the seat belt demonstration : this slays me in itself, like who does not know how to operate a seat belt these days ? Anyway the attendent says : "In the event of sudden loss of cabin pressure" part ... and not ONE person is listening, well accept for me. She states: WHEN THE SCREAMING STOPS pull the mask sharply towards yourself .... well you get the point ! So now I am laughing so hard all of the passengers are looking at ME! The attendant and I got along great after that, she gave me free drinks for the next 3 hours ... telling the other passengers that I was the only one that answered the skill testing question....dang good flight. cheers

WHAT ? :shock: Thats all .... :twisted: j/k :thumbright:

Argh: missed the allocated time for edit, I bet that AZCEP will add his comments regarding the use of nitro before a IV Line .... hmmm not in my hood.

Gee wraider, no need for an apology dude, your learning and looks like you are really applying yourself, kudos as this is only your 27th post so a great start, hey your senario made ME think ! The dang internet ate my first post and I forgot to incude this in the next try .... shame on squint! Perhaps the sounds you heard were an attempt at "Purse Lip" breathing, although we observe this grunting in the stressed infant and called "grunting respirations" we also observe this with the COPD card holding club members. It is an attempt to generate intrinsic or auto PEEP, aka positive end expiratory pressure" this increases pressure within the terminal alvolus, in an attempted to: 1- Drive O2 into the aveolar/ capillary membrane, it is an intrinsic manouver that overcomes the osmotic vs hydrostatic pressures (in CHF) 2- This expiratory pressure tends to hold the terminal airways open ( COPD) and allows for improved CO2 removal with the " decrease of elasticity " of those terminal bronchioles. The Whole point of that CPAP machine in fact, quite please to hear you have that option, sounds as if you are working with a progressive provider. 3- Make mental note next call to observe accesory muscle usage as well, supraclavicular indrawing and intercostal indrawing, all signs that your patient is circling the drain and has pooped out, and may need to "chew" on plastic soon, ie the dreaded ETT for the COPDer, as most don't wean well off the Ventilator, non-invasive Positive Pressure Devices are staying off the tube for many these days. cheers and happy oxygenating !