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EXACTLY: Yukon ambulance workers in Watson Lake and Dawson City are still waiting for a government response to their en masse resignations in July. The CBC (September 6) quoted Haines Junction practitioner Neale Wortley as saying providers have now compiled a list of demands to jump start the negotiation process. Wortley, who said he hoped discussions could begin in the next couple of weeks, said key to the outcome will be the establishment of some paid positions. Dawson Mayor John Steins echoed Wortley’s impatience, saying the use of interim paramedics to fill gaps is not working. Out of the loop when it comes to communication with Health Minister Brad Cathers, Steins said he is now writing the minister to force an update on the situation. credit for this information goes to PNN Paramedic Network News

OUCH! Slam the Canadians Day is it ?

You mean to tell me that this is an OLD story and did not come the Great Down under.... or maybe it just took this long to reach Phill? cheers

Well Phil if your fantasy does come true, I will send the Video to Jill ! You two timer YOU .... take that! cheers LMFAO!

Well first off a great senario here, and presented quite nicely, but I do have just a few queries, before I hang my hat on a Pulmonary related sepsis. Ok was their a positive Babinskis sigh? LOL @ Hammer. Lets recognize hammers advice Beta 2s are right on the money! Chuck in a little atrovent too what the heck, could prove to broncodilate and therefore improve oxygenation from the get go. Hmmm: I did not check the site you provided but from a modicum of experience I find this ABG interpretation a bit odd a compensated respiratory acidosis you say? There is a way, without having to go to a website to interpret ABGs, its a simple, yes simple way of understanding a weak acid base balance, So first off throw away the Bicarb measurement it is a "CALCULATED" value not "MEASURED" when you understand the relationship of PaC0 2 and PH it becomes rather apparent that bicarb is a touch high, and just my .002 cents not of real importance. Bicarb is usually "Measured" in Venous samples but lets no go there for now. [align=center:505afbd12f]Now just memorize this simple relationship. PaCO2 vs. PH 50 = 7.30 40 = 7.40 30 = 7.50 OK.... In a perfect world.[/align:505afbd12f] This is the ventilation portion ONLY, so you have a PaCO2 of 53 (measured) so round it off to 50 just fer fun K? Your expected PH SHOULD be 7.30....you follow so far? but it AINT its even lower so perhaps indicating a tiny bit of a metabolic of compensation but not the point of my ramblings. So your measured PH is 7.295 so what is happening here ? This old gal is not moving enough AIR er CO2 absolutely right! so make it simple. Your ETC02 readings are telling you something here too. Her major component in ABG evaluation that concerns me is a Respiratory Acidosis (as defined by Shapiro..in passing the ultimate authority on ABG interpretation) AND is defined as VENTILATORY FAILURE, sorry for yelling....l :shock: . Now in a hospital controlled environment or MICU these gasses would be quite seriously factual data that this Gal is circling the drain, she's crapped out dude and at her age VERY unlikely to compensate for very long, time to think about chewing on plastic ! Now on to another option "deep tracheal suctioning" this could tell you what was going on as well, Sputum tells you a LOT....pink foamy, vs. green/ yellow thick. Are you looking for a DX or treat the patient ? This Is what I am pointing at here, If you have enough experience/ confidence to shoot an NPT, and lots of Xylocaine (spray then viscous) deep tracheal suctioning this is done very frequently for DNRs in hospitals, oh yea did I mention am a mean SOB in the short run, long run I get kisses ! Personally I try to be less invasive as possible, as committing someone to an ICU stay I take VERY seriously, I love my NIPPV K now I am showing off ...bad bad squint! Don't know if you RSI in your area? but if I had these gases at bedside and quite frequently I have an I-stat available flying this is just a teaching note persay: That is not really relevant in this scenario, the bedside sputum clinically findings after "shooting a tube" could support your choice to take immediate actions. If this Gal had a huge pneumonia sure sounds like it from your presentation then clearing these thick GREEN goobers therfore her ventilation and oxygenation COULD improve, maybe consider some fluid in this case, perhaps staying off the dreaded tube, if you found Pink Foamy Stuff then time to consider BIPAP or CRAP and Lasix. ps a side bar: The nursing / home care provider and history of a 30 minute onset is most likely crappola, perhaps just the last time she visited by her then multiply the number of other patients (dude be gentle on them, please accept that they are less educated and in most cases just doing there best too! tolerance of others is professionalism in part of those not putting down the other's) minus 1 on the dustdevil scale :twisted: I suspect if patient is not a DNR than that is MOST likely "ETT" what they have done in the ER, please do a follow up for us .. ok. Just saying here that we work in very different environments (and scopes of practice) and when transport time a truly excessive then one sometimes has to be far more aggressive, initially but don't get me wrong. I think transport L & S is way to go in an urban setting I am NOT suggesting you did anything wrong, just providing options is all. Her initial SaO2, of 82% is life threating, it correlates to a MEASURED PaO2 of just for mental exercise on the Oxygen dissociation curve to about 50 or less and that alone could tell you she is in deep KA KA. this is most likely indicative of Shapiro's "RESPIRATORY FAILURE" sorry for yelling again, my bad? (ps thats oxygenation) and if it is correlating with pulse rate. BUT you treated that the field nicely and correcting this respiratory failure, after the fact ask yourself does she actually need to have a PaO2 of 200 + hmm another thread perhaps, could that be harmful ? There is ONE question I have, now all things being equal how did you get a measurement of ETCO2 value of 59 is when measured ABG value is PaO2 is 53, it does not compute it does not take into account deadspace ventilation. Granted patients do change but this too could be rationale to shoot that ETT too? Yes I know her GCS was 15, do you have Versed and Fentanyl the "poor mans" RSI ? THE BOTTOM LINE IS THIS GALL IS 95 y/o but without a clear written DNR one cannot look at age as a a means to limit treatment, thing is People actually do MOVE ON we are not IMMORTAL can't wrong you for ANY of your RX...really. I had a very simmilar case study, although I do wear a few differnt HATS anyhow, Lady got TUBED by me in the ER and shaking my head at that time that we were NOT doing the right thing.....was I wrong .... yup, just 2 days after committed to a VENT, I got to extubate her as well, and (my friend) knowing that we had bought her the time to say goodby to her family was a big deal for me (she died 2 days after that) and seriously I did get a kiss from her. IT was sweet!...K no tongue though :shock: Like I never end my posts without making you laugh :twisted: :twisted: :twisted: cheers squint

Quote some duke: Correcting the Correction. There is no absolute contraindication to hi-con O2 in the field, edit[/font:af197142a3] at this point in time, (hopefully) in the ongoing devlopment of EMS and evidence based medicine research will be applied some day. I am beginning to believe that the New Unabridged Kanukistanian Dictionary is not currently available at most book stands at the 7/11 ? a sad commentary. YET .... "How to Make Kookies" is a best seller. cc could be critical care ? I'm just saying..... cheers

OMG now thats good, sure hope HammerPCP don't see this one!

Ok Phil: Just one question remains, did you get sex back..... down boy down. LMFAO a great story from a mind down under.

You want good PR ? 1: This idea worked for a show a long time ago that I was involved with...so all of the vollies get a grant to become CPR constructors, then get one big ass sign on the Station offering FREE CPR courses......to all local taxpayers. You NOW have a means to contact those that VOTE in your community, with 1 call a day your laughing, word of mouth is the fastest way to spread the news in small town (wherever) 1a Post all the letters of thanks from your patients in the local rag... have them do it, the paper can't turn that down. 2: You do have a 2 party system there ? Someone get VOTED IN to council as is it not the duty of the elected officials to provide care, for the community at large? Oh yea talk in terms of a monthy.... (not $200 per house additional tax per year) try $16.66 a Month, or even divide that by the number of actual people in your community per day....following here ?) hell's bells I drink more milk than that in a month put in terms that the locals understand. 2a: Just threats of withdrawl of services is huge media to get YOUR story told. 3: Or get a job as Walmart greeter with those little stickers ! cheers good luck, but you will win in the long run.

Well just from the Alberta / Kanukisanian present legal perspective: I so hear your distress, I too was assaulted by a very similar patient (the right hook did connect and drew blood from both parties) going down the assault route when he was impaired and not responsible for his actions BS was a waste of time too. So following company ID policy I reported to the ER and was told that the patient had to give permission to have their blood work drawn and (the individual was 3 sheets to the wind) therefore not capable of giving permission, soo long story short the original RN informing me of this while taking my blood work this was a pain in the ass and damn scary for me and she didn't even try to gain permission.... bitch. Appears that this IS the law here and as a result our National Paramedic Association (not just in consideration of my my case either, their was over 12 cases presented in the debate one for each province) did some lobbing for the "BLOOD SAMPLES ACT" unfortunately the initiators of this proposed act (the police, firefighters and dentists) were defeated in their actions. (in passing the "Nursing Associations" did NOT get on board with this incentive) GOOD GRIEF what is wrong with them? Any way, I did say this was the abbreviated version...right? I did manage to find out from an MD (a good friend) in that ER, thank god I worked their in another capacity as well, that the patient was evaluated for "other reasons" for the patients well being. SO that sure made a huge difference for me as he phoned me at home and took a risk at breaching that patients/ bugeaters rights. I will always be indebted to him as the prospect of taking AZT ++++ just "in case" is just really not an good option and can screw one up ones body on its own. The forced to use "protection with my now ex spouse" did not side well either, she was wanting to replicate at the time as well, notice I said ex. But the thought of somehow infecting my children WAS the worst part of my short-lived nightmare. Sometimes its who you know not what is the "Human Rights Protectectors/Liberal do gooders" that make the difference in Life, so take Anthony's advice GO UP THE FOOD CHAIN STAT! The excuse in the debate on the floor and why the "Blood Samples Act" failed, was that safeguards and medications were made available at no cost to the Public Servants. This Act was not only for assault reasons but inadvertent cross contamination from needle stick or a ripped glove. cheers ps With a human bite your statistical chances of infection at the site of injury is your biggest concern.

So did it work did the patient wake up, and what a great tecknique so no way he could identify you in the court room too, I am picking up what your laying down. Just helping out here it is MY job ! cheers bro

No offence intended but the "jet box" or was it a "long box" ? These are extremely underpowered and very poor excuse for a Medivac Bird, they are also a bitch to work in as well, just my 2 cents, I have long lined under them....a very LONG time ago. So when will the FAA put some form of controls on types of birds allowed to be designated "Medivac" ever hear of the military using this Bell 206 as a medivac platform...NOPE and for good reason, good grief this is a sad state of affairs. As for cross wind ? was the pilot attempting to put it down and not taking into account winds on final with lines ??? hmmm there is more to this, me thinks. I am very pleased to hear that no one was killed, Question is just when will the FAA get serious about these abominable statistics...maybe listen to Bledsoe ! and very soon I hope.

In addition: "thesmilineyesofmyjesuses" (all one word) or S.E.M.J. roughly translated ... spinal meningitis. AS = athletic siezure. GCS = 16 for those that are possesed by an additional entity. cheers and great stuff.

Specific would be good, so do you have a job for me ? In the Mid Atlantic ? cheers

Are you sure about that ? Do you get a lot of snow storms/ blizzards in Florida ? The contrast of a blue light "I would think" may make it more noticable and an earlier recognition of a problem. The amber or yellow is such a common warning light as to be pretty much ineffect (due to conditioning) just my way of thinking. cheers

Oddly enough, the legislation here is over 30 years old...OMG. All that is required "by Law" for an ambo is a rotating "RED" light that can be observed in 360 degree's. Have you entertained the idea of Blue, its less harsh on the eyes and it is the first "observed" colour to the human eye ? Albeit depends on your state rules, we in Ambulance operations here are restricted as the Police are the only ones permitted to use a red/ blue combo. cheers

Ah the Incident Command System, is this the same deal that is being implemented in just about every government agency that I work with (Forestry i.e. woodland FF, SAR and ERP Oilpatch response) ? Someone is making a pile of cash with this concept. If it is, I hear do your pain and frustration, it is quite complex system and until one gets to the ICS 400 level it (I feel) it just introduces a finger pointing system with all the multiple divisions and their state of ongoing confusion pertaining to responsibilities ... IC SHOULD be straight up. The Buck Stops Here type scenarios, perhaps at Katrina IF FEMA had realised EARLIER and stepped in, like "someone with actual experiance" not a silly Mayor or Govenor ....they should have been used to hand out sandwiches .... sorry rambling. Could you provide a link to the site if possible, I don't want to be TOO premature in my opinions, yet but having to actually deal with this ICS as a "Medical Unit Officer" placed under Logistics (well until the operation becomes a Medical or Rescue in Nature) I have found just a few individuals that actually know how to apply it properly. I have always used an old preceptors philosophy: If you need to call the Boy Scouts and Girl Guides ..... CALL THEM and put them in the ERP in the initial plan. cheers

Funny you say that Richard, as that "time vs distance" or "bout an hour and ten" thang it is so common in the outlying areas that its almost expected, but I had no idea that Kanukistanese was parl'ed in Joisey too! It must be part of the "free trade" agreement I recon, yes another oxymoron. cheers

I think that you may be under an impression that there is not as little "Grid Lock" other than in the Big Apple, I can reasure you that this is really not a reality in Alberta. The main Hiways are rather crazy as most every where in North America and the posted limits are 110 km thats = 68 mph (as if most oilpatch types don't move one hell of a lot faster) the downtown corridors as well are quite nuts too...., but its those damn moose that fail to push the cross walk button that get me going... :shock: (oh ps, I have done a "ride along" in NYC outa da Bronks Burrow) the typical response time when I was there last was based on the speed of the elevators :roll: cheers

I hate to rain on a parade, but this acceleration and "G" force recorders have been around for > 20 years. I believe that the audible feedback is a excellent means of learning and teaching how to operate an emergency unit, but YES to hell with the "E" response. Make the ride with a patient a glide ! Make the ride smooth for the Medic in the back of the Gut Wagon so smooth so that they can work without hitting the wall or stagger around like a drunk. Kick back at a stop sign is just poor operation, as is not tolerating the other drivers and predicting the sillyness of THEIR actions.....Two of the most important thang (s) I learned from My Preceptor are: 1- "EXPECT" the unexpected. 2- DON'T GET ANGRY....their all idiots get so used to it. cheers

Umm....ever think of using a Back Pack? This works nicely for me in the back country .... and when you don't need it I can take 38 lbs. OFF ! Then one does not HAVE to look like a psuedo "Dawg the Bounty Hunter" good grief. cheers Reminds me of an old joke: Why are there 2 doors on an ecnalubmA ? One for the Paramedics Head and One for the EMTs Belt.

HUH ?? OK then this is ALL balderdash and nonsence ! Everyone knows that SMOKING has been known to be GOOD for YOU, and we ALL need to promote this Actively. Hey I am working on a cushy home care job in my retirement as an RRT, PLEASE Stop raining on my Parade would you ..... Your scaring my potential patients. Cheers: A very informative thread and good exchange of ideas without getting silly. On another topic: I am starting an ETOH nebulizer BAR, any interested investors out there inquiries welcome ... te he.

No but let us know how the 'buzz' goes ! cheers

Nope: The active metabolites are presently under review here, no word just yet but reports of leaping from hieghts has been reported...thing is that routine drug testing ie "pee dip tests" would not show the metabolites BUT mass spectrometry will identify, that said only if one were looking for it... cheers ps I have never heard of medical applications of Salvia, interesting.

RATs....BUSTED AGAIN! Ok then Duke: First thing tommorrow I will staple a "toonie" to my Fed-Ex, express delivery Raven and give her directions to your hooch . cheers