tniuqs

FOR STREP????? WTF? OMG can you say ABUSER in so many ways! The ER doc needs HIS Head examined is he asking for an OD too or is this guy a roided out and a wrestler, perhaps with homicidal thoughts.. ??? Oxycodone and Dilaudid for a sore throat...yea keep the customer happy...right then. So did this Patient drive home or take the red and white taxi as well ?

whit72: Look a bit futher NORTH, like beyond your Borders, it IS happening now... granted a different Legal System and fewer litigators too. ps please keep them, (lawyers that is) cheers

Yes this does bring up a interesting thread, I stongly suspect that many cross-trained individuals are in the US? but likely more RN/Paramedic than RT/Paramedic individuals. I think there is just a handful in Canada (like 6 of us) The advantage here to an employer (as Fly boys and gals or interfacility acute care transfers) speaks volumes as only one chair is needed...ie the Lear Jet (the flying cigar tube) far more cost and phyisical space effective. One that has 2 tickets as will always be in high demand. and when you get old and your back hurts you can always go into home care (coffee with the little old ladies is a hoot) There is "more than a few" that believe that they understand ventilation....but NOT always the case...I have run across a few RN/ Paramedics that get way too cocky in that regard. So I guess I am saying that one needs that extra piece of paper to climb the ladder and provide optimal care. Happy readings.

Oh yes in passing don't get "stuck" in the "naughty bits" pages as Dust did! One can go blind...I heard ? Was that my outside voice, like again? cheers

Ok...this is a bit scary, should I ask how high tidal volume settings? Let us not forget that the "cook book recipie" for estimation of Tidals Volumes is based on ones ideal body weight as well (this is often lost in translation) It is a start point not the rule as one needs to take into account the underlying patho AND what is succsessful...its ALL gray/grey in respiratory care! I sure hope for the pts sake that Peak Inspiratory Pressures are lower than 40 cmh2O and plateaus are less than .032 or perhaps flip them to Pressure Control ?... that said if a patient is transported on PC then you do need an RRT as things can get a touch more complex Resitance and Compliance changes affect minuite volumes..big time. We er some RRTs have quite a bit of latitude when it comes to ventilation in hospital settings here in Kanukistan, (some facilities) but a matter in most instances of approval and acceptance from years of working with the attending MDs. The true irony is EMS initates O2 threapy..we do our best to get Fio2 down as low as we can.... 02 tox and all that. By all rights the golden standard is ABGs following any Vent setting changes, ETCO2 and Pulse Ox are helpful in trending but in the transport enviroment this may not be readily available.....and dont rush to get a "fresh" gas.... patients need time to equilibrate. I have posted the paper on "ventilation with lower tidal volumes as compared with traditional volumes for acute lung injury" in other threads from : NEJM Sept 14, 2000 Volume 343, no. 11. cheers ps Ventmedic will you marry me? lol.

I wouldn't get too stressed out about it there JPINFV, sounds like you may need a Murse or 2, te he.. some RNs are very well versed in this area with backgrounds in CC or ICU, and are quite capable of IVP rx if needed. but just a regular nurse off wards or floors would raise a few eye lids here too. cheers

When the PR stunt is successful.

Well, I commend your incentive as this is what will guide you along the path to the Dark Side. When I first started out I found 2 books of great value...yes, I AM a Slow learner, but they worked very well for me. ps a crappy speller too...lol (edit) Called The Anatomy COLORING BOOK and PHYSIOLOGY COLORING BOOK, in fact after I showed my instructors they adopted this as recomended reading er (colouring) the canadian spelling...Eh! A Canfield Press / Barnes and Noble Book, a Department of Harper & Row, Publishers. cheers

Have you ever thought about trying a bribe....? LMFAO their JUDGE....looks good on yah, EH. ps enjoy the beer, be at one with the beer (Bushys religion in fact)

MORE rocket surgery, really I am shocked that Calgary is the ONLY city looking at these projections. So yet another question, so just whos ePCR tech support company/corporation anyway, could someone inform me... please? OH Yes a previso: I do think Calgary runs a good show but on the Whole North American Continent ?... I just can't swallow that at all. cheers

Whoa there NELLY: Ok so the ZOLL company decided that CowTown was the best service ? Ok, like across all borders? So just what was the real criteria ? I guess a company can compare apples and oranges ? Well this is news to me, with completely different focus, social values, funding or perhaps gulibility of Albertan's...I am so embareassed. Could market share have any weight in this Award ? Odd when Calgary has serious plans to expand service = purchase more Monitors? ps (Holly is going to freak!) So would it be politically correct as to ask what ECG machines are in the back of Cowtowns Trucks ? or even perhaps the other honerable mentions as well? And oddly enough right when Labour negotiations are in progress, could this be just a wee bit skued ? Do the Medics have influence in the choice of Equipment or evaluations of them? DUH! Could the next award be to STARS for the best dedicated rotary wing operation in Alberta, (ps it is the only one) Serving 94 % of the total population of Alberta ? huh. Explain that please Dr.Powell my math tells me, a lie plane and simple. So just what are 12 other dedicated stiff wingers flying daily... so way off topic . Oh the irony: is correctamundo.

Well I think that FEAR of the unknown is a GOOD Thing! The reason there is this specialty area.... the so called RRT is for very good reason, Ventilation can be quite a complex area this on top of all the "flavours" of Ventilators as well, how the Vents work is as important as the interactions of pulmonary patho. oh yes ALWAYS carry an ambu-bag with you. Get as much training as you can, as questions of the toothless walrus, if they are good at what they do, they will want to educated you. ps an educated hand is very important as well. cheers

Through collaberation with Aeromedic and squint while in a hyperethanoememia state, presently in-theater Millet, AND freaking 33 C weather!!! Have decided to nominate you for the position(s) of: (current titles available) 1: Judge of EMT-City? 2: Jury of EMT-City ? 3: Executioner EMT-City ? 4: Barrister of EMTCity ? (an unlikely concept :shock: ) 4: DUKE of EMT City (sorry taken :wink: ) 5: Dean of EMT City (yea...that's stall is currently occupied as well ). previso being: that WE are still in the process of "binding arbitration" in regards to of all the post (s) prior. In the internm: [align=center:2076a31285] It is Declared that This thread is now deceased ![/align:2076a31285] Despite BEST efforts of rescuers and argumentative (and possibly combative ) nature of the said Paient) signed "the TERMINATOR of the NEW Improved EMT City" cheers

Dust: First off you are a SUPERMEDIC already! I am not saying ALL just some, for example treat and release for Hypoglycemic events, wack a couple of sutures in, slip in a folly that gets yanked out in the nursing home stuff like that. One must consider some other alternatives as not all demographic areas and groups are the equal, so instead of transporting to a facility and sometimes great distances at times, taking a truck out of service for way longer than just treating (get the papers autographed) are you saying yes fill up another ER bed for something that can be treated within-scope-of practice. Hey some ERs are using bunk beds these days...EDMONTON in the spring had up to 10 trucks for up to 6 hours on HOLD...this is not a good use of resorces to my way of thinking either. In fact we do just that in some remote deployments right now, in Kanukistan. I believe that instead of wasted transport and then "HIT THE WALL IN ER" treat and put the Truck back in service asap, oh yes, then the delivery back home don't forget little detail I saw lots of this at the Katrina thing, man do ERs get there panties in a knot when there is no truck to empty THEIR ER bed...sorry off topic. Just my 2 cents but I already think we are being abused already as the big red/white taxi service so why fill up the needed ER beds?

So Faster care = Better care? :twisted: :evil: :twisted: :evil: Hmmm.....then sould we start a fund for new running shoes fer the DOC? My Evil Twin told me to type that!

Well.... don't think of it as HARDER Erdoc.... just FASTER.... Or perhaps more cloning of Doctors in general may help ? ERdocs were not born lazy...just tired is all. (old joke) if I only could just get a Pizza in under 30 minutes (or free) then I would be a one happy camper. Seriously: I have to absolutely agree with Chbare statements 100% ! An education campaign was attempted here and as per norm it failed miserably and the stats didn't change at all. Why ? Because of today's " INSTANT" society and attitudes. The general societal misunderstandings: Health Care's definition of EMERGENCY = a life threating injury or illness. PUBLIC perception of EMERGENCY = the 24 hour 7/11 of health care "catch all" (or fill in your pertinent gas and convenience corner store as per state or country) I believe that EMS is not helping to reduce workloads in the ER's globally, concerned with liability issues, here is a point.... So ever hear these words come out of your mouth ? [align=center:af10eb2c9b]"Hey buddy maybe it would be a good idea to get that checked out"[/align:af10eb2c9b] Could EMS BE part of the problem as well ? Perhaps empower Paramedics, as they have in the UK the so called supermedic to treat in the field. This idea certianly makes a lot of sense to me empwering RNs @ Triage to have more input into care is not the answer to stay off the masses, as there is no freaking beds to start with (just my 2 pence) cheers

North: Yes this can be a serious concern for many that have had limited On-Car experiance it concerns me a great deal that most in the patch just sit on their asses...hoping that the real test will never arise, SO I applaude the incentive you show! Most industrial providers are more interested in the computer games and movie watching, certianly answers my question how the term evolved and I so enjoy being called a "Band Aid" myself. Man down drills are a must in the patch, putting an ERP on paper is JUST the Start ! One can use the Due Diligence regulations to impact on some occassion and this CAN be a way to encourage those less than stellar "rig pig's with a phone" to actually test the system in place, that said the reason that one is on-site is to do the real work of getting the gas and or oil to surface.....did someone say safely? Drills and Senario testing really "should be" the responsibility or job of a QA guy or Gal, to assure standards...(unfortunatly senarios do fall short of the real thing) QA should NOT just count inventory and check cleanliness in the truck... they should be visiting the remote site's on a routine basis for teaching and evaluation er does the phrase: "with an ongoing medical audit" apply ? to last "man down" evaluation? Unfortunatly, I have yet to see this implimented in ANY service for Industry in Alberta..well, the ones I have worked for despite there PR claimes and balderdash..you know the catch phrases like "premium care" "best in the patch" "biggest and best" "we care" ++++ Seriously when I see the bs on numerous websites I need a barf bag....sorry ranting again. Have You EVER actually observed an OH +S person in the field ? Not me! Here is a response I recieved from ASK AN EXPERT! (some likely have pre-hospital experience) ?????? The very Govenment Agency (OH+S)to set the standards.... WELL that sure makes me feel better, don't know about you. The Term the Blind leading the Blind comes to mind. cheers

Perhaps this saves having to wash the glass ? :shock: Personally I would not have any idea what the results may be :oops:

Dear Le Diable de Poussière: Your Icelandic needs some work, I think it is Bouche a Bouche...hence Mouth a Mouth, in French! But it appears that it has belt loops for easy transport ..... a must for all the whankers.

Firstly this is an old dragged up thread and 2 issues: please re read Ventmedics comments there quite to the point and consise, please refer to 'Oxygen rate for chest pain" thread as it is a more current "view" of 02 therapy. 1- Hypoxic Drive The Myth yes still in acualility this myth is still a huge concern for EMS today and quite self evident with the initial post and self perpetuating from old school thinking Paramedic's. To keep it brief the % of COPDers that are truely Hypoxic Drive is more akin to 5 % of this population, yes, it can take hours to identify and MANY of this group do not follow any rule book ...... in passing, they just dont read all the studies..lol. The only way to identify these patients as truely Hypoxic Drive, is Serial ABGs in a more controlled enviroment than the back of a delivery truck, and the underlying pathology is as as complex as pulmonary mechanics...yet another thrilling read. My Suggested Guidelines: The target for 02 therapy in the COPD group and more or less a concensis with respirologists these days in this group so let SaO2 be your guide: of 88% to 92% so titrate your 02 to accomplish this, but remembering that Pulse Oximetry can be + or - 2 to 4 % in error as well. ETCO2 may be of some assistance but can be frought with complications as breathing patterns change and purse lip breathing can affect clear readings. If in any doubt use the squezzy thingy, all EMS providers can assit breathing with this handy lttle gaget. 2- That said: on the underlying thread, so please take a minute and find a book by Dale Carnagie (sp) called how to make friends and influence people...it just may help get the point across and educate others whatever there god like status and without conflict, the best EMts I have worked with know my next move before I do in a lot of cases, GOOD EMTs are not a dime a dozen...they are GOLD! Frankly BiPAP is my prefered method to "thwart the tube" in this group of patients and the use of Broncho Dialators...ie Atrovent is stongly advised, yes, I am aware that EMT Bs are restricted but at the very least this not so stellar Paramedic should have been thinking this route...as well but no mention in the thread that I saw, did any GOOD EMT ask if this drug may be indicated....perhaps your getting my subtle hint now? ACE really did contribute some good and current data, perhaps review and some questions to query's will be clearly answered as well. Punisher is not the only RT in EMT city, never has and more to come I bet $$$. Ventmedic....maybe leaches and bloodletting ?...LMFAO. cheers

POA...hey thats hurtful, you know I have not has a POA for quite some time, is this why I am grumpy? -5 to dust for thread hijacking...lol, hey I didnt start this!

Once again Erdoc provides most intelligent and interesting commentary, Yes doc I do remember Superman, he as most Ventilator dependant quads took quite some time to die after repeated nosocomial pulmonary infections, and despite exemplary care. Firstly: I would like to welcome "broken" as I see that you are relatively new to this site. So just whom do you think is responsible for the Initial Insult in this accident? Was there any ETOH involved? Just exactly what occurred, MOI? Perhaps an upset of ATV climbing a hill to steep, any operators licence ? What was the speed when this ATV accident occurred ? So if your following here the "blame" in this event is not "JUST" in the care received. But squarely upon the OPERATOR! I certianly hope that you are you following, I really dont think you will recieve what you are looking for on this site..but then again I could be wrong. Secondly: I sense that your involvement here is other than a Professional Inquiry ? In fact the "tools" that treated you so poorly, could it be perhaps that you were just a just a bit overbearing, attempting to dictate your own care? Have you ever wondered why you were tod to shut up...or was it more like "calm down sir, please its in your best interest. And so just who decided that Hospital "W" for... whatever, has such a poor reputation? Personally I have found (with a just a few years of experience under my belt) that one facility should NOT be judged based on opinions of others (I don't) well until I have personally been mistreated. The fact remains that your closed femur fracture could have been treated by most "non trauma designated facilities" So just why did you not receive Medication for 4 hours for your Pain....hmmmm I wonder? Now when ones physiological state (the flight or fight response) was overly stimulated, ones judgement is seriously affected and the way that OTHERs are treated on scene quite frequently can affect care. This term LUCID ? as referred to prior is NOT medical term used routinely I suggest that knowledgeable individuals commentary prior should be appreciated, as I must agree I too would be highly suspicious of Head Injury with because I get rather annoyed when I have had very serious PAIN myself....... and I have. Now the way I would have treated you? 1- Spinal immobilizing...without a doubt (ps I can RSI!) 2- Traction Splint to Extremity. (this relieves pain by reducing muscle spasm) a very effective "tool" in fact, but it cannot be applyed in the position you decribe. 3-Entonox prn for the move, in addition.."consideration of Narcotic analgesia" and a "touch of Benzos" chaser with the very anxious patient. 4- If possible Medivac....? 5- In light of review of "posts" Haloperidol 2.5 to 5 mgs IM. cheers

North: YOU have NO SHAME first off ! And is ALL about the N/S... Ass for the Hooters, I didn't know that you had a franchise in Hyth ?.... whoo hoo! So hide your town Kwackcropator.. full speed ahead .... North here I come. ps: will pick you up a Double Whopper in GP enroute!

Dust WTF you talking about? Just got in under the wire... lol. Here is where I got the Definition..... the New Unabridged Kanukistanian Dictionary, don't you have a copy ? ps Yes dust we all revert to our childhood when we "get on" in our golden years. ouch !

Thats a great idea, Im all over that. Anyone know where I can get a "tniuqs" decal?