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Interesting topic; The point of having a Paramedic in this role does have serious advantages, in my hood (presently in Industry) the provision of Acute Care has been very clearly established, OH + S has recognised this. But we fall down in the delivery of primary care. (curently unaddressed in our Education System) combining these 2 roles could prove to be cost efective and improved delivery of care. Dare I believe that early intervention in primary care could avoid costs in Acute Care. The only problem seams to be the lack of forward thinking...ie failing to recognise some Gap skills, ie suturing and bug juice delivery. cheers

Er speaking of idears...did we rule out Trauma? Any recent falls? MVC? ???

Scope: Which Nation? check out the flags!

Did not forget the all important lecture on BEER? Now just in passing this IS not a Slam, but many of the informal gatherings "after class" are more far enlighting than the actual lectures... cheers

Rid; Some schools here have implimented "must attend" College Annual general meetings OR "do a paper" on the development on EMS in this province/ Canada..... 2 schools cancelled classes due to a memorial for a fallen comrade.... Participaction teaches more than any theory can...period. KUDOs to those schools leading through example... Augustana, Northern Alberta Institute Technology and Canadian College of EMS.

60 y/o Hmm: Ok: lets get the meat first svp. LOC? Am assuming GCS = 15? Soco economic status? Wieght? Primary survey? any dyspnea? VS ? Lung sounds, cough productive? what color? ok: Hyperlipidemia...PMHX therefore ECG, the elderly female is high risk for atypical presentation for MI. Pnemonia?...bug juice.. Did she take with food? Any herbal remidies? has she taken any rx since onset? Was abdo pain onset generalized? then focused to RLQ? PMHX no surgeries. Focused exam....tender abdo? Rebound? N + V? LBM? ps do me a favour there ERdoc....this "yall, meds stuff" can you use genaric names as in Kanukistan we have diff RX trades it sure srews me up...lol. Diff DX: Stuck Fart?

-10 for off topic. -6 for using this forum for your entertainment. -300 for professionalism. Personally I wil no longer bother to respond to your foolish giberish. cheers goodbye

Oh you have all the kewl toys ! The point that I believe needs to be made (well from my Kanukistanian chair) is this: Yes I too am quite disappointed with the Provider level books (I drove 100 kms to take a look yesterday) they do not have the same research based data nor references that we as professionals (the grey team) are accustomed to seeing. I too was quite shocked as the Provider level books appear to be so bloody basic, that said: Those that are dedicated and have google and a few subscriptions (for journals) or even the links to the ILCOR research (i.e. the justification based on evidence based medicine.) In fact many threads on this site are self evident of that fact. If a practioner accepts this new "improved" teaching methodology one must look "just why" is these guides have been "dummied down"...... to teach a huge demographic population,this is a means of delivering educational material, Your individual Licensing body is them to validate your capabilities... it is up to the true professional to chose to excel in this area or just accept the status quo. The Heart foundations world wide have heard the feedback of this I am quite certain things will change once again. I personally would like to see a new "International Consensus on Science" as in the old publication of Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, that had some meat to it, yet there were many of my respected colleague's that never even opened the first page...you get my point, I hope. ps I don't WANT my General Practice MD to even have ACLS! nor do I want to do prostate examinations or fecal (digital) disimpaction. cheers

Well: Its is not very difficult to see the difference in a Professional vs a silly monkey in this thread....I need say no more? ooh but I will, It is quite interesting with the implimentation of new CPR standards that some improvement to ER door is up to 9 % in some areas ? firefighter523, just polite suggestion, you SIR (a loosely applied term) are in the wrong place and your dedication and attitude is deplorable. cheers

Well lets look on the positive side for "just a second", the link shows a picture of the Professionals that Rid and myself related to. Matt Green and Matt Lewis, Tech Rescue Squad members and Virginia Tech students http://www.philly.com/dailynews/local/2007..._the_shock.html

Yes Rid, I saw this too, a most excellent and intelligent commentary by Dedicated Professionals this makes me with very mixed feelings somehow PROUD....... in the face of absolute tragic event. As I write this I am watching an Interview on CTV TV, the Media is "typically" is pounding the subject...in Virginia one can purchase a semi automatic or handgun without a background check, even without ID....that's just a little bit scary to me. One interviewer suggested that the Professors be armed....OMG! Stand away from that crack pipe! This is NOT even a viable suggestion! This individual was know as a Loner, anti social, bizarre writings, stalking (known to the police) and death threats.....maybe we should pass legislation "For the Teachers" to report this pattern of behavior to the authorities and give the Police the POWER to actually do something. Oh yes, someone will scream a humans rights issue.. but a simple room search ? (if you have nothing to hide) is just not a problem for someone who is innocent.... just to my way of thinking. But the good part of this "if there can be": is "The EMS Workers" were commended for their very Professional Response, describing that through training on "weekends" and "days off" they practice for MCIs and situations like this. The (CTV) interviewed EMTs and Paramedics were called "prepared" and "well trained" "very professional" and they stated when the interviewer goes to the personal part (they always do?) that the EMS workers grieve AFTER the patients receive appropriatle Medical Care and are Safely in Hospital. If one could find "a silver lining" perhaps these PROs have accomplished this....KUDOs to my southern brothers and sisters, they put themselves at risk once again. ps they were "not" wearing body armour, as were the police. cheers

I believe you are missing the entire point here, going to the media will not accomplish the goal of convincing this individual to do the right thing, that of cooperation and respect for all emergency workers. Bring it to the attention of the media and it will become a public battle. Besides the point that its "not" the Labour Board, as they have been successful in there lobbing, this concept has achieved first reading in the Manitoba Legislature....it is in the initial quote. Thanks for your opinion and assistance.

MEDIA NO, my letter of complaint and request for his immediate resignation was sent 1 days ago: Sent: Sunday, April 15, 2007 8:46 AM [align=center:b54dc45442]pres867@aol.com [/align:b54dc45442] This does not show up as a link, and it is the e-mail address for Mr. Forest ...... so send him your perspective. EXACTLY.

Thanks there Deano: I will not dispute this point, but is not the topic, really, the government is looking at passing a Bill in the legislature. I could use more intelligent ammunition, so to speak. I have received correspondence in reply, unfortunately diversionary tactics and off topic information ...even a denial, that those were his words...oddly enough a reporter quoting someone out of context is liable....... in Canada. His reply: REALLY? This only adds evidence to the fact that the initial comments were from himself, and feels that somehow (as you put it) Paramedics somehow should be lumped with with teachers and construction workers, cause if it wern't for janitors we would all be in ****! cheers

Preamble: Memorials to honour fallen police, firefighters, workers My letter of complaint: [align=center:d01c5125f9]pres867@aol.com[/align:d01c5125f9] This is the public domain of the Figher Fighter Paramedic Union that Mr. Alex Forest represents and speaks for both groups "at this time" The sad part about this commentary by Mr. Forrest... if the Paramedics of Manitoba came out and belittled the Fire Services LODD the way he did. We "EMS workers" ... it would be stuping to a level we have never done publically before and a road I hope we as professionals don't follow them down. If anyone wishes to assist myself in an electronic letter writing campain to have this individual removed from his position....PLEASE FEEL FREE TO CONTACT THE ABOVE ADDRESS. This would be a good message in my humble view, my only request is that no "disrespect" be implimented, and please no "Toban's" respond, let the rest of us make a statement on your behalf, cheers and thanks all in advance. cheers and squinting

Eloquent. cheers

Rats a day late and a dollar short! Yes in the COPDer the studies are very signifigant that FEV1/FVC improves without the side effects of B2....AZCEP is quite correct (like he needs my ego boosting... .) There is a tremendous over usage of B2s ! and the profolactic use of Roids needs far more work in education. Sure Doesn't leave the EMS practitioner many options when the patient has had 37 MDI treatments prior to arrival. cheers

Ok we are really getting off topic here, but I will answer your queries as best as I can: Many longer distance transport teams use them in Canada...why not in the back of a rig? An ABG is positive factual data "not negligent" thats nonsense dude, are you saying that ABGs done in a Hospital setting are? Its still the "golden standard" and prior threads disputing bedside the use of Peak flows (by Rid) so just how do we quantify FEV1 in the ER ? Or are you just attempting to start a argument here. EYES EARS and Listening are JUST clinical observations and highly subjective especially when doing studies, in fact when the introduction of pulse oximetry the observations (a blind study with experiance flight guys "in your very own US of A") noted that cyanosis was not "observed until SaO2 was noted at less than 77%............hence the serious "world wide" introduction of this now accepted new vital sign. cheers

: Yea was poorly written, I am trying to explain the History in the use of Ventolin, it was good observation on the researches part to not just focus on the labour but all the systems affected..... any beta will affect "smooth muscle" its a physiological fact jack...lol. Berotec is another that has lost favour as well as Terbutaline, (yes, I know you southern guys still get it prescribed by GPs for Asthmatic cases) The reason that this Ventolin IV or (even S/S neb trialed in one ancient study) this has lost favour with the NeoNatal crowd is there are more effective medications with less serous side effects for the kid in utreo....( will not get into those really not applicable on this board) Pemature Labour and NICU transport Teams are the WAY to go with these gerbils and uncooperative Mothers. The placental barrier could be just "theoretical" we are very aware that narcotics are not affected by this suspected barrier. Are YOU positive ?.....My southern brother ?......So just how much change do you have in your pocket? I do take CC as well. :twisted: Frankly we know that Roids work but the exact mechanism is still NOT explained other than the fact that Roids stabilize cell membranes....hey when in ICU, and nothing else is working ....LOADING with ROIDs is a very common practice. Good point, add to the fact that just how do we evaluate "better ventilation/oxygenation" could we be talking ABG machines in the rig as well? An EMS study is frought with issues absolutely agreed. [hr:9a18f9b802] OH I hear you man, when your down to there! I too have no problem in giving it a shot....have never said I haven't used myself, justification is what I need when I walk into the ICUs and get quizzed. [hr:9a18f9b802] Ok who mentioned CPAP or BIPAP.....now this is thinking outside the box a bit! Instead of using a "medical approach" and it fits on CHFer, COPDers, and Athmatics......now if we could just find a Ventilator, that was multi-roled, Invasive and non-Invasive... that didn't cost more than Hammers tuition fees for 2 years. So just my 2 cents (and I know its off topic) but this would be where I would put all the cash "from all my winnings" ! ps, Oh yea that Gauntlet.... is more like a used Nitrile Glove.... :twisted:

Interesting points all: I believe in the PHTLS they are refering to non visualized airways, I have observed a few "Gas Passers" do this. But a moving target is going to reduce first attempt sucess, I suspect ? I like the SLOPE acronym and first time I have heard of it.....must be an eastern coast thing? LOL.

Oh sure, pick on the dumb Kanukistanian challenged by snow, ice and trying to find a doorbell on those damn igloos! :oops: Yes in this case (from the commentary and reported ascultation) more likely a LLL aspiration, but your point well presented the Right Mainstem is far more a favourite route for "peas and carrots". VentMedic enlightens us with the "chronic, bed-ridden" patient and most excellent comentary, yes, the BLS approach of suctioning with an Trumpet tube would (most likely) have been my first option as well, yet again, well stated the armchair quarter back is always correct post play! BUT the thing in VentMedics World "rumoured" is that when he flushes the Toilet Bowl it circles the OTHER WAY ?.... This point is also well made ( I failed political sensitivity training 101) far more diplomatic, so in conclusion, patient presentation a systematic approach and the possibilitys that one can not be 100% correct all the time was attempted by Overactive Brain, so + 5 on the Dust devil scale as this was a great teaching post, it refreshed my under active brain as well! Overactive Brain does post some great stuff and a very valued member on EMT city, hope I wasn't TOO harsh. This point: I must whole heartedly agree ! and it clearly demonstrates your willingness to learn and not accept a pre-concieved status quo notions.....I think its crap too.....perhaps "that" MD.... as specialists do thrive on this elitism idea. Perhaps this pulmonologist should get off his opinionated ass and do more teaching as well..... :twisted: Gosh darn good thing WE have the very respected ERDoc and his daily (almost) comitment to this board. ps Just in passing Overactive Brain...if the opportunity ever presents itself again, ask to review the CXRay this is a great learning experiance even though it can be most humbling at times, (I have been!) The difference between a Good medic and a Great one is never let bedside personality differences cloud your learning, my personal experiance has been that one recieves way more brownie points from ER staff when one is open minded. cheers

Trust hammer to show up out of the blue, and forward an interesting controversy; So a pleasant dream or nightmare? Sorry DOC and the rest of you: Mag sulfate is a trace element (elecrtolye as we know) it is used on spec. with those that may have nutritional or ETOH abuse PMHX in our CCUs. Poor nutrition has been linked with some of the population of asthmatic/ obese children. Fact of the matter is one needs a whole heck of a lot of Mag. Sulf. to see loss of DEEP TENDON reflexes. Mag Sulfate was used for years to slow premature delivery, but we loaded 4 times the standard dosage that one presently carries on car these days, for torsades. You know....... I can not believe that EMS and some ERs have jumped on this "BANDWAGON"... now..... for those evidence based medicine dudes and duddettes, I challenge you and throw down this gauntlet. 1- I bet $$$$ that for every anecdotal remark that Ventolin and Atrovent (concomitantly) is already on board as with "standard of care" in patient treatment and usually (MS) started within 15 minutes. So the question is: Just what are the peak effects/vs time with Ventolin.....hmmmmm....your going to tell me M. S. this is definitive conclustion to patient improvement?......please think again, cough, splutter, wheeze. 2-Your comparing 2 drug modalities at the very the same time and drawing the a concusion......NONSENSE! Your beating the horse with 2 whips, this so NOT science. 3- SHOW ME THE STUDIES! for every one you show me I will show you a study that disproves it, The first (study?) was a young asthmatic female that was weaned from a ventilator....this study is totally a shame and has absolutly no EMS application. 4- That said: the discovery that Salbutamol was effective for use in smooth muscle relaxation was FIRST noted in the investigation of "slowing of premature delivery". (the patient was also an ashmatic) ps Ventolin IV, in the gravida patient has not been used for years, and disproven to be effective for that condition, just to big of a "hammer" no pun intended. :shock: 5- For hammer...could it be that the uterus and smooth mucle (in the male airways) makes us more in touch with our female side ?...I digress. 6- The use of "early" use of nebulised steroids has far more promising with current studies...google it out, especially paeds. Ok: For the research crowd in EMS...a very rare breed....put together a study to actually study this supposed phenomenon in EMS....but medical legal ethical questions will get in the way....this I put $$$ on too. Off to soak my feet in Epsom Salts! cheers

This is a PCR format that I use, not that its the best, I have lots to learn myself, but a logical case presentation should be followed: C/F- Dispatch info Code's O/A- scene/mech/RN/MD Pmhx- SAMPLE bgl C/C- PQRST& assco.c/o CNS- APVU-A+O M+S function losses? CVS- perfusion, pressures, central /perf.- Heart sounds. ENT eyes edema reflex+consentual .neck CVS B/P perf.pulse cap refill PULM o/a, a/e , adventica ABDO tender/non-masses/rebound G/I G/U lbm / output urine bowel sounds. DERM -temp. color' moisture, edema. petechiae ORDERS M.D. RX prior/ RX HX Noted changes enroute. CXR,ABDO,CT,LABs,U/S TX V/S Urine output monitor,Sa02,ETCO2,ABG,12- lead Totals ins/outs-drains VENT-settings, IV rate/RX/totals # Bags I Vs & Type of fluids. Papers,belongings, INCIDENTs Police # Follow up findings.

Differential Diagnosis ? Ok, now don't take this as a personal attack, just constructive criticism is all. The case presentations I have seen lately on this board smacks of "did I do the right thing" and I believe attempts for others to empathize this its getting silly....Your asking for Diff Dx... when your not using a presentation that is logical. PERIOD. I will quote your own words.....which scare me a bit frankly: Your jumping to conclusions.....not Physical examinations and findings. Listen to the PMHX (when you hear the HOOF BEATS think horses not Zebras!) What leads you to believe that Pulmonary Oedeama is present when the pathophysiology of this disease (and your knowledge base) needs some serious reading, Excacerbations with Neuro Muscular disorders and Aspiration Pneumonias are not only "common" but the factual "top of the Hit Parade" statistically. Seriously flawed thinking, Lasix is NOT benign! You may have complicated electrolye balance "Nutrition for the MS patient is always a concern" for what reason would you diurese a patient with your stated BP findings? Am I just confused here or is your presentation? Ok justify why you think this helped her? PLEASE. 132 systolic is NOT HTN.....@ 50 years of age! So why no Diastolic.....this is very important and palp is notoriously 10 mmhg lower than auscultated? You have not included what meds this patient is on...BGL would be an idea too, perhaps a TEMPERATURE? OXYGENATION GREAT but what were SATs prior? Was there an O2 deficit, you state Laboured Breathing what was the rate? If you don't know your assuming? What medications again? LOC...? You state GCS of 15, with aphasia...very confusing. LUNG SOUNDS HUH? The most common aspiration problems are (LLL) when supine or the infirm patient. I would! But you have no positive findings......sooo: ED Nurse says "Aspiration Pneumonia" no doubt. and the ER nurse hinted that i was wrong for doing so. AGREED TOTALLY...... based on this presentation you should LISTEN TO THE RN she/he is telling you something here.

[align=center:e47ff87a50]Oh I am SO happy for you AK! I had no idea that one could legally marry a Camel. But your Elk is going to be so so Sad![/align:e47ff87a50] So I will volunteer to assist the Elk to deal with the rejection.....cheers.