tniuqs

late edit .. dang chbar beat me to the punch line ... again.

Hmmm interesting presentation, age ? colour ? V/S ? ECG ? SPO2? ETCO2 ? First I would support A B C ---> then look for other reasons in decreased LOC, most likely do another BGL, would I give a half an amp nope not these days. I would try to rule out CVA, Head Injury, MI, ETOH, or siezure as one could be actually increasing morbidity/ mortality as direct result of pushing D50W on spec. Counter query .. if this was a know ETOH abuser would you push D50W on that patient too ? Late edit ... could you answer the first question I posed ?

Dear little pee pee hater: This last post a perfect example of the methodology implemented by crotch .. PSTD ---> morph's into ---> ADD (brought over from another thread) ----> then morph's into ------> Single Mothers raising children (because that has some relevance to ADD) ----> morphs into Black single mother's raised children ----> A very predictable identifiable pattern of behaviour apparent with this poster, as to HIS agenda. I do love the statistical studies reference to support his agenda but other statistical studies are are incorrect and based on opinions, well this is what I call ______ you fill in the blank.

Interesting post crotch ... so if (dependant on scope of practice) Paramedics could treat hyperglycemia in the field for a suspected MI and the "studies" indicated improved mortality morbidity, then how would one know or what signs / symptoms would one use ? Your point on QA/QC and due diligence is taken at face value, this should be a given but worth mentioning if one is starting out and you really have nothing to add to thread at this progressive juncture. The days of treat your patient based on "just clinical observation" are just about over in EMS this "old school teaching point" has been taken out of context, it was if I can recall way back when. It was do not defibrilate a patient that is sitting up and talking to you .. oddly enough now, that we can cardiovert we actually do treat the machine, the wonders of modern science eh what ? The reason why we are now viering away from this old school concept is because of 12 lead ECG, Pulse Oximetry, ETCO2, the Masimo rainbow COHGB, iStat ABGs, Stat lytes, Troponin, CPK, Myoglobin (bedside testing) field ultrasound and who knows what next . D50W and 2 amps bicarb .. wow you really are old.

Awesome news ... I am 0 x 1000% convinced and am on my way to become a Buddhist and practice Voodoo this very minute. I believe that is due to chance .. anti-chance .. just saying. And as if marketing does not affect " Read My Book On My Conspiracy Theory" or "Watch My Interview" bandwagon because that's not a cash cow either. The best and most informative was that the "governments" invented AIDS portion .. wow very enlightening that. Perhaps look back to his 1600 + posts and use your own judgment. Yes, I too know a very few pple that agree with his perspective in this area, some believe in magic too and that gogi juice cure's cancer, unfortunately they are too swayed by sensational journalistism by poorly educated individuals that profess they are experts, voicing options without real facts. This when he know very well that a few are personally far more adept and personally experienced in daily life on these hot topics, is cause to believe that he may not be, what he professes to be.

Oh yes physical insult does so much for self esteem in my books, it gives proper correction to the child and it proves that your bigger and stronger as after all, might makes right. Maybe take the blinders off that some children turn out just fine with a one parent family, could you give us your insight and in-depth understanding of child psychophysiology into the cause of that curious result ? I am all ears. http://www.medicinenet.com/script/main/art.asp?articlekey=52516 http://www.raisehealthyeaters.com/2010/08/think-sugar-causes-hyperactivity-in-children-its-probably-this-instead/ http://www.playnormous.com/blog/?p=179 http://en.wikipedia.org/wiki/Hyperactivity cheers is that enough crotch ?

Rodger that ... I liked the "tribal" bling thing you did as an incentive back a bit .. will kick a few pesos myself if so required. cheers

Just kidding bro .. I typically stay at Sproat up island .. and at the Dog and Duck pub I am considered a "local" But will PM you if headed out that way fer sur.

I do pay attention to expiry dates on milk ...

Hey Hey .. hold on there sonny ... knitting is very therapeutic and make excellent Christmas presents. ps What size of sock do your wear and do you like rainbows ?

Now that is way better

WHAT ??? No where is the rope, where is the tree or screaming for guillotine .. I am buzz busted ! Seriously this taking an EMT course to become a Bucket Fairy is like baking a cake and expecting a roast beef to come of of the oven. (ok that's the best I have today) Dood new guy, straight up you present yourself very well, excellent questions that many just don't know how to ask nor answer. I really hope to let us follow along with you if you choose the EMT B program someone is always here in EMT City to help. I can not add much myself to the excellence in advice prior... except one thing . When the Pain exceeds the Coping Mechanisms you have intrinsically ... go to friends for help .. they will get you through. cheers ps I think we should have a EMT Student of the Year award ? What says the rouges gallery ?

Yes your probably correct, ERDoc he really doesn't really need my 2 cents to embarrass himself, he does do it so well on his very own, I believe that maybe some day crotch could change his spots .. I do have a little hope left . <late edit> the asian and voodoo are better that western medicine .. I guess thats the way he was brought up, so pass the tiger penis, bear gall bladder, snake blood and maybe a rhino horn for ED ... just saying. I added the link for those that would like to see what my respected countrymen / woman have to say in brief about the matter . Fortunately for myself, no close family members are afflicted by this affliction, of the truly unknown etiology. I do empathise with those that do, I really wish I could do something to help and fighting ignorance is all I can do I tried very had to educate about thimerosal when I was involved with H1N1. cheers

Mike you calls em the way you sees em

Yes I am with you crotch lets stick with supposition, hearsay, opinions based on religion, the occult, voodoo, conspiracy theories, dead chickens, warts are caused by toads and Jenny McCarthy. COME ON SERIOUSLY I can not believe you are a Paramedic, and best not eat a can of tuna .. nope you look why. http://www.cps.ca/english/statements/id/pidnote_jun07.htm

Hate to tell you your ARE EMT City faculty

It would be nice to get Paramedic spelt properly in the link .. ask LS about "donor" cycles .. its not the driver most cases its the other drivers. How does one transport a patient after a response ..on the back ?

Funny in a black humour sort of way Richard. I just remembered I had 4 video guys and one PR gal in my Zodiac (doing a Swift Water Rescue Standby) during a flood is southern Alberta a few years back.. I was attached to RDSAR. Funny thing to, while launching the boat (I really didn't want 5 extra) only 2 was my initial offer to RCMP liason but the 2 teams were TV competitors so I caved just to show them the dikes ++ that was done by the community to prepare (it was stellar really saved 500 homes) Ok so I stepped off the Boat, it got hung up with all the extra weight, into way deeper water than "expected" I was soaked to my chest to get the boat free ... shutters were clicking maddly, buddy with huge ass camera was STANDING when I was telling him NOT to move in the boat with currents and debris and hidden obstructions ... so who's very red face ended up in "Breaking News" ... well live and learn . Here is a pic of them .... tit for tat I say : Securing a floating propane "pig" with FD ... no PR dudes that trip for obvious reasons re risk.

BCAS and CUPE ... they intricacies in the way they pay you,well makes my head explode OMG give me a day rate or hourly rate and its all good yikes. Sure hope your getting more than 2 bucks an hour to pack a pager and not visit the pub for a cold one. Good Luck, in your new station and if I ever get out that way .. well first round is on me btw have you got a place for a tent ? I pay my camping fees in fish and dungeoness btw LOL.

Firstly: I am always curious about the FDA placing "expiry dates" on bloody everything, just how does metal and plastic in a sealed plasticised sterile container go "bad" in the first place, other ther than exposed to direct sunlight, moisture, and getting beat up in a soft case. I send all my 'expired" whatever's to a NGO organization that I support and all the stuff (especially dried Antibiotics in sealed vials, they are VERY happy to get those) go to humanitarian 3 rd world crisis zones. Where are my manners .. Shalom EMT -P Israeli, first post is always an opportunity to welcome. Apologies in advance to OP for going off topic a tad, I do not presently have an IO device on my truck and would very much like to hear the the advantages disadvantages that providers have had. The EZ IO was on a car in I worked but never had a opportunity to use it, have only seen the BIG inadvertently discharged into a "students hand" during an in-service (not the best impression from day one).. the spring actuated I would believe is not as superior to hand control for a number of reasons. WE had some excellent Israeli's on this site at one time (IMHO the more diversification world wide, that we can get the stronger we become as a profession through communication) speaking personally your system and education is seriously excellent for some rather obvious reasons, the triage system and transport is simply astounding compared to where I reside. I would love to visit again sometime soon. (my piggy bank permitting) Gosh it is HOT there. WE had (past tense) a friend that was a great contributor to this EMT City website and we learned much from her, a great heart and worldly prospective, many of us communicated for years with her. Call sign asy she was (a wannabe Pirate) has been missing in action from this venue and very sadly for quite some time, she is in my prayers that she has not become a statistic in one way or another. ... ok enough smultz ... back to the IO convo. cheers

Hmm sad to hear re your patient.. I see your point about a predictor vs is treating hyperglycemia and outcomes .. I think that cortisol levels do have a lot of direct influence (most honestly its beyond my pay grade) that said this innocent query has really got me looking again, so thumbs up to the OP for asking what initially perceived was a benign question "in my view" live and learn. jstalmm .. I see your relatively new to EMT City ... so a hearty Welcome, it appears from your post you have some very valid things to contribute, I would encourage yourself to participate more often.

Has anyone checked out Bryan Blesoes website lately ... some great "handouts" on 02 (controversial) and EMS myths about trauma ... check it out .

An excellent find have learned something today I do remain sceptical about elevated BGL in any arrested patient for any length of time, this will undoubtedly result in decreased BGL, due cellular metabolism, complicated by anaerobic respiration, lactic acid production +++. besides I am under the impression (could be wrong) there are accuracy limits when typical BGL evaluation in regards to PH. We have come a long way from drop the blood on a stick, wait a certian time and compare &quot;colours&quot; to now with jump drives that do record keeping graphs and spread pages. This topic has really piked my interest in regard's to delivering hypoglycemic agents at the critical care level in the field during cardiogenic shock. If cardiogenic shock is being treated and hyperglycemia is documented. I will now be doing BGL on all Chest Pain even if no IDDM is the history, I did not in past. I have been doing bedside troponin as a diagnostic guide and am pushing to get these on car in my hood. Evidence Based Medicine now entrenched in EMS / AHA these day, this study is suggesting that their is a decreased morbidity mortality. Could this study be pointing the way for improved delivery of pre-hospital care ? That said, the study is a prognosis indicator and not if relative hyperglycemia &quot;treated&quot; reduces mortality, (from what I read) then of course funding for a study in EMS .... hmm well ..... not a lot of cash for that these days. Second thought getting into the books / studies, the increase in blood glucose is marginal (~ 9.2 ) to be using a typical insulin sliding scale (yup and controversy there too) as the sliding scales are used in know IDDM only, then, giving insulin SQ with decreased perfusion. Well it could be more more complex for my lil bean. Historically insulin has not been used to treat hyperglycemia in EMS, bucking the old school could be an issue as well. Perhaps other hypoglycemics could be trialled, maybe worth some time in a follow up with a researcher. I know one a few doing transplants with islets of langerhan in livers at the University Hospital in Edmonton and having great success. cheers

Well you go for it 2c4 ... my tax dollars paid for it and I am not bitching about it in the slightest, good work that would have been a bitch to lower by winch to scree slope on the approach and a ton of manpower without a fling wing long line system, btw its part of National Parks mandate to provide Public safety / Rescues at no cost .. provided its not negligent or criminal behaviour that incurs a rescue. Just imho and have been that goat on a ledge on broken limestone .. its more of a hazard to even try to roll onto anything other than a genie bag .. most of my limited experience was in a crevasse's and impossible to do much of any anything spinal other than C collar, then again most were body recovery's and frozen like peepsicles. (most are prior to this SPOT GPS identifier came on the market, very good insurance. I use an EPIRB on the ocean, but not a lot of remote back county any more these days.

Firstly ERdoc ... brilliant I have forwarded to others that lecture on this topic of EBM. Army Grunt ...you make a awesome point, in my hood the EBM new improved "protocols" many time become consensus of Expert Opinion, and in meta studies very often the conclusions drawn and "exclusions" made usurp the most important factor of good clinical observation .. root cause of Diabeties was discovered when ants were crawling in a dogs urine, Pulse Oximetry by a scientist cuting his finger in non destructive testing of building materials .. Salbutamol in a premature delivery .. the list goes on and on..