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Quoting : usalsfyre If you've spent a few years in "lung school" as you call it then you should know that an ETT is not a device that prevents aspiration whatsoever. WOW ? Sure, it is a "better" device and reduces the chances, but it's not a secure device. Secondly, find me the study that shows a massively higher level of aspiration with alternative ariways than ETT in the cardiac arrest population. So yes I agree, a bronchoscope is the REAL rescue device, but it's not the common rescue device in certain settings. None lately, but long term ICU ventilation and a bridge therapy while hands are short isn't exactly comparing apples to apples. By extending your logic, we should be traching all these folks anyway, cause that's what they might end up with. The two devices mentioned are not suitable for long-term ventilation. But per your thinking, it's such a quick and easy procedure it should be no big deal right? Even though I only have four sets of hands to provide good quality compressions, secure an airway, obtain venous access (better go ahead and place a PA cath while we're there, wouldn't want to subject the patient to unneeded procedures and they're going to get one of those in ICU too), administer any needed medications, figure out how to remove the patient should we get and ROSC....I'm not placing an LT because I think it's the "best of the best", I'm placing one because it's the reality of care delivery in my environment. I don't believe medicine is different in the field, but you have to acknowledge there are delivery differences at times, this being one of them. As Bernhard noted, the thing is like a "super OPA". I can have my Basic partner place it (as she is credentialed to do) and focus on other more pressing issues. thus end's coffee driven ramblings.

< reason for edit> dang quotes again .

Frankly it always amazes me that AHA or ERC and ever-changing concesis of procedure protocol based on metastudies are the actual authority and gospel according to god himself .. meh. When one should listen to the "real airway specialists" in the OR, have yet to see an LT King in that place maybe a Carlens or 2, and very few LMAs either. From the link that Chbare so kindly provided:

Sure why not, use an LT King ... in a cadaver. 1-The LMA is NOT a definitive airway, it is a device developed for "belly empty" short term OR procedure's. 2- If this "could be" a viable patient then you will be subjecting the "save" to another procedure and piss off an RRT. 3- VAP- Ventilator Acquired Pneumonias (or procedure acquired) are the biggest cause of mortality in the ICU. 4- Using a positive pressure ventilating (plastic brain) without the gold standard ETT (closed system).. is a recipe for DOA. 5- Ever see an ETT "not passed" in every code in hospital ? There is a reason that no LT Kings or vagina on a stick are absent in the code cart. University of Alberta Hospital Canada (Dr. Brindley) any mention of LT King or LMA used ? ... nope. http://ecmaj.ca/cgi/content/full/167/4/343 http://bja.oxfordjournals.org/content/104/4/496.full http://www.hkmj.org/article_pdfs/hkm0708p258.pdf Permission to hunt down Wong et all and punch him in the nose ...

Firstly .. I believe you are seriously deluded that these "generic tittles" but in passing would also state that the PCP program in ONT is one of the best in the free world, I had the pleasure of working with a stellar PCP at a forest fire in northern AB ... what a relief compared to working with a EMR that did not know how to pull a cot out of a rig. Following that should we be calling the EMR level a Paramedic as well ? (for the US guys and gals this is a 120 hour course with zero actual patient contact) So just what is in a Title .. really ? Is it just arrogance or does it go way beyond ? I know that it does ... hope you can follow my rambling missive. Absolutely disagree with the generic "Paramedic" title used for all levels, although at one time I voted for this with PAC the PCP, ACP, CCP levels the rationale at the time being "the public was confused" with EMT and Paramedic ? Was the public confused .. NO,and in hind site which is 20/20 this has just added to the confusion and I believe delayed the development in any government run system period ! The reason I regret my vote is this is because of the British Columbia experience, where every Ambulance has "EMERGENCY PARAMEDIC" stencilled permanently on the side. As a the direct result of this has the public believing that EVERY gut wagon has a real "PARAMEDIC" inside. This is false advertising bottom line ! the typical Joe Public in BC does and still can recall the days of Gage and Desoto, and is expecting the same ... btw that TV show had tremendous positive impact on the psyche of the North American Public. For an example compare AB vs Ont experience and the number of ALS services in rural and remote areas, then get back to me, hell out of Kenora the level of care on board many fixed wing Air Ambulance is PCP. There is simply no rational medical justification that every Ambulance in Canada should NOT have the ACP level, why should an urbal taxpayer have a superior level of care compared to the rural taxpayer ? Look to the Canada Health Act guidelines, under assesibility but I digress. BTW the OPAL studies are HUGELY flawed, funded with the intent to "save government money only" and if you don't believe me. I have managed to convinced Dr. K. Westley (JEMS) of this (with the assistance of a bottle of screech) and he has since reversed his position on his initial meta-studies. In fact the vast majority of these BCAS trucks just have a silly flash box and a tank of O2, maybe Entonox (if they have that endorsement) so just compare that to AB where the "generic" ACP is packing RSI, Cardiac meds, narcs, and TNK. Quite a difference in level of care is it not ? It is very unfortunately the outcome studies have never been undertaken "remote vs urban" ALS vs BLS because they do not HAVE rural ALS in BC, it could be a real eye opener alone with a patient satisfaction survey in pain control alone. IMHO The BC government (or any government operated entity) adopting this singular term has without doubt delayed the development in the provision of Advanced Life Support to rural communities. I am very concerned with the AHS (AB) "takeover to perfection" following this BC lead we are witnessing this in may areas ... ps just ask Mobey . Opinion -> If one has worked in "remote" BC .. the arrogance of the run of the mill PCP is at an all time high, you may find this to be a very true statement when and if, you BEorP get to work in industry and see for yourself the WCB / BCAS influence ... meh what a mess. New Topic The term "DOC" I have worked with the Americans that have "traditional" military background, this term is used as a right of passage for a field medic with their platoon or unit. Initially I had some difficulty when I was called "Doc" until it was explained that it was a positive sign of acceptance within a tight knit group, bottom line this is a compliment. I was called "THE VET" i.e. Veterinarian one day by a very senior Safety Officer at a rather Large Woodland Fire Overhead Team meeting, he was a true horseman and most sincerely this title used was one of the biggest compliments I have ever received in my entire carreer as Vets are educated not in just one mammalian system, but every critter under the sun, (very applicable at a Forest Fire btw) they are the top ten percent of all those that apply to the "medical" fields. cheers ... VET to the 2 legged mammals.

Just my 1.02 cents .. the term "medic" up in industrial igloo land is way overused .. everyone is a "medic" from the 120 hour Advanced First Aid course to Critical Care Flight veterans with all the merit badges .. Meh no point in getting panties in a twist, it will not change. There is another term used here and that is "Band-Aid" because in the vast majority of providers that is the entire scope of practice, unfortunately that is the high standard that most blonde, zero experience, zero patient contact, 19 year old bimbos have set. I prefer Ambulance Driver myself

Whadyahmean ? .... rambling is my middle name I guess Ok will dust those "items" off, headed to land of smoke, blisters, bad teeth, sore throat, caribou, mossies, smoke ... and did I say smoke ?

You should have seen the mess before I actually fixed the multi quote deal ...

I think you answered your own question, and I have no idea why I am even posting this ...

Ruff you should be asking an immunologist or an internist this is not a EMS level query (although reaching out, keep us posted and I do hear your concern very understandable.) Things like is he on steroids, or has he been, his serum cortisol levels, neutrophil and band count +++ and a biggy with PMHX of ticks is Lymes Disease as this can be very difficult to diagnose as well.

Sorry Toni I have to disagree with all of your points to rationalize this position, I will not go into anecdotal stories, of I saw this once and that guy .... All gradate Paramedics DO HAVE field experience,called field praticums and hospital clinicals but guided and supervised by trained educators, so the students don't kill anyone, because they "didn't know" just like in a thing some call MEDICAL PRACTICE.(ps because that is what we do!) Show me ONE only "book trained" not evaluated in the field, Paramedic, and I will show you a failed education program. Besides the fact that "parroting" pneumonics is SOP in basic EMS .. this does not teach critical thinking, diffencial diagnosis, or evidence based medicine, this is how to teach monkeys. IT IS THE BIGGEST SINGLE PROBLEM with this so called profession and if we DO NOT ABANDON this stepping stone education concept EMS is doomed to be first aiders and falsely glorified "life savers"

This is funny ! well almost. So one needs time with ill patients with ~ 120 hours of training and you call this "clinical experience" ... can you not see the glaring error's in the educational philosophy alone ?

Correction(s) <insert lame excuses> some days I should actually read what I write before hitting ADD REPLY ! my bad ? When I see "old wives tales" perpetuated by a body that regulates, examines and believes they are "world leaders" .. simply stated I loose my fricken mind ! PaC02 < 30 defines hyperventilation (see Shapiro) CCP = ICP minus MAP Mean Arterial Pressure ICP (being a fixed value in this case say > than 20 mmhg ) ps I can't believe Dave didn't bust my balls with these glaring errors. cheers

Dr. Westley is very forward thinking, well for an old hair growing out of his kinda ears guy, but he can drink the occasional rhum too, well so I am told ... lol. I personally would like to see bedside Troponin CKMB and Myoglobin ... oh wait I already do !

cheers GGB = Good Grief Batman

Agreed or consult an advice column.

http://www.collegeofparamedics.org/pages/home/default.aspx?id=2013 try ha;f way down the page on the ink. In a word ... anaemic.

For now a reprieve ... just waiting for an election to be announced. Kiwi I would remind you that any good democratic self governing body should have a knowledgeable critic to keep things honest, anything less is called a dictatorship. ps http://www.emtcity.com/index.php/topic/20036-acop-agm-2011/

Go to the ACoP website it is mentioned in the webcast.

Some late thought(s) 1- the "melon" size in relation to child's body is not similar proportion to adults, you may wish consider that in your calculations. 2- A firm back of head pad, the idea of using a soft one is all wrong in the Z shaped pad in KED. 3- I am a true believer that we should NOT use a chin strap (airway airway airway) as in the mandible is a movable joint for one, and if they puke they can't open their mouths so perhaps entertain a zygomatic arch type strap as in the Oregon Spinal System, part of the SKEDCO system, although this is demonstrated on the military educational video it (zygomatic arch spilt band) is not mentioned in any of the links I could locate on goggle. http://www.skedco.com/ 4- HAND restraints ... those lil buggers can extubate in a new york heart beat the second your looking some place else. I have on a back-country rescue (ATV I hate those POS things) used my OSS on a 10 year old .. and it worked out ok although blood soaked nylon straps needed a pressure washer and soaked in clavicide when cleaning up.

Have you actually lost your home ? I know this will not help too much but from my experience tornadoes and hurricanes are far more destructive ... I hope no lives are lost. The diversions in Manitoba Canada did help, the flooding of those that were "to be sacrificed" was no where near a bad as initially predicted ... Ah Mother Nature in action and man trying to influence a woman. nuff said.

EYEDAWN ... 110% agreed ! The whole "marketing concept" of energy drinks is misleading, they are simply stimulants, reading the label is highly advised. Vitamin B in 5 hour can be found in a thing called a proper diet. Again: If one wants Energy try FOOD like the basic sugar's found in a thing called fruit. YES I know this term is strange to some .. but you get your vitamin C, roughage, pectin, and K+ and they taste like they are actually from nature. Personally I like these things called Oranges or Grapefruit ... very cost effective too A cup of naturally derived caffeine like from coffee or tea have been proven not to be life changing either, when flying "E" call out in early dark AM, I would provide a few chocolate covered coffee beans to my pilots (they loved them) and I coined the term "Go Pills" no strokes or cardiac problems recorded. OR continue to spend your very hard earned money being duped by multinational marketing schemes on very overpriced trendy garbage, ps the mark up on that shyte is over 90% profit alone ... MEH. cheers

Dear Sad Dwayne: So you are imprisoned, very offshore, on semi submersible rust bucket with hungry sharks circling ? So let me get this right: You have a compter with internet access on board the wifi connection, and skype that actually works and your whining about no hand held device ? .... yes most seriously you have a problem .. your an electronic addict but damn lucky ! LMFAO. Buddy in some of my deployments there is zippola except for satellite phones and I pray I could staple messages to a FED EX Raven or Moose unfortunately they are very unreliable. That said and depending how far out you are in GOM, one can entertain the possibility of a signal booster, (a yagi works to amplify signal if you have very poor signal) I use that and/or a big ass 10 Db gain antennae with AirCard adapter because in some of my deployments very "remote and austere" as the company man will not permit we lowly band aids to use their systems, except for report's that have to be flash "driven" and sent to the topside EMS operator or medical director, via the Safety Doods. Dear Dwayne: My last deployment was sleeping in a tent, no heater (not by myself I may add) with snow overnight, then clouds of mossys so thick one needed an IV hep locked to stay off the frequent bouts of hypovolemia, where the bears that have awesome camo (white) and electronic fences around the camps that trap them inside the compound (very different perspective when using the term's) "safe behind the wire" or "a green zone" then with just one sat phone for comms ... btw go with iridium, globestars suck. ... so on the Turnip scale + 4 for being an electronic addict.