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http://www.cbc.ca/arts/music/story/2011/01/13/money-for-nothing-radio-play-censor.html Well check out this link ... they ban, but CBC news put a link to the SONG .... LMFAO. Look at the comments by "Real Canadian People" about this Moron Squad.

What is Canadian Broadcast Standards Council smoking or (not) smoking because they are defiantly sub thereputic with some type of medication for sure ... this is a rock classic, 25 years old and got a Grammy ... its laughable and highly likely it will increase CD sales. Lets see what other words can we ban / censor from our vocabulary ? What a joke ... now where did I put my CD so I can send it to CBSC because one person did not like a "word" used ? I guess the COMMUNIST BROADCASTING STANDARDS COUNCIL never listened to any rap or hip hop ? Should we ask them did they know that Sir Elton John is a self proclaimed <insert "F" word> ? And gasp Eric is wearing a "Pinko" suit ..... In protest of stupidity I demand that everyone clicks on this link, crank the speakers to: MAX ! Rock and Roll will never Die !

emtdavexnc ... your 17 ? get into medicine ! Volunteer in local a hospital, just to check it out. EMS is way too overrated, do not set your sights so low. cheers

Revival of old hijack ... the information posted and the 2 page power point production at the AGM states there is an improvement in approval by ACP members (those that took the time to do the survey) ... and all this for 12000.00 so I was informed by a friend.

Snow Chains ... enough said.

Greetings from Canada ... will you trade reindeer for a moose ? cheers

Might want to look at these \: Kendrick Traction: http://www.epandr.com/products/traction/KTD.htm CT-6 http://www.faretec.com/CT-6-carbon-traction-leg-splint-reviews.html Both are relatively inexpensive and work like a charm. With today's techo wizardry why improvise ? A good SAR team trains and has good kit.

This may be a tad more concise than my mindless ramblings. http://www.ccmtutorials.com/rs/PEEP/page7.htm cheers

Ok I'm in, except the quotations brackets part may be confusing, going to tru something different to respond appropriately. PEEP = Positive End Expiratory Pressures. CPAP = Continuous Positive Airway Pressure. Whats the difference ? really ? Yes fictious numbers would be correct, but the concept is more or less correct Normal breathing in energy consumption 5% of caloric intake per day, in Extremus up to 125 % caloric intake per day (just eye balling metabolic rates because we do not want to go there !!! Nice try: Part 1 not bad, Part 2 hmmmm ok ... improved V/Q match and an increase in FRC and directly out of coles notes in AHS protocols, but I don't understand the "fluid is gone part" gone where and how do requite more alveoli ... start a draught ? Care to try again ? Unfortunately it that does clearly explain why there "could" be a decrease in WOB as some "believe" in CPAP. Question: So could CPAP actually increase the workload by the right side of heart and hence more of an oxygen demand consumption ? HOPEFULLY A BETTER EXPLANATION: When NOT in extremus or distress as in normal breathing and during inspiration the WOB is generated by the diaphragm as this is primarily muscle used. (This of course will increases WOB when in extremus) and we all know exhalation is passive in Normal Breathing .. (than GOD because we would have to suck the Air out in CPR ... perhaps that will become new 2015 standards ? Back on topic less sillyness ... Sooo WHEN in extremus "forced exhalation" comes into play as is used as the body needs to move more volumes O2 in, CO2 out, lets call that Minute Volume (frequency x tidal volume = MV) now because we don't have time to wait around to exhale and need another breath (with just the elastic recoil of the chest and gravity) To accomplish this more rapid a respiratory rate the body requires accessory muscle's, purse lip breathing is the body's attempt to generate PEEP (ps auto PEEP is different) but the pursed lips and forced exhalation against this restricting mechanism. The forced exhalation breath out through a straw as you stated, is a great example. NOW if you don't believe me, that just CPAP alone doesnt increase WOB, dont trust me ... just go put a real CPAP on @ 10 cmh2O and then if you still don't believe, me go walk on a treadmill, you will get the picture. THIS WHY I STRONGLY ADVOCATE BI LEVEL SUPPORT for one thing better quality machine and will not have loss of PEEP ! In lay terms it is a PUSH opon inspiration instead of a gasping on CPAP as there is no volume or pressure support, as this offsets the WOB of the MAJOR muscle of respiration the diaphragm. Question back: Name 3 accessory muscle groups used in "forced" exhalation, 4 if you want 100%. Threshold PEEP is when oxygen transport did not correlate with respiratory mechanics or FRC. Setting an appropriate positive end-expiratory pressure (PEEP) value is determined by respiratory mechanics, gas exchange and oxygen transport. As these variables may be optimal at different PEEP values, a unique PEEP value may not exist which satisfies both the demands of minimizing mechanical stress and optimizing oxygen transport. <Whew edit late entry, after a coffee> I should have asked can you determine threshold PEEP, NO but better yet can you even MAINTAIN a constant PEEP value with average O2 equipment on ambulances. So when a patients Measured Minute Volume it must exceeded by a factor of 4 minimum, that is called a true High Flow System btw.<edit delete I:E ratios nonsense and say 1:4 is acceptable. So when one is breathing at 10 liters per minute, 10 lpm is extremis (normal MVs are average 3.5 to 5.5 lpm). Upon rapid inspiration and quite easily one can achieve 40 liters per minute, a patient can out breath or suck back for lack of fully functioning brain cell's at this juncture. ON ICU ventilators 120 lpm for flow rates are achievable ... that's to match the demands of a thoroughbred at a full gallop, if you catch my drift. So in order to maintain PEEP The machine/ device whether it be a CPAP device BiPAP or a Ventilator or even a BVM with PEEP Gauge, once again inspiratory flow must exceed the MV x 4 so that the end pressure is not lost, to zero. If you do not a device that can exceed the positive pressure during inspiration then "demand exceeds supply" (for the economists out there) then one cannot assure loss of so ask yourself when looking at any device is this capable of even accurately measuring end exhalation pressures or is it just set somehow with flows and magic theory's ? Because if it is not and no way that you can measure, therefore "you may" or "may not' be maintaining PEEP. Hell NO! Its not accurate, you can't measure it (unless you have a gauge in line and very unlikely) and its just its a cheezy spring ball called a flow restrictor, not a flux capacitor. So if you have no air flow OUT of the patient it will equalizes to zero especially true in low Minute Volumes. One MUST have true threshold PEEP to maintain, Question A BIGGY: What is the maximum flow rate you can achieve out of the wall ? And are you exceeding paietnts inspiration demand and is the I:E ratio short enough for the patient to drop go to zero ? ps on a BVM a little trick of the trade .. look at the duck valve if it looks distorted and push out end expiration and still looks like an "outy" before you squeeze the bag again you are most likely maintaining the "set" dialed number. What no guess ? - 5 for not trying This depends on the study one quotes from 12 to 14 cmh2O to measure clinically at bedside there is a way, pause the breath, turn set PEEP off the ventilator, occlude the inspitatory limb of the circuit, watch the little gauge and kinda guess .... or just hit measure auto PEEP on the plastic brain of the state of the art ICU ventilator. I include both this in my explanation because there is much controversy, I will trust the Puritian Bennet 640 or Evita. The Point being in most EMS applications of PEEP your not even close to matching the patients auto PEEP and this is the goal in an Asthmatic or COPD that to equilibrate and relieve CO2 gas trapping, goggle the term pendelluft. WOW how lucky for me second to last post from Gumby ... EBM studies on COPD patients in OZ ! http://www.emtcity.com/index.php/topic/16879-when-will-o2-truly-help/page__st__60__gopid__252055#entry252055 or http://www.ncbi.nlm.nih.gov/pubmed/20959284 No argument here .. See above explanation stop calling me at work ! Thats enough my Brain is going to explode and edit for opening quotes don't match end quotes AGAIN!

Michelle Welcome ! Yes you make a LOT of Sense and its my bet a lot of members on this board would enjoy the discussion ... I know I would. This is a very old topic in this area, (ie Oxygen when will it help) I would highly suggest that you start an entirely different (clink new topic) and then cut copy paste, maybe a title (I have Pulmonary Hypertension so why does oxygen help ?) This case is most interesting indeed and Pulmonary Hypertension as far back as I can remember, has never been discussed in any detail or a topic un to its own. I sense your not front line EMS or maybe perhaps you a dispatcher perhaps or a past EMT as I suspect it would be most difficult to work on a car with this disability. WE can learn a tremendous amount from our patients and before they get into trouble and need to call 911 or 999 dependant where you reside. cheers

Sorry I will try to be more concise and detailed in the future as you know this topic this topic is rather dear to myself firstly because well its the "B" part and not as simplistic as air goes in, air goes out, traditionally with Paramedic / EMT education that about as far in depth as it gets. The lack of recognition of Dynamic Hyperinflation has now been overly compensated by the new and improved (CPR standards and ACLS guideline's) DHI leading to PEA/EMD was a very serious concern unrecognised for years in EMS, or even addressed. If the throw this "carte blanche" CPAP device ON out of the plastic wrapper on to a real patient (reading the directions first on the insert of course and a 3 page follow the arrows and refer to coles notes ) Then to implementation a new therapy on a global / provincial level is huge folly, as I have stated before, this will be a huge fail for EMS EBM as I have stated. The 5 minute trial, and the do not use on COPD or Asthmatic ??? perhaps if it was proven that it works with EBM on PE alone then CPAP would be expanded ? I dunno but the logical thought process is flawed firstly, so only attempt 5 minute trial of NIPPV then go to directly Invasive Pressure Ventilation ? another Epic Fail in methodology alone and contra indication "PneumoThorax" being the justification, in NIPPV but not in Invasive Ventilation ? So do you see a pressure release blow off valve on YOUR BVM or on this B CPAP device ? Because if the patient coughs well big time interthorasic pressure again just saying, its not all good air goes in bad air comes out. I attended a "Futurist Lecturer " whateve the heck that is in an ACART convention, YES a very forward thinking College and ASSOCIATION (oddly just like the RN equivalent) Well this at a Respiratory AGMs (not just a one day don't answer questions and make motions, that will be overthrown by council day) but a true advocacy don't get me going about that group, I get hypertensive myself. Back on topic: Now with the demographics alone and with soon to be massive retiring baby boomers, yup the CHF/COPD crowd, hell even Ralph Klien is a self admitted COPDer, well someone ain't doing the math or lacks some serious Vulcan logic to decrease admission overall lower health care costs in the millions (if effective) BTW a extremely effective device with 2.5 of PEEP, to get an immediate bed O/A to ER and not wait in the hallway IF CPAP or BI Level support is to be effective and the bottom line with this "present govenment" is to lower health care costs (still shaking my head over that prostitution of the term in the scope of practice document) as bi means 2 levels not 2 lungs and only on inspiration, well just I had to laugh. I guess DON'T ASK DON'T TELL was adopted from the USA military "protocol" And don't get me going on whom is making these changes. IMHO the EMT level would gave no problems implementing this therapy as without the option to RSI/RSS they just get to wait till the patient crashes that said: provided the education like "gap" training was implimented as many provinces HAVE adopted CPAP for the EMT or PCP as NOCP/AOCP/SOCP/BCOCP as that will be interesting to watch, if you get the drift. The history of these terms and "modes" are subject to registered trademark ie BIPAP cannot be used because it is trademarked unless your using that machine, whatever anyway off topic, in real life the terms are interchangeable. Thing is I was researching the HDA for the OLD term's of reference for EMT or Paramedic which I guess has since changed ? In the old scope of practice was "the use of positive pressure airway devices" both EMT/ACP they should have left things as WAS ... just saying. FAIL. In regard to your comment about Paramedic education in institutes or clinical's it should be mandatory that the Paramedic student be in a "busy" ICU for minimum one week and not sit with one patient / RN but be running your ass off just like the RRTs! I have not only severe critique but also a resolution to the problem get experienced bedside RRT to develop a "special needs" course (for lack of a better term) teach the "B" part and dude no shock and awe about the exam banks I field questions every time there is a write but "good thing" their not asking about STEMI diagnosing or treating Well in comment 15 minute instruction on CPAP if AHS does not educate there may be very serious medical legal ramifications because everyone loves to sue government, or if one does uses this device especially the "bean counter selection of devices" your own ass may be hanging in the breeze perhaps ask your HSAA rep about that ? I am happy that I may have possibly affected the 3 or 4 actually reading this tread, and to bone up on this before your asked why you did not use this therapy, or did not. ps ASK for an explanation in any question and most happy to provide a short answer ... Bhwaaa Haaa Haa were did that evil smiley go ? cheers edit a bunch of times for spelling and lack of proof reading.

Well firedoc 5 A dream did come true, Susan B kicked Elaine Paige's butt ! http://www.youtube.com/watch?v=XbRRkyftbE4&feature=related cheers

Holy a revival of a really old topic, my opinion has never changed, if I am in an area where there is a potential a 2 way shooting range. If I am not permitted to carry .. then don't ask me to go in, bring them to me behind the wire. If I am permitted to carry ... no prob ... only question is what is issued and can I bring my own ? CSAR so what's your "choice" ... would like to know, am a big fan of 7.62 x 39. cheers

Sweet !

Was in my local mil spec supply store 2 days ago and came across this, 1200 CND for front and back, no carrier this quite a bargain if your headed to sandbox. cheers

And runner up of 2010 whacker of the year award, as long as the flight suit matches that is. Ok ok I so have scissor envy .

While we are reminiscing about the old days, one amp of bicarb for witnessed arrest, 2 amps for unwitnessed arrest. Ever use 90% etoh nebulised for Cardiogenic Pulmonary Oedema ? I swear it works but it is never used any more, a bit of a fire hazard possibly ? ps Mobey your way too young ! LOL.

The little knowledge part (and not intended to be personal in the slightest) is very problematic / legalistic, AHS has introduced a completely new treatment / device so has there been any education to go with this ? ps accelerating oxygen molecules like a jet engine works is also used to market this device I must agree with the EBM AHS protocol on CPAP and that the concept and implementation of CPAP (better and far more effective would be BI Level Support) that said: properly applied to the right patients with enough education by the practitioner to be successful as CPAP therapy and when a patient is in extremus this is practitioner experiance dependant success rate (something one can not very effectively be quantified) by any study. This has the potential to limit ICU ventilated bed admissions and decrese overall morbidity mortality thereby lowering health care costs but not this piece of CRAP CPAP, the AHS EMB links to CPAP justification and this device do not compute. Now just imagine if a patient died while on this poor excuse IMHO for a CPAP, and you with little or no formal education on it other than a few boxes and arrows AND the family sued or minimum a fatalities investigation, well your ass would be hanging in the breeze as would AHS. OK full points for trying to implement a concept but -5 for allowing purchasing for AHS to get involved. Then a few more issues as this $50.00 device requires huge oxygen requirements to work effectively and latest research (yes newest EMB) is indicating that increase in mortality morbidity treating the CHF patient with high oxygen concentration levels vs low oxygen concentration levels, one cannot adjust any FiO2 with this, and in passing a real CPAP device in ER is a bit more expensive. In my opinion without far more education and by a dual registered practitioner (say an RRT / Paramedic ?) This CPAP experiment it will fall flat on its face, and worse for entire EMS, if a study is actually undertaken it will reflect very poorly with "AB EMS" CPAP, if you can see where I am going with this. Again if we go back to "transition" again introduction concept without a true plan of action its very expensive (in passing) Question Hells Bells are you Pamedic or EMT level (as this does matter before my next comment's as there seams to be some current controversy as to who can use this device, and I cannot open the PE protocol link. In AOCP the under the scope of practice this "device" is NOT just oxygen delivery it is positive pressure ventilation, with no alarms if apnea occurs or if flow volume is impeded, most simply put device uses the Venturi effect or an application of Bernoulli's principle and it all goes for a shit when you have no forward flow. This is pretty generic stuff, does anyone wish to jump in and explain the difference between CPAP and PEEP just for example ? .. I would challenge that 90% of REMT-Paramedics to put a patient on a ventilator that is any more sophisticated than a Volume Ventilator with more than 3 coloured knobs. This is not intended to be a slam its intended to enlighten, as just 2 days ago had a phone call from a new grad asking the interactions of ETCO2 and minute volumes and how ETCO2 correlates to PH ... well that was a 3 hour phone bill. So a couple of questions fer fun: Does the application of CPAP increase or decrease WOB ? What is true threshold PEEP ? Can CPAP be maintained with a BVM a flow diverter with a spring and ball gauge ? What is average autopeep on a know COPD patient ? Should FiO2 of 1.0 be used on a COPD patient ? What is the statistical incidences of a COPD patient that is also CHF ? I think AHS really screwed themselves with this restriction ! Why can CPAP / BIPAP not be used on an asthmatic ? hint AHS is wrong. Can auto peep be clinically measured ? For that matter what is auto peep ? Should auto PEEP be matched or exceeded. Name 3 complication with the application of CPAP. cheers ps I know an RRT that is an REMT-Paramedic, flight and yes a fossil but that is a positive Health Care Activist looking to travel and work days ... sorry for all the edits ... I like making up questions.

Yak Tracks ... or a knock off .. don't re injure but do walk if MD allows.

It has been my experience as I too have had a meniscus tear the healing time is depedent on the tear .. i did not have a surgical fix ... btw. Agreed nsaid's and ice .. a cheap knee brace may help but watch for tensors as the can cause DVT. motivation of teens and pre teens ... are stun guns restricted items in your hood ? Fear of pain is a great motivator

On other EMS sites they are reporting that the 6th highest ambulance call volume recorded in NYC history ? I dunno. 20 inches with drifting is an real event here in Kanukistan too, although we approach it a bit differently, because its not a shock, its expected makes for good skiing and sleding (power that is) Personally I hop in my 4x4 a yota with my chains, winch and go out to pull folks out of ditches I am kinda out in the country. I do not do it for cash just fer fun, that said rhum I do accept as a gratuity. cheers

OMG watching CNN news you guys got freaken dumped on big time ! Hey ever consider moving up to Kanukistan we have way less snow eh! ok some days I just have no control over me fingers. Serious Question .. maybe get the Mayor to fund some tire chains for your buses for a repeat event. cheers

Well I am screwed then ! To OP: Don't "expect" anything accept being on the very sharp portion of the learning curve, that said: expect the unexpected .