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NICE ! First off I am more upset with myself as I explained but I did not have a crystal ball at the time mine was out at the cleaners ... the title protection thing I get pissy about because it was in part my error and cannot be undone, Canadian governments have and will capitalize on this and that is my bone of contention with me don't take it personally. Not really upset in the slightest man, but sometimes tough love is more productive, remember your on an international website, that can also be viewed by your fellow workers and your employer. Back to your thread , don't hang your hat on the term "angina" as Dwayne commented as all chest pain is not cardiac related as you do know angina is relieved by rest, O2, and nitro. .. but HEY now you know STEMI, Troponin, and have truly factored in your responsibilities working the gut wagons is not the most gentle of professions, sometimes best to learn on paper as opposed to a court room ... they are not forgiving. Quoting Lone Star, kill them in the classroom so you can save them in the streets. ps now here is a fun ecg deal ... http://www.skillstat.com/Flash/ACLS_Stat531.html on your way to become an ACP. The biggest point I wish to make is excessive use of L+S, I receive a daily brief on frequency of MVC Ambulances world wide and in the USA its abyssal although I believe that media plays a very negative factor in reporting ... please don't make yourself a statistic that I have to read about especially on this type of non life non-threatening call. You just learned a huge amount and unlike some others I did not have to hit you with a stick and cause a deadly bleed. PCP it does take a set of balls to come back from harsh pointed comments like that with a concise explanation to myself and Happy, exactly where you are in your career and were you want to go, the OFA is showing big time, you do have smarts to become a great PCP and then beyond but PCP set your sights way higher. cheers

Damn you Dave .. now we get a BP ! cheers

Yup I am Happy now cheers

Ok is this just my computer but when I went to this post there was 2 posts and I thought the topic was dead .. or perhaps folks had "cold feet" about posting, I then clicked reply to ask if Dave had dropped off the planet. But no, in the reply section there are 2 more posts ? huh ? Have I lost it or is there a computer glitch anyway just plain weird. These "shots for hemoglobin" deal is interesting was that erythropoetin or iron ? And on metoprolol with a BBB as this kinda controversial, especially with severe PVD and then zythromax do you mean zithromax ? This is not typically a commonly used for community acquired pneumonia as first line bug juice, unless C+S has identified something atypical ... anyway lots of metabolic complications here and time for an internal medical consult with corresponding blood workup stat. I would hazard a guess his lytes are out of normals as well, but if this is a "paramedical" type call, its time to pop in a line or 2 in line, O2 to improve oxygenation, get buddy monitored ECG and ETCO2 and a real BP would be nice too, (for some treatment options) I would also drop his bag of fluid and use gravity to decrease his distended abdomen, now with this the Peritoneal Dialysis ... has the patient no urine output and complete Renal Failure ? Recap: So buddy is looking shocky, 3 pillowed orthopnic, indicative of CHF, thinks he going to die, a high respiratory rate very anxiety, well heck I would be a tad anxious myself if my SpO2 was 84 on R.A. besides the suspected associated anaemic hypoxemia .... this is a load and ski-dandle kinda call. If I were a betting man I would be very concerned about a AAA / dissection I think for the worst case situation, prepare for that and hope for the least complications. Now if patient was a AAA and high up as well as both extremities being cold, so in the back of my mind thinking that cross clamping would not be an option, for surgical fix and a centre that could do bypass would be a better choice for destination facility, (if I had that option) ... but then this could be a stuck fart too. If it is this severe back pain and a rapid onset of decreased circulation to lower limbs, the above scenario well frankly speaking this is way over most Paramedic quick fix solutions. I doubt very much I would complicate with narcotic meds at this juncture, as we still have NO BP quite yet. cheers ps Aussieaid just me, but I do not think I would include GB as a deferential dx the onset is much slower and from my experience, respiratory involvement is best evaluated with beside spirometry and besides, mortality morbidity from Gillian is very low, this patient is sounding way more acute. Can we have ABG too if that's not too much to ask ?

Richard B the EMT I see a "Fail" here, but I can't point fingers. Yet. Well I do and I LOVE NEW YORK CITY cause no BS ! Agreed and quite embarrassed actually, but why ? That is because I voted to re title EMT and/or the P1 (in BC) to PCP with Paramedics Association of Canada (that was 16 years ago) and here we are today and now a "PCP" cannot interpret a farking lead 3 ECG first degree block and admit to this on an international forum for EMS professionals ? <insert head slapping noise> Well I guess I failed so many years ago to believe that "what was accepted at that time in Alberta was the standard Nationally" so FAIL SQUINT bad, bad SQUINT ! And here and now the Ontario PCP are most likely better at interpreting a STEMI that I am. I FAILED to recognise that the government(s) would prostitute this title to cause less confusion I was so wrong .. I have allowed the general public to be under an illusion that when a truck has "BC Emergency Paramedic Ambulance" on its side but does not have an ECG that can not display a rhythm is simply terrifying for the future of Paramedic profession, btw PCP "nitro" is in actually your scope of practice too ... you know just in passing. Major link worth reviewing. http://www.paramedic.ca/Content.aspx?ContentID=4&ContentTypeID=2 Link to competencies. http://www.paramedic.ca/Uploads/Area%204%20Assessment%20and%20Diagnostics.pdf Link to medications lists. http://www.paramedic.ca/Uploads/Appendix%205%20Medications.pdf rock _shoes: Sorry man no mercy here on this stupidity and bring on the negative reps from the politically I should be more correct crowd. I feel a complete shred just maybe tough love is what is needed here as a tune up, yeah think EH ? no LOL at all. So Best Advice their BC PCP: READ and EDUCATE yourself before continuing to embarrassing yourself and MY country, YES see above rock_shoes is 100% correct, interpretation of basic ECG rythum's is a National standard for PCP, first degree block is a basic arrthymia, therefore logic dictates that you are sub standard please pull up your damn socks. Agreed absolutely no excuses allowed, I believe some ripping is needed too ! This in Kanukistan is a legal responsibility called "due diligence" or in fact criminal negligence so FAIL HUGE besides as rock_shoes states there is an 110 inverter on board that truck, or was that broken ? ps BCAS is damn near completely standardized in every unit throughout the province. Excellent point(s) Dwayne an unwanted and unneeded adrenergic response, (ie Adrenergic means "having to do with adrenaline (epinephrine)and can lead to a fast heart rate this is called tachycardia and increasing myocardial oxygen demand, btw Dwayne that explanation is not intended for a pararescue ninja. Now one shot of nitro pain resolved chest pain with elevation in STEMI and an elevated "TROPONIN" level, and transported with an RN, BC is such an interesting place. No information provided in this senario indicates any life threatening distress, the patient is NOT in extremis and to pick it up L+S .. well this just increased your speed and statistical increased incidence 20 % for an MVC is that a good practice ... fill in the blank. Disagree ... an absolutly Stupid Rhetorical question did PCP ever ask the RN if L+S was required ? PCP do some "thinking" and "personal research" on the terms you wish to quote BEFORE asking questions because this thread is exactly that, rhetorical. You have failed in every thread where I have taken my efforts and sometimes extensive amount's of my time invested in YOU to be polite and educational, unfortunatly you have yet to answer one basic question, don't believe for a second that this culmulative effect speaks volumes. FAIL in legal knowledge and understanding of your scope of practice, and pure observation, that being that cold, clammy and pale says a lot about a DX when a patient is complaining of Chest Pain, you don't need a machine to tell you someone is circling the drain and needs diesel bolus. . So ok teaching point just what was the underlying ventricular rate ? You are trained in taking pulses as a PCP aren't you as that would be a vital sign or perhaps look at the pulse oximiter reading, also scope of practice, so normal B/P ? hmmm .. so why am I getting an impression that we are talking with an OFA level 3 ? So If this patient died when under when your care and in your truck (no matter the RN present) you would look the fool @ fatalities enquiry, possible criminal negligence as well. Did you write a PCR report with no information on it too ? this is absolutely no joke, EH ! Wrong answer the RN stated and again you are as responsible for that patient's condition and knowledge of vital signs as the RN, you must perform to the level of your training, period, and only if you had an MD or ACP on board assuming responsibility written and signed would you NOT get slammed in a "shotgun legal suit" just saying. Good job something learned, you can have a non STEMI and have elevated troponin levels as well, just because one has elevated ST segments does not "absolute indicate" that one is having an MI, a prior Bundle Branch Block would be one of the exceptions. TROPONIN :http://en.wikipedia.org/wiki/Troponin_test When chest pain via SL nitro relieves chest pain, this is typically be called angina, now if the call went well all in all then why generate a question ? Should I mention I am trying to quit smoking, nah that would just be an "excuse" myself for being pointed and opinionated and have pride about my profession as a "PARAMEDIC". cheers

Oddly enough Alberta has come full circle back to the term "Protocol" my dear tree hugging friend, these new improved EBM studies and analysis of meta studies done in tim buck 2 and of which have very little bearing at all on OUR population, in fact dummied down hugely to be laughable so contact OLMC when you don't even have cell service to patch for Toradol ... WTF Over? In a perfect world (and back to the OP) where in scope of EMT and (I must agree with annie)EMTs are not "personal care assistants in long term care" in fact are not trained in geriatric medicine or even how to give granny safe bath (for the most part) put EMT to work in the "emergency room" (that's the E Part isn't it ? ) With clear rules of engagement, not at the whim of a RN, but how do they expect an EMT to work and be in 2 places at the same time as this is true lunacy of it all. I do believe that EMS can become more of an integral part of Health Care but NO one turf war group especially a union, should have any influence on ones scope of practice as the glass in a window or the door is not a legal dividing line any more ... what so ever. Just speaking for this province, allowing NPs and PAs ACP's EMT's to practice (full scope) in Hospital certainly would improve care and be far more cost effective overall, will that happen well not with this {PC government it will not)IMHO. YES it is our sandbox so then why are we letting others dictate ? Most Honestly this all falls back to what Dust had said so many, many times we in EMS would have arguments on how to organise a blow job in a whore house. cheers

RS: Do you still believe in this analogy ? end rambling rant.

What that a home wall mounted CO monitor ? Or what is referred to in the new RAD 57 http://www.masimo.com/rad-57/ as in SPCO refered to in Fire Fighter rehab protocol, have yet to see a box load of those devices on car. I have question about discontinuation after 15 minutes down time ? is this cost cutting ONLY ? I have a question as to the "dial a drip" ... with epi ? sheesh not me I would rather count a 60. I have a question about narcotic max for pain is this down town EDM / Calgary or at marker 45 on the Icefield parkway on in a bottom of a coulee in Drumheller (super cell reception)I have myself this question of OLMC how does that work at 28 thousand feet in an Alberta Air Ambulance? call STARS ? <insert knee slapping noise> I have a question since the "SS" is heading up this EBM, these are "opinions of meta-studies" no volume expanders? Well the CAF is using them why not EMS in AB Canada ? No HOB up 30% in Head Injury .. using Ketamine to intubate with suspected increase in ICP ? interesting. So all STARS for every red patient? Oh btw Mr Stelmach ... so STARS is a supposedly not for profit operation right, ... but they now have control as to who and what responds. When the red blot clot flies do they not get reimbursed so following that fuzzy logic, isn't this kinda like the fox running the hen house ? Is that not "a private health care operation calling the shots now" most very curious that lottery dollars now being used to dispatch Air Ambulances ... just wait till that hits the news ! I wonder where they put the TNK in the cupboards (most likely beside the $15.00 bedside troponin tests ???) ... sure is going to be difficult to administer TNK and even if the 12 lead is transmitted to OLMC if you don't have ANY besides ALL the EBM studies are saying that PCI and TNK are equally as good outcomes. Well I have many questions the CPAP studies quoted for one are not studies done by a $70.00 device .. nor was this cheesy device ever approved for use in hospital by respiratory therapy evaluators for Alberta Health ... this is just BS and boasting from the manufacturer (accelerating oxygen at the molecular level like a jet engine LMFAO !) and the Israeli studies are not worth the paper they are printed on, there studied states lasix, B2 and ipatromum +++ were also used) as I have posted prior. Now the latest and greatest folly "attempting to restrict" a L + S response to the speed limit and come to full stop at intersections .. that's going to be difficult to do #!%! WITHOUT WINTER TIRES ! Why doesn't that hit the news ? ... RCMP have the best of the best winter tires ? why not the Ambulances ...its not like we dont have ice or snow in Alberta. A commenter on CBC news called "paddy boy" and I must concur .. AHS took a system that was one of the best in the free world and broke it. Throw this Government OUT they are killing people in the Emergency Rooms (documented) and are now trying to do it in the field.

Is not "education" a degree in of itself ? I believe this is one of the great downfalls of any EMS Education system, allowing a Paraidiot and especially a new Grad to teach without an "education to teach". Just because one has "taken" this or that course does not equate to being competent at teaching the course, BLS or ALS levels. As for SEE One, DO One, Teach One. Yes an MD philosophy BUT with the previso that this is not the first occasion this or that procedure has been discussed or reviewed, Interns / Residents do not get the opportunity to practice a procedure unless the have the background .... sheesh, I believe you have taken this out of context as well. A good Instructor should have confidence and the proven ability to teach sucssefully, in fact any new instuctor should be mentored as well, as teaching the future of this profession should not be left to new Grads needing a lesson in humility, wtf ? I can not not telly you how many times I have heard a "Student" attempt to explain something that they "believe they understand in detail" as a direct result of a POOR instructor making shit up ! Fireman 1037 have your actually read some of the threads in this forum ??? That lesson should (if needed) be taught by field preceptors, frankly even the assumpion and gross generalization that and I quote: "to humble fresh out of school Paragods" is somewhat distasteful. cheers

or STONED ? jk ps I have no excuse.

Richard: It was moreover a query to the single Medic Fly Car as this was Mr Woo's preference . Just wondering how he managed to provide ALS in a single person capacity, this is leading towards something, to be quite honest. cheers

Holy off topic batman .

So how do you like working an arrest by yourself ?

Yes Lone Star also informed me of my social faux pax, so I am blaming my blonde hair for it ... te he. cheers

Best Blonde Joke EVER ! An old, blind cowboy wanders into an all-girl biker bar by mistake. He finds his way to a bar stool and orders a shot of Jack Daniels. After sitting there for a while he yells to the bartender, 'Hey, you wanna hear a blonde joke? The bar immediately falls absolutely silent. In a very deep, husky voice, the woman next to him says: Before you tell that joke, Cowboy, I think it is only fair, given that you are blind, that you should know five things: 1. The bartender is a blonde girl with a baseball bat. 2. The bouncer is a blonde girl. 3. I'm a 6-foot tall, 175-pound blonde woman with a black belt in karate. 4. The woman sitting next to me is blonde and a professional weight lifter. 5. The lady to your right is blonde and a professional wrestler. Now, think about it seriously, Cowboy. Do you still wanna tell that blonde joke?' The blind cowboy thinks for a second, shakes his head and mutters, Shucks No ... not if I'm gonna have to explain it FIVE times ....

Interesting how treatment (and diagnosis) in Trauma evolves in war, but oddly EBM takes so long to hit the streets ? I would like to suggest a book that was recently provided to me by rock_shoes. http://www.amazon.ca/Fob-Doc-Ray-Wiss/dp/1553654722 The Book is called FOB DOC (Forward Operating Base Doctor) a Captain Wiess of Canadian Armed Forces Afghanistan (in passing all proceeds go to families of injured and KIA) the book outlines how successfully ultrasound can be used in trauma alone. http://www.dmpibooks.com/book/fob-doc The book explains just how valuable ultrasound can be for rapid dx and intervention in Mass casualties situations ie Pneumothorax Hemothorax or inter abdominal bleeding and central line insertion. I want one !

http://www.waff.com/Global/story.asp?S=13676701 Laura Elizabeth Pullam EMT dead @ 29 years of age LODD. God be careful out there everyone.

Hey nice boots there ! I like the zipper with leather cover as my old mid zipper type that I used, would rattle like crazy, so not good for sneaking about quietly. Word of advice: spend the money and get a good boot that fits well, everyone's feet are a different "last" boots are the most important part of anyone's kit.

Well Kalm ... if everyone was as thoughtful as you the world would be a better place. Merry Christmas Mother Kalm.

Anthony ... I don't know if you will get Whacker of the year but this thread is making my eyes water. It just keeps getting funnier, LMAO @ Dwayne's Blue flight suit.

I know it scared me as well. edit for spelling: Queen's English. cheers

PCP you may want to remember that the title "Paramedic" in the American website Emtcity is suggestive of an ACP or CCP where you reside, a bit of an anomaly on a world wide basis. cheers

Are these the ones ? I so have to get a pair !

Bhwaaa Haa Ha !

Dear Richard: It doesn't appear that you have failure of shift key or spelling Richard. I must whole heartedly disagree, as I believe that any request for assistance for career investigation needs a bit of clearer direction as to the expectations of "this" or "that" profession. Proper use of the Queen English would be most helpful in getting across one's point. I would make note than any of the positions that I apply, the condition of employment is fluency in spoken and written language as well as computer skills in word, excel and spreadsheets. I am not saying that by any means I could write a best seller but let us be reasonable and give positive direction and not the political correctness of tolerance in modern day lazy text jargon. On that note here is a link to some free software: http://www.brothersoft.com/downloads/spell-check.html .. can with a k .. their instead of there ? ... eves ? ... dat ? The poster is stating that they are in a city college and doing personal growth, language arts may be a very good start. cheers