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Gosh where can I join up ? To this crotch fan club ? You have got to me kidding me dude but that is the best joke I have heard all month. DocHarris: No way you would, I worked with one of THEM once ... its too hard to sleep in the same crews quarters. I guess I just can't sleep with the lights on. cheers

Agreed.

Sucrose is sucrose, Dextrose is Dextrose .... zactly go fish.

Try http://www.cardiosource.com/heartsounds/index.asp

Any one have the link to this article ?

AK I believe you have scored high in the procrastination portion ... On the other hand I scored very high in could not be bothered .... my bad ? cheers

Great, but a firendly word of advice .... keep it far away from your cell phone :oops:

Wendy, magnets are an attracting topic ... :roll: I have a very good friend that has a form of this, nerve stimulators and used in Parkinson's disease, Appears a magnet is used as a trigger so here's a link ... it certianly helps my friend, but its a bit beyond my scope or understanding how it works. http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01130.html On the magnet topic in remote settings I carry a rare earth magnet .. imbeded in an eye wand for removal of ferrous metal, foreign bodies in eyes, mostly welders helpers but I would not recommend this unless one was in a situation a long way from a proper slit lamp, florsine (dye) and marcaine or tetrocaine also included in my "eye" kit. cheers

This reminds me of a History lesson I recieved before I was thrown out of Texas, I believe that it was Paramedic Robert Waddel who clarified the words of Napoleans Surgeon (in passing he was a pioneer in many medical current practices even today) "Splint in the position of Comfort" was the surgeons directions to his litter bearers. cheers

Ambulance service broke; asks town for a loan to get to the end of the year Joe McWilliams Lakeside Leader The Slave Lake ambulance service is “out of cash,” a joint meeting of town and M.D. councils heard on Dec. 8. As such, the service is asking the town for a loan of $197,000 to get it through to the end of the year. The amount matches a contribution already made by the M.D. back in October. Ambulance society chair Lorne Larson explained the situation in a subsequent interview that it is not a matter of cost overruns. Expenditures are in line with the budget. “We experienced a downturn in call volume several months ago,” he says, “and as a result revenue goes down.” Larson says the situation is a new one and he’s not sure why it’s happened. “Maybe it’s simply an indication of less people working and getting hurt,” he says. But the fact remains the service can’t meet its payroll and needs the help. Larson says funding responsibility for all ambulance services goes over to the province as of Apr. 1 of next year. “All indications are things are going to be fine,” Larson says of the transition. “They’re increasing the base funding. Our challenge is to get from now to then.” Town council made no decision on the loan at the meeting. However, both councils requested the following: an audit of the ambulance society’s finances, an operational analysis of the ambulance service and a budget for 2009. If the loan is granted, Larson says he hopes the ambulance society would be able to pay it back, but that depends on the revenue situation. Larson points out that of all the essential services offered in the two municipalities, ambulance is the only one that depends on the revenue it generates. “We don’t expect the fire department or the police department to make money,” he says. “It puts the ambulance service in the position of competing,” with other activities people could be spending their money on. Or in this case, that the town and M.D. could be spending their money on.Westlock In other ambulance news, M.D. council heard from the Westlock ambulance people at its Dec. 10 meeting. Ambulance service secretary Darrell Garceau said the Town of Westlock is preparing to be the operator of the service under contract with the provincial government as of next Apr. 1. What’s coming is a “borderless system” controlled from a central dispatch point, in which Westlock ambulances could be called into service well outside their current service boundaries. “But they say service won’t be compromised,” he said. Nothing Garceau said indicated that the service needed extra cash to get through the end of the year. Not that there aren’t some financial challenges. He said the service carries $114,000 in uncollected debt at the moment. Then there’s the misuse of ambulance services, which ties up personnel and equipment. “We’re often transferring people that could easily be transported by a family member,” he says. “Or a cab. It’s always been a problem and it has to be remedied.” Councillor Brian Rosche asked what will happen under the post-Apr. 1 regime if the service makes a profit. What happens to the money? “The province hasn’t addressed that,” Garceau said. “We understand the service provider has to cover a shortfall; maybe it would be able to keep a surplus.” The Westlock ambulance has three paramedics and is looking for a fourth. It has three ambulances - the third is in reserve and manned by volunteers. Westlock provides ambulance services to the southern end of the M.D. of Lesser Slave River. Shane: Do you read your local newspaper ?

With RR of 6 bpm, its not looking good from the onset, Positive Pressure Ventilation ie (splint from within) would be my best advice, (watch the duck valve on the bagger and try to syc breaths) the old school use if external form of splinting does nothing accept give you something to before the patient expires, this depends on the size of the flail segment, but again if the patient is down to 6 bpm ... its not looking very positive at all, I would highly suspect "agonal" type resps. You need ALS providers and asap, with proper RSI capabilities, chest decompression (I use 10 ga. 20 will clot off way to fast) the use of PEEP (Positive Expiratory End Pressure) and very serious consideration to Hypovolemia as the costal arteries when lacerated can be a death sentence in itself. cheers and good luck with the fictious senarios.

I think we should ask AK to change the title of this thread to Alberta EMS is frozen in its tracks.

Well I know of at least one service that is now in dire finacial state of affairs, Slave Lake I was told by a little bird is on the "rocks" word has it that if the municiplly doesnt kick in because Liepert is not jumping up to the plate ... that there will be no paychecks for our brothers and sisters under the "Holiday tree" maybe Liepert is going to hang some mistletoe instead ? If you follow my drift that is.

CC: At - 28 C this morning I think you may want to rethink that .... but funny thing how errors can be made when wearing steel toed boots, getting in and out of the passenger doors ... oops. :shock: So while we are on the topic there is dang so many new pacers on the market these days, most of the patients either knew or had a little card in their wallets identifying just what type ... I could not remember all the flavours off the top of my balding head ..... So a little google search located this gem. 1st Letter Chamber Paced 2nd Letter Chamber Sensed 3rd Letter Response to Sensed Beat 4th Letter Programmability 5th Letter Antitachycardia Function A A T P P (pacing) V V I M S (shock) D D D C D (dual: pacing + shock) O O O R O A = Atrium V = Ventricle D = Dual (both chambers) O = None T = Triggered I = Inhibited D = Double (Atrial triggered and ventricular inhibited) P = Simple programmability M = Multiprogrammable C = Communicating (telemetry) R = Rate adaptive The first 3 letters are used most commonly. More modern pacemakers have multiple functions. A pacemaker in VVI mode denotes that it paces and senses the ventricle and is inhibited by a sensed ventricular event. Alternatively, AAT mode represents pacing and sensing in the atrium, and each sensed event triggers the generator to fire within the P wave. The DDD mode denotes that both chambers are capable of being sensed and paced. This requires two functioning leads, one in the atrium and the other in the ventricle. In the ECG, each QRS is preceded by two spikes. One indicating the atrial depolarization and the other indicating the initiation of the QRS complex. Given that one of the leads is in the right ventricle, a left bundle-branch pattern may also be evident upon the ECG. Note that a two-wired system need not necessarily be in DDD mode, since the atrial or ventricular leads can be programmed off. Additionally, single tripolar lead systems are available that can sense atrial impulses and either sense or pace the ventricle. Thus, this system provides for atrial tracking without the capability for atrial pacing and can be used in patients with atrioventricular block and normal sinus node function. Pacemaker programming can be performed noninvasively by an electrophysiologist or cardiologist. Because of the myriad of pacemaker types, patients should carry a card with them providing information about their particular model. This information is crucial when communicating with the cardiologist about a pacer problem. Most pacemaker generators, however, have an x-ray code that can be seen on a standard chest x-ray. The markings, along with the shape of the generator, may assist with deciphering the manufacturer of the generator and pacemaker battery. This may be helpful in the event a patient neither recalls the company nor has the permanent pacemaker card. Magnet Inhibition Placing a magnet over a permanent pacemaker causes sensing to be inhibited by closing an internal reed switch. This only temporarily "reprograms" the pacer into the asynchronous mode, where pacing is initiated at a set rate. It does not turn the pacemaker off. Each pacemaker type has a unique asynchronous rate for beginning-of-life (BOL), elective replacement indicator (ERI), and end-of-life (EOL). Therefore, application of a magnet can determine if the pacer's battery needs to be replaced. Further interrogation, or manipulating of the device, should be performed by an individual skilled in the technique. Patients should carry a card that contains information about their particular pacemaker, since these rates are dependent on the manufacturer and the model. cheers

If you have a stereo speaker in the truck that has a magnet in it ... but you never heard that from me, no, never, ever . 8) Cheers

Ever been to China ? Kind of a blanket statement there Kaisu. Rob Theriault would be the right guy for Ontario ... you can also contact him on the PAC website. In passing one of the biggest reasons that Canadians do not wright or publish EMS books is because the Market is just not big enough to make any money at it, the legal issues are far more relaxed generally speaking, but having worked many places on the north american continent and in a few capacities the physiology and drugs are very similar. cheers

Yea Bledsoe rocks !

Phil: Your a sucker for Blondes ?

Oh if I wanted too WAY more, I have observed so may screwups I could bash any so called proffessional group, some with more gusto than others ... oh and Paraidiots too ... I have absolutely no hangups about that little group either, all is fair game on the internet. Thing is I am not being insulting, RNs are simply secondary health care providers in the vast majority of cases, yes, some RRTs are trying to be more proactive but unfortunately are strictly limited in the majority of facilites to the medical directors, once the tube is in and secure or a ABG is requested well thats it at an arrest situation. RNs here assist the residence in some cases, but only the most senior of Unit Managers or CCU RNs will do anything but follow direction, the Gods still rule, the intesivists all have a different way to skin cats, ventilate, or wean, Monday mornings suck at change over. :roll: Specialty teams are that not the common denominator AND I don't do a lot of short hops, lately, I do know what its like for cell coverage at 42 thousand feet, unless its pure rescue or recovery with helo. I have no less than 8 medical directors sometimes it get confusing which one wants what some days, some ask for stuff I dont even carry .... so I just wing it most days. :shock: cheers sorry to the OP for going way off topic ... I have said enough in this thread to make my points, ACLS has been dummied down so much I am embarressed. :oops: Standing down.

And central lines already placed, triple lumin and CXRay, and invasive art line's, and bedside stat lab patient is intubated and on a Vent and educated support up the ying yang and aortic Ballon Pump around the corner, Nitric in the next room, Warm Dry well Lighted with Pharmacy and D.I. Angio down the Hall, and someone to clean up the mess. Just in the middle of the road, in the rain, in the snow, in the dark, first contact with this patient just the essentials (plus a lot of good folks that are looking at you to call all the shots and lead) and thats not just one patient too it could be a dozen .... The general concesis here is ACLS only .... is grossly inadequate ! cheers

Whoa Vent thats not your style, dont think you want to take cross border standards at all, as that would be a serious error. Is it bashing or constructive criticism, standard of care and maintaining competency are a hottly debated topic's in every field. I am saying the STANDARD in the delivery ACLS is of huge concern to me IMHO it has been sewered to incude Proffessions that will NEVER be providing these all inclusive courses. AND the cost for me easily exceeds $1000.00 every 2 years in addition to all the other registration fees I am FORCED pay to just keep my registration ... just wanting better bang for my buck is all. Exactly we are arguing the same side of the coin, the "examination" of ACLS skills should not take longer than 2 days but teaching it should take considerably longer ... point being they are not and without proper prep, ie being provided a real text book, thing is these days one CAN walk into an ACLS course no prep and pass ... pity. If the shoe fits wear it ... so whose fault is that then ? The majority of the ACLS Instructors here used to be Paramedics ... That were experianced and had actually worn that hat in conditions that would make the vast majority of other health care providers shake in the boots ... EMBARESS has jack to do with anything Some propigate the same myths too .... just as in EMS, We all have to look really hard at ourselves first. Jump On ? or just point out the differences of the different disciplines just what RN (other than an NP) or RRT takes the team lead role in any facility .. lets be realistic please. I must disagree the certification is the culmination of education, in my hood EMS is trying to change with the times ... generally speaking the new ACLS teaching needs more reevaluation and a serious focus to real frontline workers actually calling the shots ... I see the new ACLS standards as a failure ! And its not a soapbox, just my opinion. :shock:

I think in this thread that we should include ILCOR for completeness (sp)... as really this is REALLY where AHA recieves the majority of information to set standards in the US ... CHF Canadian Heart and Stroke Foundation in most cases just adopt AHA standards. .... pansies ! Can you believe that CHF new standards were held back over a year .... because of a printing delay, Europe was paracticing new Standards 2 years before North America ... wierd eh? Sometimes I wonder why I keep paying more and more for this "cert" and recieve less and less, and it means less and less or is it that we are just paying for the research to dummy it down. http://www.erc.edu/index.php/ilcor/en/ cheers

Firstly ... most RRTs are no where near your diligence level, that said the are educated in the principles of ACLS but are very limited as to input with so many MDs running around, they will keep up ACLS, or PALS or NRP only if it applies to their specific area ONLY. When I first started in multisystem failure ICU, GCS and level of inotrope's was not even mentioned in report .... the entire focus is pulmonary, and the majority of "floors" RRTs (placed thier for good reason) were no where near current standards in modern evidence based medicine, yes really. Frankly speaking a vast majority become very complacent and are no where near as progressive or assertive as the REMT-P ... Jung stated "one is a product of one's enviroment" something like that anyway as in every "proffession" there are good ones and bad ones. cheers

It just blows me away that RN instructors can teach this program when very, very few have ever actually run a code nor ever intubated anyone ... sheesh. Flash box ? Funny thing that's a BLS skill set ? I even had one bystander tell me we were not following 30:2 with an intubated patient ... hmmmm. Last course I was on a senario was presented ... Pulmonary Emboli .. The RN instructor told the student that "Coarse Rhonchi" heard over the affected side .. I quietly protested to the MD oveseer and it was never corrected ..... OMG shock and awe. Because they set the standards ? cheers