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Just how many times do qualified experianced RTs have to post this to get it to go through thick EMS skulls ? No offence to the OP intended at all .... In fact in studies that I have personally been involved with the bubble or wash bottle in 50% of the time "in hospital" the set O2 flow rate (@ the thorpe tube) and (delivered O2 flow at mask or nasal cannula) were lower due improper threading, humidifier bottle to the top, threads on wash bottle to thorpe tube, and blow off pop off valves. Besides the possibilty of the tap water (yes !) or N/S or distilled H2O carryng bacteria . zactly ... do you need Higher FiO2 ... use the BVM... ps the reservoir should not completely empty upon Ti. Do you need Humidity ... use an DAR type filter between the mask and the BVM, should be using these types on all patients btw, for your own protection, you guys do work in Ontario dont you ? ... remember the SARS thing funny that the HERT team never amounted to jack shit ...OMG. And Caution using any "field" modified device your just asking for Medical Control issues ... best be very knowlegable before even attempting, that said sometimes one does have to improvise in a pinch. There are Hi Flow Masks on the market now ... but I doubt that too many services are going to fork out the cash for them ... plus more ER staff will just chuck em out when they get to ER (protocol You Know) ... ie education issues, moreover. In fact N/S nebulised can cause broncospasm, fact is anything nebulized can cause this and the last thing one needs with upper airway burns. Agreed, hands down the criticality of burns jumps up markedly, and increased mortality/morbidity takes a huge jump too. . On the same page Ventmedic, studies with a wash bottle and on less than 6 lpm N/C this OPTIMALLY adds 4 % realitive humidity, with high flows even lower relative humidity contact time issues.

Use the search engine in EMT City ... lots of threads already. IMHO ... PEPID.

A Question raised with all of this very interesting thread line, (sans the TV medicine) bedside troponin has been used for more than 6 years (blood test variety) that I know of in ICU/CCU as it is far faster when the lab is less than "stat" the saliva tests are the new kid on the block from my understanding are being developed for a plethora of "tests" recreational drug field testing the major focus .. thanks but I sure want to stay away from that item ... I hate courts and I have Lawyerphobia. A point being is that we as EMS providers can test all we want but does it really benefit the patient or change treatment modalities in the vast majority of cases ... and going the cost effective disscussion here. 1- For a short hop in an urban enviroment, IMHO not really, with the present trendy concept to door rescueplasty asap .. that said if one is in that situation and has that option available. 2- For the more rural or long distance transport hell yea ... this sounds great if its not delaying transport but seriously but unless you are carrying thromolyitics is there really a point to doing more field diagnostics that will be repeated in the ER for liability reasons. 3- I suspect its where one is very remote and has the capability to use thrombolyics and all the goodies ... well go for it, thats where I enjoy working the most. Second query just what regular service in Canada is even attempting this routine bedside Troponin ? heck out west very few progressive services even carry clot busters because they are but typically are too "close in" and only rare occassions do they even attempt to contact medical control until their rolling in the gut wagon. With the MDs wanting to see for themselves before they push TNKase. Now Bedside Myoglobin would be a great multi use bedside test, although most on this website (with that comment) would know what patient it could be important diagnosic factor but I hardly think a spit test for that one just yet ... sorry rambling. cheers

Ahem, with current political correctness shouldn't the term "Holiday Party" be used, would not want to offend anyone not of your faith (sarcasm)... OH so don't go there, it is so out of control bending down to every minority group ... that is not my Canada, I want a change to say Christmas Tree, without getting bashed. Um don't see the analogy there, as this so called dictator was dully appointed by his party, they were voted in. So without tableing a National Budget and a non confidence motion on a money issue, could it be that other parties were pissed over other issues FIRST ? I believe this has "once again" supporting a seperatist group has polerized ALL of your Canada, just respect my opinion that Western Canada has had enough "dictatorship" from the east ... well most anyway, Freaking Nutz has her opinion too. With the numbers coming in from the pollsters its not looking good for the Liberals out here, nor elseware, as this where the deep pockets are in reality and very needed to not have the rest of Canada fall into huge ressesion. Just think about NFL and their leadership, he's dictating to the masses vote anyone except the Conservatives based on what again ? When it comes to understanding parlimentary procedure, most Canadians could give a rats arse concerning all the legalese, all they want is responsible government, we saw it before and with less support. cheers

The plot thickens.

I have to vote YES in that poll, not because Mobey wants a overly loud muffler ... its because as a student and a working guy .. he can't afford to fix it ! Got to strongly agree with Vent on this comment: Rumours have destroyed very good peoples lives ...

Oh yea it is today - 22 C ... BUT if the poll asked have you ever been lucky after a "B" shift party, well that would be different thing entirely, I am old but the Hydraulic's still work 8)

I am more than dismayed, that the Liberals would not cooperate to make a good government, Layton held the deciding power ... ps there is a reason that the NDP have never been voted in a majority government that I can recall, and this is the first time in history that Quebec Separatists (and do not have a dully elected seat in the house) are getting into bed with the arche enemy the Liberal's and Yes you should read the post from the get go. So you are saying only one MP from Alberta to represent in the House now ... because that will be the reality if the coalition is successful, we voted for winners but they got trumped in a gang bang, the people spoke. With Layton suggested as being the Industry Minister honestly shock and awe I bet big buisness in Ontario will just love that idea ... hmmm. We still can have a Canada without Quebec (btw not all Francophone live in Quebec) If its their wish to separate then "who are we to dictate" on the other hand "or be dictated to", that's what democracy is, the majority rules. I have a very good friend, he is more than tired of paying over 53% of his earnings in tax that he has no tangible say in where those funds go he is taking his Family and leaving Canada. Honestly thats just a bit of a media spin actually 62% in total "voted for other parties" with a pathetic turn out to add. I bet there will be a hell of a lot more next election, maybe this what is needed to fire up Canadians to get to the polls. DocHarris I would challange that statement there was oil/lumber/grain and (whiskey) with prosperity 25 years ago, Alberta is a has been since Lougheed. You know what gets my GOAT, the transient workers from other provinces, there are many due to the selling of the oilsands, they earn wages here in Alberta but stressing out the infrastructure, hospitals, roads, social services, +++ and then file their taxes in the province where they reside the taxpayers of Alberta are left with the tab, even NFL is considered a "have province today" I tell you if that happened in Ontario tax laws would change in a new york heartbeat ! But the reality this is all very simple, no matter what I want "personally" I am guided by whats in MY "wallet" and so should the government so if the budget does not get approval then we all loose. Give the Harper Government a chance.

Well interesting topic ... I guess I am a looser, so nope never ever @ work, period. cheers

Are they still using doors ? ... some days I just can't help me fingers .... :oops:

Vote for the Man/Woman ... not party politics ! Sir John A. Macdonald is just still just drunk and I bet rolling over in his grave trying to get out . Rep by Pop. or Rep by $$$ Get that point ?

Yoo Hoo: spenac ... the defense attorney sucked ... I defy anyone to prove that other than a Halo or the Use of Chemical Paralytic agents that total immobilization without any movement can be never be accomplished ... then there's those pot holes in the roads that "ambulance drivers" have no control over. When the prostituting (spelt correctly btw) attorney stated "whoever" lied ... the defense should have provided a better explanation, and jumped all over his arse ... Any tangible proof that a LSB prevents further injury in the Literature or an expert in the field to jump up and down ... don't think so. Good Luck with that as the reason the patient needed "Spinal Restriction" in the first place now theres your problem. cheers ps I do not know if this is an urban EMS myth on the origions of the LSB ... ? I was once told that getting Festus (after he got shot) to the Ole Docs room above the Saloon and Festus was too bad shot up to climb the stairs .... so the Sheriff Dillon used an old door ... ah Gunsmoke a true classic and why we use the LSB today. :oops:

Agreed: There is no means of way to state that the LSB actually prevents "possible" further spinal injury, in fact dependant on transport time stress ilieus has been a factor that has just started to be evaluated. mobey looks like you have read the ACoP position paper ... thing is there are better devices than the KED .. very old school in fact ... ever see the OSS ? Oregon Spinal Splint ....? Big thing with LDT and on board is one requires far more sedation to keep the patient comforable, my preferance is a Scoop or Clamshell as the BC types call it. cheers

Oh I forgot ... President "elect" Obama so lets see what happens if the other US parties form a cooperative and throw him out of power ? Well besides Obama wants to renegotiate NAFTA .... with the President of Canada. Should we tell Obama that we have a Prime Minister and second we don't know WHO it may be this week or if he will need a translator ? sheesh.

DocHarris: You have made some great observations and points here, I must agree with you the best times for the actual People of this country is when there IS a minority government, ie the Diefenbaker/ Pearson era ... and a little thing like universal health care solidified this country, and gave us a distinct cultural difference (although Alberta Consevatives are doing there very best to change that, sorry off topic) I sure wish Tommy Douglas was still around, I wonder what Tommy would say about the current state of affairs of EMS in this country .. I bet HE would be on our side ... I digress. Zactly .. but odd that just because Harper won the " High School Prom King Title" doesn't mean that the rest of the kids can swarm him like the true school yard cowards they are .... it WAS up to the official opposition to play the game with the fair rules, they stalled the country before and this is why the election was called in the first place. I agree keep things honest and keep things economically fair odd that Harper actually kept the promises he made during his first campaign ? add to that fact a Western based Conservative that are Honest Politicians, well pretty obvious whom I will vote for next Groundhog Day. Because if Dion does not cause me to Stroke out ... he has Struck out ! Green Party and there policy over Afgan Land ... then many of our Brothers have died for NOTHING! cheers ever notice my avatar ... it will stay till they all come home again.

Sorry Kat your correct my reading skills do need some improvement .... but you stated: Well we have the Liberals, the NDP and the Bloc all in bed causing this impudence, with a partizan Gov. General faceing getting cut off in more ways than one, and now the Green Party getting all friendly with a bloodless coup. Hey Neither did I, I couldn't get to the poles because I was working in a area where there is no provision to vote ... other than staple it to a passing by raven, but, federal prisoners all got to vote and my taxes pay to feed them. This Country has gone tottaly upside down with rights for everyone under the term called diversity, well except the tax payers/ voters. QUESTION REMAINS .... Will You vote for Harper Now ? ps I like lots of real butter on my Popcorn. Again your right, maybe time to close the slam the door out west !

Well its a bit tatered and but no oil rig on it ?... The borders need far more definition, maybe stretch it from Manitoba Border to BC ? but take out the King squint thing ... President ELECT Squint, thanks in advance. Hey I got an Idea ... declare democracy in Afgan Land, have El Qaeda and the Taliban plus a few warlords for good measure have a "back cave meeting" to form a COOPERATIVE .... then you can come back to Jasper and become the villiage idiots helper ..... couldnt pass on the comic relief either cheers I will buy ... Like always

TSX/TSE .... whatever, the lowest thats what CBC reported, shoot me please. Sorry I didn't see Foxworthy on the ballet, I wanted to Vote for Bubbles ! No win for the Liberals well you got that part right ... No win for Canadians would be a more truthful statement btw the Governor General was appointed by the Liberals .... need a bit of a history lesson their Kat, remenber all the other french speaking laywers as previous PMs ... a patronage scandal, an AirBus payoff ? cheers

But: Chuck Stahl can do the math it seems ?

Please remove the "are you smarter than Steven Harper advertisment pop up" I did not see any hate pop ups with Obama and McCain ... show some respect please ! Thanks in advance !it is possible to loose ALL Alberta Medics contributing to this site, as if Dion is successful then Albertas Members of Parliment will go from 27 to ONE! Alberta is the Economic Power and faces no input for the future of Canada. http://www.paramedicweb.info/ipb/index.php?showtopic=4670

Dont know if you are following Canadian politics ... but I know in Western Canada are about to take up ARMS for OUR Democracy! This is Bullshit what the HELL are we fighting for in Afganistan if this is happening IN Canada!

Well interesting topic really: Rule#1- In Canukistan "Girl Guide Camps" are exclusive to the female plumbing, if you are not of this flavour then one can not provide medical or any other services for that matter ... wierd eh ? A girl can be a Boy Scout due to a rights challenge in court here, but a boy can not be a " Girl Guide" nor even a REMT-P Father volunteer to assist in a camp, don't get me going. Rule# 2- I did a paid standby for Junior XXXXX Rangers ... co-ed, 14 to 18 y/o more or less if you are doing any assesments on a female, make dang certian a female leader is present. Rule #3 OTCs ... regs much more relaxed here, I provide only one dose ... AND assure that med is taken before my very eyes, then ALL must return for reassesment and insist that a Leader be informed to drag their asses back, sometime's kicking and screaming ... this is called the "Positive I Want To Camp Sign" ! :twisted: RULE #4 .... Never, Never, Never turn the lights on in the Ambulance after daylight hours ... it attracts them ALL like moths to the lights ... I "think" I twisted my ankle 12 hours ago, I have a "sore" knee since I was 7 y/0 , I have a cough ... >insert phoney hack< for 3 months ? ... and the list goes on, actually quite entertaining at times cheers and document document document ! My biggest worries are the Cooks and Camp Staff for serious medical ... can you believe a ETOH withdrawl DT's ... one did the funky chicken for > 8 minutes and "just" as I drew up the Sux (lots of versed before that) did he take a breath ... a "campie" narrowly missed chewing on plastic.

snakemedic: I think its a bit more complex than that, just imagine one Base for ORNGE competing for the call volume of another base ... but this is the typical situation from what I gather in the US ... correct me if I am wrong please. When will Government in countries with a social service network ie public health care (its IS their wallet in most cases one way or another) get it into their heads that ANY "privatization of services" under ANY "guise" for ANY services delivered to the public does cost more to the system than operating directly under a Governmet department ... It would be very interesting to see the actual numbers, budgets and capital expendatures levels of care around the globe ... why reinvent a wheel or model that has already been successful, in most cases we cant look across a border or a pond to see how its done, what do the do in Israel, OZ or NZ for example ? Perhaps a research study paper on a cost analysis or mortality/morbidity outcomes ground transport vs rotary wing transport rural ... that could take the some of wind out of the rotors .... BTW: I do not believe the very flawed OPALs (antiquated now) again look to the future: 1- Pain management, hugely improved. 2- Thrombolyics on-car, they do this in the UK. 3- Proper RSI drugs available to "play fair" in comparision with GPs in Rural ERs (to capture Airways) 4- Hypertonic Saline ++ These could make a huge impact to decrease mortality and morbidity for the ALS provider (RURAL) in Alberta Canada, as a proffession we should strive for improvement in delivery of services and look to a future not past Ambulance Drivers that we have been called for 3 decades . I say AGAIN there has never been a "GOLDEN HOUR" this has been concept has been fabricated to promote Rotary Wing operations in the US, with spill over elseware world wide. In Alberta there's has never been such a critter anyway well unless you can be grounded in and the "case" is already in an urban setting. Its more like the SILVER 4 HOURS of Trauma, AND the silver tongued devils :twisted: Choppers are again just a TAXI to get an experianced ALS provider to the patient, nothing more, nothing less. cheers

Yes: Common sence is no longer Common there Doc. Have your tried the higher tech Gore tex socks they work great when fording creeks, SAR work or hunting in the "skeg" ...ie muskeg ... :wink: I sure wish we had a Cabellas up here ... take the Wal Marts back please. Laura: the deer are smarter than drivers in some cases ... :shock:

Ah the antifreeze application A study was done by the US marines in BC the Whistler area concerning socks .... did you know that the vast majority of people wear the wicking type socks the WRONG way ... fuzzy stuff should be worn to the outside as this increases the surface area for evaporation. The feet should be about 5 to 8 Degrees F lower than body temp so as not to have the feet perspire wet=cold... the concept of keeping the feet "really" warm is a actually negative factor in survival in cold enviroments. I no longer use my -140 C boots (called the High Level shuffler's) unless .... I will be living outside in the winter. The in and out working in gut wagons hot, warm, hot, cold, warm, cold again is a tough one but change of socks when feet get damp is the best way to avoid frost bite. Off the topic but once my ex ... was shopping for me for socks "NATO" type and being blonde to the roots asked the clerk if there was red or blue ones ... ok so only the military guys and gals will get the humour in that. Mobey I wish it would stay below freezing because this freezing rain and the deer in rut causing havoc was at 2 roll overs and 9 fatalities (deer that is) just driving home from a job. cheers