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But then again it could be the well know syndrome O.S.P.S. Commonly refered to as One Sick Puppy Syndrome. So do I win a prize ? Like a all expense paid holiday vacation to Afganistan? :shock: I have not seen AK in a while. 8)

The oxylog 2000 isnt bad kit, the venturi can save a lot of O2 on long flights, and it actually increases inspiratory flows (but numerous documented failures out of OZ from failed exhalation blocks on the 1000) with PIP of only 21 .... I would either get Vts up trying to keep them under 40 cmh2o to correct PH and/ or add some bicarb, about Bicarb 3 amps in d5w ~ 200 to 300 mils per hour but he will not tolerate Ph of 7.30 for too long, shocking kidneys. Try another sedation regiment ... as Profol is metabolised by the liver and this fella took a to the liver, maybe its causing the hypotension. Maybe some uncrossmatched blood too as Hgb is just 11. Yes absolutely related to the trauma, looking back your asking for a working dx? Can't really hang my hat on it, but if the urine is a tad on the red brown color (vin color) then I would be swayed towards a working Dx of Rhabdomyolysis. cheers

1200 is for Wonder Women .... te he.

Agreed, AC is best in this situation because if Control is the only vent mode avaliable... this could be a serious complicating factor, just riding the vent with this minute volume and a CO2 of 28 ?? and with these gases strikes me as a bit odd. With a CO2 of 28 expected PH should be 7.50 .... agreed again look to MUDPILES. I am hoping that set MV vs actual MV at the time of ABGs were drawn and is not an issue here, some transport vents do not measure actual MV, just set. Sooo What does CXRAY look like ? Just a sidebar but the LTV 1000 would be my choice over any other transport vent with this rather complex picture, thats as if one had that option and I expect not .... just talking out loud is all. cheers

Yes great queries What Mode would the patient be on as well? Does one have the capability of doing an C (a-v) O2 diff? hmm would be correct. cheers

Here' s the best point of this thread, a proffessional exchange of ideas, not a slag contest ! cheers

I do not disagree with what you are saying, but my world is not Black and White ... its all GRAY. Oh I so fear incoming from dust with those racest remarks lol. I would not say that outright that RSS or Facilitated Intubation has no place in EMS at all nor quite so profoundly but solid background in ICU sways me a bit that said.... "WE" meaning Freak and myself our enviroment(s) are quite different, ie tubing an in patient thats in renal failure and PH is no longer compatable with life, (npo for 2 days) on interfacility transport with the MD not available for an hour to get to ER, this is the life as we know it. Having the latitude to use Guidelines and not strictly Protocol, I know from this thread have gone the other route as well, just Paralytics alone ....but this could be (my hope) an education issue not pocketing the narcs situation.

Ok explain that comment boy wonder ... I don't speak OZ remember? and are the paparazzi still after your every move ? te he.

Ah could it be that your topside medical director is not giving you all the tools you need to do your job or is he/she have a background as a G.P. ? that said, my personel preferance remains use only as much drug(s) as needed, but not having the "Hammer" is reactive Paramedicine not proactive and can really complicate the RSS senario when your at upper limits of versed and narcs .... IMHO. Hopefully that will be corrected when new provincial protocols are finally approved. One issue not discussed is that of major burns where eletrolye shifts are likely and SUX is a relative contraindication. cheers

Ok let me get this right about this Midlothing .... whatever. So the rules of engagement for EMStock. no egos, no guns, no mud, no snow, no trees, possibility of recertification of my John Deer tractor licence. only a few poisonous snakes, and BEERS then social gatherings in dust's rental from "Red Neck RV World" I bet Disney will make a movie out of this too. I just wonder if I staple myself to a flight of Canada Geese, maybe a Kanukistanian peace keeper should attend for good measure, you know just to be polite and all. cheers

Note to self: Never have an argument with Ventmedic.

Yes good points, speaking to the less confident it ETI, atypical cholinesterase is out there agreed, but etomodate is my choice in a possible increased ICP, thing is without a probe in place one has to rely on good clinical obsevational skills only, drop ICP and you may be doing harm and if we could include it in our scope Propofol would be nice instead of pulling up 5 meds (and its a neat drug) that said not without complications either.. the Rapid part unless your working with another Paramedic or RN is a bit of an oxmoron, IMHO. cheers In NO suspected increased ICP my preferance is a facilitated intubation, no point in dropping a BP and then have to treat that too, as with sometimes unknow underlying pathology then add benzos, opiates, SUX, and Pav or Vec its a turkey shoot as to why their BPs in there boots post intubation. I would like to draw to your attention the contravesy with atropine with kids, so not the way to go at all its a myth, but still included in some guidelines.

BRAVO excellent post ! So I to have a dream: 1- To become a member of a group whatever a union/ or association to have enough clout on a National level and local level to have cajones enough to influence politicians to listen, FIRSTLY to be an true advocate for the profession of Paramedicine, because ALL of us do put patient care as the Prime Objective. 2- That represents only the intersts of the EMS profession, not a mish mash of others in the mix. 3- That will stand beside me if I get a dumb ass groundless grievance (job security is rather important to me) and not have someone represent me that has never been on the street, soaking wet and covered in crap and just had to pronounce a dead kid. 4-That has barganing rights, otherwise one is sandpapering their asses, hey I AM WORTH SOMETHING TOO! 5- That as a member have a say in union dues (bylaws that have some teeth and control costs from within) and educational funds available so that I can go to this conference or that without me having to eat KD for a month. Presently in my hood my brothers and sisters are divided (and not by our own hand either) employers using fear tactics and using fear of the unknow, combine this with vast changes to a system without any even lip service given to the people that it will directly affect.

I think you have missunderstood. What micpar is stating: In fact he is providing information from a fact finding mission to Peace Country Health the first area to be "transitionized" well if thats a word, I have better words but I don't wish to be banned just yet. The scope of practice of an EMT-P is not affected at all, if it were then every industrial operator, every PRU and the OH+S regulations would be forced to be changed. Biling for the ALS sevices is the issue, as the old definition of ALS UNIT was one EMT and one EMT-P (minimum) but give the government a minuite that could change too. hope that helps.

So do you have access to a witness protection program too ? How the UAW has any bearing on a professional association or union in EMS, but comparing it to a "trade" is way beyond me on this one. Our Health care system is very, very different the Provinces are the funding bodies, not our National level, they dictate some conditions is all. Yes thats great but lets compare what you pay in health care insurance costs I bet with even huge as you call it union dues we still come up ahead. We in Alberta are basically forced by Alberta Government and are on the brink of it this very minute, to form some type of representation to protect rights and job standards many are very concerned with scope of practice thing is as without any representation, honestly who will speak for us, Firefighters, Nurses or MDs perhaps ? The private operators that threaten employees with termination because they want just more than just wage increases they want effective representation first, a say in their own future's is all. There is presently no collective voice other than a regulatory body that has let us downas a group, that too dictated by government. We the EMS providers did not start a war the government drew first blood, restructuring everything and placing the future of all EMS in limbo. Stand and be counted don't hide in fear all I am saying, the rural areas will be the individuals that suffer honestly, major communities like our CUPE got level 3 vest for their guys ... rural if you lucky you may get a high visability vest. Ventmedic: I know this is not my house as in Canada Labour Unions for the most part do promote the profession (s) its all dependant on the structure and bylaws of the this or that Asscociation or Union, agreed some are good some are self promoting, some are member driven just saying can't paint them all with the same brush. The regulatory body for Paramedics sucks, but the College for Respiratory Therapists does awesome work. But I do apreaciate your well written information, always do.

Part of the RSI guidelines we work with is sub theraputic dosage of Pav or Vec prior to SUX ... this is a recipe for disaster first off ... if one is overly sensitive then if you do have a problem they are down for a long time, and if any difficulty finding the right hole there and you are in deep ca ca ..... SUX is short lived, if you dont get the tube ... they will breath again. The rationalle being one does not fasiculate ? ....... In the OR fasiculation period ends ... then shoot the tube. (the Gas Passers I have worked with look at me like I'm smoking bud when I tell them of EMS guidelines) But then I pre sedate with versed and fentanyl every time, I have never used a sub theraputic dose of anything. Umm I lied just looked, I am out of beer ... again.

Thanks R/r, I think a big point in there is the move away from Paramedic doing ETT in the field, the fall out from US studies is affecting opinion here ... WE JUST HAVE to do do more Field studies to validate ALS with the flawed OPALs studies comming out of Ontario, heck even Dr Westly quoted them in JEMS ... may god help him. lol

I see so the market's had nothing to do with it, nor did the price of gas, or that the car makers profit margin, nor a recession had any influence ... looks like we all know where you stand. But saying that (I want too make it very clear these are not my words) The UAW fought for autoworkers to make $40.00 an hr, for a job that is worth $15-18 an hr Did you want to join Jimmy Hoffa so have you been fitted with cement shoes and are you nuts, cause you sure aint smart .... well, with that post. I will send flowers.

Well get back up on that soapbox ! This is reportable in any freaking system, either that or the patient was a cadaver ... OMG that is so not Paramedicine it is cruel bottom line.

Rid: Do you have the study ? I would be in your debt if I could prove that the bougie is the airway adjunt of choice. I have (not personally used) but did observe a boogie used in a serious facial smash as a retrograde introducer, it worked slick ! I too must agree with all the other Posts, this 10 dollar item IS the way to GO. cheers

I forwarded a email note suggesting a device known as the "Kendrick Traction Splint" or the "CT-6 there about a hundred bucks and would fill the gap nicely until rural services get the Sager back, they are ajustable for peds too. another option is the OSS Oregon Spinal Splint (akin to the KED) in conjunction with a SKED ... maybe get your Fire department to get one, they have way deeper pockets. Hell if you want a KTS, I will donate one. cheers So are Mike and Ian visiting or are you HSAA?

I thought I would just throw this in for good measure and comparison and perspective from the industrial regulations dictated by Stelmach and his very old alberta conservative old boys club to industry. The regs more or less: If an Industrial operation has over 200 workers on site, and site is more than 40 minutes from a Hospital, and High Risk Industry (which by Government classifies ALL work other than clerical) then OH+S dictates that there must be an EMT-P or RN on that site. It certianly becomes crystal clear that the Govenment is more than pleased to dictate these standard to Industry (and Industry foot's the bill for health care) but it fails miserably/ tragically when it comes to the taxpayers and the government coffers. Do I sense a double standard here? Add to the due dilegence laws, that currently drive the safety industry ... I would be very happy to see a taxpayer hold the govenment accountable and sue the government for failing to apply thier own rules of engagement, hey maybe a class action suit ? Thing is I bet my botom dollar that in your riding the MLA is a conservative too. :twisted: Some of these issues really stick in my throat and get really difficult to swallow at times. I so wish a Paramedic would run as an MLA some day, just to tune up the Legislature into the realities instead of the present advisors to government. Stats Canada indicate that there is 10 times more injuries in the Home and the highest risk assessment is travel to and from the workplace, just saying appled research is not the government's forte athough they proffess from the new documents "handbook to transition" I love the pictures and diagrams ! Did you know that in Stelmachs riding "vegatable" or commonly refered to as cardiac central, oh sorry Vegreville was an ALS service, but Volunteer Fire Based Service now, Vegreville punted the last Private ALS Provider to the curb and word has it that very few EMT-P have applied, could be the pitance of a salary they are offering just in passing, perhaps our new smiling Premier is having the wool pulled over his eyes by the very advisors he employes ? end rant. Sorry back on topic: A huge step forward for Alberta ? Who started this thread anyway? So more question's Annie ... Is your GPS a handheld device have capability of programing mapping or is it one from walmart? If you have low call volume why can't you sleep on night shift ... thats so much bull I can't believe it, I do have a study somewere will look and does your Fire Department get to sleep, I just bet their call volume is way lower. And what was the cost to restructure Peace and Palliser regions again ? ps I know that answer btw. but you still do not have a spare traction splint, backboard or KED .. for shame. No improvement in coverage since the restructuring and no flex and no "newtons cradle" btw I can see why this concept does not work in realty jump in someone elses truck with no standardization this is a recipe for a disaster. Is there any large Projects (industrial) going on in your area, and if so do you have any mutual aid agreements with those operations ? Sad that low call volume is the ratonalle used for a coverage model as opposed to the acuity of patients. Just what would be the downside if Mike and Ian visited your Hood? cheers

http://www.paramedicweb.info/ipb/index.php...ost&id=1969 cut copy paste if the link does not work. Thanks micpar, very informative, but more questions remain: Has the government ignored there own direction in regards to patient choice now? Thats quite a time frame wonder what would happen if the media got a hold of that one, yikes. Wiil Fire based services comply ? Fire response full time vs. volunteer OK first query: Just where does "but also accesses civilians and equips them with medical aid equipment" excist in the province" ???? And large Industrial sites do not have a duty to respond either ... just saying whoever is giving the answers here are NOT informed, loosing a EMS provider from an Industrial site due to serious injury, and OH & S says work is to shut down. If the Dion gets in this may change .... maybe a new Green Ambulance Hybid is hiding some where? OH good, this will improve delivery of services .... good grief.

Ok I will bite ... whats the Navy doing in Ramadi anyway? or is that a national secret ?

So back on topic ... who is staffing your clinic? 3 months is tolerable in my mind anyways. Yea those French do chicks rock on, and a good reason to learn french.