zippyRN

does the Istat magically detect a reliable troponin level far sooner than any other test ? it has to be a system wide view which is where the 'evils' of socialised healthcare are extremely beneficial . if the paramedics are able to interpret and communicate findings send a copy of the 12 lead to the recieving facility then forget door to needle for ither lytics or PPCI and start thinking 'call to needle' or 'pain to needle'

there has been some research on this , sadly i don't have the cite to hand, but the genral upshot was in the average class of 10 year olds most won't be able to do effective compressions while the average class of 11 year olds most would be able to do effective compressions. the techniques can be taught to under 5s - i've seen a 2 year old effectively inflate the 'lungs' of a 'baby' mannequin ... but don't expect their efforts to be effective unless the patient is a paed as well...

on this side ofthe pond you would lose that contract in a hertbeat , because the venue would be told change provider or you will not get the event licence and your alcohol licence will not be reviewed however the national guidance i nthe Uk says that events have to minimise impact on regualr health services ... the approach taken in the Uk to this kind of event would be to have a Senior Emergency Medicine / Immediate Care doctor on site supported by one or more additional doctors and a team of both Nursing and Paramedic staff in addition to first aiders for the crowd and circulation areas and 'EMTs' ( both ETA and QAT ) and paramedics for the 'pit' and to crew a limited number of ambulances ... we can run 4 day 80 k attendance festivals with at most a couple of hundred off site transports over the event and fewer if we can get the necessary licences for an on site Plain film X ray facility

advanced practice paramedics will not happen in the USA until the education required to become a paramedic at least approaches that required to become any other flavour of health professional. billing will also be an issue especially with the active exclusionary policies in place in the USA towards skill development

from a right pondian persepctive where the legal age to purchase alcohol is 18 ( and 16 in certain circumstances relating to 'on licences' and serving meals ) and the legal age to consume alscohol in private is 5... Alcohol consuption is an overt and integral part of university soial life, most of the larger residence complexes have alcohol licences and keep to 'pub hours' alcohol sales are a substantial contribution to the income of the Student's unions because becasue alcohol consumption is legal and overt there are 1. better controls of consumption becasue if you get drunk in the SU or a residence bar you will be facing univesity discipline - so the bar staff are even more confident in enforcing the rules - and backed to the hilt by SU / uni security and in residences he duty Senior Resident / Warden (senior residents are older and usually higher up the course Under grads or post grads, Wardens are docoral students/ post docs or junior academics - the bnefits for both are boost in stipend and cheap accomodation for the cost ofshifts on duty as the face ofthe univerity ) 2. less fear of contacting the emergency services as there isn't the issue of underage drinking , just the usual crime related to of legal age drinking ... 3. most 1st years will have been of legal drinking age for anything up to a year ( more if they have taken a year out) so it;s not a new ilicit freedom when out of the direct control of mummy and daddy ... e.g. my birthday is the 1stof october so i turned18 within a couple of weeks of beginning year 13 at school , so at the start of my first year of university i was a few weeks off 19 ... 4. there are cultural isues at play the leftpondians , particualry USAn is very much based on teaching abstinance ? here's a question how old were yu when you had youfirst parentally santioned alcoholic drink ? i can't answer that becuase i don't remember - it's always been something that happens ... so id guess 4 or 5 - it would only have been a very small amount either of 'english' cider or watered red wine ...

hypoxic and tachycardic = gets a 12 lead , assume nothing seeing more and more MIs due to traditional causes in patients in their 30s and MIs / coronary artery spasm in younger people on the the ol' colomobian marching powder...

true, but plenty of people suggestign the dogma was 'gold standard' and showing a complete lack of grip on anything other than following Doctor's orders ...

it's not just EMS , other parts of healthcare can be as bad, even with (supposedly) educated people in them ... a recent discussion elsewhere about people remaining on Long Extrication Boards once they had arrvied i nthe emergency department descended into a flame fest with accusations that that people posting the none USAn dogmatic answer (even though it;s backed up by National clinical guidelines from elsewhere in the world and they have a decent evidence base) were 'dangerous', incompetent , substance abusers or mentally ill ... while thosewho espoused the USAn dogmatic veiw were 'safe' and competenent despite the fact their practice is proven to cause iatrogenic harm

the other point to add with PHTLS is that the course expects you to be familiar with equipment and 'standard' procedures before attending and expects a level of understanding of A+P etc at a health professional level , despite it's relatively wide entry gate

right pondian perspectve paeds retrieval uses the ambulance crew primarily as drives and to make sure the kit is kept safe etc ... a lot of the services don't use paramedics becasue it;s less expensive to use middle tier / ETA / QAT crews for this given that you are carrying nurse/ ODP and Registrar / Nurse paractitioner to actually look after the patient

nifedipine and lansoprazole are the rINNs for the drugs in question movicol is a macrogol stool softener RTC = road traffic collision

medical control says good call take him to whichever of the closer EDs you think will be easier becasue of the traffic ... do you want the field physician who is in the town becasue of the carnival to see the patient or are you happy to transport him they also ask if he has any nifedipine with him ? and (skill level appropraite) to give standard dose of GTN if not

timmy examine your patient empty catheter bag does not equal no urine output ...

cold a reaonable physical examination of the patient would indicate a probable cause for his symptoms

not yet , but a possiblity if mis managed

he's not dehydrated he;'s had a glass of fruit juice and a mug of tea at breakfast and a 500 ml bottle of water and a '12 oz' can of pop since ... however his urine bag is empty ... ( not leaking , emptied before breakfast - when it was nearly full )

no new neuro normal size reactive normal for him , few more spasms than usual quite possibly

nearly 4 years has hada SPC for 3 and a half years, current catheter is a 12 week one and it;s been in 9 weeks insertion site, clean ,dry and not inflammed if any thing his BP is normally on the low side not pyrexial sinus brady

unwell, pounding frontal headache p 50 , bp 155/90 rr 16 , spo2 98%on room air t = 36.7, blood sugar 6.7 mmol face, upper chest and arms quite flushed , lower limbs normal to pale Allergies - none known Meds baclofen 10mg bd , movicol one sachet on, paracetamol 1 g PRN, lansoprazole 15 mg om , something else the patient can't remember as a PRN PMH t 4 paraplegic folllwing motorcylce RTC - some lower limb fractures at the time - now all fixed reasonably , superpubic cather insertd during rehab L - had a decent breakfast this morning, cereal, fruit juce, bacon cob, mug of tea, has had a bottle o water and a can of pop this morning while out E - no particular events while out today - no new non trivial trauma P - no particualr provoking factors for the pain - itl;s constant Q - pounding / banging R frontal headache S 5/10 T head ache noticable about 30 minutes ago , patient;s partner noticed he looked flushed aobut 5 -10 minutes before call for help T4 paraplegic following motorcycle RTC 4 years ago , pretty much complete SCI can transfer can't stand without support due to near complete lesion and spasm no neurological changes from normal for patient

i'm with the doc on this one

this is one for all skill levels to play you are on duty in a medium sized town, it is a pleasent bank holiday Monday and there is a Carnival / parade in town you are called to an 'unwell male' on arrival at scene you find a 30 something year old male who is sat in his own self propelled wheelchair R alert A clear self maintained, B present normal C present , face appears a little flushed, mildly bradycardic, D GCS 15 /15 upper limbs normal, lower limbs very weak

to the OP i presume you had permission to advertise?

it's a start is ansi class2 is as shown in the video ??? in europe you need to wear EN471 class 3 on anything other than suburban roads ( or a combination that comes up to class3 - so sleeveless fluoresent and fluoresent and reflective on fire gear can add up ... ) class 2 otherwise , class1 is additional items ( e.g. over trousers) or just for use in evnvironments like wear houses where you have fork trucks and pallet movers ... the easiest way to achieve class 3 is a sleeved garment ...

biggest problewm with IN morhpine is the volumes smaller is better - in the ED i worked in before moving to Emergency Assessment unit were were giving meds In mainly diamorphine and aiming for a 02 or 0.4 ml volume - IN morphine sulphate was discussed t it was felt that the standard 10 mg / ml presentation left too great a volume