p3medic

The Zebra was thrown out there as something to consider. I am all in favor of considering the 5 differentials of a regular wide-complex tachycardia: 1. VT, 2. VT, 3. VT 4. VT, 5. SVT with aberrancy. Symptomatic wide-complex tach is MOST safely tx as VT until proven otherwise. The management is essentially the same, cardioversion for unstable patient, amiodorone for the rest. Just my opinion of course. As for the lack of LBBB, I don't follow, slow it down, drop some p waves in front of those complexes, and it looks exactly like a LBBB. Wide, QS in V1, monophasic R wave in v6....am I missing something?

Actually it is much easier to apply for a "special project waiver" and leave the water fairies out of the discussion entirely.

There is no evidence of av dissociation, there are rs complexes in the precordial leads, there is no complex with greater than 100m/sec from the beginning of qrs to nadir of s wave and no morphologic criteria in v1 or v6.....looks to me to be an svt conduted with LBBB, at least thats my reasoning.

Looking at the initial strip, it appears there may be a delta wave associated with the sinus beats, which makes me wonder about an aberrantly conducted svt in the setting of un-diagnosed WPW, although I would love to see 12lds of his normal rhythm. The arrythmia by itself I'd call a "wide complex tachycardia" I know, its a cop out, but there you have it. If pressed, I don't think its V-tach, but a little amiodorone never hurt anyone....

Patients on oral agents that present with hypoglycemia should not be fed and released if at all possible....

If you draw up the saline in the syringe first, and then the amio, you don't end up with the bubbles either....

Every shift does a face to face drug count with the off going shift. All drug records are kept in a book with the lot # and expiration date. Two signatures go with the count in the book. Whenever a drug is used or returned to the pharmacy, two medics sign for the usage/waste or return. It is logged on the pcr, the log book and the controlled drug record issued by the pharmacy. This is only for controlled drugs.

can I see this in 12lds?

So, we just got sent to a NH for a diff breather, updated to a cardiac arrest...on arrival a private service ALS unit is on scene (contracted provider) so, we get to the room just as they are rolling the patient out, semifowler on a non-rebreather, on the monitor....all three leads show asystole....The staff then produces a DNR, and the privates say they are "all set"...so we run into them in the lobby, as one of them is trying to figure out which end of the ambu bag is the working end, and then decide it can wait till they get loaded....still semifowler on a non rebreather...we tell them she's a DNR, maybe the should put her back in bed, but they ignore us and load her up....medic one gets up front to drive, medic two is taking blood pressure(pt is dead)....maybe they should quit the medic gig and apply at the NH? WTF?

I would be very surprised if a medical facility would use the tapes blood type without double checking it, I could be wrong....In the service we had the blood type on our dog tags, and its on my body armor, but again, Its probably not necessary, they'll re-check anyway....IMHO

Agreed.

Nothing aggravates me more when a cop tells a person they have a choice between the ambulance and jail.....Around here they have no intention of taking someone to jail, it just gets rid of the problem for them....Drunks don't need a hospital bed in most instances.

No kidding, huh? MMA posted that over 2 years ago......2 :roll:

Try holding your breath for ten minutes.....I don't think proximity to a hospital should be the deciding factor, if a patient needs an airway now, they get it. I do agree however that with the lack of education and oversite, the tool is not for everyone. In a perfect world all prehospital clinicians would have the expertise in airway management to justify it, but alas, we don't live in a perfect world.

I scored in medic school....

I'm with the "No" group, for all the above reasons.

. And DMATS dont go overseas, so the Iranian earthquake is out. DMATs are federally funded and operated by their individual state. Hence their designations as DMAT-MA-1 (Disaster Medical Assistance Team- Massachusetts-Task Force IMSURT MA-1 deployed for 3 weeks to Bam, Iran after the earthquake there devestated a large area of that country. It is the only international deployable DMAT group, to my knowledge. Oh, and they get paid.

This guy certainly has illusions of grandeur with this IMERT crap. From what I've seen on your website you act as a volunteer medical corp to assist the real front line EMS folks should we have a really bad day. I have no idea were you've got this mindset that you will swoop in and take over for those of us who "don't understand." At no point would IMERT take charge of any situation. They may, perhaps someday be asked to set up a field hospital on a foot ball field to deal with overflow of minor injuries/illness while the actual hopitals and providers of that area would deal with the rest. What do you do that DMAT doesn't? I just don't see the need. I've been around DMAT for a long time, even seen them deployed, ground zero, iranian earthquake, atlanta olympics etc....They are a back up if something goes terrible wrong, which it more often than not doesn't. All this boot camp and dark bdu's making a bunch of overweight whackers feel important. Want to do somehthing important? Join the military of your local EMS agency. If the Sears tower fell tomorrow, Chicago fire and EMS would be running the show, and a million other local, federal agencies would quickly be involved....IMERT would be sent 40 miles away to set up a mash in a cornfield, and may very well never see a patient....That is what I believe the reality would be. There won't be any shortages of BLS specialists when that incoming comet strikes the Great Lakes.

Our system purchases them for all field members, and replaces them when need be.

Well having been to thier website, those pics aren't far off the mark....

whats his plateau pressures?

A better comparision would be to a state militia

Annals of Emergency Medicine and NEJM....only two I subscribe to...

I don't believe he is calling you a poor medic, what he is doing is questioning the validity of teaching the appropriate amount of education and not just how and when to perform skills. If you have a 4 year science degree than the 9 month program might be ok for you, however for the vast majority of applicants holding a ged or emt b certificate encompassing the entire knowledge base of that individual, a 9 month crammed course is a recipe for disaster. A biology degree is great, its a great place to start, you have a working kowledge of how the body should work ,and some of what happens when it does not...It does not teach you how to do a propper assessment of a patient, one focused on the problem at hand. It teaches you what the NR wants you to know to pass the test, thats it. No one has questioned your educational background, just your support for this "part time" medic factory. I went to TEEX in 89' for there marine fire fighter course while attending Texas A&M, it was one week long and crammed in everything you need to know about fighting fires at sea, according to USCG regs....problem was, I had no real concept of thermodynamics, heat stress, confined space etc.... the course was required by the university prior to the summer cruise, and was fun, but I would not consider myself knowledgable about maritime fire fighting, any more than a 9 month medic is going to differentiate a vt from and aberantly conducted svt.....yeah, we all got the certificate, but the ability of the individuals to apply that info is suspect at best....IMHO

You know we hire emt-b's. If they pass the written, practical and oral exams, they are invited to attend the academy which is appox 800hrs of clinical and field experience, rotate through various specialties, obs, ew, ccu etc....There are daily classes on a&p, patho, pharm, etc...along with system issues and procedures at fire standbys, bomb, law enforcement stand bys, crime scene management, hazmat, pepp, btls, among others....the process is about 6 months long, and includes a 500 hr field internship....if they pass all that, they get to work with a senior emt b partner for a year while they are on probation. Is it the best way? who knows, some say so, others not so much, but i can tell you that at the end of 6 months, these emt b's have recieved a significant amount of education and clinical rotations, and are far better prepared to deliver bls level care to people than someone out of a 600hr als fast course.....Just my opion....The medic internship is much worse.....(or better) depending on how you look at it. So from the look of it, our bls members get more hours of education that a fast tracked medic.....just something to think about....