New Skills for Sask EMT's

[tniuqs]

Well just me but with the availability of doing bedside Troponin just as in ER, WHY are we not using this very simple and valuable diagnostic tool ? Do MDs start loading with thromolytics before blood work comes back when angio is 250 kms away ?

Time=Muscle.

So: Questions

1: In with LBBB and RBBB are ECGs giving you the entire picture, could one observe ST elevation without infarct?

2: Can Sask EMT/PCP draw a blood sample from IV start line ?

I even think Sask has a vendor there, a great place to start a government funded EMS study EH?

http://www.tntdiagnostics.com/

cheers

[Siffaliss]

Well just me but with the availability of doing bedside Troponin just as in ER, WHY are we not using this very simple and valuable diagnostic tool ? Do MDs start loading with thromolytics before blood work comes back when angio is 250 kms away ?

Time=Muscle.

So: Questions

1: In with LBBB and RBBB are ECGs giving you the entire picture, could one observe ST elevation without infarct?

2: Can Sask EMT/PCP draw a blood sample from IV start line ?

I even think Sask has a vendor there, a great place to start a government funded EMS study EH?

http://www.tntdiagnostics.com/

cheers

Not sure if some rural services here are still drawing labs. There is/was talk about doing it in the city at some point, not sure what's going on with that. We're within minutes of the hospital in most cases, which is probably why the paramedics aren't doing it now.

[Arctickat]

So: Questions

1: In with LBBB and RBBB are ECGs giving you the entire picture, could one observe ST elevation without infarct?

Yes, there are several other conditions which could result in elevated S-T segments, pericarditis being one of them. S-T elevation is not the sole indication of STEMI on an ECG, there also has to be reciprocal changes in other leads. ie, S-T elevation in 2 contiguous leads as well as S-T depression in others.

2: Can Sask EMT/PCP draw a blood sample from IV start line ?

In a word, No, if only because the PCP can't start a line in Sask in the first place. The ICP and ACP can though. Having said that, I have used those blood tests from TnT Diagnostics. There is sufficient blood in the flash chamber to conduct the test and there is no reason I can't pass my sharp to the PCP to express the blood from the chamber and run the test. As far as being beyond the scope of practice, it's not an invasive procedure, therefore it is not addressed in our protocols. The nearest comparison would be a blood glucose test.

[tniuqs]

No not labs, bedside Trop, CKMB, Myoglobin, point of contact stuff, I sure am sold.

More time sensitive information to the Paramedic when considering Thrombolytics.

cheers

[Arctickat]

Yeah, we're not talking about NSR and fib.

Point is, you should still not be giving nitro without being able to start and maintain an IV. You should not be giving nitro without being able to obtain and interpret 12/15 leads. Why do something just because you can? That gets practitioners and patients into trouble ...

What bugs me about this comment is that we've been giving Nitro for years before there was even a capability of conducting prehospital 12 leads. Technomedics tend to forget the basic skills involved in providing high quality patient care. Were you never taught to treat the patient and not the machine? In regards to Nitro and prior IV access; I would like to hear from anyone here regarding how many times you had such a precipitous drop in blood pressure after one dose of Nitro that the patient became critically unstable. Time is muscle and the longer that muscle is ischemic the more damaged it can become, if the pressure drops significantly then discontinue and treat the patient accordingly. In 30+ years of EMS I have yet to see nitro cause a life threatening emergency, even when provided to those patients who are suffering RVI.

Edit:

Now, I'm going to throw in a true example that occurred in my service regarding a crew obtaining an ECG, even though they could not interpret it.

This occurred about 10 years ago. A 65 year old male was feeling weak and dizzy, this had been occurring transiently for several months. The only crew available was a BLS crew. They responded and determined the patient had hypotension and bradycardia. Even though they did not know how to read a strip I had taught them how to apply the leads and acquire a strip along with some very basic interpretation. They acquired a strip and during transport the patient's condition improved significantly. Upon arrival at the hospital the patient was placed on a monitor which showed NSR. My crew realised this did not match what they had gotten and showed the doc their strip. The patient was transported directly to the CCU in a tertiary facility based on the strength of that 10 seconds of lead II ECG taken by a BLS crew who had no idea what they were looking at.

The transient 3rd degree block required a pacemaker and had this crew not taken that ECG the patient would not have received definitive treatment and may indeed not still be alive.

As you can tell, I don't care if the crew can interpret an ECG or not, if they have the time to obtain one there are people down the line who may find it invaluable.

Edited November 9, 2009 by Arctickat

[mobey]

I believe the need for a 3 lead prior to Nitro is stronger than that of a 12 lead.

I have many a times had patients in a rapid a-fib with a palpable pulse around 100, but an electrical rate much faster.

The point I am trying to make is I believe a patient with a high 3rd degree and a rate of 60 would have dire concequences from Nitro, as would a narrow/wide complex tachycardia that is producing a radial pulse around 100bpm.

I have even seen 1 patient in V-Tach with an irreg pulse about 120 by palp, but the lead II interp was a nice reg wide V-Tach.

Nice part of sask is that since there is only 1 school and it teaches rhythm interp, this problem will solve itself eventually.

Arcticat: I would be interested to hear whether SIAST will be delivering the SCoP exam, or if all students must drive to a central location and have it delivered by SCoP employees?

[Arctickat]

Arcticat: I would be interested to hear whether SIAST will be delivering the SCoP exam, or if all students must drive to a central location and have it delivered by SCoP employees?

From the SCoP website:

SCoP requires practitioners to write a licensing exam in order to register with the college. SIAST graduates who successfully write a comprehensive exam at SIAST are exempt from writing the licensing exam. No other graduates are exempt as the college does not have the resources to assess their institutions’ comprehensive exams.

I am assuming you are referencing SIAST Graduates. If not, the website addresses this also:

Graduates can write the licensing exam in the province in which they trained and the results will be accepted by SCoP for licensing purposes.

If I remember correctly, you are taking your EMT-P training in Alberta. Therefore, if you are a member of the ACoP you can be reciprocated (is that a word? My spell chequer says so.) into the SCoP, but you have to be registered with ACoP. Just completing the education in Alberta will not suffice.

Edit:

Before anyone asks, ACoP and SCoP are the Alberta and Saskatchewan Colleges of Paramedorks.

Edited November 10, 2009 by Arctickat

[Siffaliss]

What bugs me about this comment is that we've been giving Nitro for years before there was even a capability of conducting prehospital 12 leads.

... so I guess all we need to give a drug to someone is a radial pulse?

As for technomedic? Not sure what you're referring to there. I always treat the patient, not the machine and have had the privilege so far of learning from people who have been in the industry for over 30 years as well. There are however some invaluable pieces of information which for instance an ECG can provide, and certain drugs can or cannot be administered according to what that reading displays. So if what you're looking for is how I treat my patients which has really nothing to do with you, then I'd tell you that I don't jump the gun and give something simply because I can. I prefer to investigate as much as possible before "drugging".

Edited November 10, 2009 by Siffaliss

[mobey]

OK, Let me ask 2 more then....

What if I do not write the ACoP exam and want to relocate to Sask the day I am done school. Do I write the SIAST exam?

And... If those SIAST graduates want to register in Ab, will they have to write the ACoP exam since the AIT states you must write an provincial exam in one of the provinces to have recirocity?

Basically what kind of hoops did you have to jump through to get registered in Sask?

The reason I am asking so much is because I would like to register in both provinces.

OK.... I should probably just phone the registrar. But why not have these answers on the forum for others to search.

[Arctickat]

... so I guess all we need to give a drug to someone is a radial pulse?

Now you're just being facetious, they don't even need to have a pulse to give them drugs.

OK, Let me ask 2 more then....

What if I do not write the ACoP exam and want to relocate to Sask the day I am done school. Do I write the SIAST exam?

And... If those SIAST graduates want to register in Ab, will they have to write the ACoP exam since the AIT states you must write an provincial exam in one of the provinces to have reciprocity?

Basically what kind of hoops did you have to jump through to get registered in Sask?

The reason I am asking so much is because I would like to register in both provinces.

OK.... I should probably just phone the registrar. But why not have these answers on the forum for others to search.

First of all, if you want to be registered in ACoP you have to challenge the entrance exam...don't you? The biggest barrier is that SCoP simply has not written an entrance exam yet. SIAST grads have to write the ACoP exam but, so far, there is no SCoP exam to write. If you want to be registered in both ACoP and SCoP I would suggest you complete the ACoP exam, then you can apply for and receive membership to SCoP. If you are a member in good standing with ACoP you should be able to get reciprocity in SCoP.

I didn't have to jump through any hoops to get registration here, I predate SCoP.

Edit:

Here is the link to the SCoP registration website

http://www.collegeofparamedics.sk.ca/SCP%20Pages/SCP%20Registration%20Information.htm

Edited November 10, 2009 by Arctickat