Medic7714

I have never read that incompatibility in any of the drug references I use or heard it mentioned from anyone before. I give lots of Zofran but we only use Normal Saline even with trauma.

The company I work for had paid for mine so I am not sure what the cost of the course is. Sorry.

Preload = volume of blood received by the heart. Afterload = pressure or resistance the heart has to overcome to eject blood. Drugs that dilate the vasculature thus reducing blood return to the heart effect pre-load... for example nitroglycerin by making the venous side bigger. There is some effect on arterial side which reduces afterload not not as much as venous / preload. Fluid boluses increase preload. Drugs that increase afterload are sympathomimetics like epinephrine, dopamine, levophed, etc. They increase systemic vascular resistance and clamp down on the arterial side which increases the pressure making it harder for the heart to overcome and be able to eject its blood volume. ACE inhibitors and CPAP offer afterload reduction. That is as simple as it gets ?

This is not correct. The diagnostic criteria for a STEMI is 1mm or more of ST-elevation in TWO or more contiguous leads. Where did you learn ST elevation needs to be present in 3 leads? I can't tell you anything regarding the strips due to the low quality of the images. But as far as your question asking if the patient could be in cardiac arrest with those rhythms, the answer is yes. That would be called PEA or pulseless electrical activity. You can have a sinus rhythm on the monitor and have a patient in cardiac arrest.

Check out Bob Page. He is a well known EMS educator and teaches a great 12-lead course all over the country and also internationally. You might want to check his website to see if he will be in your area. I attended his 12-lead course which was filled with both Paramedics and RN's. Welcome to my new site! More being added almost daily!

Generally speaking, all of the opiate class medications work via the same mechanism / mu receptor and don't have a max dose as long as the patient's respiratory and hemodynamic status support giving more. The differences come from the onset, duration, and side effect profiles. As a Paramedic, I love fentanyl and prefer it over everything else. Its an immediate onset, can give it many different routes, works great to control pain, has much less side effects than morphine and is easy to titrate. And it seems from my own experiences that patient's get better relief with fentanyl. I have nothing against morphine and Dilauded though and most of the ER's in my area are big on Dilauded. VICDRN... I think in general analgesia isn't properly prescribed and witness all the time very conservative dosing and a non-aggressive approach to relieving pain. I don't want to hi-jack the thread (may start a new one on the topic) but the lack of post-intubation analgesia in the ED drives me insane!!! Propofol and benzos do NOTHING for pain!

A really good online source.... EMS 12-Lead Follow this guy.... Tom Bouthillet - EMS 12-Lead And this is a free online video lecture on learning 12-leads. Reading 12 Lead EKGs | Learning About 12 Lead EKGs

To the OP, first I need to say that it is awesome you are taking this endeavor as it is one much needed!!!! When I was a Paramedic student we had to do clinicals not only in the ED but also in the ICU, PCU, cath lab, OR, phlebotomy, respiratory, etc. And most of the time on the floors the nurses had no clue what to do with us. In their defense, they really had no clue what Paramedic education consisted of (mine a 2yr degree program) or what the scope of practice was. Or maybe they did and just didn't feel like bothering. It was mainly just skill driven with IV starts, blood drawls, pushing some meds, ECG's, and assessments. I remember my one experience in OB, I literally sat in the break room for hours reading my textbook because that is where the nurse told me to go. The nurse said when I first got there that if a delivery happens she would come get me... well long story short a delivery did happen and she comes into the break room and says, "oh, I'm sorry... I forgot you were here". Needless to say I was ******! When a nurse has a Paramedic student they need to be TEACHING the Paramedic student. Precepting is an active role not a passive one. This means seeking out opportunities, sharing assessment tips, asking the student questions, having them listen to lung sounds, have them to drug calculations, have the student explain to them the drug they are giving, etc, etc. None of the hospitals in my area have formal programs for Paramedic students which I wish they did so sorry I can't help ya there. But hopefully by sharing my experience as a Paramedic student you can see how frustrating and non-productive precepting as a Paramedic student can be. The biggest thing I would say is have the nurses attend an in-service on precepting Paramedic students and explain to them what Paramedic education consists of and tell them to treat the Medic student with the same level of attention as a nursing student. I would throw this point of emphasis in too... and that is "when the Paramedic students graduate, it may be you that needs their care and knowledge, so teach them well". Hopefully that will drive home the point of being attentive and taking an active role.

All of the ED's I've ever been in (many in PA, VA, WV, DC, MD), all of the nurses wear scrubs. Some hospitals color coordinate by department but they still all wear scrubs. I think it would be weird not wearing scrubs in the hospital.

I do agree sometimes indiscretions occur but overall I feel that pain should be aggressively treated. My favorite equation is 2mg morphine + severe pain = severe pain. As someone else said, customer service. What better way to get good feedback scores from your patients haha.

I see this as a good thing. Pain is easily and safely treatable and has many benefits to doing so. Maybe what you're seeing is finally a trend where we no longer view opiates as taboo medications and are treating pain the way we should be. Narcotics are actually pretty safe in a controlled environment given by healthcare providers. People are also more educated overall about their care and medications. Back in the day people just took the doctors word for it and assumed the doctor knew best. I think that mentality has shifted and people are taking more control over their health and how they are treated. Maybe the patient who was specific with the request for Dilauded, Torodol, and Phenergan, had this combination for a past migraine and it worked really well. A drug seeker isn't going to be asking for Torodol. Simple logic leads one to request the same thing that worked before. I don't think it's fair to perceive this request as irresponsible or drug seeking. The major downfall of healthcare providers both in and out-of-hospital is judging a patients pain experience. We all know pain is subjective and it needs to be addressed. You have no idea how many critical patient's I receive from an ED who are minimally treated for pain or not at all. The majority of post-intubated patients I receive have received NOTHING for pain. The nurses around my area seem to have forgotten that propofol and benzos do nothing for pain. Hyperalgesia and allodynia seem to go out the window too. Why should a human being have to suffer in pain at any level in a hospital or pre-hospital when being care for by EMS?

The automatic locking mechanism on the pump tubing wasn't the issue. I use IV pumps all the time and that is a basic in the troubleshooting process. Fluids not on a pump get taken off the stretcher IV pole and hung on the ceiling of the ambulance which is where the blood was so that wasn't an issue. The blood was infusing through a dual-luman central line. If I had an extra set of blood tubing I would have switched it out all together. I appreciate every ones feedback and insight. I think the line became clotted somewhere high either within the cassette or above it.

I'm aware that blood can infuse by gravity without any problem and it is common practice at places to run blood this way. That isn't my question. My question is the practice of infusing blood by gavity with PUMP TUBING. The pump tubing has a cassette or cartridge in the line which is what has me wondering about common issues if this type of tubing is used for gravity flow of blood. Do you guys run the NSS at the same time as the blood or turn the NSS off after the tubing is primed? I've learned to turn the NSS off until the blood finishes but some say that running the NSS with the blood reduces viscosity and allows the blood to flow through the line better.

Have a quick question. I had a patient the other day that I was transferring 2hrs from a community hospital to a regional medical center. Pt. was receiving a unit of blood that was to infuse during the transfer through a central line. My plan was to have the blood remain on the sending facilities IV pump to make life easier and just return the pump after the transfer. The sending RN would not allow us to take the pump and removed the blood so that it infused by gravity via the pump tubing. Long story short, we get down to the ambulance and blood is not infusing. I troubleshooted the line... all clamps open, flushed the central line, tried pressure on the bag, and tried to aspirate blood from the line. Nothing worked. My question is... can blood flow by gravity through pump tubing or is actual gravity flow blood tubing required? The blood only filled the drip chamber and it seemed like the cassette within the pump tubing was the culprit. I called the sending doc who had me discontinue the blood and run NSS. Any help is much appreciated!