# So, what did you learn today?



## liftwithlegs (Sep 1, 2009)

Post something that you learned about medicine today. Maybe a new way to do a procedure, something about a part of the human body, etc.


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## johnrsemt (Sep 1, 2009)

not new;  but review about treating PVC's (or not).

remember if you treat PVC's you may be dropping the patients heart rate also.  Ex:  patient has HR of 80, with bigemny perfusing PVC's:  get rid of the PVC's and patient may now have a HR of 40.


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## PapaBear434 (Sep 1, 2009)

I learned that you shouldn't break your hip if you live down a bumpy, unpaved road.


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## FutureParamedic609 (Sep 1, 2009)

I didn't learn this in med school (cuz of course I'm not in it yet..) but my teacher told us today that when men are aroused they can't think properly because not a lot of blood is going to their brain. 

She's an art teacher - very knowledgable  - and we definitely had an interesting conversation today! lol. 

Emily


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## rescue99 (Sep 1, 2009)

FutureParamedic609 said:


> I didn't learn this in med school (cuz of course I'm not in it yet..) but my teacher told us today that when men are aroused they can't think properly because not a lot of blood is going to their brain.
> 
> She's an art teacher - very knowledgable  - and we definitely had an interesting conversation today! lol.
> 
> Emily



So that's the problem????? :lol:


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## PapaBear434 (Sep 1, 2009)

OH!  I have one.  Wasn't today, but it was back in my EMT-B class.

Our paramedic professor told us in regards to a pregnant woman in labor, the very first thing you should do is give her a baby-aspirin.

"Um, wait, doesn't aspirin thin the blood?  Isn't that the last thing you want to do before a person goes though an experience that includes a lot of bleeding?"

"I never said you give it to her to swallow.  You put it between her knees and tell her not to drop it until you get her to the L&D floor."

A lot of laughing resulted, of course.  I imagine that is an old joke in EMS, but it still makes me laugh.


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## LucidResq (Sep 1, 2009)

FutureParamedic609 said:


> I didn't learn this in med school (cuz of course I'm not in it yet..) but my teacher told us today that when men are aroused they can't think properly because not a lot of blood is going to their brain.
> 
> She's an art teacher - very knowledgable  - and we definitely had an interesting conversation today! lol.
> 
> Emily



I just want to clarify... before you proceed with incorrect information... that this is not true and your teacher was probably making a funny. Just making sure.


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## Sasha (Sep 1, 2009)

That kidneys are far more complicated then I knew, and that EMTs definitely shouldn't be able to decide if a patient is ALS or BLS.


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## Ridryder911 (Sep 1, 2009)

PapaBear434 said:


> I learned that you shouldn't break your hip if you live down a bumpy, unpaved road.



Did not learn this today, but FYI......" _When the penis (visible on the x-ray as a shadow) points towards the same side as a unilateral medical condition (such as a broken bone), this is considered a "positive John Thomas sign", and if the shadow points to the other side, it is a negative John Thomas sign"........_"

R/r 911


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## Medic744 (Sep 1, 2009)

That the amount of BS calls and wild goose chases is in direct proportion to how bad your headache is.


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## daedalus (Sep 1, 2009)

Ridryder911 said:


> Did not learn this today, but FYI......" _When the penis (visible on the x-ray as a shadow) points towards the same side as a unilateral medical condition (such as a broken bone), this is considered a "positive John Thomas sign", and if the shadow points to the other side, it is a negative John Thomas sign"........_"
> 
> R/r 911



You read Dr. Whitecoats blog!!!!
do your read happy hospitalist too?


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## ResTech (Sep 1, 2009)

Started the Fall semester and began the Infectious Disease chapter. Learned quite a bit about the Hepatitis alphabet and immunity.


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## PapaBear434 (Sep 2, 2009)

Ridryder911 said:


> Did not learn this today, but FYI......" _When the penis (visible on the x-ray as a shadow) points towards the same side as a unilateral medical condition (such as a broken bone), this is considered a "positive John Thomas sign", and if the shadow points to the other side, it is a negative John Thomas sign"........_"
> 
> R/r 911



Oh god... From the Wiki...

*The sign is employed as a humorous aside.[1] However, some analysis of its validity has been performed.[3][2] Genital asymmetry correlates with handedness,[4] and a relationship between handedness and injury has been proposed as a mechanism for the sign.[2]*

They are actually doing serious studies related to one of the oldest jokes I know of from the medical field...  THIS is where our money goes.


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## Shishkabob (Sep 2, 2009)

"How's it hangin'?"


"To the left"




HAHAHAHAHAHAHA


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## VCEMT (Sep 2, 2009)

I learned me where them Kingtube/ResQPod kits will go in a rig.


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## daedalus (Sep 2, 2009)

VCEMT said:


> I learned me where them Kingtube/ResQPod kits will go in a rig.



I cannot believe they are giving the Ds the king tubes. There is a medic on every emergency scene in ventura county....


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## absolutesteve81 (Sep 2, 2009)

Linuss said:


> "How's it hangin'?"
> 
> 
> "To the left"
> ...



"Sir, You say you felt a 'pop' in your left leg immediately before the pain?  I need to check something..."

*Zzziiiiippp*

LMAO




Back on topic...I have been out of school for a few months, so I may not learn new things every single day, but today I read a few nice articles on necrotizing fasciitis.  A family friend nearly lost her leg because of this and then a JEMS article got me researching it.


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## VCEMT (Sep 3, 2009)

daedalus said:


> I cannot believe they are giving the Ds the king tubes. There is a medic on every emergency scene in ventura county....



I think the BLS rigs have them, I don't know. I know all the fire departments' apparatus will have them.


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## mycrofft (Sep 3, 2009)

*I was reminded of something last week..*

The primary complaint is not necessarily the highest priority, the pt can have more than one condition and they can in concert resemble other conditions, and that sociopaths make cruddy historians.
All on one pt, so I counted that as "one".


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## Wee-EMT (Sep 3, 2009)

Don't 'F' with the Pancreas


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## Akulahawk (Sep 3, 2009)

mycrofft said:


> *The primary complaint is not necessarily the highest priority*, the pt can have more than one condition and they can in concert resemble other conditions, and that sociopaths make cruddy historians.
> All on one pt, so I counted that as "one".





Wee-EMT said:


> *Don't 'F' with the Pancreas*


So VERY true on both counts...


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## MIkePrekopa (Sep 4, 2009)

that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask. looking forward to the part where we shove tubes into dummies


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## daedalus (Sep 4, 2009)

MIkePrekopa said:


> that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask. looking forward to the part where we shove tubes into dummies



I wish they would stop teaching EMT students this silliness.


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## Shishkabob (Sep 4, 2009)

COPD.

Oxygen toxicity.


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## Akulahawk (Sep 4, 2009)

COPD and Oxygen Toxicity... mostly myth, but you _can_ shut down their respiratory drive if they truly have stopped responding to CO2 levels... and are on oxygen drive.


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## Akulahawk (Sep 4, 2009)

MIkePrekopa said:


> that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask. looking forward to the part where we shove tubes into dummies





daedalus said:


> I wish they would stop teaching EMT students this silliness.


Agreed. What about 25LPM by cannula???


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## Shishkabob (Sep 4, 2009)

Just because it isn't likely does make it any less...err... ignorant... to give everyone 15/6 without actually assessing.


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## Ridryder911 (Sep 4, 2009)

MIkePrekopa said:


> that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask. looking forward to the part where we shove tubes into dummies



Too bad the curriculum and the criteria they are teaching from does not educate you properly to respect or on the proper administration of oxygen therapy. More shameful, it is doubtful that your instructors actually have a grasp on even the basic concept of oxygen therapy. 

The "shoving tube" philosophy is just immaturity. When in fact a true educated provider would attempt by all measures to have to prevent and reduce the occurrence of these procedures have to occur. Knowing and recognizing there are times these procedures are needed but as well recognizing the extreme associated dangers associated with them as well. 

I would like for you to ask your instructor some basics of the oxyhemoglobin ratio or even more simplistic oxygen ventilation ratio.  

As more time progresses we are recognizing that oxygen is a medication and that administrating is not as benign as once was thought. It alike any other medication has side effects and dangers associated with it. Unfortunately, the old standards are being taught and re-enforced so along with this comes bad patient care. 

Glad for your enthusiasm but dig a little deeper you will find providing emergency medical care is not as simplistic or black & white as it appears. You will question more and more of treatment being taught and will become more informed. 

Good luck, 

R/r 911


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## VentMedic (Sep 4, 2009)

> Originally Posted by *MIkePrekopa*
> 
> 
> _that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask. looking forward to the part where we shove tubes into dummies _


 
Does anyone believe 6 L/M NC and 15 L/M NRBM are equivalent to each other?  Did anyone hear of FiO2, Minute Volume, Tidal Volume, dilution, air entrainment or purpose of each delivery device?   How about just the purpose of providing O2 to a patient?  Did any instructor discuss "why" this is done other than just its in the protocol?  Does anyone know why some medical directors must write their protocols as they do?  



Akulahawk said:


> Agreed. What about 25LPM by cannula???


 
If you work in a hospital, you'll see up to 40 L/M NC. Even on a neonate you might see 8 L/m by NC. However, we do use a very good humidification system. If you study relative and absolute humidity, you will understand why this is possible. No, you can not use one of those little humidifiers you see everywhere attached to NCs in the hospitals for this purpose and in reality those do not serve much purpose. 



Akulahawk said:


> COPD and Oxygen Toxicity... mostly myth, but you _can_ shut down their respiratory drive if they truly have stopped responding to CO2 levels... and are on oxygen drive.


 
Not eactly myth because there are reasons medical reasons for why this was thought for years. However, they now find it is not the "hypoxic drive" that initiates the responses. As well, you have to differentiate the different types of COPD and each has its own process that requires a different plan of treatment. 

Oxygen Toxicity is a serious issue but it is rarely a concern for EMS who is only with the patient for a few minutes. It is a concern for hospital personnel who work with ventilator patients as the clock starts ticking until we can get patient belows 60% O2 at least. I few more comfortable when they are at 50% or less. However, certain disease processes require higher FiO2 so the risks and benefits are examined. If the patient is on a sepsis protocol and the SvO2 levels are being monitored, we will run the FiO2 higher until the SvO2 is stabilized and/or the lactate levels are below 4 mmol/L or at least trending in the right direction. Again, EMS will not need to be concerned for this in the short term.


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## PapaBear434 (Sep 4, 2009)

MIkePrekopa said:


> that EVERYONE who MIGHT benefit by O2 gets 15L nonrebreather, 6 by nasal cannula if they don't want the mask. looking forward to the part where we shove tubes into dummies



I realize that everyone has probably already nailed you on this, and I don't want to stack on, but not EVERYONE will benefit from O2.  In fact, some people can actually be hurt by it.  

Follow what your instructors say for now, so you can pass the class.  But when you get to the street, remember that you have to treat every patient individually and O2 isn't necessarily the first thing you should reach for.


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## spisco85 (Sep 4, 2009)

My paramedic partner on wednesday explained to me that the trendelenburg actually can cause more harm than good be cause it fills the bessors (SP?) glands so the body has a false idea of its blood volume and slows down its heart.

Any one have any studies on this? JEMS only provided a small amount of information on it.


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## Shishkabob (Sep 4, 2009)

I'm going to assume your partner said Baroreceptor. These are sensors located in the blood vessels (aortic arch and carotid are the only ones I remember) that help in the negative feedback of blood pressure. When pressure drops and they sense it, they increase periph. resistance and increase cardiac output. 

Trendelenberg only sages what, 250ml of blood volume?  And that's before they get decompensated.


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## VentMedic (Sep 4, 2009)

spisco85 said:


> My paramedic partner on wednesday explained to me that the trendelenburg actually can cause more harm than good be cause it fills the bessors (SP?) glands so the body has a false idea of its blood volume and slows down its heart.


 
This is why some college level A&P can be very helpful.



spisco85 said:


> Any one have any studies on this? JEMS only provided a small amount of information on it.


 
You probably found this article.

http://www.jems.com/news_and_articles/columns/Wesley/the_myth_of_the_trendelenburg_position.html

Whenever reading something in a fluff mag like JEMS, always look up the original article they are reviewing or the references at the end of the article.

http://www.cjem-online.ca/v6/n1/p48


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## spisco85 (Sep 4, 2009)

Thanks. So I had the basic understanding down.

VentMedic- I agree college level A&P would be helpful, just can't start the class till the class starts


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## Akulahawk (Sep 4, 2009)

What I got out of reading the article (that JEMS reviewed) is that the Trendelenburg position might cause more issues than it resolves. In any event, another thing that stuck out to me was that in healthy subjects, Trendelenburg increases LV filling, stroke volume, and therefore Cardiac output... but also that the effect is transient. In hypotensive patients, there probably isn't enough "fluid in the tank" so to speak to show any positive changes, and since it can put pressure on the diaphragm, you could very well see a decrease in CO. Which to me says, if your patient is in shock, IF you use it, use it briefly... long enough to get a line and begin volume replacement... and by extension, once you're doing that, return the patient to a flat position. 

Another way to think about this is: if the MAST doesn't work, Trendelenburg probably won't work well either. You're attempting to autotransfuse the central circulation... one method uses external pressure... the other uses gravity.


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## Shishkabob (Sep 4, 2009)

Who said MAST pants don't work?


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## cm4short (Sep 4, 2009)

I learned to titrate your narcan or you'll wish you hadn't gave it at all


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## PapaBear434 (Sep 4, 2009)

cm4short said:


> I learned to titrate your narcan or you'll wish you hadn't gave it at all



I learned that lesson by watching a nursing student push it behind curtain #2 while I was standing in front of #1, waiting to turn over a patient.  

I am VERY glad I was standing in front of #1, rather than #2.


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## Ridryder911 (Sep 5, 2009)

Linuss said:


> Who said MAST pants don't work?



There are numerous studies that have proven that PASG are not as effective as one once thought. That is if application was that as the current procedure & application was followed at that time. 

Studies does not prove that they do not work, rather they have no increase in outcome survivability. The same could be placed on other various treatments we now perform routinely. 

New research is demonstrating that it does increase TPR to a small degree, but with this also comes the harmful side effect of lactic acidosis. I do believe we will see PASG return on specific injuries and conditions with a new different application and inflation procedures. As just part of the treatment of shock and definitely recognizing it is only aiding in treatment but it maybe a while as it was slammed very hard in the early 90's. 

R/r 911


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## Shishkabob (Sep 5, 2009)

I was leaning more towards the usage of bilateral femur fractures.

The 'off-the-label' usage.


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## Akulahawk (Sep 5, 2009)

Ridryder911 said:


> There are numerous studies that have proven that PASG are not as effective as one once thought. That is if application was that as the current procedure & application was followed at that time.
> 
> Studies does not prove that they do not work, rather they have no increase in outcome survivability. The same could be placed on other various treatments we now perform routinely.
> 
> ...


The PASG makes for a nice splint... however, you would not be doing the patient any good if you just release the pressure from the garment... Vacuum splints actually work better and are less uncomfortable for the patient when you try to remove them. The down side is that people in the ED don't know you can "shoot through" them nor how to remove them, so they cut the vac splints off. The PASGs do work for splinting pelvic fractures and multiple long bone fractures. However, a properly used bedsheet can splint a pelvic fracture pretty well.

What, specifically, do you see the PASG being used for in the future?


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## Level1pedstech (Sep 5, 2009)

Akulahawk said:


> The PASG makes for a nice splint... however, you would not be doing the patient any good if you just release the pressure from the garment... Vacuum splints actually work better and are less uncomfortable for the patient when you try to remove them. The down side is that people in the ED don't know you can "shoot through" them nor how to remove them, so they cut the vac splints off. The PASGs do work for splinting pelvic fractures and multiple long bone fractures. However, a properly used bedsheet can splint a pelvic fracture pretty well.
> 
> What, specifically, do you see the PASG being used for in the future?



 I don't think you should make such a blanket statement about ED people. We do portables all the time on traumas with vacuum splints in place. We don't remove field splints until we are ready for one reason,patient comfort. Usually a splint will stay in place until someone from the ortho service arrives and makes a determination as to what treatment path to follow. I'm sure its been a problem in some ED's but we do know a thing or two about those fancy tools you all use in the field. I second the pelvic wrap with a sheet,simple but very effective. We see more unstabilized pelvic fractures than you might think. I would wrap anytime there is even the slightest possibility of a pelvic fracture.


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## dmc2007 (Sep 5, 2009)

Akulahawk said:


> The PASG makes for a nice splint... however, you would not be doing the patient any good if you just release the pressure from the garment... Vacuum splints actually work better and are less uncomfortable for the patient when you try to remove them. The down side is that people in the ED don't know you can "shoot through" them nor how to remove them, so they cut the vac splints off. The PASGs do work for splinting pelvic fractures and multiple long bone fractures. However, a properly used bedsheet can splint a pelvic fracture pretty well.



What are your thoughts on the SAM sling for Pelvic fractures?
http://www.sammedical.com/sam_sling.html


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## Akulahawk (Sep 5, 2009)

Level1pedstech said:


> I don't think you should make such a blanket statement about ED people. We do portables all the time on traumas with vacuum splints in place. We don't remove field splints until we are ready for one reason,patient comfort. Usually a splint will stay in place until someone from the ortho service arrives and makes a determination as to what treatment path to follow. I'm sure its been a problem in some ED's but we do know a thing or two about those fancy tools you all use in the field. I second the pelvic wrap with a sheet,simple but very effective. We see more unstabilized pelvic fractures than you might think. I would wrap anytime there is even the slightest possibility of a pelvic fracture.


I do apologize if you think I'm slighting ED staff. I'm actually glad your ED actually has experience with vacuum splints. You really have no idea how happy that makes me! Most of the EDs I've been in quite literally have no idea about how to deal with them as they never or very rarely see them. (And I've been to about two dozen EDs over the years.) I'm not exactly naive of ED equipment either...


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## Akulahawk (Sep 5, 2009)

dmc2007 said:


> What are your thoughts on the SAM sling for Pelvic fractures?
> http://www.sammedical.com/sam_sling.html


The idea sounds good. It appears to provide a similar function as the bedsheet method. If it does what they claim it does, I can see that being added as a field device for stabilizing pelvic ring fractures. I would like to see the metal removed from the device to allow for use in MRI units >3 Tesla. My feeling is that if it does become part of regularly fielded equipment, providers will also have to be trained in stabilization of those fractures using field expedient methods as the SAM Sling won't fit all patients nor is it designed for peds. 

It seems to be a relatively new device... that I'd like to see more info on.

So.. I'll reserve my own judgment on this till I get more info on it.


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## Level1pedstech (Sep 5, 2009)

Akulahawk said:


> I do apologize if you think I'm slighting ED staff. I'm actually glad your ED actually has experience with vacuum splints. You really have no idea how happy that makes me! Most of the EDs I've been in quite literally have no idea about how to deal with them as they never or very rarely see them. (And I've been to about two dozen EDs over the years.) I'm not exactly naive of ED equipment either...



 No apology necessary just keeping you on your toes. I want nothing but goodwill between the ED and our field providers. Its true that some staff don't know how to deal with field equipment like traction and vacuum splints. During trauma assessments I have seen PA students take shears to vacuum splints much to the dislike of the trauma surgeon leading the call. We are a teaching hospital and I think some things get overlooked.

  I can tell you that I wish agencies would do a better job of marking their splints, after I remove any equipment be it a splint or a backboard it goes out to the bay for pickup at a later time. I seldom see vacuum splints with agency markings which makes it hard to get the equipment back to its home. Field equipment and ED equipment are alike in alot of ways and knowing that is why field providers make such great additions to the ED staff.


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## Smash (Sep 5, 2009)

dmc2007 said:


> What are your thoughts on the SAM sling for Pelvic fractures?
> http://www.sammedical.com/sam_sling.html



I don't have it on me (waiting for dinner typing with my thumbs on my iPod) but I recall a study that debunks some of the ideas behind using SAM splints or pelvic wraps.

The pressure that is generated is not typically enough to create any effective tamponade as blood continues to seep into the retroperitoneal cavity. 

I don't recall specifics about reduction in pain or anything else though.


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## JPINFV (Sep 5, 2009)

I learned that I hate embryology.


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## Ridryder911 (Sep 5, 2009)

JPINFV said:


> I learned that I hate embryology.



Ditto..I have only seen one that did and he was not a normal person. 

R/r 911


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## LucidResq (Sep 5, 2009)

I learned all about PPE, courtesy of a chubby 10 yo boy, in online orientation for my new job. 

Don't child labor laws prohibit the employment of children in environments in which they will be exposed to hazards that necessitate the use of full face shields and protective earmuffs?


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## Cory (Sep 5, 2009)

Catilage is 3x more slick than ice.

And if it's true, I have some faith that a gym teacher just might be able to teach health, still not convinced though.


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## mycrofft (Sep 5, 2009)

*Akulahawk, you know my coworkers!*

I wasn't there, but I had to refill a 250 liter cylinder after O2 given via "NRB NC" per the med record. Tx times and time pt was taken under wing by EMS was ten minutes...hopefully they just left the cylinder on, or that pt 's gonna need chapstick up their nose.


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## usafmedic45 (Sep 5, 2009)

spisco85 said:


> Thanks. So I had the basic understanding down.
> 
> VentMedic- I agree college level A&P would be helpful, just can't start the class till the class starts


Actually I think she was implying (and if she wasn't- which I doubt- I am) that you should have had it BEFORE your EMT class.  No offense to you but it's just another reflection of the sad pathetic state of EMS education in this country.


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## usafmedic45 (Sep 5, 2009)

And here.....

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum



> The present study shows that oral sex and swallowing sperm is correlated with a diminished occurrence of preeclampsia which fits in the existing idea that a paternal factor is involved in the occurrence of preeclampsia.



That's a piece of research every man can use to his advantage.... :lol:


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## Sasha (Sep 5, 2009)

Ah, nevermind.


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## medic417 (Sep 5, 2009)

I learned we can survive w/o emtlife.


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## Sasha (Sep 5, 2009)

medic417 said:


> I learned we can survive w/o emtlife.



Speak for yourself. If I wasn't at work, I could have died, but after talking to my partner about EMS I was too afraid to arrest next to him, I would've been a goner.


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## Lifeguards For Life (Sep 5, 2009)

Cory said:


> Catilage is 3x more slick than ice.
> 
> And if it's true, I have some faith that a gym teacher just might be able to teach health, still not convinced though.



i think the EPC book says 5-8 times more slippery than ice? all the obscure facts learned in lecture class


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## Lifeguards For Life (Sep 5, 2009)

the 2 different wave lengths used in a spo2 detector are 650 and 805 nm, if anyone ever wanted to know


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## Thindian (Sep 5, 2009)

I learned that I may as well move to the most barren, deserted part of Africa and practice EMS there... since I live in LA County :glare:


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## Lifeguards For Life (Sep 5, 2009)

Thindian said:


> I learned that I may as well move to the most barren, deserted part of Africa and practice EMS there... since I live in LA County :glare:



they both sound like interesting places to work


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## PapaBear434 (Sep 6, 2009)

Lifeguards For Life said:


> the 2 different wave lengths used in a spo2 detector are 650 and 805 nm, if anyone ever wanted to know



Hey, I just learned that a couple days ago!  Get out of my head!


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## MIkePrekopa (Sep 6, 2009)

The "I can't wait to shove tubes into dummies" line was meant to be humorous. I prefer the hands on learning over reading textbooks. Sorry if my immaturity showed, ill do me best to keep it covered up next time.

I know not everyone needs O2. I know its not the first thing you reach for. I know there is more to giving O2 than turning it on. Just let me state I have only been in class 2 weeks (a total of 18hrs.) I know I still have A LOT to learn. We went over COPD, and were told how O2 can neg. effect someone. When it was said to us (the 15L NRB, ect.) it was more of "never hold back O2 if you think it might help".


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## WannaBeFlight (Sep 6, 2009)

I learned in the first 3 days of class... "If you are sick and running a fever, DO NOT COME TO CLASS!" Unfortunately someone didnt take note of that, and decided to sit in class for three days this week running a fever and coughing, and was diagnosed with the Flu!! 
WTF! we are all adults, why do we still not listen... Now I am sick and pissed off...<_<

Other than that, learned to Intubate patients on Friday!


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## JPINFV (Sep 6, 2009)

That's the problem with a strict attendance policy. If I'm sick and I have the choice of:

A: Staying out of class while sick and run the risk of being kicked out for missing too many days.

or 

B: Going to class

I'm going to pick B. Considering EMS's general hard on for clock hours and forcing people to sit in the classroom no matter what (note: medical students accross the country regularly skip lecture if they learn poorly in lecture and the average graduation rate for medical students is somewhere in the 95% range), I doubt most instructors would work with someone who is sick, but missed too many days. At my school, it was drilled into us that if we're sick, call the Office of Student Affairs and leave a message for the assistant dean because the school will work with students over missed exams and quizes.

It sucks, but that's what happens with strict requirements like clock hours.


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## Melclin (Sep 7, 2009)

Today, whilst in four more hours of respiratory physiology, I learned that I'm incredibly thankful that I did all the sciences in high school.

Honestly, if I didn't already have a grounding in concepts like Boyle's law, osmosis and diffusion in general, concentration gradients; chemical equations and scientific notation; the behaviour of substances in different states and in solution.....I'd be so lost. I feel for the mature age students who haven't touched that stuff recently in high school.


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## Jinx (Sep 7, 2009)

Funny, we are covering Resp system at uni atm to. Albeit the physiology side of things is only touched on lightly because the class is Clinical Practice so it is more treatment based. Today we covered chronic obstructive bronchitis, emphysema, asthma, anaphylaxis, and different types of drowning both dry and wet and fresh and salt water. Along with all the different treatments h34r:


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## Smash (Sep 7, 2009)

Jinx said:


> and different types of drowning both dry and wet and fresh and salt water. Along with all the different treatments h34r:



So, what can you tell us about the difference between salt and fresh water drownings?


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## Lifeguards For Life (Sep 7, 2009)

Smash said:


> So, what can you tell us about the difference between salt and fresh water drownings?



     in a saltwater drowning, the lungs fill with salt water which draws blood out of the bloodstream and into the lungs. This liquid build up in the alveoli stops oxygen from reaching the blood
     in freshwater, the water filling a person's lungs can enter the bloodstream quickly causing blood cells to swell and burst. Also, the fluid filling the person's lungs will prevent the body from taking in enough air. This leads to cardiac arrest.
freshwater drowning, most likely you will be unconscious by the time heart stops


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## Akulahawk (Sep 7, 2009)

Fresh water also will wash away surfactant...


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## BossyCow (Sep 7, 2009)

I was once again reminded never to assume that because someone has their EMT cert that they have retained anything at all from their class pertinent to the call in progress.


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## WannaBeFlight (Sep 7, 2009)

JPINFV said:


> That's the problem with a strict attendance policy. If I'm sick and I have the choice of:
> 
> A: Staying out of class while sick and run the risk of being kicked out for missing too many days.
> 
> ...





But our instructors set the attendance policy and it is their policy that if you are running a fever, do not come to class. They will consider illness with a note an excused abcense and will work with you to catch you up. We have great instructors and they do nto want to be sick either.


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## Jinx (Sep 7, 2009)

Lifeguards For Life said:


> in a saltwater drowning, the lungs fill with salt water which draws blood out of the bloodstream and into the lungs. This liquid build up in the alveoli stops oxygen from reaching the blood
> in freshwater, the water filling a person's lungs can enter the bloodstream quickly causing blood cells to swell and burst. Also, the fluid filling the person's lungs will prevent the body from taking in enough air. This leads to cardiac arrest.
> freshwater drowning, most likely you will be unconscious by the time heart stops



Beat me to it


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## mycrofft (Sep 8, 2009)

*I learned about drownings twice....1972 and 1981*


1981: Freshwater drowning=haemodilution with attendant swelling, lost clotting and lost oxygenation. Seawater drowing=haemoconcentration and more fluid in lungs.

1971: in virtually all drownings, two factors apply: even a teaspoon of water will slam the glottis shut, preventing more water (or air)from entering until the central nervous system is so shut down that the reflex is gone; and that since it takes as long for that to occur as brain death to start, most survivors of immersion accidents ("drowning" is literally a death, not a "condition") have relatively little, if any, water actually _*in their lungs*_, and that the rest are usually dead, either there and then, or later on. A slim minority fall between the two extremes, especially in cold water-mammalian diving syndrome cases.

Finding water _*filling the lungs *_is signifcant for a medical examiner, very significant.


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## Seaglass (Sep 8, 2009)

Not really EMS-related, but I learned that saltatory conduction isn't limited to vertebrates. 

I also learned that I'm better at distracting screaming toddlers than I thought. 



JPINFV said:


> That's the problem with a strict attendance policy. If I'm sick and I have the choice of:
> 
> A: Staying out of class while sick and run the risk of being kicked out for missing too many days.
> 
> ...



Every school I've attended has been very strict. One of my jobs is too. If we're sick, we're supposed to either trade shifts or just show up and wear a mask. Ignoring the whole contagion issue, it still sounds like a great way to increase patient care errors to me...


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## Smash (Sep 8, 2009)

Great answers regarding near drowning!  (Near drowning is all we are interested in; drowning means they are dead)

Not at all relevant, but great nonetheless 

In order for alterations in blood volume to occur the near drowning victim needs to have aspirated over 10ml/kg of fluid, and for electrolyte imbalances to occur they need to aspirate over 20ml/kg.

Most near drowning victims aspirate less than 5ml/kg of fluid.  If any electrolyte imbalances occur they are likely to be as a result of ingestion of large volumes of fluid, not aspiration.

Near drowning is primarily a problem of hypoxemia and should be managed as such.  There may be complications from atelectasis due to aspiration of fluid, however this is unlikely to affect prehospital providers, but rather be a consideration further down the track.  This is not to say it will never be an issue, but it is unlikely

By far the biggest prognostic factor for near drowning victims is how dirty the water is.  Microorganisms like aspergillus can cause catastrophic problems when aspirated.

The salt/fresh water thing has been discussed for generations, but it is really an entirely academic subject and not really useful to paramedics.


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## Melclin (Sep 9, 2009)

Smash said:


> Great answers regarding near drowning!  (Near drowning is all we are interested in; drowning means they are dead)
> 
> Not at all relevant, but great nonetheless
> 
> ...



hmmm nice. Interesting. Got any resources or articles of interest?


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## mycrofft (Sep 9, 2009)

*I learned that the hammer saying is true.*

If you'r good with a hammer, every solution involves nailing something. (Or bashing it).

People who work in hospitals then get put in primitive conditions panic if they can't do their accustomed things and are very uncomfortable with waiting. Every pt requires O2, labs, an IV or two, spine board and manual transport to a place the responder feels comfortable in.
Corollary: doctors tend to make either really bad , or really good, EMT's or first-aiders, depending upon their age and background.


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## mycrofft (Sep 9, 2009)

*Last drowning shot:*

http://emedicine.medscape.com/article/908677-overview


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## Lifeguards For Life (Sep 15, 2009)

hr typically increases by 10bpm for each 0.6 deg celcius increase in body core temp


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## Shishkabob (Sep 15, 2009)

That girls are complicated creatures who say and do one thing, then change their mind 5 minutes later.... and twist the past.


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## Mountain Res-Q (Sep 15, 2009)

Linuss said:


> That girls are complicated creatures who say and do one thing, then change their mind 5 minutes later.... and twist the past.



ah... a true pearl of wisdom... Linuss is wise beyond his years...


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## Lifeguards For Life (Sep 15, 2009)

Linuss said:


> That girls are complicated creatures who say and do one thing, then change their mind 5 minutes later.... and twist the past.



darn it linus, why did you not bestow this wisdom on us a long time ago?


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## Shishkabob (Sep 15, 2009)

I'm sorry.  I heard of it's existence before, but couldn't confirm the truth until last night.


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