# NREMT few questions



## thenuke1 (Feb 1, 2011)

my test is thursday and im still a bit iffy on a few things no remembe these are for the NREMT not on the job

*1.* Reading my book i noticed in a few emergency care sections it says "based on Spo2 readings and if no signs of hypoxia and respiratory distress are present O2 my not be necessary, instead apply a nasal cannula at 2-4 lpm" now is this for ALL emergencies or just those where it is specified ...

*2.* You are transporting a non emergency patient. You stopped at a + intersection and notice that another car has also stopped at the same time in the lane next to you. Who has the right of way ?

*3.* what is the correct way to do the power lift ? i know its legs bent back straight but the test words it a different way and its not lateral or upright either.


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## cmetalbend (Feb 2, 2011)

thenuke1 said:


> my test is thursday and im still a bit iffy on a few things no remembe these are for the NREMT not on the job
> 
> *1.* Reading my book i noticed in a few emergency care sections it says "based on Spo2 readings and if no signs of hypoxia and respiratory distress are present O2 my not be necessary, instead apply a nasal cannula at 2-4 lpm" now is this for ALL emergencies or just those where it is specified ...
> 
> ...



1. I believe it's due to the teaching that all patients get oxygen as EMT-B's and 2-4 ltr won't aggrivate a patient with COPD. Or less chance anyway.
2. General traffic laws says the "Guy to your right has the right of way" well if you don't have a "Right" then thats you. 
3. I'll get back with you after I double check tomorrow


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## thenuke1 (Feb 2, 2011)

cmetalbend said:


> 1. I believe it's due to the teaching that all patients get oxygen as EMT-B's and 2-4 ltr won't aggrivate a patient with COPD. Or less chance anyway.
> 2. General traffic laws says the "Guy to your right has the right of way" well if you don't have a "Right" then thats you.
> 3. I'll get back with you after I double check tomorrow



1. so it refers to all patients ? even if the book doesnt mention a nasal cannula in certain patients


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## cmetalbend (Feb 2, 2011)

thenuke1 said:


> 1. so it refers to all patients ? even if the book doesnt mention a nasal cannula in certain patients



Again, I am refering to what the instructor drilled into our heads. "Every patient gets Oxygen" so the fall back on amount would be the minimum for a patient who's numbers don't indicate a need so to speak.. Now blow by might be less, but depending on administration. With that being variable, nasal would be the my choice for a measurable amount. And yes, I would say that applies to all patients. Remember Oxygen is the 'Miracle Drug". "Never withhold Oxygen from the patient." is stated several times in my book. Even in COPD patients. When dealing with an UNKNOWN case of COPD with very poor o2 stats you would apply a NRB. Because the benifits outweigh the risk. Personaly I would ask your instructor for his opinion. It makes sence if you think about it. To use the min. as a fall back, on a "have to issue" when there are little or no indications.


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## TransportJockey (Feb 3, 2011)

Hopefully with the new AHA guidelines that old tired BS line that EMTs are given about giving O2 to every patient will change. For the moment the NREMT test says put it on every patient, but they're finding out that O2 is not as harmless as once believed. In the field treat the patient, not the monitor.


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## cmetalbend (Feb 3, 2011)

jtpaintball70 said:


> Hopefully with the new AHA guidelines that old tired BS line that EMTs are given about giving O2 to every patient will change. For the moment the NREMT test says put it on every patient, but they're finding out that O2 is not as harmless as once believed. In the field treat the patient, not the monitor.



I agree to some extent anyway. I really don't know the real answer as to why "All patients get oxygen." My best understanding would lean towards the prevention of shock. On another note could you name a few scenes when it would be contradicted? other than COPD.


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## reaper (Feb 3, 2011)

> Hopefully with the new AHA guidelines that old tired BS line that EMTs are given about giving O2 to every patient will change. For the moment the NREMT test says put it on every patient, but they're finding out that O2 is not as harmless as once believed. In the field treat the patient, not the monitor.





I agree to some extent anyway. I really don't know the real answer as to why "All patients get oxygen." My best understanding would lean towards the prevention of shock. On another note could you name a few scenes when it would be contradicted? other than COPD.[/quote

]Oxygen does not prevent shock! It is not contraindicated in COPD. Treat your pt. If the pt needs O2, then give it as needed. 

Not all pts need O2. It can be harmfull in stroke, TBI and a lot of other cases. Research the medication you are using. Don't trust some idiot instructor to tell you everyone needs it.


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## TransportJockey (Feb 3, 2011)

reaper said:


> > I agree to some extent anyway. I really don't know the real answer as to why "All patients get oxygen." My best understanding would lean towards the prevention of shock. On another note could you name a few scenes when it would be contradicted? other than COPD.[/quote
> >
> > ]Oxygen does not prevent shock! It is not contraindicated in COPD. Treat your pt. If the pt needs O2, then give it as needed.
> >
> ...


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## JPINFV (Feb 3, 2011)

cmetalbend said:


> I agree to some extent anyway. I really don't know the real answer as to why "All patients get oxygen." My best understanding would lean towards the prevention of shock. On another note could you name a few scenes when it would be contradicted? other than COPD.



Shock?
[YOUTUBE]http://www.youtube.com/watch?v=G2y8Sx4B2Sk[/YOUTUBE]


In a patient who has an appropriate oxygen saturation and eupneic, what are you hoping to achieve with supplemental oxygen?


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## cmetalbend (Feb 3, 2011)

JPINFV said:


> Shock?
> [YOUTUBE]http://www.youtube.com/watch?v=G2y8Sx4B2Sk[/YOUTUBE]
> 
> 
> In a patient who has an appropriate oxygen saturation and eupneic, what are you hoping to achieve with supplemental oxygen?



What part about I DON'T Know, don't you understand? As an experienced professional(I use that loosely) you can argue it to death, but till YOU change the material they teach and print, AND fail you on during your state practicals if you forget, please stop trying. And no 02 is not contraindicated with a COPD patient, only the amount, to prevent other issues.


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## JPINFV (Feb 3, 2011)

Where did I say anything about COPD?


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## cmetalbend (Feb 3, 2011)

JPINFV said:


> Where did I say anything about COPD?



That was aimed toward Reaper. Sorry I was using a shotgun approach.


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## ffemt8978 (Feb 3, 2011)

cmetalbend said:


> That was aimed toward Reaper. Sorry I was using a shotgun approach.


You'd be better off taking that approach via PM.


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## reaper (Feb 3, 2011)

cmetalbend said:


> That was aimed toward Reaper. Sorry I was using a shotgun approach.



You are the one that mentioned COPD as a contraindication for O2. I told you it is not. No, amounts are not contraindicated either. If you want to treat your pts off what you were taught for a test, that your choice. Or, you could research and further your education to learn the correct information. I gave you examples you asked for, as what events O2 can be harmful.  Now do some searching and read up on the subject, to help educate yourself better. That is the best thing you can do.


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## cmetalbend (Feb 3, 2011)

reaper said:


> You are the one that mentioned COPD as a contraindication for O2. I told you it is not. No, amounts are not contraindicated either. If you want to treat your pts off what you were taught for a test, that your choice. Or, you could research and further your education to learn the correct information. I gave you examples you asked for, as what events O2 can be harmful.  Now do some searching and read up on the subject, to help educate yourself better. That is the best thing you can do.



I will look at  TBI and CVA, and thanks. But in the END it doesn't change what's in black and white on the paper. And I really don't want to answer for why I deviated from that.


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## JPINFV (Feb 3, 2011)

EMT text books aren't the end all, be all of medicine.


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## thenuke1 (Feb 4, 2011)

JPINFV said:


> EMT text books aren't the end all, be all of medicine.



as far as testing goes ... they are ....

on the field its a whole new ball game


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## cmetalbend (Feb 6, 2011)

After some review and discussion with my mentors, I re-affirm the o2 for help in the prevention of Shock. Here's my rational. If the patient has injurys that are not found (such as internal bleeding), or other issues that may seem minor upon arrival (possibly not fully developed) O2 will help prevent shock. It says "If you wait for signs of Hypoperfusion or shock to develop, before beginning treatment for such, you have waited to long".  So considering I can't (nor can you) DX everything in the feild. That is why every patient gets oxygen.


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## JPINFV (Feb 6, 2011)

Under what mechanism are they expecting supplemental oxygen to increase oxygenation in a patient who is anemic due to blood loss? The amount of oxygen diffused in the plasma goes from negligable to... well... negligable. Dissolved oxygen is like turning a garden hose on against a fully involved 2 story house fire. Sure, I guess it's water, but... well... it's not going to do much in an anemic patient.


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## cmetalbend (Feb 6, 2011)

JPINFV said:


> Under what mechanism are they expecting supplemental oxygen to increase oxygenation in a patient who is anemic due to blood loss? The amount of oxygen diffused in the plasma goes from negligable to... well... negligable. Dissolved oxygen is like turning a garden hose on against a fully involved 2 story house fire. Sure, I guess it's water, but... well... it's not going to do much in an anemic patient.



Would you say that if the blood loss was slow? But even still a garden hose will buy SOME time, wouldn't you agree? I mean we can't fix internal injurys in the feild so anything to me Is better than nothing.


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## 8jimi8 (Feb 6, 2011)

JPINFV said:


> Shock?
> [YOUTUBE]http://www.youtube.com/watch?v=G2y8Sx4B2Sk[/YOUTUBE]
> 
> 
> In a patient who has an appropriate oxygen saturation and eupneic, what are you hoping to achieve with supplemental oxygen?



JP just quit, he's trying to prevent shock...


Metal, just stop. if you can, delete your posts and we will take the shovel away.  Or as Meclin says.... " Dig up..."


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## JPINFV (Feb 6, 2011)

Blood loss being fast or slow is irrelevant since hemoglobin, which is confined to the red blood cells, is, for all practical intents, the only way oxygen is moved around the blood. Increaing the fraction of inhaled oxygen does nothing to increase the amount of hemoglobin or slow down its loss. 

I think the best illustration for this is the oxygen content equation. 
CaO2 = (SaO2 x Hb x 1.34) + .003(PaO2) 
The first part is the amount of oxygen carried on hemoglobin. The second part is the amount that is dissolved in. Consider additionally that the normal amount of hemoglobin is 14 g/dL and normal SaO2 is around 97%. PaO2 with 100% inspired oxygen (which doesn't happen prehospitally anyways) is 760 mm/Hg. With room air, it's .21*760, which is 159.6

So, 0.97*15*1.34=19.497=amount of oxygen bound by hemoglobin. 

With room air, the amount of oxygen dissolved in plasma is  0.479

Under 100% inhaled oxygen, the oxygen dissolved in plasma is 2.28. Mind you, you aren't going to get an airtight seal with a NRB anyways, so you are going to have a mix of atmospheric air and medical oxygen which is going to decrease PaO2. 


A few other things to think about. The concentration of hemoglobin isn't going to decrease in the short term unless you start administering a lot of IV fluids. So, as RBCs leave circulation, they do so in plasma. So even under the best of conditions with the NRB mask you're still going to get about 10:1 ratio of oxygen bound to hemoglobin to oxygen dissolved in plasma. I'm not sure how much oxygen can dissolve in saline, but saline does not carry RBCs, so the major part of the carrying capacity doesn't come back with saline. 

FiO2 and PaO2 is not the same. As the air moving through the conducting airways picks up water from the walls of the airway, the concentration of oxygen (as well as other gases) decreases.

V/Q mismatches can be present, which can further decrease the ability of oxygen to move into the blood stream. 


As far as "something being better than nothing" err... no. I would not subscribe that just because you can do something doesn't mean you should.



Of course, one final thing to think about. This is stopping *hypoxia*, not _hypoprofusion_.


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## cmetalbend (Feb 6, 2011)

Well I have no doubt I can use the material in the last post, more than a video from you-tube. Although it is a damn funny Movie. Thanks for the discussion and debate. But it's really sad we couldn't answer the first Post request as to why we still apply o2 to a non-hypoxic patient. Or atleast why the material for EMT-B's states we should. :wacko:


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## 8jimi8 (Feb 6, 2011)

cmetalbend said:


> Well I have no doubt I can use the material in the last post, more than a video from you-tube. Although it is a damn funny Movie. Thanks for the discussion and debate. But it's really sad we couldn't answer the first Post request as to why we still apply o2 to a non-hypoxic patient. Or atleast why the material for EMT-B's states we should. :wacko:




A better question is why we let basics administer ANY medication at all.

You apply o2 to every patient because of a lack of education.  

Not every patient needs it. Not every patient needs it.  Not every patient needs it.

Just remember that.  Use your assessment skills to know when a patient needs oxygen and you if can't tell when they do, then you have no business using it.


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## cmetalbend (Feb 7, 2011)

8jimi8 said:


> A better question is why we let basics administer ANY medication at all.


Just another personal stab toward EMT-B's(not to worry, he prides himself)     


8jimi8 said:


> You apply o2 to every patient because of a lack of education..


  Quite possibly true, but in regards to NREMT and state practicals, if you forget the o2 at the basic level, you failed. 


8jimi8 said:


> Not every patient needs it. Not every patient needs it.  Not every patient needs it..



Agreed


8jimi8 said:


> Just remember that.  Use your assessment skills to know when a patient needs oxygen and you if can't tell when they do, then you have no business using it.



For sure, and above all in the real world.


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## 8jimi8 (Feb 7, 2011)

To quote myself



			
				Myself said:
			
		

> A better question is why we let basics administer ANY medication at all.







cmetalbend said:


> Just another personal stab toward EMT-B's(not to worry, he prides himself)
> 
> .



Don't worry you will feel the jab when I give it.   

(jab incoming)

You being the prime example of why Basics should NOT be allowed to administer medications.  Without referencing JP's post, can you please explain what shock is and why oxygen is the intervention that you believe will treat it?


I suggest you pull out your emt basic text and look up shock.  Then i suggest you read the chapter that introduces oxygen as a drug.  Then i challenge you to synthesize and apply that material to this thread and see if you come up with any mistakes or mistaken assumptions you might have been employing when you were posting previously.


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## cmetalbend (Feb 7, 2011)

8jimi8 said:


> To quote myself
> 
> 
> 
> ...




OK I accept. Lets start at the top. Perfusion is the supply of oxygen to, and removal of waste from the cells and tissues of the body. Hypoperfusion(shock) is the lack of the bodys ability to circulate the blood carrying the Oxygen to, and waste from the tissues & Cells. An EMT's interventions are limited to A)Maintain an open airway AND admin high consintrations of o2. B) elevate the lower extremities, if there is no major trauma(spine,head and such). C) cover the patient with a blanket. D) transport.  Since shock is the failure of the cardiovascular system to provide sufficient blood to all the vital tissues. Administration of Oxygen helps the blood that does reach the tissues deliver the maximum amount of Oxygen.   OK do you agree with this so far?


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## 8jimi8 (Feb 7, 2011)

cmetalbend said:


> OK I accept. Lets start at the top. Perfusion is the supply of oxygen to, and removal of waste from the cells and tissues of the body. Hypoperfusion(shock) is the lack of the bodys ability to circulate the blood carrying the Oxygen to, and waste from the tissues & Cells. An EMT's interventions are limited to A)Maintain an open airway AND admin high consintrations of o2. B) elevate the lower extremities, if there is no major trauma(spine,head and such). C) cover the patient with a blanket. D) transport.  Since shock is the failure of the cardiovascular system to provide sufficient blood to all the vital tissues. Administration of Oxygen helps the blood that does reach the tissues deliver the maximum amount of Oxygen.   OK do you agree with this so far?



While I agree that in the face of hypoperfusion getting as much O2 to the tissues as possible is beneficial....


Your definition of perfusion is incomplete.

How does oxygen help circulation?


This would be the reason i'm jabbing at you.




cmetalbend said:


> I agree to some extent anyway. I really don't know the real answer as to why "All patients get oxygen." *My best understanding would lean towards the prevention of shock.* On another note could you name a few scenes when it would be contradicted? other than COPD.



Shock will not be prevented, nor cured by administration of oxygen.


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## JPINFV (Feb 7, 2011)

cmetalbend said:


> OK I accept. Lets start at the top. Perfusion is the supply of oxygen to, and removal of waste from the cells and tissues of the body.



Not quite. Profusion is the supply of blood to the tissues. One of the components of blood is oxygen, however if the oxygen content of blood is low, than it is hypoxia (or, if PO2 is low, "hypoxemia"). So a patient can have good profusion, but low oxygen. Remember, oxygen isn't the only thing in the blood that cells use.




> Hypoperfusion(shock) is the lack of the bodys ability to circulate the blood carrying the Oxygen to, and waste from the tissues & Cells. An EMT's interventions are limited to A)Maintain an open airway AND admin high consintrations of o2. B) elevate the lower extremities, if there is no major trauma(spine,head and such). C) cover the patient with a blanket. D) transport.  Since shock is the failure of the cardiovascular system to provide sufficient blood to all the vital tissues. Administration of Oxygen helps the blood that does reach the tissues deliver the maximum amount of Oxygen.   OK do you agree with this so far?




Yes, the basic interventions that EMTs are limited to is basic airway maneuvers, supplemental oxygen, shock position (which is another thread completely), protection against loss of heat, and transport. 

Yes, shock is the failure of the cardiovascular system to provide sufficient blood. 

What I disagree with, though, is that in a patient that is adequately oxygenating the blood that supplemental oxygen is useful to prevent hypoprofusion. There's a finite amount of oxygen that can be loaded onto the blood and the vast majority of that is bound to hemoglobin. In a patient with hypovolemic shock due to trauma, the important thing is to stop bleeding and increase fluids (with packed red blood cells as needed), largely to do it in that order. This is why a certain amount of hypotension is permitted in patients with traumatic injuries.


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## 8jimi8 (Feb 7, 2011)

8jimi8 said:


> While I agree that in the face of hypoperfusion getting as much O2 to the tissues as possible is beneficial....
> 
> 
> Your definition of perfusion is incomplete.
> ...




AND no one would have a problem with your posts if you stuck with " i don't know."  Rather than confusing someone else who was smart enough to ask a question, when they didn't.


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## cmetalbend (Feb 7, 2011)

8jimi8 said:


> AND no one would have a problem with your posts if you stuck with " i don't know."  Rather than confusing someone else who was smart enough to ask a question, when they didn't.



Seriously, relax. I said SO FAR. Too much info at once gives too much to argue about.


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## cmetalbend (Feb 7, 2011)

8jimi8 said:


> Your definition of perfusion is incomplete..



I repeated it nearly word for word as printed, after I read the chapter.


8jimi8 said:


> How does oxygen help circulation?.




Don't know, wasn't covered in that depth.

I'll finish my rational later today, fire meeting to attend.


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## Scooter76 (Feb 10, 2011)

Hey all.. took my Paramedic exam..

came across this type question..

I finished with this question... I will summerize.
I had this situation where I determined it was SVT. I elminated two answers, the question asked what would I administer first?
choices left were 1.) give 6 mg adenosine IV push. 2.) give a cartiod massage.

I was thinking of #2 cuz of vagal manuvers first.. am i wrong?


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## 8jimi8 (Feb 10, 2011)

Scooter76 said:


> Hey all.. took my Paramedic exam..
> 
> came across this type question..
> 
> ...



Do not repost NREMT questions.  You signed an agreement not to discuss the contents of the test.  Personally it doesnt bother me, but it is against the posting policy on this forum. 

Only doctors may perform carotid sinus massage.


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## reaper (Feb 10, 2011)

> > Hey all.. took my Paramedic exam..
> >
> >
> >
> ...



Where do you get that last part from?


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## Scooter76 (Feb 11, 2011)

I thought it was you couldnt post exact questions from the exam. I didnt.
I was very vague about the question. Didnt state the question at all.


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## 8jimi8 (Feb 11, 2011)

reaper said:


> Where do you get that last part from?



It has been re and over emphasized in my last two ACLS courses.  Vagal maneuvers ok, carotid sinus massage for physicians only.

Maybe they trained you too long ago my friend


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## reaper (Feb 11, 2011)

I teach ACLS. No where has it ever been said that it is by physician only.

Every service I have been with over the last 20+ years have had it in their scope. Maybe it is just a TN thing.


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## 8jimi8 (Feb 11, 2011)

reaper said:


> I teach ACLS. No where has it ever been said that it is by physician only.
> 
> Every service I have been with over the last 20+ years have had it in their scope. Maybe it is just a TN thing.



Let me see if i can actually find the little sentence that I can see in my mind's eye.  Obviously being an instructor has more credibility than me taking the class twice.  But i could swear that was drilled into my head.


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## reaper (Feb 11, 2011)

Here is a link to the AHA journal.

Scroll down to the VVM section. It still list CSM, with no mention of physician only.

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-67


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## 8jimi8 (Feb 11, 2011)

Maybe I got it confused because I saw it close to seek expert consultation.

Heck... maybe the person who taught us said that NURSES can't do it.  I wouldn't have held on to that idea if it hadn't been repeated to me.


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## reaper (Feb 11, 2011)

That could well be. We all know them nurses have hard time at it! haha

It is not something that is done often, but needs to be kept in the back of your mind. If it is ever needed.


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## 8jimi8 (Feb 11, 2011)

reaper said:


> That could well be. We all know them nurses have hard time at it! haha
> 
> It is not something that is done often, but needs to be kept in the back of your mind. If it is ever needed.



just like surprising someone with a cold wash cloth on their face from behind...


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## Scooter76 (Feb 11, 2011)

So I guess I should have just answered the 6mg IV push of Adenosine.


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## 8jimi8 (Feb 11, 2011)

Scooter76 said:


> So I guess I should have just answered the 6mg IV push of Adenosine.



yes, but always try a vagal maneuver first.  Awesome watch that instaneous conversion and you get to do it for free.


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## reaper (Feb 11, 2011)

8jimi8 said:


> just like surprising someone with a cold wash cloth on their face from behind...



I have found that a good kick to the groin will convert anyone!


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## 8jimi8 (Feb 11, 2011)

reaper said:


> I have found that a good kick to the groin will convert anyone!



i actually literally LOL right then and there.


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## Scooter76 (Feb 11, 2011)

8jimi8 said:


> yes, but always try a vagal maneuver first.  Awesome watch that instaneous conversion and you get to do it for free.



I don't get it. If I should ALWAYS try a vagal maneuver first, why then wouldnt that be the answer to do first?


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## 8jimi8 (Feb 11, 2011)

Scooter76 said:


> I don't get it. If I should ALWAYS try a vagal maneuver first, why then wouldnt that be the answer to do first?



Because my answer is a real world answer, and your answers were limited by the test.


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