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  1. ThadeusJ

    EMS Response to the Coronavirus outbreak

    The masks that are being used in Canada are as a line of defense in the pre-hospital setting up to and including the care and transport of patients prior to isolation facilities. Its upon first contact when oxygen therapy is being applied. That's the problem with common respiratory etiquette...
  2. ThadeusJ

    EMS Response to the Coronavirus outbreak

    China manufactures a significant percentage of disposable medical devices and the quality is certainly there if you go to the right facility. That being said, any company who puts their name on it and sells it still must perform their due diligence in quality control. There are delays in...
  3. ThadeusJ

    Blood from nose and mouth during CPR

    So no blood thinners or organic/naturopathic blood thinning foods or drink? Its a bit of a reach, but you never know what home remedies people ingest nowadays and some people will go overboard if they see it as a miracle food.
  4. ThadeusJ

    Billing: Bilevel versus simple CPAP

    Quick question about billing and reimbursement: is Bilevel different from simple CPAP? I realize the clinical implications and outcomes, but from a logistics persepctive, is there a difference besides cost of equipment? I'm exploring a cost/case examination.
  5. ThadeusJ

    Heart ripped out of body by deceleration/ crash

    Not along the same vein, but I artery be OK with it.
  6. ThadeusJ

    Heart ripped out of body by deceleration/ crash

    I aorta known you would say something like that.
  7. ThadeusJ

    Heart ripped out of body by deceleration/ crash

    When I had just started as a RT, one of the hospitals I worked at was next to where Canada's largest airshow took place. A British Nimrod recon plane had recently crashed (1995) with no survivors. The ICU doc later explained that his buddy was involved with the investigation and examination of...
  8. ThadeusJ

    Why does an adult BVM have a 1600ml capacity?

    They were developed back in the day when you ventilated with 10-15 ml/kg, and we have kept those sizes. For a standard 1500 mL adult BVM, the one hand stroke volume is still 850 mL while the two hand effort can reach 1150 mL. You could probably vent using a pediatric bag (600 and 740 mL...
  9. ThadeusJ

    Budesonide ?

    Its more of a "control the issue" medication versus a rescue medication and traditionally not used as a first line drug for acute exacerbations. Even if the studies prove to be successful, one has to determine the cost/benefit analysis of making them pre-hospital and even then it would take...
  10. ThadeusJ

    Using Collapased Adult BVM for Children or Infants

    Come on, man...given the tools, we make it work!
  11. ThadeusJ

    Using Collapased Adult BVM for Children or Infants

    Thank you all for your comments as this suggestion has perplexed me. As a matter of reference (and for full disclosure) I work with a BVM designer and manufacturer (plus a crapload of formal education and clinical experience, mind you): Our standard adult BVM has a volume of 1500 mL, single...
  12. ThadeusJ

    Using Collapased Adult BVM for Children or Infants

    Need some help from the professionals here. I have heard of people using a collapsed adult BVM for use on children and/or infants in order to obtain a smaller tidal volume. As a clinician, I never needed it as we always had a supply of proper sized units. For the life of me, I don't know the...
  13. ThadeusJ

    Thoughts on High Flow O2

    If a patient has no shunt (i.e. no issues absorbing oxygen into the bloodstream) a very rough "rule of thumb" is that the PaO2 should be 4+ times the FiO2. That means a normal person should achieve a blood gas PaO2 of 80+mmHg when breathing 21% oxygen. Likewise, if receiving true 100% (NRM...
  14. ThadeusJ

    When do you use bvm & Nonrebreather?

    Mask/circuit connectors must follow an ISO standard (ISO 5356-1) which is also captured in the ISO standard for BVM connectors, ISO 10651-4. The masks must either have a 22mm female connection or a 15mm male connection. The is why most masks have both, with a 22mmOD/15mm ID connector. Infant...
  15. ThadeusJ

    CPAP for COPD ?

    CPAP can decrease the work of breathing, hence its use in COPD, asthma and other pathologies not APE. Technically, any positive pressure application has the potential to create a pneumothorax, so you always have to be vigilant. Its interesting that your protocols may not indicate its...
  16. ThadeusJ

    CPAP vs BiPAP

    When given the choice, most healthcare professionals would prefer Bilevel (BiPAP is a brand name of Respironics) over CPAP because you are able to control more parameters. That being said, I don't believe there is a scientific based consensus on which provides better patient outcomes. Also...
  17. ThadeusJ

    Jammed ETT Connector...Solutions?

    . Good judgement comes from experience and experience comes from bad judgement. When we used to pre-cut the tubes, we would do it on an angle, however too much of an angle and the cut would be longer than the actual connector (facepalm). At least you didn't cut the pilot balloon.
  18. ThadeusJ

    Jammed ETT Connector...Solutions?

    Having a discussion with my esteemed colleagues and would like additional input. Has anyone experienced a jammed ETT (or other device) that was jammed onto the BVM or vent connection so tight that you couldn't separate them and/or use the wedge that may have been supplied? Any thoughts and...
  19. ThadeusJ

    CPAP for flail segment

    Its a huge risk that provides very little support if you're wrong and/or things go south. There is an increased risk of pneumo with a flail as you state, plus the changes in WOB may make it more uncomfortable for the patient (there may be decreased inhaled WOB but also an increase in exhaled...
  20. ThadeusJ

    The absolute begining.

    If I may speak about boots...as my most current life involves standing on concrete trade show floors, decent shoes are a must (I have a colleague who wears custom made Italian shoes solely for this purpose). I was at EMS World one year and was discussing this with one of my colleagues and when...

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