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    I was a bit concerned about giving fluids to a sick renal failure pt, who is probably already fluid overloaded, but maybe the benefits (reducing K+ concentration) would outweigh the risks in this case, especially since he is going to be dialysed shortly anyway. I'll keep it in mind next time I...
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    I had the same thoughts about pacing, it would probably screw things up even more for this guy. I never considered epi, but it makes sense, it would accomplish the same thing as the Ventolin, and get the heart rate up more as well. I was pleasantly surprised how well the nebs worked, though.
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    They gave him Calcium gluconate right away in the ER and also the insulin and dextrose. Not sure if they gave bicarb. He went for dialysis shortly thereafter.
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    Did this call yesterday: 58 y/o male with long hx of renal failure and dialysis. Missed his last 2 dialysis appointments and was c/o SOB and weakness. Also, numbness and difficulty moving his arms and legs. GCS 15, pale with cyanosis and difficulty breathing (lungs clear). No radial pulses but...
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    Pacing PEA/Asystole

    So I should set my pacer to 30-35 bpm, and when he went goes into a ventricular standstill, the pacer will start for a few seconds, and then stop when he converts back to the 3rd degree block at 38bpm? I was thinking start the pacer only if his ventricular standstill became prolonged, say 10-15...
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    Pacing PEA/Asystole

    So I had an interesting pt the other day. We were transferring a 68 y/o male from a small regional hospital to a large university hospital for cardiology. He had been having near syncopal episodes over the last day and went in to the hospital to get "checked out". Lo and behold he is in a 3rd...
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    Feeling frustrated with trying to adapt to my new position

    Good advice given so far. When I started in EMS I also struggled with confidence issues and would really beat my self up about small mistakes. I found that it just takes time. My confidence eventually grew and I realized that working hard and being willing to learn goes a long way. Things will...
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    Morphine and Fentanyl

    For those using Ketamine along with Fentanyl, or just Ketamine alone, do you find that this causes any sedation or decreased LOC in the patient, or do you just get pain relief with the pt remaining fully alert? The one opportunity I've had to use this combo, the pt was completely pain free and...
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    Morphine and Fentanyl

    Here's our Toradol protocol: To be used for moderate to severe pain. Indications: Isolated hip or extremity trauma, renal colic, acute hx of musculoskeletal back strain, cancer related pain. Contraindications: Pregnant pt, allergy or hypersensitivity to ASA or NSAID's, Ibuprofen or NSAID use...
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    Morphine and Fentanyl

    We don't have it in our protocols for psych, only Versed and Haldol, so I guess I'm jealous of you.
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    Morphine and Fentanyl

    Thanks, those studies are pretty clear that Morphine and Fentanyl are equally effective for different types of pain. Our medical director doesn't care which one we use and we can use them fairly liberally without online med control. We do carry Toradol and both our PCP's and ACP's can give...
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    Morphine and Fentanyl

    I've been told by people that I work with and by my instructors in school that morphine is more useful for abdominal pain and non traumatic back pain and that fentanyl is better for pain related to trauma. Has any body found this to be the case? Or does it really matter? There is nothing...
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    Hosting and working marathons makes the elderly die quicker

    This is a little bit ridiculous. You make it sound like marathons are causing the death of innocent citizens everywhere ( "We was just standin' there mindin' our own business when this big ol' marathon come along and, well, that was it for poor Joe!"). If a couple of minutes longer response...
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    NIBP vs Manual BP

    I like NIBP for the reasons you mentioned, especially on a more high acuity call, when I can just put on the cuff, hit the button and move on to the next task. My service uses the LP15's and I find it is accurate for the most part. If the patient is moving to much, or if the ambulance is driving...
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    Common Nomenclature

    I'm a Primary Care Paramedic in Canada and we actually do start IV's and give intravenous medications like naloxone, ketorolac, and antiemetics. There are some smaller, rural ambulance services here that hire EMR's to work on the ambulance, but they would be partnered with a PCP and would...
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    Labor anelgesia

    We use nitrous oxide all the time for patients in labour, and I find it to be very effective for most people. You really have to explain it well and get them to use it properly though. If they take full tidal volume breaths and hold each breath in for a couple of seconds then it works the best...
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    Monro-Kellie doctrine and venous ICP patho

    Thanks for posting this, it was an interesting read. Didn't realize that c-collars had such an effect on ICP.
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    How long until you were comfortable starting an IV?

    It took me probably 30 iv starts before I had the basic technique down pat, and close to a year before I felt really confident. Like others, there are times when I feel like I can't miss and also times when I miss a bunch in a row. Interesting how your level of confidence can make a difference.
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    paramedic accountability in Canada

    I work in Saskatchewan, Canada. In this province we have our own regulatory body called the Saskatchewan College of Paramedics. They are in charge of setting our protocols as well as making sure we are held accountable as paramedics for our actions and patient care. If a patient or patients...
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    Advice for EMT-B Student

    I would focus on learning to do through, complete patient assessments (this takes practice, not just reading in a text book) as well as practicing taking a good patient history. Also, the more you can study A&P, the better. There are a lot of good videos online if you get tired of just...