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  1. Melclin

    CARING for the patient :wub:

    Once or twice in the past I have taken palliative or lonely nursing home patients to their destination via some lovely spot to which they've not been in many years. Once to the lakeside and another to the beach, each time unloading the stretcher to sit in the sun with the patient. I stole the...
  2. Melclin

    Permissive hypotension

    I'm sure some of us here operate under a protocols/guidelines that recommend permissive hypotension/fluid restrictive resuscitation/hypotensive resuscitation of some sort. e.g. 250ml boluses targeting radial pulse or good mentation. If you do, could you post a link to you guidelines...
  3. Melclin

    36YOM - Chest pain

    Case taken from another crew, presented for your opinion on the ECG particularly in regards to the elevation in II. Prehospital ECG Hospital ECG approx 40 mins later. 36 YOM 3-4 day hx of cellulitis for which the pt is taking a course of abx. Nil other medical hx. Increased stress in...
  4. Melclin

    Omission of spinal precautions

    It has been my practice for a while now that I omit spinal immobilisation in a certain group of patients. Namely, the very old in high care nursing facilities, with significant comorbidities. These are patients that cannot be clinically cleared because of their age, comorbities or are poorly...
  5. Melclin

    Pseudo seizure dilema

    We have a patient locally who has recently been recognised as a frequent flyer after discussing his most recent presentation, ?continuous seizures. I realise some of this information is not entirely clear but we’re working on a lot of second hand information at the moment. His most recent...
  6. Melclin

    Spinal Immobilisation

    Question 1: Has anybody ever come across the idea that LOC precludes a patient from being clinically cleared? Its in our clearance guidelines and I've never been able to figure out why. I mostly ignore it but given that I do, I'd like to understand it better. Nobody has ever been able to provide...
  7. Melclin

    FOAM presentation

    In a few weeks I'm giving a presentation to a small group of people at a regional clinical education night about FOAM (Free and Open Access Medicine/Medical education), as part of a general drive to improve CME. For those not down with what the kids are into these days, FOAM is a term used to...
  8. Melclin

    Full text

    Can anyone help a brother out with the full text on: http://jama.jamanetwork.com/article.aspx?articleid=1557712#qundefined Thanks to anyone who can or who tries.
  9. Melclin

    Another stroke? 85YOM

    Well I'm on leave now so I'll be doing a bit of posting in between eating and drinking my weight in cheese and wine. In the same vein as my other thread, here is an everyday scenario for your consideration. At 0127 on a reasonably warm spring morning you are dispatched to an 85YOM (...
  10. Melclin

    88YOF - stroke?

    This is not so much a who dunnit as perhaps an average case presenting several common challenges and I'm interested in some different approaches to dx and management. At 1342 on a positively beautiful spring afternoon, you are dispatched to a lights and sirens case (Code 3 for Americans...
  11. Melclin

    Continuing education

    I looking for pearls of wisdom and/or creative ideas about how to encourage continuing education in a small group of people/branch/station/small service. I'm not talking about courses, certs, resume builders or alphabet soup adder-onerers. I'm not talking about QA/QI or formal CME at a large...
  12. Melclin

    Australian Paramedic origins

    Thought people might find this video on the history of the Victorian "paramedic" or what we would call a Mobile Intensive Care Ambulance (MICA) paramedic. Some of it is a bit propaganda-ish, but if you've got a spare 25 mins and your curious...
  13. Melclin

    Scene times

    I've been thinking about scene times a bit lately. Then tonight I found myself reading a post on another site about scene times. So many people seemed to have what I would consider to be ridiculously short scene times. 10-15minutes. Kinda blows my mind. Many of my scene times are longer than 30...
  14. Melclin

    Fluid in septic LRTI

    This is an issue that I've discussed with a lot of people at work and its hard to get a clear answer. I may have even asked the question here as well. I'll give you a quick scenario to illustrate my my point. 55YOM, hx well controlled hypertension, "small MI" 3yrs previously with no...
  15. Melclin

    City of Miami Fire Rescue

    Anybody know much about this service? What are their training requirements? How is their scope (a link to protocols would be nice if anyone has them)? How well regarded are they? Im interested to know in regards to a intubation study there that showed some pretty dismal results.
  16. Melclin

    To collar or not to collar.

    The age old debate in EMS. Consider the following three jobs I've been to in the past 2 weeks: 1. A modern SUV involved in a single car role at 110km/h with significant cabin intrusion on drivers side. Driver GCS 6, cushings triad, RSI'd flown to level 1. Pt, usually healthy 27YOF, was...
  17. Melclin

    Arranging articles/Books on an Ipad

    So for better or for worse, I've just bought a new Ipad. One of the reasons I bought it was to read and store articles and textbooks for browsing/reference at work. Problem. iBooks is a steaming pile of s**t. -I can't rename files that I download using the iPad browser. I would like to...
  18. Melclin

    IM midazolam

    Is anyone NOT using IM midaz? If so, why? http://www.ncbi.nlm.nih.gov/pubmed/22335736 BACKGROUND: Early termination of prolonged seizures with intravenous administration of benzodiazepines improves outcomes. For faster and more reliable administration, paramedics increasingly use an...
  19. Melclin

    Pt education

    What role do you believe we have in patient education? I often find myself waffling on to patients, teaching them about this or that. EG 1. Teaching a patient who finished chemo 3 days ago about their anti-emetics, hydration and options available in the community to assist them. EG 2...
  20. Melclin

    Real CPR footage

    I do a bit of CPR/first aid training now and again and I like to have real footage of CPR/arrested pts/agonal breathing because I think its important to 1) Do as much as you can to prepare people for the nasty sights involved, 2) Provide actual examples of how deep/violent CPR needs to be or...

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