ResTech
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About EMT intermediate
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ResTech
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What about it? A Paramedic has no way to determine that in the field nor do they have the time to. That stuff is not helpful to me as a Paramedic student... it really isn't.
3/4 of what you preach is not even EMS relevant. Sure, its medical but most does not relate to what it takes to be an EMS provider. You like to micro-advocate. Don't take your RRT stuff and try to make it into what should be considered common knowledge for EMS providers.
And "my bad" for infringing on your EMTLife education campaign... I'm entitled to my opinions and always provide FACTUAL support for what I state. I'm not someone who is looking to be a Para-God or impress ne one.. all I want is to be a Paramedic to provide the best care I can within my capability as a Medic... and be very humble while doing so. I'm not afraid to admit when I'm wrong... all I ask is that anyone provide info that is contrary to what I have learned and am reading in black and white on my computer screen. Do that and I'll be humble enough to admit I am wrong. You have not done that.
You need to start running as a Paramedic again on a 911 truck and come down off your pedestal. How long has it been since u ran 911 as a Medic? I heard its been awhile. You almost seem as if your too good to run calls on a 911 Paramedic unit.
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Good article but AGAIN, do you not understand the different types of hypoxia? Tissue hypoxia? What do you think I have been saying about SvO2, lactate and pH? The hypoxia is just one part as the PAO2 and PaO2 can actually be quite high.
Now you must also differentiate the sytem involved as again and again I discussed the effects on different systems with both O2 and CO2.
Again and again, read the whole article and understand the different terms including tissue hypoxia.
You're pulling stuff off the net at random without seeing the full story.
I have no problem with the statement hypoxia causes dilation but again that depends on the system we are discussing, the time frame and the other mediators for vasodilation that are released which may be the actual cause. Correct management of buffers and pressors can alleviate these actions which is why some people with sepsis respond to some pressors and various intervention protocols for maintaining SvO2 better than others.
Now, look at the points I also makes about pulmonary vasoconstriction. Can you not differentiate between the different disease processes? Can you not understand the difference in mediators for the action and reaction? Can you not understand when I say the same recipe may not apply to all patients as unlike some in EMS believe, not oall patients come with just one simple diagnosis?
ResTech
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I understand that perfectly... however, I think you forgot we don't have 12hrs a day with our patients with access to full diagnostic results, direct physician input after they examine the patient, and conditions to do the majority of what you say we should.
EMS has usually 20mins or less to do their job... in the hospital is a bit different.
Wow! Are you insulting Paramedics by saying they should only think within their protocols for a 911 truck!
None of that book learnin' stuff is of any value?
No one should ever think about being a flight or CCT Paramedic or even a better 911 Paramedic?
Get over the "just a Paramedic" or Para-God attitude.
Just because I choose to do HEMS/Flight/CCT/Specialty instead of a 911 "truck" does not make me any less of a Paramedic. Just because I chose to get an education along with my patch you find fault with that? At least I have lasted in the profession for over 30 years and also put a decent 20 years in a truck do 911.
How long have you been an EMT?
I would hope that Rid's dream of the Paramedic becoming a Practitioner comes true someday but as I see it now, attitudes like yours where you believe an understanding of physiological aspects of medicine pertinent to EMS is beyond the Paramedic will continue to hinder any advancements in this profession.
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ResTech
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Much of what I say I think you intentionally take out of context and spin it.
"Book Learn'n Stuff" you say?... I love book learn'n stuff... prob why I carry a near 4.0... if it wouldn't be for that one "B" last semester in the practicum it would be a 4.0.
I never said don't think outside of protocols. What I said was, in the field you need to be streamlined... there is so much to do in such a short period of time.. cut the filler... get to the point and root of the patients problem.... treat them accordingly... and transport them to where they ultimately need to be.
The field has limitations... understanding them contributes to a good provider.
I concentrate on the "pertinent" physiology related to EMS... I come back when stuff way out of the EMS ball park gets touted as common knowledge. It's not beneficial to the many Paramedic students on here to be made feel like they should be on level 10 when really level 3 is the only place they need to currently concentrate on being. Help ppl get from point A to B first without going straight to Z. The basic concepts of physiology need taught before the advanced ones can be understood and appreciated.
"Book Learn'n Stuff" you say?... I love book learn'n stuff... prob why I carry a near 4.0... if it wouldn't be for that one "B" last semester in the practicum it would be a 4.0.
I never said don't think outside of protocols. What I said was, in the field you need to be streamlined... there is so much to do in such a short period of time.. cut the filler... get to the point and root of the patients problem.... treat them accordingly... and transport them to where they ultimately need to be.
The field has limitations... understanding them contributes to a good provider.
I concentrate on the "pertinent" physiology related to EMS... I come back when stuff way out of the EMS ball park gets touted as common knowledge. It's not beneficial to the many Paramedic students on here to be made feel like they should be on level 10 when really level 3 is the only place they need to currently concentrate on being. Help ppl get from point A to B first without going straight to Z. The basic concepts of physiology need taught before the advanced ones can be understood and appreciated.
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You have so little faith in what a Paramedic can understand or the potential this profession has. Hopefully you will very soon step aside with your attitude and let a well educated generation emerge in EMS.
I know there are others on this forum that will bring new ideas and a better future for EMS. You are not one of them.
I know there are others on this forum that will bring new ideas and a better future for EMS. You are not one of them.
Shishkabob
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Am I one of them?
*puppy dog eyes*
*puppy dog eyes*
ResTech
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I have a lot of faith in what a Paramedic can do... if I didn't I would be merely wasting my time right now. I'm just not one to bow down and accept everything that is spoken by somebody else.
My views on EMS systems and roles come from many years of active involvement in different positions. You are one voice out of thousands of providers across this Country and this forum surely does not represent the majority.
LINUS... she is prob referring to the ones who sit in the back corner who keep their mouth shut and don't ever challenge ne thing. The ones who play follow the leader without finding out for themselves.
My views on EMS systems and roles come from many years of active involvement in different positions. You are one voice out of thousands of providers across this Country and this forum surely does not represent the majority.
LINUS... she is prob referring to the ones who sit in the back corner who keep their mouth shut and don't ever challenge ne thing. The ones who play follow the leader without finding out for themselves.
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Ridryder911
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I will unfortunately admit you are correct. You do have the "normal" attitude of most EMS providers and thus part of the problem of EMS. We have to "think outside the box"; sorry you acclaim that you want knowledge.... as long as it does not really pertain to real medicine; hence not what the current EMS curriculum has.
Again, alike so many others acclaiming BLS vs. ALS; it is all rhetoric and unfortunately you do not have the level or the experience to give an authoritative opinion. I don't care how many years one has "working" in EMS, if they are not at the highest level common provider then really that experience is negligible and usually not counted for clinical practice.
I do hope and really do believe you will see much difference after you become a Paramedic and recognize the short falls of your training and level. I also believe that you will also become a great advocate of such as you have demonstrated such passion for the profession.
R/r 911
daedalus
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See, that is where I disagree with you (civilly of course).
Why do you place so little faith in what a paramedic student can learn? Most other health care professions are made to learn so much more than we are, where a PA will be going to school 5 days a week and taking a load equal to 22 credit hours per semester (average full time college student takes 12). No, I am not saying we should be PAs but why do you think that they have to be better than us? Why do you think that we should not have to learn anything not pertinent to the current way field care is practiced? If you think that we will only need to learn new things when they are placed in our scope and curriculum, you doom us all, because if you do not learn before, we will never advance.
Actually you are and you better do us proud.
You're posts show the direction you want to go with EMS.
The nay-sayers for the advancement of EMS just show how hard this generation has to work to overcome negativity to get this profession moving. There will always be those like ResTech who say the education should be "streamlined" which is what has kept the Paramedic with just a few hundred hours of training.
I will continue to promote education for the Paramedics. Maybe that makes me a minority but hopefully that will change someday.
I also haven't heard many complaints about too much book learnin' from those in Oregon who now have had their education standards with a two year degree for a few years.
But you are not yet a Paramedic so none of those positions have been as an advanced provider so you do not have this experience yet. Job hopping may give you an insight on the way various companies are managed but if you are not working as a Paramedic in those positions, you do not have the same point of view.
Now there are members on this forum who do not have their Paramedic patch but do have higher education that understand the concepts of physiology better than you. You may claim to have some education but you refuse to see what good it can do for you as a Paramedic.
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ResTech - o.k. time out for a second.................
How can you get to the root of the problem without a thorough understanding of why the abnormality is occuring? O.k. so you can't monitor SvO2, I'll give you that one, but the FACT is that everything else Vent is saying holds water when it comes to the physiology of respiration, ventilation, and perfusion.
What I see in your typed words is frustration and disbelief that you need to know the depth of her description. Do you have to have mastery to that level to function as a proficient Paramedic? No. An understanding though? He!! yes. Not to mention the knowledge she brings to this forum has the potential for you to show all sorts of cool "how it works" to your friends and co-workers. There is a name for it if I recall............now what was that????????
Oh yeah, CONTINUING EDUCATION! Constant learning increases rote knowledge and recollection. There was a lot of good learning to be had from this thread, I myself benefited from the knowledge. You, however, ignored that good educational writings and went for irrelevant personal attacks. You are trying to prove an assumed point that a. no one really cares about, and b. cannot be proven. Sorry to be the bearer of bad news but your Paramedic student status holds little water against an educated, degreed individual who has been in EMS and Respiratory Therapy since Johnson was in office.
I don't always like some of her jabs either, but this is going nowhere. Choose the battles if you want to win the war.................
How can you get to the root of the problem without a thorough understanding of why the abnormality is occuring? O.k. so you can't monitor SvO2, I'll give you that one, but the FACT is that everything else Vent is saying holds water when it comes to the physiology of respiration, ventilation, and perfusion.
What I see in your typed words is frustration and disbelief that you need to know the depth of her description. Do you have to have mastery to that level to function as a proficient Paramedic? No. An understanding though? He!! yes. Not to mention the knowledge she brings to this forum has the potential for you to show all sorts of cool "how it works" to your friends and co-workers. There is a name for it if I recall............now what was that????????
Oh yeah, CONTINUING EDUCATION! Constant learning increases rote knowledge and recollection. There was a lot of good learning to be had from this thread, I myself benefited from the knowledge. You, however, ignored that good educational writings and went for irrelevant personal attacks. You are trying to prove an assumed point that a. no one really cares about, and b. cannot be proven. Sorry to be the bearer of bad news but your Paramedic student status holds little water against an educated, degreed individual who has been in EMS and Respiratory Therapy since Johnson was in office.
I don't always like some of her jabs either, but this is going nowhere. Choose the battles if you want to win the war.................
ResTech
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And what point is that? The only thing I was stating was hypoxia causes vasodilation and oxygen has vasocontrictive properties. Is that wrong?
To me, Vent was speaking on a very basic level that hypoxia induces vasoconstriction. This is evident when she made the statement about "reviewing some basic factors of Oxygen". This statement in this context is not correct.
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My bad I read that wrong when you said "past 30" I figured > 30
No; we use 100% oxygen; my bad!
Can you explain please why you only monitor SvO2 i.e. oxygen saturation of the veins? I really am making a determined effort to understand this; so if the SvO2 (ie amount of oxygen in the deoxygenated arterial blood) is going down then the amount of oxygen that the tissue bed is extracting is going up? (see here: http://www.ccmtutorials.com/rs/oxygen/page05.htm)
I think I got that right
No I'm not and no I don't think those terms explicetly are covered in our entry-to-practice qualification (Diploma of Ambulance Practice) but they were covered in the A&P classes I've taken. That's 2am posting for you
Have you seen No Country For Old Men? I'm only going to worry about people carrying oxygen tanks around if they look like that dude Chigur and if it has a little metal firing rod thing attatched to the end of it! :lol: :lol:
I've never seen an IFT go out "priority" (lights and/or siren) and have seen two priority transports back to hospital in 3 years; one was a STEMI and one was a seizure.
This stuff is really interesting; it's like chocolate for my brain! ^_^
My bad I read that wrong when you said "past 30" I figured > 30
No; we use 100% oxygen; my bad!
Can you explain please why you only monitor SvO2 i.e. oxygen saturation of the veins? I really am making a determined effort to understand this; so if the SvO2 (ie amount of oxygen in the deoxygenated arterial blood) is going down then the amount of oxygen that the tissue bed is extracting is going up? (see here: http://www.ccmtutorials.com/rs/oxygen/page05.htm)
I think I got that right
No I'm not and no I don't think those terms explicetly are covered in our entry-to-practice qualification (Diploma of Ambulance Practice) but they were covered in the A&P classes I've taken. That's 2am posting for you
This stuff is really interesting; it's like chocolate for my brain! ^_^
I was wondering what your level of training/education was since many of your posts do appear with a higher level of discussion.
We rarely have the SvO2 monitor for continuous monitoring with us unless we know there is already a line established that we can hook up to. These patients may be from one of our sister hospitals. It is portable but still takes up considerable room. We can however do SvO2 or ScvO2 values from the lines (central preferred) for a data trend with the iSTAT. The SpO2 monitor is of course on as is the ETCO2.
http://ccn.aacnjournals.org/cgi/reprint/24/4/73
Here's some links of interest...hopefully. This is just to wet your appetite for what is out there if you want the challenge.
Pulmonary Hypertension in the neonate
http://www.ranichildrenhospital.com/presentation/PPHN.ppt
Variety of good articles (Flight)
http://www.ems1.com/Columnists/paul-mazurek/
http://www.med.umich.edu/survival_flight/Conference/Mazurek - CHDrevisitedSFConf..pdf
Adult Congenital Heart Disease (Yes, you will see more of these patients)
http://tchin.org/adults/index.htm
ScvO2 monitoring (Pedi)
http://www.edwards.com/products/presep/pediasatdemand.htm?PediaSatConsumption=1
Currently trialing
http://www.edwards.com/products/mininvasive/flotracsensor.htm
Since I do a lot of neo/pedi transport, we do blenderize our O2 so 28% could be delivered to a bag or NC. For neo/pedi, even the nasal cannulas run off a blender to better control the amount of FiO2 as their minute volumes are smaller and air entrainment will be less. Thus, a 2 liter NC running off a 100% O2 flow meter will give the small childr or infant close to 100% O2 instead of the 28% as "calculated" for the adult.
eveningsky339
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There are only a couple of ambulance services around my area, but they are all well-respected. A few are paramedic-level only (with EMT-Is assisting), and they don't hire Basics unless they know that the employee is the man for the job.
I can imagine how it is in cities where the market is flooded with cherry Basics, though. :wacko:
daedalus
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Really?? We are requested code 3 (priority) for all sorts of things on our CCT unit. In fact, we respond code for all suspected ACS going from an ER to cardiac facilities per county protocol. Others include brain bleeds, high risk OB, dissecting aneurysms, we get a lot of emergencies on our unit and treat it as such.