tag:blogger.com,1999:blog-4505990433916682663.post1422303300012522049..comments2024-03-13T02:04:31.476-04:00Comments on Paramedicine 101: Death By BVMAdam Thompson, EMT-Phttp://www.blogger.com/profile/18107359165856983910noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-4505990433916682663.post-42867898621694686992009-09-18T14:51:27.321-04:002009-09-18T14:51:27.321-04:00Kevin,
Thank you for the insightf...Kevin,<br /> <br /><i>Thank you for the insightful post.</i> <br /> <br /> <br />Thank you.<br /> <br /> <br /><i>I am a Paramedic student working towards my degree and information like this is invaluable. Oh and I do apologize for attempting to breach the ranks and put one more Paramedic on the streets since there seems to be an abundance of them, this is something I've dreamt of doing since I was a kid. Standards should most definitely be higher for acheiving the certification, it should be something held in high regard and less common.</i><br /> <br /> <br />We will always need more medics. I just want them to be good medics. One way is to have fewer of them responding to more serious calls.<br /> <br /> <br /><i>Sorry about that just re-read your paragraph about the abundance of P's and I'm in complete agreement with you. I took it the wrong way.</i><br /> <br /> <br />It is my fault, if I do not make myself clear.Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-81112077566231409512009-09-18T12:04:01.760-04:002009-09-18T12:04:01.760-04:00Sorry about that just re-read your paragraph about...Sorry about that just re-read your paragraph about the abundance of P's and I'm in complete agreement with you. I took it the wrong way.Kevinnoreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-36556342366367740722009-09-18T12:01:37.639-04:002009-09-18T12:01:37.639-04:00Thank you for the insightful post. I am a Paramedi...Thank you for the insightful post. I am a Paramedic student working towards my degree and information like this is invaluable. Oh and I do apologize for attempting to breach the ranks and put one more Paramedic on the streets since there seems to be an abundance of them, this is something I've dreamt of doing since I was a kid. Standards should most definitely be higher for acheiving the certification, it should be something held in high regard and less common.Kevinnoreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-20718981453181109712009-05-14T21:39:00.000-04:002009-05-14T21:39:00.000-04:00Walt Trachim,
I don't disagree with the premise o...Walt Trachim,<br /><br /><I>I don't disagree with the premise of raising the standards of pre-hospital providers. Far from it, in fact; I believe it would be a welcome wake-up call if that somehow could be achieved. Question is how, though.</I> <br />One way would be the elimination of the farcical goal of providing each candidate with the same testing experience. It isn't about avoiding any possible perception of bias. It is about assessing competence.<br /> <br /><I>RM, you advocate "the OR test." So do I. It is a very strong lesson to teach someone who is learning to manage an airway properly, from someone who is well-qualified to do so. An anesthesiologist or a CRNA is a great resource for teaching this skill. I know that when I was in the position of being precepted by an anesthesiologist in the OR myself I learned - quickly - how to do it right. If I didn't, there was no way I'd be allowed to intubate patients. And there is nothing that I know of, other than the limits set by the facilities themselves, that says an EMT-B or EMT-I student can't learn the skill of ventilation from one who knows it as well as either one of the practicioners mentioned.</I> <br />I completely agree.<br /> <br /><I>This was an excellent post. Thank you for sharing it - as usual, you done good... :)</I> <br />Thank you.Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-71749619269608370792009-05-14T20:38:00.000-04:002009-05-14T20:38:00.000-04:00I don't disagree with the premise of raising the s...I don't disagree with the premise of raising the standards of pre-hospital providers. Far from it, in fact; I believe it would be a welcome wake-up call if that somehow could be achieved. Question is how, though.<br /><br />RM, you advocate "the OR test." So do I. It is a very strong lesson to teach someone who is learning to manage an airway properly, from someone who is well-qualified to do so. An anesthesiologist or a CRNA is a great resource for teaching this skill. I know that when I was in the position of being precepted by an anesthesiologist in the OR myself I learned - quickly - how to do it right. If I didn't, there was no way I'd be allowed to intubate patients. And there is nothing that I know of, other than the limits set by the facilities themselves, that says an EMT-B or EMT-I student can't learn the skill of ventilation from one who knows it as well as either one of the practicioners mentioned.<br /><br />This was an excellent post. Thank you for sharing it - as usual, you done good... :)Anonymoushttps://www.blogger.com/profile/03159620314795295144noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-57704271251001724912009-05-14T19:58:00.000-04:002009-05-14T19:58:00.000-04:00Nick G.,
As Adam mentions, CPAP is one of those t...Nick G.,<br /><br />As Adam mentions, CPAP is one of those treatments that is inexpensive, when you consider how effective it is and what the alternatives are. How cheap is it to run a code on a patient, in stead of transporting them alive to the ED. <br /><br />Many of these patients have dramatically decreased hospital bills after CPAP vs conventional EMS treatment. They may be discharged the next day, rather than spending a week in the ICU. It is only expensive if you do not use it.<br /><br />IO vs IV. IO needles can be expensive, but they are really only supposed to be for when you cannot get an IV <B>and</B> the patient is not going to feel it due to being unconscious or unstable (not always the same thing).Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-88890121388498457872009-05-14T19:49:00.000-04:002009-05-14T19:49:00.000-04:00Anonymous Aussie,
Do your hospitals have MRIs? D...Anonymous Aussie,<br /><br />Do your hospitals have MRIs? Do you have heart monitors?<br /><br />They are expensive as well.<br /><br />I understand the cost issue, but the benefit of CPAP outweighs the cost for sure! If I were you, I would be pushing CPAP on everyone. I would cary the research around with me. Imagine not having to wait and watch your next CHF patient flood and become unresponsive so you can tube them. Usually, from what I have read, Austrailia EMS organizations are pretty progressive.<br /><br />The IV vs IO debate doesn't make much sense to me. An IO could be used in those instances where IV access is too difficult. An IO is not a substitute for an IV, just a contingency plan. It has also become quite useful in pediatric emergencies.<br /><br />AdamAdam Thompson, EMT-Phttps://www.blogger.com/profile/18107359165856983910noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-18279236651245148112009-05-14T19:34:00.000-04:002009-05-14T19:34:00.000-04:00CPAP/CO2 - we dont get it in my region in australi...CPAP/CO2 - we dont get it in my region in australia due to one factor - $cost$....hmm same for IO actually $180 a pop...much cheaper to get an IV.<br />Nick GAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-12224928844150353382009-05-14T18:15:00.000-04:002009-05-14T18:15:00.000-04:00Adam Thompson, EMT-P,
Does that patch come in blu...Adam Thompson, EMT-P,<br /><br /><I>Does that patch come in blue?</I>Maybe, but in this case, the patients are the ones that are blue. Sad and cyanotic.<br /><br /><I>The art of the BVM. I have never heard of the OR test, but that sounds like an amazing way to teach the skill properly.</I>It isn't as if an anesthesiologist, or CRNA, is going to let you get away with bad BVM use. This is not a mannequin that can be abused without evidence.<br /><br /><I>With EMTs using combi & king tubes, should they acquire ETCO2 monitoring as well.</I>Waveform capnography is something that would be much better in the hands of BLS, than pulse oximetry. It is more useful and less dangerous.<br /><br /><I>If we are going to continue expanding the scope for EMTs as well as medics, the class should be longer than a single semester. I have actually taught a half-semester class, 8 weeks long.</I>The length of the class should be appropriate to teach the material. It should not be based on what other college course lengths are. It should only be based on what is needed to educate. We need to spend more time on making sure we have instructors who actually can educate students.<br /><br /><I>As for CPAP, I think EMTs would have to be taught the physiological effects and how to recognize a patient who needs it. This is easy for you and me, and I am sure this skill could be adopted into their scope. I think that they should call for ALS transport depending on where they are though.</I>I think the physiology can be explained pretty easily. This is only used with conscious alert patients. If the patient is not able to protect his own airway - no CPAP. <br /><br />I agree with ALS transport - as long as the hospital is not the closest ALS.<br /><br /><I>Yet another good read!</I>Thank you.Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-90658441354676979852009-05-14T17:57:00.000-04:002009-05-14T17:57:00.000-04:00Does that patch come in blue?
The art of the BV...Does that patch come in blue? <br /><br />The art of the BVM. I have never heard of the OR test, but that sounds like an amazing way to teach the skill properly.<br /><br />With EMTs using combi & king tubes, should they acquire ETCO2 monitoring as well. <br /><br />If we are going to continue expanding the scope for EMTs as well as medics, the class should be longer than a single semester. I have actually taught a half-semester class, 8 weeks long. <br /><br />As for CPAP, I think EMTs would have to be taught the physiological effects and how to recognize a patient who needs it. This is easy for you and me, and I am sure this skill could be adopted into their scope. I think that they should call for ALS transport depending on where they are though. <br /><br />Yet another good read!Adam Thompson, EMT-Phttps://www.blogger.com/profile/18107359165856983910noreply@blogger.com