mvfire8989

I have no idea what the protocols for this study are, that being said in the hospital environment FFP is a relatively small volume product and in current use is most often used to correct factor deficiencies that can develop in an acute hemorrhage. Many trauma centers have a massive transfusion protocol that calls for the replacement of plasma and platelets when transfusing more than 5 units of packed rbcs. What I imagine that this study is looking at is if earlier normalization of pt/ptt would be beneficial to patients. I would be surprised if they are looking to replace crystalloids for fluid resuscitation. There has been several large studies that have looked at doing that with various colloid fluids like albumin and hydroxyethyl starch but to date they have not been shown to be superior and may have their own problems. Like Bnechis mentioned transport times for the most part are short in metro areas where this would be likely to be used, getting some NS or LR running and diluting their blood is the best in the short term. That way the volume the patient is losing is not all blood, and they lose less oxygen carrying capacity.

Just to be clear this article is talking about blood plasma, it does not have a major role in transporting oxygen to tissues. This is a product with plasma proteins and coagulation factors only. It does not contain red cells, white cells or platelets.

Mt Vernon says it isn't needed (in bold caps no less) http://cmvny.com/wp-content/uploads/2014/01/2013-Firefighter-Exam.pdf

I think a lot of people are missing the whole point of why people who have contact with patients should be vaccinated. We are talking about a disease that has a significant mortality risk for the elderly and otherwise immunocompromised, that we can transmit to our patients when we have NO or very minimal symptoms. It's not going to hurt us that bad, but it could kill them. This disease has a high incidence and prevalence, and it is highly infectious with respiratory droplet transmission. Most other vaccinations that you receive, such as hepatitis B are things that you could potentially get from your patient but not something you would transmit to patients using standard precautions. Hepatitis B is blood borne. I understand the desire to control your own body. The risks from this vaccine are extremely low, it DOES NOT and CANNOT give you the flu. The efficacy is somewhere around 60%. No vaccine reaches 100% efficacy but we administer them because the risk reduction is well researched and statistically significant.

For most people, egg allergy is no longer an absolute contraindication to being vaccinated. Here is an excerpt from a recent paper published in JAMA. For many years, egg allergy was a contraindication to influenza vaccination, and those with severe allergic reactions (ie, anaphylaxis) should still avoid influenza vaccination. However, recent evidence-based guidance advises that all other egg-allergic patients should receive influenza vaccination based on the rationale that the risks of not vaccinating outweigh the risks of vaccinating these individuals as long as basic precautions are followed. Specifically, the Advisory Committee on Immunization Practices advises that those with an egg allergy who have only experienced hives after egg exposure should receive influenza vaccine with postvaccination observation for 30 mintues.9 However, egg-allergic patients with a history of angioedema, respiratory distress, nausea, vomiting, or a reaction that required epinephrine or emergency medical attention after egg exposure should be referred to an allergist for further evaluation. Talbot TR, Talbot H. Influenza Prevention Update: Examining Common Arguments Against Influenza Vaccination. JAMA.2013;309(9):881-882. doi:10.1001/jama.2013.453. I suppose that if you still cannot get the vaccine and the non egg based vaccine is not available to you, then yes you would be stuck wearing the mask. It is the responsible thing to do as a healthcare provider. Edit: Per the company making the "flublok" vaccine with no egg components, availability is expected by thanksgiving. http://www.prnewswire.com/news-releases/flublok-influenza-vaccine-availability-update-product-to-be-available-to-allow-vaccination-by-thanksgiving-227219901.html This same article has a point for you to consider, "“I never get the flu/I am healthy.” This rationale neglects one of the major reasons vaccination is recommended. While some people, such as healthy adults, may not develop a classic, severe influenza-like illness when infected (and a substantial proportion may have minimal to no symptoms), they likely still can transmit the virus to others. Refusing vaccination because of a perceived low risk ignores the potential risk to close contacts, especially those who cannot get vaccinated or who will not mount a strong immune response to the vaccine and rely on herd immunity for protection. This risk has driven many health care facilities to require influenza vaccination for their HCP as a professional and ethical intervention to protect patient safety and promote a safe workplace." While I'm sure that someone is crunching the numbers about the masks vs. shots issue that you bring up, that is not really the central issue. If your workplace decided providing masks were cheaper, then they should be worn. In my mind that does not change the ethical responsibility of anyone coming into contact with patients to be properly vaccinated. We have a responsibility not to expose our patients to danger that can easily be prevented. The best way to prevent the flu is to be vaccinated.

You are welcome not to get the shot, and since you are young and probably healthy you will almost certainly survive. Influenza is also potentially avoidable if you either: A. get the vaccine B. avoid people during flu season OR C. Wear appropriate respiratory protection for the duration of the patient contact through the time when your ambulance is decontaminated. People can transmit influenza before they experience any symptoms. So this means that we must treat every patient as potentially infectious, and that we also may become ill and transmit this infection to our patients. You may certainly choose not to get vaccinated, I just hope you are willing to stand behind that decision and properly protect yourself from infection, and more importantly protect the patients from being infected by you.

Since you have access to a computer, you are the best person to evaluate the effectiveness of any supplement that you are considering taking. From a quick search on the lipozene that you mentioned, I'm fairly certain that you would have a better result saving that money to spend on healthier food choices, the gym or investing in some exercise equipment for your home. The only effective way for anyone to lose weight is by consuming less calories than you need in a day. One thing that a lot of people struggle to do is understand exactly what they eat in a day. By using one of many websites or apps available, you can track the number of calories you are consuming and also track things like fat and salt. There are some medications available that can increase your metabolic rate slightly, these are prescription only and generally only used in people with a BMI of 30 and above. The only verified pharmacologic way to help you lose weight available OTC is Orlistat/Alli which can decrease fat absorption, but commonly causes diarrhea, fatty stools and flatulence as a result. You also mentioned that you don't consume much in the way of fluids. In general, if you are considering a supplement of some kind this is not a good idea. The lipozene is a fiber, acting as a bulking agent to hypothetically feel more full after consuming less food. If you were taking it in a dosage to be effective it is going to absorb fluid in your colon and potentially cause constipation. All of the recommendations for fiber intake presume you are consuming an adequate amount of fluids. In summary: 1. Consume less calories than you burn 2. Track the food you consume and adjust accordingly 3. Try to exercise 30min a day most days of the week. Aerobic exercise such as running or biking is best for weight loss. Aim for a HR of 50 - 85% of your predicted max sustainable HR = 220 - Age 4. Shoot for a weight loss of 1-2lbs/wk if you want to maintain the results.

For those who know better than I do, lets say this was the situation. He was stopped for speeding and during the course of the traffic stop he identified himself as possessing both valid pistol license and the firearm listed on his permit was on his person and loaded. Now the the officer is aware of the firearm what can be required of this individual under the new gun laws. Here are my questions 1. Regardless of what would be polite or nice, does does a duty exist for someone with a concealed carry permit need to notify the officer at all? 2. Can the individual be required to surrender the pistol during the course of the encounter with law enforcement? 3. If the pistol comes into the officers possession, but the person is not being arrested, what can the officer do to render that firearm safe. Does emptying the magazine entirely of all rounds constitute a search more that what would be necessary to make the firearm safe?

I'm in

Maybe I am missing something or don't understand the legal intricacies, but how is the new magazine ban not an ex post facto law and therefore unconstitutional under Art. 1 Sect. 10 of the constitution? I purchased all of the magazines that I own legally, according to the law as it existed at the time of my purchase. It seems that retroactively banning these items would be a prime example of an ex post facto law.

Here is an article that deals with the issues surrounding testing for THC concentration in blood. It seems like there is no clear standard at this point. http://blogs.seattleweekly.com/dailyweekly/2012/03/the_science_behind_stoned_driv.php

Not sure that one will buff out.

But there IS a different requirement for neurosurgery between area and regional trauma centers. I would argue that this can and should impact your choice of destination for some patients, especially in a case with relatively equal transit times to the receiving facilities. This may have been a good case to consult with on-line medical control while the air medical resource was en route. We don't always need to make the destination choice on our own.

No medical director is required for that, but per HIPAA they should not be receiving information on the disposition of that patient without the permission of the patient in question. In the context of QA/QI information can be released, but the "minimum necessary" rule applies, so generally things like names should not be included in this either.

This is really a terrible policy on behalf of the Justice department and the court system for establishing disparate impact as a standard for proving discrimination. Just because there is a statistical chance that minorities may score more poorly should not and in my opinion does not prove discrimination. If anything it is indicative of a failure of the education system to prepare those from less well off areas adequately. It is a shame that they were possibly not afforded an equal chance to succeed as a child, however, it is not the responsibility of civil service tests to accommodate those who the system has failed in the past. The tests should be hard, because we should strive to challenge the applicants, especially for the promotional exams. I would argue that even tests that don't have "job related" questions, can be of value. If everyone is aware of the content of the exam and provided study materials, those who preform the best have shown the drive and determination that is necessary to succeed in any position. It makes me ashamed to be "represented" by those who have such an obvious agenda. I have yet to see how a written test can be racially biased, since I am reasonably certain a test cannot see the color of the person taking it.