RNEMT26

Who wants to sit here and have a pissing match with people about the same stuff over and over again. Im currently pursing my masters in a specialty aspect of medicine and the forum I am on is amazing...why ? Because we push each other to try different things and we can ask for and get amazing advice from the 11,000 or so members instead of it getting derailed by someone with a piss poor attitude. Everyone that is in this particular specialty loves their job and we are always trying to find new and better ways to do it. Do we disagree on certain things, well yea. Not everyone is going to like what you say, but there is an exceptional level of professionalism on that forum that isn't anywhere to be seen here. Unfortunately, here it's always the same stuff and the same people with the same crappy attitudes, who wants to deal with that ? Not me. It's sad to see this site become a shadow of its former self.

- For real?? Those are some prettily brazen statements to make, guy. There's a lot of people who work for them on here and I'm pretty sure they'd disagree with those statements. MLSS is a business and it's run like any other business, to make money. Your comments are just ignorant.

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- Honestly, in my opinion we like to have a heads up of whats coming in and if we need to move people in order to open up a bed it's a lot easier to do it before you get there. Calling in a report doesn't necessarily change the treatment, but it can allow us to be a little bit more prepared for what is coming in, regardless of whether the patient is critical or not.

As an ER and ICU nurse, don't bore me with information that does not matter. Most of the time we do not have time to sit by the radio and listen to a 10 min long report when you could have easily condensed the info into literally 2 minutes and a couple of sentences.

I had a patient who coded 2 separate times, the first tim he became bradycardic and then asystolic and was brought back. And then he coded again and had CPR preformed for almost an hour and a half, they did also use a automated compression machine. Long story short, he was crashed down to VA ECMO, required 13 drips, and continuous dialysis for a week or so and he walked out of the hospital a couple weeks later with a fully intact mental status.

- Sorry but I have to respectfully disagree with you..... I started as a CFR at 16, and I saw a lot of really awful stuff. And it taught me a lot about myself, the fragility of life and a host of other things. Was it difficult to bear witness to that stuff?...Of course, some of what we see and experience are things most people wont ever see or encounter in their life. I agree with the fact that some people may not be able to handle it and they either need to mature or be taught about to deal with that stuff and not compartmentalize it like so many people like to do with the thought that it's the right way to deal with emotionally difficult situations. I think that younger members maybe more at risk for ineffective coping mechanisms because a lot of them (like myself at one point) do not want to seem that they 'can't handle it' or are being 'weak'. We as senior members need to help them out and talk to them about it and let them know that it's ok cry/be upset/ or sad about things. And that these feelings are normal and expressing them is far better than suppressing them.

People died, young kid/adults died. To sit here and have a discussion about, ventilation and whether or not what those good samaritans was right/wrong, good or bad goes beyond words. Those people did what ANY of us in emergency services would do, HELP. Isn't that why we are all in this anyway ? To help people ? You can't fault someone for just trying to help to lives. To even attempt to go into a burning building with out any gear takes more balls than I could ever have, and those people should be given a pat on the back just for trying to get in there to save those people. This discussion makes me sick and im just as guilty to engage in this, nonsense. RIP to the young lives that were lost in this tragic incident.

Dutchess 911 to ________ respond for a person with a self inflicted gunshot wound, to the rear, at xxx" - to the rear??? and by rear he meant his asssss bahaha

This isn't a solely a 'college' problem, this is a societal problem. Screwed up people with access to firearms, and no one ever says anything because it's always the famous line of 'well we didn't think he would really do it" Unfortunately, we as a soceity will never be able to eliminate the possibility of some deranged person grabbing a gun walking over to the local mall and killing everyone in sight. Unfortunately, it's something we just have to live with, take away all the guns then maybe you have some possiblity of decreasing how often things like this occur. But if the gang bangers can get them illegaly then obviously anyone else can, so is there a good way to fix all of this? Don't think so. It's something that can happen anywhere at anytime, and if it does while you're around...duck.

Ive been in a couple humbling experiences actually but ya know there are some pretty stupid medics and emts and also some stuid nurses with whom i wouldnt let touch my dead dog

No pocket guide can ever replace common sense and a gut feeling. The way you get good at it is by doing it as much as you can and asking questions when there is something going on with a patient that you dont quite understand. Some medics love to teach, other do not. Me personally I like to teach new EMTs because I enjoy what I do, outside of EMS and FF I also work as a Critical Care RN, so I'm a bit smarter and have a considerably deeper knowledge base than the average EMT/Medic. The best thing to do is learn not only what to do, but whyyyyy you're doing it. Too many people come into EMS and simply just do things because the protocol says to do it. I'm a big believer in that no protocol is a substitute for common sense. Always trust your gut.

I totally agree and that's what I was saying before and some people got their undies in a bundle about it. Unfortunately some EMS workers fail to understand the 'why' part of what we are doing, or trying to accomplish. And people just do things and their excuse is "because it's protocol' right, however in every protocol ive ever worked with in the hospital or anywhere, here is usually a little caveat that says it's not written in stone and that the protocol is no substitute for good clinical judgement. Unfortunately some people dont get that.

I have not seen may people need CPAP/BiPAP for bronchitis. Of course there are exceptions to everything and people have gone into resp. fail and required intubation, strangely enough those patients usually have COPD but it's usually comlicated by Pneumonia and sepsis. IMO, CPAP is ok. COPDers have BOTH Chronic Bronchitis AND Emphysema. Now there are other forms of COPD- Bronchiectasis and CF, but for simplicity sake and reality sake I think most of what we see and treat in the field is the regular COPD and by that I mean Chronic Bronch. and emphysema. Im sure maybe someone working in NYC or another major metro area may have seen the other diseases I mentioned but out in the suburbs I highly doubt it. Either way you slice it, CPAP gonna increase oxygenation, but you gotta make sure they can get the air out too. BiPAP attempts to do that, with 2 levels of pressure, 1 to help the air in, and a lower one to 'help' the air out. PTs with Emphysema 'air trap' which leads to increases in CO2 and eventually leads to Resp. acidosis and a host of other problems, which is why they tend to have a 'barrel chest' if you've ever noticed. People with Bronchiectasis produce large amounts of sputum daily, almost 250cc. And the same goes with people with Cystic fibrosis, hence why these are termed 'obstructive pulmonary diseases' the major problem with them is the 'obstruction' on the bronchi and smaller air passages with sputum/phlegm etc. So if CPAP is all you got then you use what you have and make due. It will help with oxygenation, but what they need the most is to clear their airways. Which is why some of the CF PTs wear chest percussion vests to help with that.

It depends on the situation. Im not sure of how much you know about BiPAP/CPAP but it has obviously 2 settings a IPAP (inspiratory) and an EPAP (expiratory). Usually we set it @ 10/5 with most patients and tweak it as necessary. The EPAP is lower and is supposed to help with exhalation. CPAP it just what it says Continuous Positive Airway PRessure, so a COPDers have a problem with air trapping, so it's getting their out not, not necessairly getting it in. Now if it's somone who is in resp. failure then chances are this person is gonna get intubated at some point, which in all honesty is sometimes the best thing for them. We usually rest their lungs for 2-3 days and then wake them up and pull that tube. If the situation is more in the CHF realm then you can us BiPAP or CPAP with diuretics and nitrates (sometimes) to help clear their lungs up.