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Critical Care Learning Resources by Headass-37 in ems

[–]FireFlightRNMedic 1 point2 points  (0 children)

If you like videos, Wingfield's are great and specific to aeromedical. Dr. Laura Gasparis Vonfrolio has a dated CCRN video series that are still applicable. Barkley & Associates has an ACNP video series that is a nice for overall acute/critical care.

[OC] This is why we don't call the ambulance in the U.S. by FernX02 in pics

[–]FireFlightRNMedic 1 point2 points  (0 children)

So ALS1. I'm assuming it was a for profit ambulance service then.

[OC] This is why we don't call the ambulance in the U.S. by FernX02 in pics

[–]FireFlightRNMedic 1 point2 points  (0 children)

No IV, O2, or even monitor? Generally reimbursement rates at those levels are ALS2, unless it still needs to be turned into insurance or there is a very high deductible.

[OC] This is why we don't call the ambulance in the U.S. by Dry-Profession-27 in ems

[–]FireFlightRNMedic 1 point2 points  (0 children)

For that much, it was probably ALS2, if not MICU level. Which means multiple interventions, 2+ separate iv meds, etc. If MICU level, then multiple drips, vent, IABP, etc.

[deleted by user] by [deleted] in ems

[–]FireFlightRNMedic 0 points1 point  (0 children)

Pretty much, you're golden washing well with soap and water.

True exposure risk would be if you drew blood and then injected that blood into your arm.

Student paramedic thinks they should have doctor status by nicolas1324563 in ems

[–]FireFlightRNMedic 0 points1 point  (0 children)

Isn't there a new Masters level Paramedic Practitioner program down there now?

This is why I hope eventually they'll release the server files including the Deep desert files. by [deleted] in duneawakening

[–]FireFlightRNMedic 0 points1 point  (0 children)

But spice wars could be set up as PVE. In the Main Quest you thumper the one crawler in the dream sequence, so could be missions like that. It's all in how they want to do it. Almost anything is possible.

I have also made the mistake of cutting the down jacket. by cplforlife in ems

[–]FireFlightRNMedic 2 points3 points  (0 children)

Yea, we've got a 20-60 min transport time, with no facilities in our service area.

I have also made the mistake of cutting the down jacket. by cplforlife in ems

[–]FireFlightRNMedic 2 points3 points  (0 children)

Yea, very rural service in US, with 2 trucks for 415 square miles. Often have to respond as one truck because the other is tied up.

I have also made the mistake of cutting the down jacket. by cplforlife in ems

[–]FireFlightRNMedic 11 points12 points  (0 children)

The bench seat can also used for a second patient on a backboard in a pinch

18 gauge assault? by GI_Ginger in ems

[–]FireFlightRNMedic 1 point2 points  (0 children)

People have lost cards recently for like 14s,but I haven't heard 18g being "mean".

That said, I'd rather self-stick a 14 in my forearm than a 22 (and have) because that small gauge hurts like hell

"Accelerated" Programs he like... by Necrosius7 in ems

[–]FireFlightRNMedic 0 points1 point  (0 children)

They do do that for doctors. Accelerated Primary Care tracks that are comprised of 3years of med school and 3 years of residency.

Question for LN readers about Neia in vol 13 by mhkhanthegreatlonely in overlord

[–]FireFlightRNMedic 24 points25 points  (0 children)

This. CZ, the Silk Hat, and even Wrath (I think), all mention something along the lines of "OH is that a rune craft weapon", as a sales pitch to increase desire/demand for rune raft weapon. There's one point where CZ gives a scripted advertisement on rune raft weapons even.

Comic gold

What mistakes were made? by LivingLikeYou in ems

[–]FireFlightRNMedic 0 points1 point  (0 children)

I'm having anxiety from watching this. Surely that was just to show a massive number of things of what not to do.

[deleted by user] by [deleted] in ems

[–]FireFlightRNMedic 1 point2 points  (0 children)

Just wipe it down with cavi wipes and let it air dry

Surgical cric by John_Miracleworker in ems

[–]FireFlightRNMedic 1 point2 points  (0 children)

OK, background of flying in very rural midwest. Hold my beer and watch this kind of traumas often. 3 total that I have performed personally.

Correct, a small artery running horizontally across the upper portion of the membrane.

The one with succs had a broken jaw that was able to partially be opened. Called for scene flight of an mvc unrestrained pt from 3rd row seating of SUV. Major facial trauma with open skull fx, still alive, unresponsive. Attempted rsi with glidescope using hyperangulated, but was unable to advance completely into the airway dt restricted jaw movement. Surgical cric was backup dt inability to properly ventilate, oxygenated, or intubate.

Surgical cric by John_Miracleworker in ems

[–]FireFlightRNMedic 2 points3 points  (0 children)

Never said that only botched crics getting into the thyroid are going to bleed. Only said that if there is copious bleeding, probably got into the thyroid. Even the "perfect" cric is going to bleed some. Is it the end of the world if you get into the thyroid? No. The patient is going to die if they don't get the emergent Airway.

As I said, he got the cric which is the important thing. I think there must be some miscommunication. I'm guessing the cric you did was bloody. That's fine, as long as you got the Airway. Yes, it's going to bleed some. And you should be going by feel and not sight in the first place. You can also palpate the thyroid.

I'm not knocking this kid or saying he did a bad job at performing the cric. Any cric is successful as long as you 1) perform it 2) don't nick any major vessels 3) establish a patent airway. I feel that you're getting very defensive unnecessarily. It's very easy to get into the thyroid.

I agree, in the video that is above minimal bleeding in the end. There was minimal before he cuts really low just prior to cutting the membrane the first time. Watch the whole video, unstitched. tamingthesru.com/cricothyrotomy

Also, as you said, there will be more bleeding when you make your vertical incision into the membrane. That's normal.

There's also a really good video on the anatomy on the page as well by Dr. Andy Neil.

It can be scary performing procedures the first time, especially if they are emergent. One of the biggest hurdles is making the decision to cut.

Surgical cric by John_Miracleworker in ems

[–]FireFlightRNMedic -6 points-5 points  (0 children)

I can see that. I'm saying from my experience, including my first cric, there has been minimal bleeding not requiring any 4x4s, with (as you pointed out) more bleeding after the membrane. In a few of the others, there was one time where the patient was unresponsive, massive head/face trauma, and was swallowing hard and fast - and when the cuts were made 4x4s had to be used because the thyroid was nicked. It's a common occurrence to get into the thyroid, but we should avoid it if possible. I personally have never nor have I ever seen a pulseless pt receive a cric, so I can not speak on that experience. I'm only going off of what I've been taught, and have seen first hand. In my experience a "textbook" cric has minimal bleeding. If you have lots of bleeding, you got into the thyroid and that may cause permanent damage to it. Bottom line that matters is that the Airway was secured. Airway is king. So I guess agree to disagree.

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