(45:41) Lots of stuff on pediatrics and the body’s defenses. Let’s try a slightly different version of the show notes. Here’s my actual outline from the show.

Laryngospasm

Review of system defenses, mostly at the cellular level

Pediatrics

No babies being born

Starting to review for Med Emergency exam on Monday

Out of Side Kicks

Peter Gabriel – Sledgehammer video

None this week, send us yours

(49:11) 2 tests two fails. Ron says, “The ICU scares me.” Kelly talks about how is GSW, first ICU patient, and first dead body transport were the same person.

In Pediatric IO how do you hold the leg? In Newborn resuscitation, using the ET for suctioning, do you use a new tube each time you go in? In the past it was “baby is pink, baby is good”, now AHA has preductal PSa02 values

Kelly learns something new, you can use alcohol to stop labor because it decreases ADH and oxytocin.

Ron studied the endocrine system this week and discovered just how many of our drugs are hormones.

Guillain-Barre syndrome

(Side note: when I got my wisdom teeth taken out, the original plan was an in-office procedure. Well, since the oral surgeon decided to use a pedi needle on me, she missed 3 times and I had to go to an OR to get it done. Even there, 1 nurse missed in my arm, and the anesthesiologist eventually got me in the hand. Apparently my veins hide.)

(29:02) In Special Episode 7, Ron interviews Jeff Isaac from Wilderness Medical Associates.

Ron and Jeff discuss how wilderness doesn’t necessarily mean deep in the back country or in a cave, how the definition has changed over the years, and why WEMT is useful for all EMT and Paramedic practitioners.

Jeff is a physician assistant with a particular interest in backcountry and marine medicine. His 30 years of professional experience includes service as an ambulance and fire/rescue crewman, professional ski patroller, and medical staff in hospital emergency departments and ski area trauma clinics. He has also been a senior instructor and course director with the Hurricane Outward Bound School and has worked as mate and licensed captain aboard sail training vessels from New England to Trinidad.

(41:29) We’re talking birthing babies, vomit and poop this week. Ever seen a breech deliver? Heard the term “Macro peds”? The changing rules of suctioning meconium babies. Projectile vomiting and being covered in vomit. Kelly discusses laryngo-spasm.

Episode 10 – Don’t Know Nothing About Birth’n No Babies

(37:17) The EMS Newbie Podcast live from Las Vegas at the 2011 EMS World expo.

Thanks again to ProMed for bringing us to Las Vegas and doing a great job netcasting all the podcasts done from there.

Now on to the kilted ones.

(27:11) Ron missed the first week of school because off EMSWorld Expo, so the guys talk about what happen there. Answering questions like, “What’s the most memorable thing that happen to you at the expo?”, “See any cool gadgets at the show?” and “What’s it like to be kilted in Vegas?”

Ron’s Kilted to Kick Cancer Page

Our medics have been doing this “forever” except there’s one small problem – it’s not in our protocols. (and apparently our medical director was livid when the paramedics & EMT-I’s admitted to doing this)

We have a rural practice – over an hour by land to a community hospital, over an hour by air to a level 2 trauma center.

I’m an Emergency Medical Responder currently, but even I realize there is a difference between a fishhook in the finger, just through the skin, and one embedded in an eye or a “true impalement” Like a shark hook in the gut.

Thanks!

A. Ranger

Although I had considered myself fairly internet savvy, I have no experience in the blogosphere. After listening to the Newbie podcasts, I then started listening to the EMS Garage podcasts.

I see the websites of ems1.com, JEMS, Happy Medic, TOTWTYTR, but I am painfully inexperienced with the whole blog world. I have also never heard of “RSS feeds.”

The Oregon EMS conference is coming up and is actually the three days prior to my EMT-B 105/106 accelerted course beginning.

I need help connecting with the blogosphere community, especially in my area. I plan on attending the conference as a student, which is acceptable as long as I show my registration, but I will be attending before every stepping foot inside of a classroom.

I fount the OregonEms.Org’s facebook and requested to join their group.

Basically, what I need is help beginning my hopefully long-term connection with the EMS online “scene”, especially local. It would be great to connect on the internet with some of the attendees of the conference so I can have someone to meet once I get to Salem, if at the very least to give me an EMS welcome, hi, hug, or high-5. I am nervous, brand new, and have no resources. With the ridiculous amount of information I have devoured in the preceeding months, I am sure this is for me.

Please help connect me to “scene”, I know its out there, in full force.

Sincerely,

(25:57) Ron has his cardiology finals. Both the written, which was a third of my grade, and the practical which was 3% and got him his ACLS card. But it was 3% if you don’t pass, you don’t pass the course.

This episode sponsored by MedicsTest.com

Listener Questions

On the last podcast y’all talked a little about CPAP. Our CPAP protocol says to use our ETCO2 monitoring equipment which resembles a nasal cannula. I would think that using that would prevent a seal around the mask, defeating the purpose of using CPAP. What are your thoughts?

Lastly, say you have a patient with a respiration rate of 40 with a hx of COPD, and they are unable to speak in complete sentences. They have diminished lung sounds, however you can hear wheezes in the upper right lobe, slight cyanosis in their lips and nail beds, initial sat was 84% after a NRB with 10 LPM it comes up to 92%. Would you give a neb treatment to see if they improve or would you go ahead and attach the CPAP? I’m sure that I’m probably in the minority for EMS providers but my philosophy is to do the least invasive treatment which in this case would be CPAP before I begin to administer drugs.

Kelly: After all the years of schooling and the many calls you have run, has your thoughts or views on EMS as a whole changed, and if so, what about?

EMS Freak

(36:47) Ron learned the basics of 12 leads finally. We also talk about equipment failure on scene, and changing stethoscopes.

Newbie resource page.

Anyways my first question is regarding drugs for nebulizer treatments. The protocols at my EMS service for COPD/dyspnea include giving neb treatments with 2.5mg of albuterol mixed with 4mg of dexamethasone sodium phosphate (AKA: decadron). I’ve researched information on the drug but cannot find any literature on using it in combination with albuterol for nebulizer treatments. The usual EMS usage for decadron seems to be for cerebral edema, anaphylaxis, and COPD. Yet, it is given either IV or IM. It seems like the standard EMS neb treatment is albuterol and atrovent. What’s are your thoughts on using decadron vs atrovent?

(36:33) This week Ron studied CHF and asks “Why do they call it congestive heart failure?” He also had Exam III cardiology. He and Kelly discuss how traing for a code is different for nurses and paramedics.

Last week we talked about how everyone shouldn’t get oxygen and Ron mentioned his medical director sent out a protocol memo saying almost the exact some thing. Then there is a brief discussion of how great HCEC’s medical director Dr. George Kiss is.

On the ambulance this week Ron collected my first strip. He could actually look at it and know something was wrong and have an idea what it was.Saw his first use of CPAP and first NPA insertion.

Harris County Emergency Corp

(25:26) Stroke and Acute Coronary Syndrome were the ACLS topics of the week. Kelly talks about AHA’s sorid past with stroke, and Ron talks about medics that missed his father in law’s stroke.

“Everyone gets Oxygen” Really? Kelly doesn’t think so. Nor does the AHA.

Hey Nurses, what the mass of a grain? Doesn’t matter, cuz Kelly says any doc that still perscribes it that way should be avoided.

CEVO or Defensive Driving? Hard for Ron to tell the difference.

Kilts for a Cure