(21:40) Ron took his second cardiology exam this week. Also learned about aberrant conductions rhythms, and practiced the pushing of adenosine. During listener questions you will learn two ways for paramedics to do 2 finger CPR.

Listener VinceD’s comment on Kelly’s comment on hypomagnesemia.

(36:05) Continuing on learning the language of the heart Kelly & Ron discuss Battlestar Galactica (the original series) as well as places further down the heart. Ventricular rhythms, the pulseless part of the algorithm (PEA), why to give drugs or epi first, when to use Edison therapy, or when it is time to all in to end efforts. Also, Kelly discusses how things one learns in school, and the algorithms for giving drugs, can be very very different than what may happen in the field.

(42:27) Move’n on down the heart we get to the AV node and junctional rhythms this week. We also talk about the ACLS tachicardiac algorithm and stable vs non-stable patients.

Also Kelly summarizes all the pediatric course like PALS in 30 seconds.

Six Second ECG

ENPC

75 yom complaining of chest pain, you initial impression is that he going down the crapper. On the monitor you see a paced rhythm at a rate of 56 beats per minute (with electrical & mechanical capture). All signs point towards that the heart isn’t beating fast enough to adequately perfuse the body. BP floating around 85/50.

Would you trans-q pace the patient? The crew that brought the pt in didn’t nor did the ED doc.

(31:01) This week Ron learned about dysrhythmia – and wonders whether the interpreting of rhythms is an art or a science. Ron and Kelly discuss different methods of reading strips, whether or not Ron should have multiple sources for learning to read them, and the difference between ECG and EKG.

Basic Arrhythmias by Gail Walraven

Pocket Reference to The 12-Lead ECG in Acute Coronary Syndromes by Tim Phalen, Barbara J Aehlert

Assessing Mental Status article

Can they really refuse your care? by Kelly

(29:01) This week the newbie learned how to break up, interpret, analyze, something EKG wave forms. We talk about the algorithm he learned and some tips from Kelly.

And Kelly says he loves poo poo.

Ron was also shown three cardiac monitors and we talk about the good and the bad of monitors.

Interpreting Algorithm

Lifepack 12 and Lifepak 15 from Physio Control

(21:10) Ron talks about learning the electrical parts of the heart, as well as the different chambers, and the part of the heart that looks like a Bishop’s mitre hat.

Kelly talks about why one needs the anatomy of the heart even though it isn’t used directly all that often.

There is also discussion of syncytium, and intercalated discs.

Ron also had an interview for an EMS job and talks about how to answer interview questions.

(48:11) Ron started cardiology this week and they went back to basics CPR. For about 6 hours this week. He and Kelly discuss changes to CPR. We talk about the Phillips cardiac monitor “hockey puck” and the Zoll AED’s talking. Survivor Paramedic has Ron’s class down to 7 students, but we supplemented by 8 nursing students, meaning there are more women than men in the class.

Also is “neurologically intact” a good measure of resuscitation success? What do they track when gauging success? Can you intubate while someone is compressing the chest?

Also talked about how Ron’s White Cloud Fu overcame an entire district of EMS calls on Saturday.

EMS Newbie Podcast DVDs

Kelly’s medic math post

“The National Registry of Cardiopulmonary Resuscitation (NRCPR) was developed by the American Heart Association to provide a better understanding of the circumstances surrounding in-hospital cardiac arrest.17 Although the primary purpose of the NRCPR is quality improvement, it is a robust database that includes objective assessment of neurological status by cerebral performance category (CPC). The CPC is a valid measure that defines function using a simple scale, where CPC-1=good cerebral performance, CPC-2=moderate cerebral disability, CPC-3=severe cerebral disability, CPC-4=coma or vegetative state, and CPC-5=certified brain death.18 Our objective was to use the NRCPR to identify factors associated (positively or negatively) with CPC-1 or -2 at discharge (henceforth referred to as “neurologicallyintact survival” [NIS]) for patients with acute HF who suffer an in-hospital cardiac arrest.” –Circulation: Heart Failure. 2009; 2: 572-581

For Example chest pain – Bill, 45, woke from sleep app 7AMLeft sided chest pain radiating to Left arm. on arrival pale sweaty, hypotensive,tachycardic, ECG -ST elevation lead 2,3, AVF. we’ve given oxygen @ 4l/m nasal, Aspirin 300mg, IV access morphine 10mg good effect transport code 1 ETA 10min. On pre arrival call only change is we add last name and date of birth so a file can be made or retrieved if previous patient.

Same AMIST for Trauma patients. EG. Bill 45, riding bike fell hit headon concrete, no helmet. ALOC upto 10min, vomit x2 nil resp distress, laceration Right occipital, normotensive, tachycardic, we’ve immobilised, oxygen IV access, metoclopramide 20mg IVI code 1 ETA 10min.

physician given chance to ask questions when handing over in resus or trauma room. This seems to work well.

Also , in response to some discussion on your health reforms and potential increase in workload for ambulances. We have free ambulance to residence as subscription is included in there electricity rates. So we get alot of taxi jobs. We do however get to leave some people at home if there is no clinical or social reason to go to hospital by ambulance. This is the secret to free health provisions- clinical knowledge to point out ambulance transport is not warranted. In saying that our hospitals are overflowing as it is cheaper to go to hospital than see a GP.

Thank you for the podcasts I do enjoy them

Jeff

(22:40) Ever wonder what it is like to go from paramedic to doctor? Well in this episode you will find out. Ron interviews Dr Ryan Hodnick a resident in Emergency Medicine at UNLV medical school in Las Vegas. He answer’s Ron’s questions about why ER docs do things and what EMS can do to help them. Also talks about what it is like to change from paramedic to doctor.

(48:42) It is the end of Ron’s second semester in Paramedic school, and time for another best of episode. Here are some of the best clips of the last few months.

(39:57) School is over and Ron has taken his EMT-I exam…but does not yet know the results. And so we devote an entire episode to listener questions!

And don’t forget to write your entry into the…

Links to the other Podcast in which Ron is appearing:

Ron:

I’m curious to see how you to react to religion. I, myself, am an atheist so I’m not exactly sure how to feel when someone asks you to pray with them. Also, how do you feel exposed to different religions that determine treatments – for example Jehovah’s Witness’ and blood transfusions.

I was reading the Western Australia Ambulance Services’ Medical Director presented a study on pre-hospital use of adrenalin in cardiac arrest – the PACA trial. It showed that while adrenaline is useful in ROSC it showed no significant difference in 28 day outcome. Wat are your thoughts on adrenalin?

Why don’t cops ever get any credit for their contribution to EMS?

Do Ron or Kelly have a certain structure or mnemonic when you are giving a handover to the nurse or doc at the EED?

1) Why do you believe acid/base balance to be an important topic?

2) Talking about International EMS and looking beyond your own horizon – I’m currently touring the UK and North America and what an eye opener it is to experience different systems.

First, would you say that having moderate asthma that is well controlled with medication and moderate scoliosis be a problem working as a paramedic?

You often say, when discussing spinal motion restriction, to place the board higher than the patient. Would you still do this with a very tall person?

Given where you two are in classes and careers, if you could go back and tell yourself one tip, trick, or lesson, to help yourself before starting your EMT-B course…what would it be?

I ran into my old partner the other day and he related to me a call that he had. The patient had an obvious ankle fracture and the patient was wearing over the ankle style work boots. My former partner elected to leave the boot in place and use a pillow splint to immobilize the ankle. When the BLS truck arrived on scene (they) proceeded to undo the pillow splint and remove the boot without giving the patient any pain medication first…and used an air splint…My question to Kelly is, have you ever had this problem before and what would be the reason for removing the boot if it was helping to maintain immobilization?

1) Besides a pelvic fracture, when would you use a scoop stretcher instead of a stair chair?

2) Any tips on patient assessment (in testing situations)?

3) From an EMT-B standpoint, what makes a good handoff report?

4) What are your opinions on the status of EMS in the United States today and in your views, where does it need to go?