# Medical. : Intro/Qualifications/Goals



## HeloMedic1171 (Jun 16, 2009)

who you are, what you do, what you're looking to learn/study.....


Helomedic, resident nomad and stepchild of the Army Medical Department.  I've been deployed twice now, and have served in Aviation units in a CASEVAC/MEDEVAC capacity, MPs as a line medic and senior medic, and Cavalry as an Aid Station medic and Line/evac medic.  currently vacationing in the desert with 1st Cav Division.

I'm a 68W10, Combat Medic, and EMT-B certified.  I've been to BCT3, CMAST, and CLS instructor courses, and teach CLS to my Joes.

I'm looking to stay sharp on my current skills, as well as learn new tricks others might know that I haven't seen, and also share knowledge with other fellow practitioners of medicine.  

I look forward to my brain hurting.  

where's the beer?  we can't learn without beer!!!!
:)


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## Muppet (Jun 16, 2009)

Helo: You said you want to learn A.C.L.S.? Look up the Sympathetic and Parasympathetic nervous systems. Thats a BIG start. All of the meds. and treatments stem off of the patho-phys. of that stuff. Remember: Break and gas.

F.M.


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## HeloMedic1171 (Jun 18, 2009)

WILCO.

I'll have an answer for you soon.


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## Chopstick (Jun 18, 2009)

Im a medical assistant.  Have worked in a Morgue(no snickering),Family Practice, Interventinal Radiology, OB/GYN, Gyn/Onc, Research assistant and currently in Pulmonary medicine. I would like to get back to Gyn/onc and/or work with a more motivated patient population.  COPDers are not the most inspirational group.  
I am here by invitation and basically for the party.  Ill mostly be over in the corner observing and listening.  
Thanks for having me here!;)


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## Muppet (Jun 19, 2009)

Chop: Talk when you want. We all have stuff to add.

As for me: I am a Paramedic/FTO (Paramedic instructor) in a busy suburban county system. I was a U.S. Army combat medic/Paramedic qual'd while @ Ft. Bragg. I operated as a line medic, senior line medic and evac medic. I worked multiple rotations in the Airborne medical clinic and on the post E.M.S./Medic unit for training. I spent 4 months in Saudi Arabia in "97". I got out and re-certed my Paramedic and have been doing it since getting out. I am glad to be on here. It keeps me sane.

F.M.


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## amlove21 (Jul 9, 2009)

Alright lets see- Im a pararescueman, NREMT-P. We get a lot of follow on quals- PALS, PEPP, PHTLS, and a lot of add on stuff for the military. Focusing a lot on clinical medicine lately, and Im going on a great med rotation in the states very soon. Ive been trying to step my game up a lot lately. I dont feel week on medicine at all, but I much prefer keeping sharp as opposed to thinking im the shit and getting caught. So, thats why im here. I wanna feel stupid as much as possible! 

And chop, you talk whenever you want. That goes for all!


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## HoosierAnnie (Jul 10, 2009)

RN (BSN with lots of masters credits)  mostly women's health, labor and delivery for more years than Id wanna admit.  Currently doing case management at a small (under 100 bed) hosp in central Indiana.  Along the way I spent three years as a Dept of Army civilian birthing mil babies in Germany (2nd FLd Hosp Bremerhaven)


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## HeloMedic1171 (Aug 3, 2009)

I'm going to put this in the nicest way I think I possibly can.  

if you are sincere about what you posted above, my suggestion is that until you hold a real, credible, and useful cert.... make that your last post, ever - especially in here - until you fulfill the criteria I just outlined.  be a sponge.  sponges don't talk or type.  that is all.


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## HoosierAnnie (Aug 3, 2009)

G - Lemme reinforce what Helo just said.  Your role back here is sponge.  You have ZERO real world experience, ZERO formal training as of right now.  Read, Listen and sometimes ask intelligently thought out questions.  If your posts back here come across with the same 'tude that I see from you out on the main loop, I for one will not hesitate to get out my "charge nurse voice".  I have experienced MD's listening to me, I won't be corrected by you (or anyone else with zero training for that matter).  This is your only warning from me.  Now engage mind and put mouth in park.


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## Muppet (Aug 4, 2009)

Hey G, I would listen to them BOTH. Behave in OUR group please.

F.M. (Admin of this group).


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## Diamondback 2/2 (Aug 14, 2009)

I am a 11B (Infantrymen) with 8 years service in the NG/ RC, deployments include 1year CDTF, 29 mths OIF and 3 years SARG Instructor. Other then CLS and some do this if this happens classes from a few HSLD medics I know nothing about the medical field. I may end up having to reclass to a different MOS and have been looking at the medical field along with other options.

I want to learn more about the 68W MOS and other medical MOS's that would keep me close to the fight...


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## Muppet (Aug 14, 2009)

Welcome all to the group. Thanks for joining.

F.M.


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## HeloMedic1171 (Aug 15, 2009)

Sweet :)  glad to have you!


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## HoosierAnnie (Aug 18, 2009)

Wilkommen JAB


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## midnight (Aug 22, 2009)

This is a great group thanks for the invite. Like I said in my original introduction I was at MEP's over a year ago where I learned that I had lost a degree of my red green color vision, probably welding, I have blue eyes. I am in great shape and have always been dialed in mentally, have 110 plus on all my GT's so I was dead set on a Ranger contract. When I found out I couldn't get a Ranger contract I was devastated but found out I could possibly at least by regulations enlist as a 68w and get a option 40, so I went home and enrolled in A&P and the likes and got into a EMT program.


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## midnight (Aug 22, 2009)

To the medical community on this forum it might sound like I'm learning emergency medicine just to become a Ranger but it has become much more then that. The more a learn the more I am fascinated by medicine and what I can do with it to help people who are sick. I would be very happy to just get in as a 68w and would not want to enlist in and field that did not have to do with medicine. So my goal now is to get all my paper work together next month and go in with a recruiter after the fiscal year starts in Oct so that I have more opportunity waiver wise and job wise and go for a option 40 or 8 and then let my drive take me the rest of the way. 

I don't have any paid civilian experience only credentials and volunteer time, I also read and write and speak and hear Arabic buuuut I don't yet quit know what it means that I'm reading and writing.

I would appreciate any advice and lets keep the assesments going in the medicine section.


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## Muppet (Aug 23, 2009)

Hey. Welcome over here.

F.M.


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## HeloMedic1171 (Aug 23, 2009)

aSalaam Alaykum.  and if I spelled that wrong, Bienvenidos, tambien.  glad to have you. :)


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## Recon Doc (Sep 8, 2009)

who you are, what you do, what you're looking to learn/study.....


Currently AD with 3rd Force Recon, Paramedic since '94, 8404 since '87, Just did the 18D refresher at Tier 1 Group (great F'n Place to train)   When I'm not on AD I am a Contractor with the Army teaching 68W MOSQ, CLS, CMAST, EMT-B and am a Paramedic student preceptor at our service.

I'm here to sponge up all medical goodness :)


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## Muppet (Sep 8, 2009)

Welcome to our home. 

F.M.


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## HeloMedic1171 (Sep 10, 2009)

A home, a home, home away from home.   :)  welcome to the mad house, as you take beers from la nevera, ponte un otro, por favor.


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## HoosierAnnie (Sep 17, 2009)

Welcome guys. Obviously, most of my med stuff comes from the in hospital side of the house, but I think I can hold my own for field stuff (can I Helo/FM?)

I'm off to the KY shoot this weekend. Looking forward to meeting some more of the loop-folks, have only met RB and Viper thus far.  Shall we do another scanario first of the week??  Recon, you up for leading this next one??


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## Muppet (Sep 17, 2009)

You can hold your own Annie. You can. Not bad for a R.N.:eek:

F.M.


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## HeloMedic1171 (Sep 18, 2009)

I agree with my Philly brother.  you would do well in dirt medicine. :)  Enjoy the KY shoot - usually I just rub it on, but I guess shooting it might work too.... be on the watch for phlebitis though, JIC.    lol


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## Pacer (Jan 29, 2010)

I guess this is where the creds go.

L (FM) conned me into signing in.

I don't type so well, and am doing flash sessions, so I apologize for the typos :)

I am physically DQ'd from USAF entry (1984) and since have had the near death MI and resultant disabilities. 

My mind and experience are my assets, and FM may or may not agree on the value of those.

I currently teach primarily medical students emergency medicine theory and technigue, having about 35 years of prehospital and hospital experience.

My bio is on the board intro, so if I forget anything important, oh well.


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## Pacer (Jan 29, 2010)

part 2

I started EM life as an Eagle and started an Emergency Services explorer post. Served as a dispatcher, aidman, "nurse" and driver for a volly ambulance, then a pro ambulance as one of the States first EMT's (1975). Worked as an orderly in ICE in a catholic hospital at night, with tours in CCU and ED, graduating BSN and Paramedic training, working with a major metro FD Paramedic program in the days of block grants (early 80), More time in the ED as RN, medical school through 1988, em residencyin a major metro knife and gun ED, with tours in three other MIEMS progeny Trauma centers, a burn center, and aninternationally known peds hospital. Started the centers EMS fellowhsip for docs, brough BTLS to the East coast of my state, and have been continuing to teach (my love) ever since. 

Ask and I'll point the way


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## Muppet (Jan 31, 2010)

Welcome to out little home doc. It's good to see you here.

F.M.


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## kaja (Feb 18, 2010)

Oh hai

I am student of AČR (Czech Republic's army) Faculty of Health Sciences, paramedic field. I had some first aid/ mountain rescue courses before enlisting, and continue in attending everything I can. But still i have lots to learn, and will mostly lurk here. I'd love to contribute, but I will stay in my line. 

Thank you all for sharing information here and for letting me to absorb them :)

Kaja


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## HeloMedic1171 (Feb 19, 2010)

welcome, gents!! :)


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## Sierra Bravo (Apr 2, 2010)

My .02 
Accupressure, Accupuncture, Herbalist / Holistic Wellness
First Responder
Most of my experience has been in the sports / Martial art field
Glad to be here & thanks for the opp to learn more


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## Muppet (Apr 8, 2010)

Welcome again bro.

F.M.


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## ffhammer (Jun 7, 2010)

I'm a career firefighter and a former paramedic.
Here in Ontario, Canada, you need to complete a college paramedic course, and then pass a provincial exam to be qualified to work for an ambulance service.
I worked as a paramedic-1 (symptom relief and defib) for a few years before becoming a firefighter.
I don't do any real medical stuff anymore; we're first response until the ambulance arrives. And as a Captain, I'm back taking notes a getting a med history while the action is going on.
I still teach first aid/CPR and defib.
I also get reminded of all kinds of med stuff since my wife became an RN 3 days ago.


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## Muppet (Jun 8, 2010)

Welcome again Hammer. Good to know you Capt.

F.M.


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## pardus (Jun 19, 2010)

I'm a 68W10 with EMT-B.

Civi side I'm a Veterinary Technician, have plenty of experience in Veterinary work, almost zero in the 68W/EMT side.

Despite getting a decent GPA at AIT (85.5) My skills IMO are weak, I missed a hell of a lot of training during AIT due to being asleep half the bloody time in class, I have serious issues with the cadre during AIT for that.
Hemorrhage/trauma I'm OK with but if you need drugs for example go elsewhere.

I need to fill the voids in my training, those voids are often basic shit that I should know.


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## Muppet (Jun 22, 2010)

Pardus: The idea of A.I.T. is too get the basics down. The "real" O.J.T. starts @ your unit level, IMO. May I suggest using your EMT-B to your advantage and getting a gig on the outside of the Army to enforce your skills. Anyway, you have lots of support on here and it WILL come to you bro. I promise you that. As you know, experience is the best teacher. Also, keep going through your books and re-learn your basics and google lots of stuff. I like going to North American Rescue Products web page. They have on line lessons on everything, including but not limited to bleed control to needle decompression. If you have questions, you have come to the right place. Welcome to the medical side of things.

L.


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## pardus (Jul 2, 2010)

Thanks FM.

Problem with the OTJT is I'm in the nasty guard. Since graduating in Nov '09 Ive learnt the difference between a miller and a mac laryngoscope blade. :uhh:

They haven't even heard of a Hyfin chest seal, they just look at me weird when I talk about it :doh:
I'm sure our training and skills will all be updated and solidified before we deploy, but at the moment the medic platoon is rebuilding and it's preoccupied with Army BS.

Ho Hum welcome to the machine lol

On the other hand I was at work the other day and was pounding on the chest of a dog who decided to expire from severe pulmonary edema, So that was good OTJT.


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## Muppet (Jul 4, 2010)

C.P.R. on a dog. I give ot yo you bro. I have done that in the past and rather not deal woith animals. I love the little fury things and it would kill me to have to work with them on a daily basis. Props to you Pardus.

L.


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## pardus (Jul 6, 2010)

Worse part about it was that the owner was there patting the dog's head, crying, telling the dog he loved him and to live etc...

I have no problem separating myself from that and concentrating on the job but it's embarrassing to watch a grown man cry.


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## Muppet (Jul 7, 2010)

Yea, well I would prolly cry like a bitch also. :)

L.


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## HeloMedic1171 (Jul 9, 2010)

true story.  my dog, and my kid.  and probably my wife too, cuz she's pretty cool, and I'd miss her mac and cheese casserole.


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## MK1-USCG (Sep 13, 2010)

Hey folks, thanks for allowing me to join the group. I'm currently active duty Coast Guard at a Search and Rescue station, with less than a year left on my enlistment. I've really wanted to get into field medicine after I attended a TCCC course prior to an OIF deployment, and I found it ain't gonna happen in the CG. I'm currently in an NREMT-B course, and concurrently taking some college courses. My ulitimate goal is to lateral to the AF and give PJ a shot, so I've been doing everything I can to streamline the process and make myself as marketable as possible (prior service slots are slim and seemingly competitive right now, so I'm hoping every little bit helps). My father is kinda my driving force in my choice, he was an Army SF Medic in Vietnam, so he's a big motivation to get my shit together. Thanks again for all the info you guys have put out there, this website's been a big help.


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## Muppet (Sep 13, 2010)

Welcome to the aid station brother. Hope all goes well with your wishes.

F.M.


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## MK1-USCG (Sep 15, 2010)

Thanks F.M.


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## policemedic (Sep 22, 2010)

I'm a former 68W, and current police sergeant/tactical medic on our Emergency Response Team (we'd call it SWAT but God forbid we offend someone with a non-pc acronym).

I hold a FL and PA EMT-P as well as NREMT-P certification.  I've taught at the basic and paramedic/RN levels. Done the alphabet soup courses, and hate the merit badge concept.

I'm here to learn, particularly from folks who've been doing this longer than I have and/or whose operational experience exceeds mine.  The more I learn, the more I can help my guys, and thats really what it's about, isn't it?

I'm also here to mess with Firemedic.


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## Muppet (Sep 24, 2010)

It's about damn time D. Call me for christ sake!

F.M.


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## Red Flag 1 (Oct 13, 2010)

Greetings!

My cerdentials are posted to Boondocksaint375 as part of my vetting. I am a retired military trained anesthetist. Completed USAF residency and boarded in Anesthesia in 1977. Military practice until 1990, back for DS and out again APR 91. Civillian practice into 2001 when I finally retired. Mostly bread and butter anesthesia including Gen Surg, Trauma, Ortho, Neuro, ENT, Peds, ICU, and pain management on limited basis. IG team member for ATC, and MAC. I was a member of President Ronald Reagan's support team at his ranch Rancho del Cielo, Ca '83-'85. Had a great oppertunity to interface with B/2/
20th GP (ABN) from '85-'89.

What I do now is limited to what ever I want. I'm not being a smart ass, simply persuing many interests that I could not chase down while I was in practice. I do have some health limitations, but enjoying the good life. I stay as current as I can in anesthesia and medicine in general, and sites like this help. I teach when I can, and learn from the young guns.

I hope you can put up with this older gent from time to time. I look to learning from you "younger guns". Thanks for this site and a chance to join in.

RF 1


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## Muppet (Oct 13, 2010)

Welcome to the aid station Red Flag 1. We can always use a expert airway person here.

F.M.


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## Red Flag 1 (Oct 13, 2010)

Thank you Firemedic.

RF 1


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## DoctorDoom (Nov 15, 2010)

AD Army 61J, General Surgeon, ATLS instructor, Navy Trauma Training Center, prior LA County Trauma program Resident, and some other stuff.  Here to learn as much about tactical medicine as possible.


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## surgicalcric (Nov 15, 2010)

Red Flag 1 said:


> ...Blah...Blah...Blah...



Well look who the cats drug in.

Welcome Brother


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## Red Flag 1 (Nov 18, 2010)

surgicalcric said:


> Well look who the cats drug in.
> 
> Welcome Brother



Thanks Crip!

Good ta see ya!

RF 1


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## JOgershok (Mar 11, 2011)

Do I need an invite?  Former SF medic (91B3SLAW7) with 5 years in the big sandbox, BS Psychology, EMT-B, 12 years working in prison as a counselor and block supervisor?

I am looking for the science of why PA's protocols are tape 3 sides while the military is straight occlusive dressing for a sucking chest wound. May not find anything concrete - expert opinion is NOT what I want. Scholarly articles IS lacking out there.


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## DoctorDoom (Mar 11, 2011)

JOgershok said:


> ...while the military is straight occlusive dressing for a sucking chest wound.



Wow, where do they teach that?  I honestly haven't heard that at all.


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## pardus (Mar 12, 2011)

Really? That has been the standard for several years now.
That is out of the standard Army medic course for sure and according to a member here who was an advanced instructor it was standard period.
The Hyfin chest seal is 100% occlusive, which obviously requires close monitoring. Some units require an NCD after a hyfin is placed.


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## tido300 (Mar 15, 2011)

Hello all!

I just recently graduated IDMT school in Decemeber and will be leaving for Mildenhall in a couple of weeks. I'm greener than hell so you won't be hearing much of anything from me - just a ton of reading on my end. I've been an AF medic for about 2 years and hold an NREMT-B cert as well as a BLS and SABC instructor cert and head to paramedic school in May. I have a ton to learn and look forward to it all. Thanks for all your input on this forum, guys.

Tyler


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## Nasty (Mar 15, 2011)

tido300 said:


> Hello all!
> 
> I just recently graduated IDMT school in Decemeber and will be leaving for Mildenhall in a couple of weeks. I'm greener than hell so you won't be hearing much of anything from me - just a ton of reading on my end. I've been an AF medic for about 2 years and hold an NREMT-B cert as well as a BLS and SABC instructor cert and head to paramedic school in May. I have a ton to learn and look forward to it all. Thanks for all your input on this forum, guys.
> 
> Tyler



I'll see you when; and you will, attend the ISOC and CASEVAC Course. Your road to AFSOC is not yet complete, bust ass at the EMT-P course and keep up the good work. See you soon!


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## tido300 (Mar 15, 2011)

Nasty said:


> I'll see you when; and you will, attend the ISOC and CASEVAC Course. Your road to AFSOC is not yet complete, bust ass at the EMT-P course and keep up the good work. See you soon!



Will do! Sounds good and see you then.


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## x SF med (Mar 15, 2011)

Former 18D and 18B...  well I was an 18B first and reclassified into medic...  my primary instructor in 300F1 is now the USSOCOM Surgeon.  I still keep a little current - First Responder CPR/Defib, frist aid, and self study to keep the other skills from getting too rusty.   I just want to keep current and sharre brain cells with the guys in the fight.  I think I still know enough old school jungle medicine to help give some ideas to the guys who haven't been taught it.


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## Muppet (Mar 16, 2011)

Hell, we have quite an aid station here. I love it...

F.M.


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## Nasty (Mar 16, 2011)

Retired AF IDMT/EMT-P/Aerovac medic. Currently working as a loggie at Hq AFSOC/SG office supporting training pipe-line for AF SOF Medics.


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## DoctorDoom (Mar 29, 2011)

pardus said:


> Really? That has been the standard for several years now.
> That is out of the standard Army medic course for sure and according to a member here who was an advanced instructor it was standard period.
> The Hyfin chest seal is 100% occlusive, which obviously requires close monitoring. Some units require an NCD after a hyfin is placed.



Yeah man, I'm serious.  We've never been taught to place a 100% occlusive dressing, and needle decompression following semiocclusive dressing placement indicates treatment failure.  But there's usually a pretty big disconnect between hospital based surgical therapy and current military standard.  I took CLS 6 years ago and honestly don't remember if that was even taught.


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## pardus (Mar 29, 2011)

Interesting.
6 years ago was long before the hyfin was standard.
Then again, my unit still doesnt have them.
Our protocols are changing so fast no one knows WTF to do now, doh.


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## TLDR20 (Mar 29, 2011)

The standard is a 100% occlusive with Needle D afterwards. I think the thought process behind this is that you are in control of the situation. There will always be a disconnect between the operating room and the battlefield. The reason is the OR is a controlled environment and the battlefield is not. That is why you want to control what you can.


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## x SF med (Mar 29, 2011)

@cback....   Nah, you are just a control freak

Document and control the situation - the keys to a great 18D


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## pardus (Jan 17, 2013)

cback0220 said:


> The standard is a 100% occlusive with Needle D afterwards. I think the thought process behind this is that you are in control of the situation. There will always be a disconnect between the operating room and the battlefield. The reason is the OR is a controlled environment and the battlefield is not. That is why you want to control what you can.


 
Just for my education, is this still the case as of Jan 2013?


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## DoctorDoom (Jan 18, 2013)

That approach does make sense in the tactical environment as practiced by well trained soldiers/medics. Definitely shouldn't be the standard across the Army though, given the data showing how frequently the diagnosis tension pneumo is missed and how 30-40% of needle decompressions don't penetrate the chest wall.


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## 8654Maine (Jan 18, 2013)

That occlusive/semi-occlusive dsg was taught in the mid 80's when I was in. I've done some Pubmed searches and not much reliable evidence shows up. It would be nice to have some trials. My trauma director in residency was one of the Army surgeons involved in the Pope paratrooper burn incident and he couldn't give me any concrete reasons of one over another.

My creds: Force recon, then college, med school, and Emergency residency at a big Level 1 trauma center. I've worked w/ some great folks and teachers. Been practicing 10 years at a Trauma center in Maine. The more I do this, the more questions I have. If you think you know it all, that's when you become dangerous.

Now have a hankering for something else. Am in discussion w/ HH Actual about going to NZ or re-upping as a Reserve Physician. Either way looking for advice and shooting the shit.

The more I do this, the less I think I know. D'oh!!


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## TLDR20 (Jan 18, 2013)

pardus said:


> Just for my education, is this still the case as of Jan 2013?



Yep...100% occlusive in initial, once you have a chance to diagnose pneumo, needle D. This is from the TMEPS, TCCC and what I teach everyday at the JSOMTC.


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## pardus (Jan 18, 2013)

cback0220 said:


> Yep...100% occlusive in initial, once you have a chance to diagnose pneumo, needle D. This is from the TMEPS, TCCC and what I teach everyday at the JSOMTC.


 
Thanks.


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## TLDR20 (Jan 18, 2013)

DoctorDoom said:


> That approach does make sense in the tactical environment as practiced by well trained soldiers/medics. Definitely shouldn't be the standard across the Army though, given the data showing how frequently the diagnosis tension pneumo is missed and how 30-40% of needle decompressions don't penetrate the chest wall.



Well in that case you can use MOI and difficulty breathing as justification for a needle D. Training correctly should be preferred over letting guys die because officers are afraid of incorrect placement.


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## DoctorDoom (Jan 18, 2013)

cback0220 said:


> Well in that case you can use MOI and difficulty breathing as justification for a needle D. Training correctly should be preferred over letting guys die because officers are afraid of incorrect placement.


 
You nailed it. I, like all officers, would rather let guys die because we're afraid of training them right.

I was thinking along the lines of basic medic-level training when I say standard throughout the Army. And that data is among EMT's, not exactly poorly trained yahoos.

But I certainly don't prefer having guys die due to my fear of incorrect placement. Rather, I'm wondering because I don't know for certain, why not go back to using a 3-sided semi-occlusive dressing, and obviate the need for a needle decompression? Is the degree of "control" that much superior that it's worth the risk of creating a tension pneumothorax (an often missed diagnosis despite clinical signs) with a fully occlusive dressing, that is bailed out by a frequently non-efficacious additional intervention even in experienced hands ? Of course, this is the data that is lacking.


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## TLDR20 (Jan 18, 2013)

MOI(a GSW for instance) and a pt with difficulty breathing, are the ONLY indicators needed for a needle D. Us training medics to perform IAPPs which can be difficult to perform correctly and can make it difficult to diagnose tension pnuemos is what I am bitching about. We take a basic medic(EMT) and expect him to make a life saving intervention based off of something that MD's often misdiagnose. When in reality, most pts with penetrating chest trauma would benefit from a needle d solely based on there MOI and difficulty breathing.


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## jcooper.84 (Jan 16, 2014)

hey guys im a lateral transfer in the austalian army from grunts to medics, im currently half way through my training.


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## medicchick (Jan 16, 2014)

jcooper.84 said:


> hey guys im a lateral transfer in the austalian army from grunts to medics, im currently half way through my training.


Why don't you pop over to the intro area and make a thread there.


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## pardus (Jan 16, 2014)

jcooper.84 said:


> hey guys im a lateral transfer in the austalian army from grunts to medics, im currently half way through my training.



Damn Aussies, all crims that wont follow rules!

Post an Intro Digger.


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## x SF med (Jan 16, 2014)

jcooper.84 said:


> hey guys im a lateral transfer in the austalian army from grunts to medics, im currently half way through my training.



When you signed up for this site you agreed to post an introduction as your first post.  Or have they stopped teaching reading comprehension in Australia, I'm sure a few of our senior members from The Southern Hemisphere would be horrified if they had... 

Post your intro immediately, or you will not like the consequences.


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## jcooper.84 (Jan 21, 2014)

haha sorry guys i have now conformed and followed the rules


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## Seajack (Feb 19, 2014)

Navy Corps School student, wrapping up my last few weeks of training/school. Still have no orders so I haven't a clue of what exactly I'll be doing post-graduation


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## DA SWO (Feb 19, 2014)

Seajack said:


> Navy Corps School student, wrapping up my last few weeks of training/school. Still have no orders so I haven't a clue of what exactly I'll be doing post-graduation


You enjoying Ft Sam?


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## Seajack (May 6, 2014)

SOWT said:


> You enjoying Ft Sam?


I enjoyed my time at Ft. Sam. The training wasn't all I thought it was going to be, but now I understand why. We have a very broad scope of practice, and our work is pretty subjective to where you ultimately land as far as work goes, in which case you're going to have to learn that specific clinic/hospital's policies and ways of doing things. I've always preferred OJTing and trial by fire myself; I am a total kinesthetic learner so books and dummies will never do me as well as the "watch, do, teach" method.

I'm now working at the mother-infant care center. Learning _a lot_, very quickly.


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## VegasDoc (May 6, 2014)

I spent 4yrs as a combat medic in the army. i have a B.S. in micro bio/physiology and a B.S. in immunology, and last but not least a M.D. from UC Davis and currently a hospital slave as a emergency medicine resident..


----------



## pardus (May 6, 2014)

Seajack said:


> I'm now working at the mother-infant care center.



That's why I could never be a Navy Corpsman... My only interest is combat medicine.


----------



## TLDR20 (May 6, 2014)

pardus said:


> That's why I could never be a Navy Corpsman... My only interest is combat medicine.



Yeah I'd kill myself if I joined to be a corpsman and ended up in an infant care center.


----------



## Muppet (May 6, 2014)

I was going to say what you guys were thinking but held off.  It's kinda weird that a corpsman would be doing OJT  in a non "combat" type of job. Not like there is follow on training similar to 91c. Does FT. Sam still do LPN? Years ago there was 91B then 91C for LPN. 

F.M.


----------



## policemedic (May 6, 2014)

Firemedic said:


> I was going to say what you guys were thinking but held off.  It's kinda weird that a corpsman would be doing OJT  in a non "combat" type of job. Not like there is follow on training similar to 91c. Does FT. Sam still do LPN? Years ago there was 91B then 91C for LPN.
> 
> F.M.




It's now 68C.


----------



## TLDR20 (May 6, 2014)

policemedic said:


> It's now 68C.



I had one of them tell me she could drop a chest tube. Um yeah ok, step aside private....


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## x SF med (May 6, 2014)

TLDR20 said:


> I had one of them tell me she could drop a chest tube. Um yeah ok, step aside private....



I had one at WRNMMC while I was out there say that it's harder to be an LPN than an 18D, and that they get more useable med creds than an 18D...
the other 18Ds in the room and I just agreed and later asked him how he could even say such a thing...   his response... "when I get out of the Army, I can walk into a high paying job as an LPN..."  our responses... "What? changing bedpans and sheets?"


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## Muppet (May 7, 2014)

x SF med said:


> I had one at WRNMMC while I was out there say that it's harder to be an LPN than an 18D, and that they get more useable med creds than an 18D...
> the other 18Ds in the room and I just agreed and later asked him how he could even say such a thing...   his response... "when I get out of the Army, I can walk into a high paying job as an LPN..."  our responses... "What? changing bedpans and sheets?"



Cause while I have a few friends that are L.P.N.'s, both of those girls work in nursing homes pushing med carts, not a high volume shock trauma E.D. Most places will not hire L.P.N.'s and they tell them to follow up with R.N. I do not take away respect from my friend Adde and Polina cause they do a hard job but more qual'd than a 18D or a paramedic for that matter...not.

F.M.


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## medicchick (May 7, 2014)

Firemedic said:


> I do not take away respect from my friend Adde and Polina cause they do a hard job but more qual'd than a 18D or a paramedic for that matter...not.
> 
> F.M.



So true.  One sister is a Medical assistant (taking PA classes as she can) and the other is an LPN.  Trauma and peds, they asked me.  Old people problems I asked Amy (the LPN), Pam is up on immunizations and office stuff.  Even my out of date knowledge (I really need to get back into the game) I still knew more emergency stuff then both of them.

That does remind me, it's nurses week.  I need to send Amy the link for free Cinnabons...lol


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## Muppet (May 7, 2014)

medicchick said:


> So true.  One sister is a Medical assistant (taking PA classes as she can) and the other is an LPN.  Trauma and peds, they asked me.  Old people problems I asked Amy (the LPN), Pam is up on immunizations and office stuff.  Even my out of date knowledge (I really need to get back into the game) I still knew more emergency stuff then both of them.
> 
> That does remind me, it's nurses week.  I need to send Amy the link for free Cinnabons...lol



I just got back to the station from the local E.D. / next door (we are on hospital property) here. I wished the R.N.s there a good week and offered a few hot nurses my free TUBE test. Totally Uneccesary Breast Exam. None wished to partake in that...assholes.:wall:. All are good eggs. Most there were there for me when my life went to shit.

F.M.


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## Seajack (May 7, 2014)

TLDR20 said:


> Yeah I'd kill myself if I joined to be a corpsman and ended up in an infant care center.


lol I knew it was a possibility. Not what I wanted at all but tough shit, I'll take what I can from it. My class went through A school at the wrong time for grunt unit billets. Everyone ended up getting C school, hospital, or Med Bn (basically med supply now since the Navy is drawing back on logistics specialists and upped Corpsman billets, despite being overmanned).


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## amlove21 (May 8, 2014)

TLDR20 said:


> I had one of them tell me she could drop a chest tube. Um yeah ok, step aside private....


 Try hearing an IDMT tell you that he should (not asking mind you, telling me he SHOULD) be flying on our missions because he's equally as valuable as a PJ and moreso than a DUSTOFF medic.

Cause yea. Rage.


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## DA SWO (May 8, 2014)

amlove21 said:


> Try hearing an IDMT tell you that he should (not asking mind you, telling me he SHOULD) be flying on our missions because he's equally as valuable as a PJ and moreso than a DUSTOFF medic.
> 
> Cause yea. Rage.


I could IDMT *see* doing DUSTOFF, but equal to a PJ?

Change in bold, don't know why the first sentence came up.


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## policemedic (May 8, 2014)

SOWT said:


> Should have been
> 
> I could IDMT doing DUSTOFF, but equal to a PJ?



Wow. Just...wow.


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## amlove21 (May 9, 2014)

SOWT said:


> Should have been
> 
> I could IDMT doing DUSTOFF, but equal to a PJ?


 Well- IDMT's are paramedics, right? I mean, PJ's are just combat paramedics that ride on helo's, right?

F*&#$ng. Eye. Roll.


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## policemedic (May 9, 2014)

amlove21 said:


> Try hearing an IDMT tell you that he should (not asking mind you, telling me he SHOULD) be flying on our missions because he's equally as valuable as a PJ and moreso than a DUSTOFF medic.
> 
> Cause yea. Rage.



Did that earn said IDMT a throat punch and an opportunity to independently treat himself?


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## DA SWO (May 9, 2014)

amlove21 said:


> Well- IDMT's are paramedics, right? I mean, PJ's are just combat paramedics that ride on helo's, right?
> 
> F*&#$ng. Eye. Roll.


I think part of the problem (and should have stated in my post) is that they have IDMT flying on the HH-1's at Fairchild (and the missile support squadrons IIRC) , so these guys quickly assume they are doing your mission, which is crap, at the same time the guys/gals on the DUSTOFF missions do not have your qualifications.

Large number of people really don't understand the CSAR part of the package, look at the Nat Geo series, DUSTOFF Mission was emphasized, and the other aspects briefly mentioned.  (more later)


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## TLDR20 (May 9, 2014)

amlove21 said:


> Well- IDMT's are paramedics, right? I mean, PJ's are just combat paramedics that ride on helo's, right?
> 
> .



Yes.....?


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## Diamondback 2/2 (May 9, 2014)

TLDR20 said:


> Yes.....?



Bawhahahaha!


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## amlove21 (May 12, 2014)

TLDR20 said:


> Yes.....?


Lol. I will give you that one, pretty funny.


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## x SF med (May 12, 2014)

amlove21 said:


> Lol. I will give you that one, pretty funny.



IDMTs don't have the plethora of fiber based hair products, right? Nor the fancy red headgear...:wall:


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## policemedic (May 12, 2014)

Do PJs have to line their berets with plastic or something to keep the hair product from staining the wool?


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## Muppet (May 12, 2014)

policemedic said:


> Do PJs have to line their berets with plastic or something to keep the hair product from staining the wool?



That's not nice. LMFAO. It is however funny but when the P.J.'s here see this, I would love to be a fly on the wall here...

F.M.


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## amlove21 (May 13, 2014)

Firemedic said:


> That's not nice. LMFAO. It is however funny but when the P.J.'s here see this, I would love to be a fly on the wall here...
> 
> F.M.


 Let me just say that there are 40 or 50 other very butthurt comments I have typed/deleted/rage quit on.

Keep it up, nerds!

And no, using the proper hair product only enhances the beret and extends it's life. That's science.


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## policemedic (May 13, 2014)

amlove21 said:


> Let me just say that there are 40 or 50 other very butthurt comments I have typed/deleted/rage quit on.
> 
> Keep it up, nerds!
> 
> And no, using the proper hair product only enhances the beret and extends it's life. That's science.



I'm glad we got that sorted!


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## x SF med (May 13, 2014)

amlove21 said:


> Let me just say that there are 40 or 50 other very butthurt comments I have typed/deleted/rage quit on.
> 
> Keep it up, nerds!
> 
> And no, using the proper hair product only enhances the beret and extends it's life. That's science.



You didn't answer my questions...  Now you owe me ice cream, seared animal flesh and beer.


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## Muppet (May 13, 2014)

amlove21 said:


> Let me just say that there are 40 or 50 other very butthurt comments I have typed/deleted/rage quit on.
> 
> Keep it up, nerds!
> 
> And no, using the proper hair product only enhances the beret and extends it's life. That's science.



LOL.

F.M.


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## amlove21 (May 13, 2014)

x SF med said:


> You didn't answer my questions...  Now you owe me ice cream, seared animal flesh and beer.


 Threaten me with a good time, go ahead. I might even be home long enough this summer to make it happen!

Bring your boy @Firemedic and I'll include single barrel and some cigars.


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## x SF med (May 13, 2014)

amlove21 said:


> Threaten me with a good time, go ahead. I might even be home long enough this summer to make it happen!
> 
> Bring your boy @Firemedic and I'll include single barrel and some cigars.



Have you tried the Glenlivet/Davis Nadurra?  Nice Cask Strength Single Malt...   But if you have to give me Bourbon, I like some Blanton's... a lot...

If you like wine, I can bring a few bottles of good stuff from my favorite local winery.


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## Seajack (Jul 13, 2014)

After a very short stint of catching babies, I've been moved to the Med Surge Ward and could not be happier. We get a high variety of patients, I have a great chain of command, it's all very good right now. It's still in-patient care as opposed to the field medicine that I wanted to do when I joined, but I've learned so much between picking the doc and nurses brains trial by fire. I am genuinely enjoying the medicine I'm learning/doing right now, and thoroughly look forward to advancing my learning.


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## DA SWO (Jul 13, 2014)

amlove21 said:


> Threaten me with a good time, go ahead. I might even be home long enough this summer to make it happen!
> 
> Bring your boy @Firemedic and I'll include single barrel and some cigars.


Don't forget your backpack.


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## Red Flag 1 (Jul 13, 2014)

Seajack said:


> After a very short stint of catching babies, I've been moved to the Med Surge Ward and could not be happier. We get a high variety of patients, I have a great chain of command, it's all very good right now. It's still in-patient care as opposed to the field medicine that I wanted to do when I joined, but I've learned so much between picking the doc and nurses brains trial by fire. I am genuinely enjoying the medicine I'm learning/doing right now, and thoroughly look forward to advancing my learning.



It is so very refreshing to hear that you are enjoying your time in caring for people.  It is so easy to get caught up in the demands of caring for people who are ill, or injured, or in need of care. Caught up in those demands, it can easily change one's focus away from the very reason we entered the field of health care.  I admire you quest for knowledge. Keep picking those brains, learn to find paths to information that will further answer your questions; and trigger even deeper questions.  We need health care providing people at every level, myself included. Stay with it, it will bring you rewards that you never dreamed of. There are a lot of great thinkers and doers here on this site, so you may be able to learn from members on this board. Thanks again for sharing your passion of health care with us; I know that I appreciate it.


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## Seajack (Oct 6, 2014)

Working on getting my ACLS cert.


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## TLDR20 (Oct 6, 2014)

Seajack said:


> Working on getting my ACLS cert.



I used to be an AcLS instructor, I always enjoyed teaching it. Let me know if you have problems.


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## medicchick (Oct 6, 2014)

I think the best ACLS recert I had was when the instructor had us actually play our rolls.  One guy was a dentist IRL, I was a Paramedic and we had a few nurses.  We had to pass and know all the usual stuff but for a practical part he gave us what we would have so others (mainly the nurses TBH, they complained the whole time about the lack of EMS doing anything important:-/) would see what we actually had to work with. 

It really helped some of the people there to see exactly how things happen, the dentist had never really seen it from start to "finish", the nurses had no idea what we could walk into at a scene.



*edit* Sorry for the rambling trip down memory lane, I'll go have my tea now.


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## Muppet (Oct 6, 2014)

Ditto if you need help. I am also an instructor...

F.M.


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## policemedic (Oct 6, 2014)

Firemedic said:


> Ditto if you need help. I am also an instructor...
> 
> F.M.



I've been regional faculty ever since I bought that high speed DVD player....






*Yes, Sheldon. That was sarcasm.


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## Muppet (Oct 6, 2014)

policemedic said:


> I've been regional faculty ever since I bought that high speed DVD player....
> 
> 
> 
> ...



Yep. I try to not kill with power point or video. I try to add my own stuff including running full codes, having crews walk into a "house". I recruit EMT-B's into "first arrival" and also add other than the typical V-Fib arrests into play. Usually works good but there is always somebody, know it all if you will that thinks they do not need to practice or do this stuff. I try. 

F.M.


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## Muppet (Oct 6, 2014)

A favorite code I like to add, or 2: For the experienced paramedics.

(1): 52 male, drop at home, witnessed arrest after diaylisis t/x.
(2): 22 female, overdose on Doxepin, unresponsive and seizing upon EMS arrival and codes soon after arrival.
(3): For added pleasure. 68 male, bradycardic / high degree block, non responsive to pacing and pressors and 2 empty bottles of Lopressor in kitchen...

F.M.


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## policemedic (Oct 6, 2014)

Firemedic said:


> A favorite code I like to add, or 2: For the experienced paramedics.
> 
> (1): 52 male, drop at home, witnessed arrest after diaylisis t/x.
> (2): 22 female, overdose on Doxepin, unresponsive and seizing upon EMS arrival and codes soon after arrival.
> ...



Interesting, since they all require the medic to know his/her pharma and A&P.   How many people quickly see the cAMP issue in #3 and reach for the Glucagon?


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## Muppet (Oct 6, 2014)

policemedic said:


> Interesting, since they all require the medic to know his/her pharma and A&P.   How many people quickly see the cAMP issue in #3 and reach for the Glucagon?



Surprisingly, the newer medics see it before some of the more experienced but I say half in half. I am also happy to see that some medics understand that the dose of Glucagon is way higher than we carry in the box but they start off after calling MEDDCOMM, giving it all. Some medics that think outside the box request Epi drips, which will most likely not work but they ask, so I am told by docs. Sometimes it works. Edit: Sometimes I get..."we are too close to the E.R. Lets just transport". Doc Jaslow likes to tell them then.." We practice the first hour of emergency medicine in 25 mins. It makes a difference and if we stay on scene to try to correct a life threat, do it"...

The reason I put these scenarios into play is that I have had them. I have thought outside the box. I like to add crush including rhabdo after being on the floor for hours after an O.D. or fall. Hypotension, extreme tachycardia or rapid AFib, all the s/sx. with that and I like to see who cardioverts instead of using large doses of NSS IV, calcium, bicarb, albuterol....The typical ACLS is a canned course and I hate that shit...

F.M.


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## 8654Maine (Oct 6, 2014)

policemedic said:


> Interesting, since they all require the medic to know his/her pharma and A&P.   How many people quickly see the cAMP issue in #3 and reach for the Glucagon?



Nice.  And higher than usual amounts.

Also, I wonder what the QRS duration was for #2?

IV Lipid Emulsion should take care of #2 and #3.


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## Muppet (Oct 6, 2014)

8654Maine said:


> Nice.  And higher than usual amounts.
> 
> Also, I wonder what the QRS duration was for #2?
> 
> IV Lipid Emulsion should take care of #2 and #3.



The pt. for #2 doc was Sinus tach, then a wide complex tech under 150 then v-tach. I told dad to grab all scripts and when I saw Doexpin, she coded. I shocked at biphasic 200J, IO, standard ACLS but added Bicarb off the bat (called MEDCOMM off the bat also which is not the norm but this case was weird and I knew I would need expert consult / we practice under a broad standing order). Orders were for another Bicarb and with another 2 mins of CPR, a sinus rythmn (wide / narrowing during transport) was secure with pulses and ok b/p. NSS wide open, pressors not needed but ordered per doc if needed, intubated w/o difficulty. She did this again but was resus'd again and transfetred to ICU. She is alive today.

@8654Maine . Doc. Can you explain the lipid emulsion therapy?

F.M.


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## 8654Maine (Oct 6, 2014)

Good call with grabbing all meds and seeing the Doxepin.  Prolonged QRS (>100ms) is usually the danger sign for Sz with TCA toxicity.
Good call on the Bicarb.

ILE (IV Lipid Emulsion Therapy) is the new kid on the block for treatment of certain overdoses.

It has been used for drugs with high Volume of Distribution (lipophilic drugs, i.e. more tissue bound). 

The proposed mechanism is that it takes it out of circulation/tissue and surrounds it into a lipid cage to be metabolized and excreted safely.

It has been used in toxicity from Beta blockers, Calcium channel blockers, Local anesthetic toxicity, antidepressants.

I've used it several times and had success.


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## Muppet (Oct 6, 2014)

8654Maine said:


> Good call with grabbing all meds and seeing the Doxepin.  Prolonged QRS (>100ms) is usually the danger sign for Sz with TCA toxicity.
> Good call on the Bicarb.
> 
> ILE (IV Lipid Emulsion Therapy) is the new kid on the block for treatment of certain overdoses.
> ...



Roger that doc. Thanks for the info. Good to know. Have not heard about this yet. Another question. Would this current therapy be used for overdoses with severe s/sx. such as anticolinergic toxicity or sympathomemtic toxicity?

F.M.


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## policemedic (Oct 6, 2014)

Firemedic said:


> Sometimes it works. Edit: Sometimes I get..."we are too close to the E.R. Lets just transport". Doc Jaslow likes to tell them then.." We practice the first hour of emergency medicine in 25 mins. It makes a difference and if we stay on scene to try to correct a life threat, do it"...
> 
> 
> 
> F.M.


 
Jaslow has his shit wired tight.
I hate lazy medics; lazy is often accompanied by stupidity. "I don't know what to do, so I'll order a diesel infusion."


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## 8654Maine (Oct 6, 2014)

Firemedic said:


> Roger that doc. Thanks for the info. Good to know. Have not heard about this yet. Another question. Would this current therapy be used for overdoses with severe s/sx. such as anticolinergic toxicity or sympathomemtic toxicity?
> 
> F.M.



Yes.  That's why it's used for neurotoxic meds, including pesticides, herbicides and anti-depressants, local anesthetics.

Here's an easy way to think of it.  Think of drugs as hydrophilic or lipophilic.  The hydrophilic  drugs are relatively easy to get rid of.

The lipophilic ones are more difficult.  They enter tissue and cross the blood/brain barrier easily and are hidden from the usual antidotes that are circulating in the blood stream.

The favored mechanism of action is that the the emulsion acts as a lipid "sink" which attracts the offending drug from the tissues (i.e. brain or heart) and bring it into the circulation and out of the toxic location.

This is a very simplified way but it helps me understand.  Hope this helps.


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## Muppet (Oct 6, 2014)

8654Maine said:


> Yes.  That's why it's used for neurotoxic meds, including pesticides, herbicides and anti-depressants, local anesthetics.
> 
> Here's an easy way to think of it.  Think of drugs as hydrophilic or lipophilic.  The hydrophilic  drugs are relatively easy to get rid of.
> 
> ...



I understand doc. Thanks! I recently had a pt. who ingested a large amount of Benadryl, Tramadol and an unknown third med. Found unconscious, responded to pain and then remained responsive to verbal. Also displayed myoclonus, HTN, tachycardia and tachypnea with hot but moist skin. Expect for the moist skin, the typical anticolinergic toxidrome...I gave Versed after consulting with MEDCOMM but the myoclonus remained. I asked about Physostigmine but got no answer from attending (not the most docs that like to teach). Guess I ask too many question because I like to learn...:wall:

F.M.


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## Muppet (Oct 6, 2014)

8654Maine said:


> Yes.  That's why it's used for neurotoxic meds, including pesticides, herbicides and anti-depressants, local anesthetics.
> 
> Here's an easy way to think of it.  Think of drugs as hydrophilic or lipophilic.  The hydrophilic  drugs are relatively easy to get rid of.
> 
> ...



Oh! How does the drug used with the treatment clear body? Urine? Forgives if this sounds stupid doc...

F.M.


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## 8654Maine (Oct 6, 2014)

That's a good question.  The answer is multifold.

2 theories for clearance:
(1)  Eliminated similar to chylomicrons, i.e. fat metabolism.
(2)  Eliminated by the Marcrophages (white blood cells).

Brother, you've really got me stretching my neurons here.  That's good.


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## Muppet (Oct 6, 2014)

8654Maine said:


> That's a good question.  The answer is multifold.
> 
> 2 theories for clearance:
> (1)  Eliminated similar to chylomicrons, i.e. fat metabolism.
> ...



Thanks doc. I like stretching my neurons also. LOL. Thanks again doc!

F.M.


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## 8654Maine (Oct 6, 2014)

No prob.

If you really want to know more about ILE therapy, talk to the gas passers.

This was their baby at the start.  

Besides, if you really want to know biochem and physiology, talk to an anesthesiologist.


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## Muppet (Oct 6, 2014)

8654Maine said:


> No prob.
> 
> If you really want to know more about ILE therapy, talk to the gas passers.
> 
> ...



Paging @Red Flag 1...What's you're imput doc?

F.M.


----------



## x SF med (Oct 6, 2014)

8654Maine said:


> Yes.  That's why it's used for neurotoxic meds, including pesticides, herbicides and anti-depressants, local anesthetics.
> 
> Here's an easy way to think of it.  Think of drugs as hydrophilic or lipophilic.  The hydrophilic  drugs are relatively easy to get rid of.
> 
> ...



as an aside....  *Bacon, IV, STAT!!!*  back to the seriousness of the thread.  Sorry for the hijack.


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## Muppet (Oct 6, 2014)

x SF med said:


> as an aside....  *Bacon, IV, STAT!!!*  back to the seriousness of the thread.  Sorry for the hijack.



Bacon has everything to do in medicine Troll! LOL.

F.M.


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## x SF med (Oct 6, 2014)

Firemedic said:


> Bacon has everything to do in medicine Troll! LOL.
> 
> F.M.




You said lipid emulsion therapy...  lipids = bacon and bacon fat can be emulsified in blood....


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## Muppet (Oct 6, 2014)

x SF med said:


> You said lipid emulsion therapy...  lipids = bacon and bacon fat can be emulsified in blood....



BUT....BUT IT'S BACON!!!

F.M.


----------



## x SF med (Oct 7, 2014)

Firemedic said:


> BUT....BUT IT'S BACON!!!
> 
> F.M.


 EXACTLY!!!


----------



## Red Flag 1 (Oct 7, 2014)

Firemedic said:


> Paging @Red Flag 1...What's you're imput doc?
> 
> F.M.



.........Hello.........What??!! you want to give IV Bacon??!!..................A,a, er,.....Bacon, you said.....well....Did ya call the Resident yet?..........He did, did he!......well sure, just read this, http://www.thepoisonreview.com/2012/07/30/lipid-emulsion-therapy-for-poisonings-a-review/,  &  ,http://emergencypedia.com/2013/06/20/intravenous-lipid-emulsion-therapy/ , before ya do OK?

For some history, anesthesia providers administer large volumes of local analgesia/anesthetics in the course of some regional techniques. It is possible for some of the injectate to go intravascular. If the volume is great enough, there can be cardiotoxic events. Some of the agents we use can have very long lasting effects, with cardiac standstill/asystole as a result. The worry is greatest with the use of Bupivicane , because of it's long acting ability.  As the article points out, the mechanism of action of is not fully understood, the result is a "Lipid sink" sort of pulling off the toxic agents. The best analogy I can think of is a "Heat Sink" when doing any soldering in radio/computer equipment. Between the soldering point, and other components, the tech puts a metal clamp to provide an alternate route for the heat to go, and protect other components from the heat generated by soldering. I have to be honest, though and say that being retired for a few years now, I have no experience in using ILE. We were the first to use lipid emulsions as induction agents, Diprivan to be specific. It was really hard to push the plunger on the Diprivan syringe for the first time; 20ml of what looked like milk directly into a vein:-/:-/:-/.

I expect ILE will show up in ACLS, if it has not already. It seems to be effective for Sodium and Calcium Channels, and tricyclic antidepressants like Elavil. Now, let me get back to................just mail me the $5.00, and remember to call the resident first.....


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## Muppet (Oct 7, 2014)

Good info doc! Thanks! I'll read the articles later on.

F.M.


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## x SF med (Oct 8, 2014)

I'm wondering how well ILE would work for some of the tarrier opiates and food based cannabanoids (yes, you can od on ingested Tetrahydrocannabinols, and they are lipid soluble)?


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## policemedic (Oct 8, 2014)

Do you mean would it compete for the same receptor site and knock off the opiate, thus releasing that opiate into the bloodstream where it could be enveloped by the circulating lipids and then excreted?  Sort of like Narcan with removal capability?


----------

