RNEMT26

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.

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.

What you are referring to is called a Hypoxic drive. Normally we breath because our bodies pick up on the concentration of CO2 in our blood on the arterial side of the system via chemoreceptors located in various, but specific parts of our body. High levels in our PCO2 will cause us to breath faster in order to 'blow off CO2' and low levels in the PCO2 will cause us to breath in deeper and at a slower rate in order to retain CO2 to keep our Ph in between 7.35 - 7.45. The body must maintain this range in order to keep everything working optimally, too high or too low and things can get whacky, esp if it's for a prolonged period of time.
(On a side note, COPDers problems lies in that the are chronically hypoxic, and they are CO2 retainers because their problem isn;t necessarily getting the air in, it's getting the air out, called 'air trapping'. )
A hypoxic drive is when the body has changed over and is now monitoring the PO2 instead of the PCO2. So theoretically if the person reaches 100 % saturation then you've knocked out the stimulus to breath because the body thinks, oh well I'm 100% I guess i dont have to breath. COPDers are as i said, chronically hypoxic, so their drive to breath is because their normal PO2 is low, therefore signals to the body to breath. This hypoxic drive accounts for a low percentage of the population something like 9-10%. Recent studies have no found that COPDers are not soley dependent on this hypoxic drive. So while this may decrease morbidity/mortality, you won't necessarily 'knock out' a COPD PTs resp drive by giving them high flow O2.
One more point, I agree with this research and the titration of O2. Too many people I have found will put a patient on 100% NRBFM because "It's the protocol" Well thats stupid, and dangerous. Not everyone needs 100 O2. If someone is 98-100% if you really feel the need to put them on O2 then put them on 2-4 L N/C. And if it's not even a cardiac or resp related call, and their SpO2 is 100%, then can someone please tell me why it's necessary to place them on 100% NRBFM ? Really? Sorry I'm just an ICU/CCU RN, I clearly don't know what I'm doing..lol

What you are referring to is called a Hypoxic drive. Normally we breath because our bodies pick up on the concentration of CO2 in our blood on the arterial side of the system via chemoreceptors located in various, but specific parts of our body. High levels in our PCO2 will cause us to breath faster in order to 'blow off CO2' and low levels in the PCO2 will cause us to breath in deeper and at a slower rate in order to retain CO2 to keep our Ph in between 7.35 - 7.45. The body must maintain this range in order to keep everything working optimally, too high or too low and things can get whacky, esp if it's for a prolonged period of time.
(On a side note, COPDers problems lies in that the are chronically hypoxic, and they are CO2 retainers because their problem isn;t necessarily getting the air in, it's getting the air out, called 'air trapping'. )
A hypoxic drive is when the body has changed over and is now monitoring the PO2 instead of the PCO2. So theoretically if the person reaches 100 % saturation then you've knocked out the stimulus to breath because the body thinks, oh well I'm 100% I guess i dont have to breath. COPDers are as i said, chronically hypoxic, so their drive to breath is because their normal PO2 is low, therefore signals to the body to breath. This hypoxic drive accounts for a low percentage of the population something like 9-10%. Recent studies have no found that COPDers are not soley dependent on this hypoxic drive. So while this may decrease morbidity/mortality, you won't necessarily 'knock out' a COPD PTs resp drive by giving them high flow O2.
One more point, I agree with this research and the titration of O2. Too many people I have found will put a patient on 100% NRBFM because "It's the protocol" Well thats stupid, and dangerous. Not everyone needs 100 O2. If someone is 98-100% if you really feel the need to put them on O2 then put them on 2-4 L N/C. And if it's not even a cardiac or resp related call, and their SpO2 is 100%, then can someone please tell me why it's necessary to place them on 100% NRBFM ? Really? Sorry I'm just an ICU/CCU RN, I clearly don't know what I'm doing..lol

What you are referring to is called a Hypoxic drive. Normally we breath because our bodies pick up on the concentration of CO2 in our blood on the arterial side of the system via chemoreceptors located in various, but specific parts of our body. High levels in our PCO2 will cause us to breath faster in order to 'blow off CO2' and low levels in the PCO2 will cause us to breath in deeper and at a slower rate in order to retain CO2 to keep our Ph in between 7.35 - 7.45. The body must maintain this range in order to keep everything working optimally, too high or too low and things can get whacky, esp if it's for a prolonged period of time.
(On a side note, COPDers problems lies in that the are chronically hypoxic, and they are CO2 retainers because their problem isn;t necessarily getting the air in, it's getting the air out, called 'air trapping'. )
A hypoxic drive is when the body has changed over and is now monitoring the PO2 instead of the PCO2. So theoretically if the person reaches 100 % saturation then you've knocked out the stimulus to breath because the body thinks, oh well I'm 100% I guess i dont have to breath. COPDers are as i said, chronically hypoxic, so their drive to breath is because their normal PO2 is low, therefore signals to the body to breath. This hypoxic drive accounts for a low percentage of the population something like 9-10%. Recent studies have no found that COPDers are not soley dependent on this hypoxic drive. So while this may decrease morbidity/mortality, you won't necessarily 'knock out' a COPD PTs resp drive by giving them high flow O2.
One more point, I agree with this research and the titration of O2. Too many people I have found will put a patient on 100% NRBFM because "It's the protocol" Well thats stupid, and dangerous. Not everyone needs 100 O2. If someone is 98-100% if you really feel the need to put them on O2 then put them on 2-4 L N/C. And if it's not even a cardiac or resp related call, and their SpO2 is 100%, then can someone please tell me why it's necessary to place them on 100% NRBFM ? Really? Sorry I'm just an ICU/CCU RN, I clearly don't know what I'm doing..lol

What you are referring to is called a Hypoxic drive. Normally we breath because our bodies pick up on the concentration of CO2 in our blood on the arterial side of the system via chemoreceptors located in various, but specific parts of our body. High levels in our PCO2 will cause us to breath faster in order to 'blow off CO2' and low levels in the PCO2 will cause us to breath in deeper and at a slower rate in order to retain CO2 to keep our Ph in between 7.35 - 7.45. The body must maintain this range in order to keep everything working optimally, too high or too low and things can get whacky, esp if it's for a prolonged period of time.
(On a side note, COPDers problems lies in that the are chronically hypoxic, and they are CO2 retainers because their problem isn;t necessarily getting the air in, it's getting the air out, called 'air trapping'. )
A hypoxic drive is when the body has changed over and is now monitoring the PO2 instead of the PCO2. So theoretically if the person reaches 100 % saturation then you've knocked out the stimulus to breath because the body thinks, oh well I'm 100% I guess i dont have to breath. COPDers are as i said, chronically hypoxic, so their drive to breath is because their normal PO2 is low, therefore signals to the body to breath. This hypoxic drive accounts for a low percentage of the population something like 9-10%. Recent studies have no found that COPDers are not soley dependent on this hypoxic drive. So while this may decrease morbidity/mortality, you won't necessarily 'knock out' a COPD PTs resp drive by giving them high flow O2.
One more point, I agree with this research and the titration of O2. Too many people I have found will put a patient on 100% NRBFM because "It's the protocol" Well thats stupid, and dangerous. Not everyone needs 100 O2. If someone is 98-100% if you really feel the need to put them on O2 then put them on 2-4 L N/C. And if it's not even a cardiac or resp related call, and their SpO2 is 100%, then can someone please tell me why it's necessary to place them on 100% NRBFM ? Really? Sorry I'm just an ICU/CCU RN, I clearly don't know what I'm doing..lol

What you are referring to is called a Hypoxic drive. Normally we breath because our bodies pick up on the concentration of CO2 in our blood on the arterial side of the system via chemoreceptors located in various, but specific parts of our body. High levels in our PCO2 will cause us to breath faster in order to 'blow off CO2' and low levels in the PCO2 will cause us to breath in deeper and at a slower rate in order to retain CO2 to keep our Ph in between 7.35 - 7.45. The body must maintain this range in order to keep everything working optimally, too high or too low and things can get whacky, esp if it's for a prolonged period of time.
(On a side note, COPDers problems lies in that the are chronically hypoxic, and they are CO2 retainers because their problem isn;t necessarily getting the air in, it's getting the air out, called 'air trapping'. )
A hypoxic drive is when the body has changed over and is now monitoring the PO2 instead of the PCO2. So theoretically if the person reaches 100 % saturation then you've knocked out the stimulus to breath because the body thinks, oh well I'm 100% I guess i dont have to breath. COPDers are as i said, chronically hypoxic, so their drive to breath is because their normal PO2 is low, therefore signals to the body to breath. This hypoxic drive accounts for a low percentage of the population something like 9-10%. Recent studies have no found that COPDers are not soley dependent on this hypoxic drive. So while this may decrease morbidity/mortality, you won't necessarily 'knock out' a COPD PTs resp drive by giving them high flow O2.
One more point, I agree with this research and the titration of O2. Too many people I have found will put a patient on 100% NRBFM because "It's the protocol" Well thats stupid, and dangerous. Not everyone needs 100 O2. If someone is 98-100% if you really feel the need to put them on O2 then put them on 2-4 L N/C. And if it's not even a cardiac or resp related call, and their SpO2 is 100%, then can someone please tell me why it's necessary to place them on 100% NRBFM ? Really? Sorry I'm just an ICU/CCU RN, I clearly don't know what I'm doing..lol

I live and work in a town here unfortunately there are STILL people who only walk into the house with a clipboard and nothing else. It really grinds my gears and bothers the crap out of me to say the least. Not to mention alot of my fellow EMTs on the rescue squad are "ALS dependent". It's sad honestly. I've witness (and intervened) when a fellow EMT sat there with a PT who was in extremis (resp distress/impending failure) and we heard they were coming from a good distance, after 5 min of everyone standing around with there thumbs up their A**ES, i said I think it's time to get moving and so they did, but of course with moans and groans under their breath. It really seems to me that (and i believe other people have stated the same) that people don't understand the 'why' part of why and how we do things. I've been told by an EMT when I said why are you doing that, their answer was "Because it's protocol" I said just because it's protocol does not mean it is always the right thing to do at that time. It seems to me that they will give any idiot who can pass the class an EMT card (i know you have to pass the test and have some sort of knowledge retention) but really it's a disgrace.

As far as field treatment goes, medics dont have invasive hemodynamic monitoring there is not much you can do. If the kid is herniating then it's time for surgery, however by the time s/s of herniation are detected it's already too late. Also depends on the type of herniation (central. uncal, subflacine), if it's a central then good luck with that one. I haven't seen many people come back from those, they usually end up being veggies, trached/peg'ed and off to the nursing home, sounds like fun right? Not the way I'd wanna live.
I honestly don't think that medics should carry mannitol, do you know what the ICP is that ur treating? Sounds dangerous to me. In my ICU we aren't treating with mannitol until they are 15 or so and no coming down with drugs (propofol/Fentanyl/ativan) We usually snow these kids down as far as we can get them, they are usually max at 50mcg/kg/min of propofol and whatever we can give them. We don't often use hyperventilation off the bat, but we attempt to keep the PCO2 near 30.
So how do you help this kid. 1. Pray and 2. Get him to a level 1 trauma ASAP because he needs an emergency craniotomy.
Hypercarbia (high CO2) = Vasoconstriction, less blood flow
Hypocarbia (low CO2) = Vasodilation, more blood flow

I do know nurses who have done the excelsior program and have gotten fine jobs. However, in all honestly, it's difficult for new graduate nurses to land jobs esp, in the hospital without knowing someone. Unfortunately most of them have been stuck doing LTC (long term care) i.e Nursing homes and rehabs. Hospitals are low on cash and some have gone into hiring freezes and are not hiring new grads because it cost a significant amount of money to train them, I mean orientation alone will last at least 3 months or so. And even with that you wont feel comfortable doing things on your own till you have at least a year under your belt.
As for Goose's question on how they the two degrees stack up. That's a good question, I did the traditional classroom bit, but if people have gotten jobs with it then I don't see much of a difference. Alot of it has to do with experiece, whether it be professional (Medic/EMT/PCT), or volunteer.
As far as commitment goes, I mean you can do anything. However nursing school is demanding, the work is hard and studying takes hours. With a 3 months old at home (Congrats btw), I'd say it might be a bit of a challenge, but i guess anything is possible with time management.
From what I've heard (now this is just hearsay) essentially you do all of your testing and stuff online. You do a certain amount of clinicals and within those clinicals you take some sort of practical test and need to score a 100%, altho I am not fully sure what score you need to get inorder to pass, but my gut is that it's 100%. If you do happen to do with online, MAKE SURE WHOMEVER YOU TAKEN THE CREDITS WITH THAT THEY ARE CREDENTIALED, either by the CCNE, there is another agency but i forgot the name of it. Otherwise 1. You wont be able to take your NCLEX 2. You just wasted an assload of money for nothing, so def. buyer beware.
While I am a Nurse I do not have experience with online classes, like I said I did the traditional classroom bit and viola! 6 years later (with transferring and a alot of other BS) I finally earned my degree and now I work in the ICU and have my BSN. Any questions feel free to PM me and I'll try to the best of my ability to answer them. I can ask one of my coworkers who did excelsior how it was ect. Good luck.

You have idiots that drink regular booze and still black out from drinking to much, and unfortunately the teenagers and underage teenagers give the drink a bad rap. If ur 21 and you're stupid enough to drink till you black out or give yourself ETOH poisoning then ya know what, you're a moron and should probably stop drinking. Have I drank too much and puked? Hell yea and it sucks, but I never ended up in an ER or had to call an ambulance. If you don't know your limit then stick to O'Douls or something. lol
I don't think banning it is going to fix the problem cuz either way you slice it, high school kids and college kids will still have ways to get booze and I don't think it's the drink itself. It's the inexperience of the drinker. Now ok ok, Is four loko the safest thing in the world? I'll admit that it's probably not.
Take a look at the local ERs on a thrus, fri, or sat night. With Marist and Vassar near by there is at least 3 a night that come in cuz they drank too much. Ooops ! lol

Can i ask what you mean by "The whole dutchess saga" ???

After reading all of the posts here about MLLS most do not know our operation and most will not know until you have an oppurtunity to work for the MLSS family. Besides being the premier agency in the Hudson valley we have accountability within our employees which I am very proud of and thats what has gotten us to be the premier provider. Besides there is so much behind the scenes that most of you don't see for instance MLLS is the reason we as ALS providors have cpap now in our protocols we are the company that took it upon ourselves to for go the expense to be the pilot company in the Hudson Valley to get everyone the availability of cpap now if your providor chooses not to have such a valualbel tool well I'm sorry for you. I also am not able to elaborate but there is also new technology that is being tested in the field as we speak.So the bottom line is instead of bashing the MLLS family come on over to New Windsor and see for yourself what we are about. That goes for all of you that can be accountable for your actions. Remember there is no life like Mobile life