Guest guest Posted November 11, 2000 Report Share Posted November 11, 2000 There are now machines available that can provide 12 lead ECG, interpretative capability, with the ability to transmit ECG via Fax, land line , gsm. The machines have a new algorithm for the delivery of thrombolytic treatment called the " Algorithm " which with the input of certain data will indicate treatment. This is currently being used in the UK Pre-hospital field. >>> timothy.m.cranton@... 11/10/01 07:57am >>> All, I like the idea of the 2 minute test thats being researched / developed in Hong Kong. What a godsend that would be. This would certainly back up a 12 lead. As far as rythmn recognition is concerned most machines will diagnose for you so the need to 'interpret' is almost taken away from you. So long as you can record an ecg and send onshore that should be okay. I think if Thrombolitics were to be provided offshore it would be at certain locations that fall within a certain criteria, ie. * Distance from needle - within 1hr (as in SNS) and a POB regularly less than 25, not required. * Distance from needle - over 1hr (as in NNS) and a POB of 50 or more, Thrombolitics required. In saying that there can't be anything wrong with keeping a one off emergency dose in with the cardiac drugs on any rig. We are not talking huge stock piles here. Obviously the right training and certification should be awarded prior to anyone giving these drugs. I'm talking a couple of days on rythmn recognition and a revision of ALS skills if anything goes wrong rather than a drug listed in a formula and 1/2 hr discussion on a Rig Medic course. Obviously the right equipment needs to be in place, ie. 12 lead capability, telex / fax ability for onshore interpretation / confirmation etc. I cannot imagine that this is something we will see much of. Probably for the select few on large installations for medics who are just medics not HLO or Radio Op. Tim Member Information: List owner: Ian Sharpe Owner@... Editor: Ross Boardman Editor@... Post message: egroups Subscribe: -subscribeegroups Unsubscribe: -unsubscribeegroups Thank you for supporting Remote Medics Online. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2001 Report Share Posted November 9, 2001 The diagnosis of myocrdial infarction is classically made from two of three hits History ECG changes CKMB rise For many years the only factor we had to go on was the history. With the advent of cheap 12 lead ECGs provisional diagnosis of MI was within the reach of remote practioners although it required, and still does, the input of trained personnel to read the trace. (Of interest most faxes are not of good enough quality to diagnose subtle changes. Direct transfer is required, either telemetry or email). Near patient CKMB tests are useful although these may not be positive umtil the later stages of an infarct. I seem to remember that one of the local cardiologists had anecdotal evidence that it took around 6 hours for a cardiac patient to reach CCU from offshore without any outside delay. Far to long for thrombolysis to be of the best effect. Now that telemedicine is commonplace and there are several products that can transfer ECGs with no reduction in quality, there is no reason to stop the application of thrombolysis as two of the three criteria can be met. The only contraindication would be the lack of ability to deal with arrhythmia, something that all remote medics should be able to deal with. The new agents appear much safer in any case. My topside has an arrangement with the local hospital where we can pick up thrombolytics and take them offshore. I can quote one case where it has allowed someone to leave hospital on their feet rather than in a hearse. If only for this case I am all in favour of bringing " clot busters " closer to the patient. Greg Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 9, 2001 Report Share Posted November 9, 2001 All, I like the idea of the 2 minute test thats being researched / developed in Hong Kong. What a godsend that would be. This would certainly back up a 12 lead. As far as rythmn recognition is concerned most machines will diagnose for you so the need to 'interpret' is almost taken away from you. So long as you can record an ecg and send onshore that should be okay. I think if Thrombolitics were to be provided offshore it would be at certain locations that fall within a certain criteria, ie. * Distance from needle - within 1hr (as in SNS) and a POB regularly less than 25, not required. * Distance from needle - over 1hr (as in NNS) and a POB of 50 or more, Thrombolitics required. In saying that there can't be anything wrong with keeping a one off emergency dose in with the cardiac drugs on any rig. We are not talking huge stock piles here. Obviously the right training and certification should be awarded prior to anyone giving these drugs. I'm talking a couple of days on rythmn recognition and a revision of ALS skills if anything goes wrong rather than a drug listed in a formula and 1/2 hr discussion on a Rig Medic course. Obviously the right equipment needs to be in place, ie. 12 lead capability, telex / fax ability for onshore interpretation / confirmation etc. I cannot imagine that this is something we will see much of. Probably for the select few on large installations for medics who are just medics not HLO or Radio Op. Tim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2001 Report Share Posted November 10, 2001 Hi Greg As far as history goes, I have not seen a high success rate of diagnosing AMI with it (not sure if this is the context you intended). Many times the same risk factors can cause other symptoms or H-Pylori is the culprit for chest pains. There are some studies to be found at www.bmj.com that illustrate the need for Troponins to be tested along with CKMB to be diagnostic. Obviously not everyone with CKMB rises is having AMI but nearly everyone with CKMB and Troponin is. Those that are using the cardiac markers pre-hospital do get 12 leads and of course everyone conscious will have a history taken, but positive hits on the enzymes will get the patient treatment. From what I hear, the 12 lead is not the leading indicator but is an adjunct. Now for those with no enzyme hits, they will typically be transported to the hospital and eventually diagnosed with unstable angina and will get the full chest pain protocol. For more info too, look at www.cardiacstatus.com they have a lot of info available although you may have to request it. The Lancet ( www.lancet.com ?) also is a good reference on this same subject... Kind regards Nick Nudell, NREMT-P Glacier County EMS www.glacierems.com Northern Rockies Medical Center Cut Bank, MT Big Horn County EMS Hardin/Crow Agency, MT " Over-reliance on experience leads to making the same mistakes with increasing levels of confidence " Unknown Thrombolytics The diagnosis of myocrdial infarction is classically made from two of three hits History ECG changes CKMB rise For many years the only factor we had to go on was the history. With the advent of cheap 12 lead ECGs provisional diagnosis of MI was within the reach of remote practioners although it required, and still does, the input of trained personnel to read the trace. (Of interest most faxes are not of good enough quality to diagnose subtle changes. Direct transfer is required, either telemetry or email). Near patient CKMB tests are useful although these may not be positive umtil the later stages of an infarct. I seem to remember that one of the local cardiologists had anecdotal evidence that it took around 6 hours for a cardiac patient to reach CCU from offshore without any outside delay. Far to long for thrombolysis to be of the best effect. Now that telemedicine is commonplace and there are several products that can transfer ECGs with no reduction in quality, there is no reason to stop the application of thrombolysis as two of the three criteria can be met. The only contraindication would be the lack of ability to deal with arrhythmia, something that all remote medics should be able to deal with. The new agents appear much safer in any case. My topside has an arrangement with the local hospital where we can pick up thrombolytics and take them offshore. I can quote one case where it has allowed someone to leave hospital on their feet rather than in a hearse. If only for this case I am all in favour of bringing " clot busters " closer to the patient. Greg Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2001 Report Share Posted November 10, 2001 Well done that man, You are 100% right I have been working as a medic and A & E nurse now for almost 8 years (medic first) and one of the hardest things to teach new medics and doctors is, TREAT THE PATIENT AND NOT THE STRIP. An ECG is a great tool when used in conjunction with all of our assessment skills and available diagnostics, but is not a sole or true indicator in a lot of cases, though it can lead you in the right direction. Colin Nurse-Paramedic Ships Medic Ramform Viking Work email vikmedic@... Satellite Phone: 00-47-67-51-48-33 >From: " Nick Nudell " <emsnick@...> >Reply- >< > >Subject: Re: Thrombolytics >Date: Sat, 10 Nov 2001 01:19:29 -0700 > >Hi Greg > >As far as history goes, I have not seen a high success rate of diagnosing >AMI with it (not sure if this is the context you intended). Many times the >same risk factors can cause other symptoms or H-Pylori is the culprit for >chest pains. There are some studies to be found at www.bmj.com that >illustrate the need for Troponins to be tested along with CKMB to be >diagnostic. Obviously not everyone with CKMB rises is having AMI but nearly >everyone with CKMB and Troponin is. > >Those that are using the cardiac markers pre-hospital do get 12 leads and >of course everyone conscious will have a history taken, but positive hits >on the enzymes will get the patient treatment. From what I hear, the 12 >lead is not the leading indicator but is an adjunct. Now for those with no >enzyme hits, they will typically be transported to the hospital and >eventually diagnosed with unstable angina and will get the full chest pain >protocol. > >For more info too, look at www.cardiacstatus.com they have a lot of info >available although you may have to request it. The Lancet ( www.lancet.com >?) also is a good reference on this same subject... > >Kind regards > >Nick Nudell, NREMT-P >Glacier County EMS >www.glacierems.com >Northern Rockies Medical Center >Cut Bank, MT > >Big Horn County EMS >Hardin/Crow Agency, MT > > " Over-reliance on experience leads to making the same mistakes with >increasing levels of confidence " Unknown > Thrombolytics > > > The diagnosis of myocrdial infarction is classically made from two of >three hits > History > ECG changes > CKMB rise > For many years the only factor we had to go on was the history. With the >advent of cheap 12 lead ECGs provisional diagnosis of MI was within the >reach of remote practioners although it required, and still does, the input >of trained personnel to read the trace. (Of interest most faxes are not of >good enough quality to diagnose subtle changes. Direct transfer is >required, either telemetry or email). Near patient CKMB tests are useful >although these may not be positive umtil the later stages of an infarct. > I seem to remember that one of the local cardiologists had anecdotal >evidence that it took around 6 hours for a cardiac patient to reach CCU >from offshore without any outside delay. Far to long for thrombolysis to be >of the best effect. > Now that telemedicine is commonplace and there are several products that >can transfer ECGs with no reduction in quality, there is no reason to stop >the application of thrombolysis as two of the three criteria can be met. >The only contraindication would be the lack of ability to deal with >arrhythmia, something that all remote medics should be able to deal with. >The new agents appear much safer in any case. > My topside has an arrangement with the local hospital where we can pick >up thrombolytics and take them offshore. I can quote one case where it has >allowed someone to leave hospital on their feet rather than in a hearse. If >only for this case I am all in favour of bringing " clot busters " closer to >the patient. > Greg > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2001 Report Share Posted November 11, 2001 Alan, Would you be by any chance the Gibbo that Wardale (ex Merseyside) refers to? Ross > Re: Thrombolytics > > > There are now machines available that can provide 12 lead ECG, > interpretative capability, with the ability to transmit ECG via > Fax, land line , gsm. > > The machines have a new algorithm for the delivery of > thrombolytic treatment called the " Algorithm " which with > the input of certain data > will indicate treatment. This is currently being used in the UK > Pre-hospital field. > > >>> timothy.m.cranton@... 11/10/01 07:57am >>> > > All, > > I like the idea of the 2 minute test thats being researched / developed in > Hong Kong. What a godsend that would be. This would certainly back up a 12 > lead. As far as rythmn recognition is concerned most machines > will diagnose > for you so the need to 'interpret' is almost taken away from you. So long > as you can record an ecg and send onshore that should be okay. I think if > Thrombolitics were to be provided offshore it would be at certain > locations > that fall within a certain criteria, ie. > > * Distance from needle - within 1hr (as in SNS) and a POB regularly less > than 25, not required. > > * Distance from needle - over 1hr (as in NNS) and a POB of 50 or more, > Thrombolitics required. > > In saying that there can't be anything wrong with keeping a one off > emergency dose in with the cardiac drugs on any rig. We are not talking > huge stock piles here. > > Obviously the right training and certification should be awarded prior to > anyone giving these drugs. I'm talking a couple of days on rythmn > recognition and a revision of ALS skills if anything goes wrong > rather than > a drug listed in a formula and 1/2 hr discussion on a Rig Medic course. > Obviously the right equipment needs to be in place, ie. 12 lead > capability, > telex / fax ability for onshore interpretation / confirmation etc. > > I cannot imagine that this is something we will see much of. Probably for > the select few on large installations for medics who are just medics not > HLO or Radio Op. > > Tim > > > Member Information: > > List owner: Ian Sharpe Owner@... > Editor: Ross Boardman Editor@... > > Post message: egroups > Subscribe: -subscribeegroups > Unsubscribe: -unsubscribeegroups > > Thank you for supporting Remote Medics Online. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2002 Report Share Posted March 20, 2002 We've just received Alteplase this morning. Cheers, Bill RE: Cannulation and shock > >Date: Fri, 15 Mar 2002 11:37:46 +0000 (GMT) > > > > > > Ask your mate to go to the Med center and look on the wall, there is a > >plaque dedicated to the Acton Bridge Preservation Society, if he can tell > > >me what it's about and who's name is on the founder member list! > >PS the dates on it too. It should be next to the fingers and toes in > >plastic. > >.MM > > gordon scott wrote: > >, > > > >thanks for your comments. I am aware of protocols. I am also aware of the > >array of diffent protocols and that they change. They are in the main for > >first world and not remote medicine, we can not ignore them but we must > >take > >everything into consideration. The scary thing is there are some people > >who > >follow blindly and do not look at the evidence base. > > > >Let's take your comments about the 30 degree headup position from the > AHA. > >I have been taught the CPP=MAP-ICP. There are schools of thought that say > a > >30 degree head up position affects the MAP and will reduce CPP. There are > >also those that say a rising MAP will increase a bleed. > > > >What do your protocols say about this? > > > >As for your comments about " been there seen it and done it " I have phoned > >someone who is suspicious of your comments and says that I should ask you > > >to > >supply the date for the up and coming reunion. That if you have as you > say > >been there and seen it you will be able to confirm the date. Not the > >venue! > > > >Regards > > > > >> > > > Gordon, have a read back through what's been said and you see that > most > > >of what has been said relates to possible future new recommendations, > not > > >what we have on protocols. Now if you don't know protocols, where they > >are > > >and what they are, pray tell, what are you doing in this job? Gordon > >maybe > > >you should think befor you say some of the stuff you just did. It seems > > >you're not being very diplomatic. > > >. > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > >Get your FREE download of MSN Explorer at > http://explorer.msn.com/intl.asp. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2002 Report Share Posted March 20, 2002 Bill hows it going, I know of a few Ambulance services that use Fibrinolytic/thrombolytics but I think it is mainly local protocols and depends on the A & E docs or if they have a cardio center. As u may remember we have Rapilysin offshore on the Clipper, as part of an individual risk assesment, for a guy returning to work. I have the contra indications in front of me and Heavy vaginal bleeding is in there along with a list as long as ? Any help Denis >From: " Base Paramedic [bT] " <Base_Paramedic@...> >Reply- >< > >Subject: RE: Thrombolytics >Date: Wed, 20 Mar 2002 15:42:54 +0100 > >We've just received Alteplase this morning. >Cheers, >Bill > > RE: Cannulation and shock > > >Date: Fri, 15 Mar 2002 11:37:46 +0000 (GMT) > > > > > > > > > Ask your mate to go to the Med center and look on the wall, there is a > > >plaque dedicated to the Acton Bridge Preservation Society, if he can >tell > > > > >me what it's about and who's name is on the founder member list! > > >PS the dates on it too. It should be next to the fingers and toes in > > >plastic. > > >.MM > > > gordon scott wrote: > > >, > > > > > >thanks for your comments. I am aware of protocols. I am also aware of >the > > >array of diffent protocols and that they change. They are in the main >for > > >first world and not remote medicine, we can not ignore them but we must > > >take > > >everything into consideration. The scary thing is there are some people > > >who > > >follow blindly and do not look at the evidence base. > > > > > >Let's take your comments about the 30 degree headup position from the > > AHA. > > >I have been taught the CPP=MAP-ICP. There are schools of thought that >say > > a > > >30 degree head up position affects the MAP and will reduce CPP. There >are > > >also those that say a rising MAP will increase a bleed. > > > > > >What do your protocols say about this? > > > > > >As for your comments about " been there seen it and done it " I have >phoned > > >someone who is suspicious of your comments and says that I should ask >you > > > > >to > > >supply the date for the up and coming reunion. That if you have as you > > say > > >been there and seen it you will be able to confirm the date. Not the > > >venue! > > > > > >Regards > > > > > > >> > > > > Gordon, have a read back through what's been said and you see that > > most > > > >of what has been said relates to possible future new recommendations, > > not > > > >what we have on protocols. Now if you don't know protocols, where >they > > >are > > > >and what they are, pray tell, what are you doing in this job? Gordon > > >maybe > > > >you should think befor you say some of the stuff you just did. It >seems > > > >you're not being very diplomatic. > > > >. > > > > > > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > > >Get your FREE download of MSN Explorer at > > http://explorer.msn.com/intl.asp. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2002 Report Share Posted March 20, 2002 Hi Denis, In fact, version 2 of the national paramedic protocols, hopefully soon to be posted on the JRCALC website, will contain the national protocols. The local guidelines vary only slightly from these. For our protocol, in fact, we have managed to distill down to 7 questions, some of which can quickly be discounted (pregnancy and immediately preceding CPR), leaving really only 5. Out of interest, we do not use A & E docs but ambulance service docs, a la " topside. " Even small DGHs will have CCUs, although not full cath labs and cardiac surgery, but we will happily deliver thrombolysed patients to relatively small DGHs where they can receive cardiac monitoring. The issue of rescue angioplasty for failed thrombolysis is an issue we have not really met head-on, pending the research trial evaluating recue angioplasty versus repeat thrombolysis for failure of ST segment resolution post initial thrombolysis. Cheers Anton Denis Kelleher wrote: > > Bill hows it going, > I know of a few Ambulance services that use Fibrinolytic/thrombolytics but I > think it is mainly local protocols and depends on the A & E docs or if they > have a cardio center. > As u may remember we have Rapilysin offshore on the Clipper, as part of an > individual risk assesment, for a guy returning to work. > I have the contra indications in front of me and Heavy vaginal bleeding is > in there along with a list as long as ? > > Any help > Denis > > >From: " Base Paramedic [bT] " <Base_Paramedic@...> > >Reply- > >< > > >Subject: RE: Thrombolytics > >Date: Wed, 20 Mar 2002 15:42:54 +0100 > > > >We've just received Alteplase this morning. > >Cheers, > >Bill > > > > RE: Cannulation and shock > > > >Date: Fri, 15 Mar 2002 11:37:46 +0000 (GMT) > > > > > > > > > > > > Ask your mate to go to the Med center and look on the wall, there is a > > > >plaque dedicated to the Acton Bridge Preservation Society, if he can > >tell > > > > > > >me what it's about and who's name is on the founder member list! > > > >PS the dates on it too. It should be next to the fingers and toes in > > > >plastic. > > > >.MM > > > > gordon scott wrote: > > > >, > > > > > > > >thanks for your comments. I am aware of protocols. I am also aware of > >the > > > >array of diffent protocols and that they change. They are in the main > >for > > > >first world and not remote medicine, we can not ignore them but we must > > > >take > > > >everything into consideration. The scary thing is there are some people > > > >who > > > >follow blindly and do not look at the evidence base. > > > > > > > >Let's take your comments about the 30 degree headup position from the > > > AHA. > > > >I have been taught the CPP=MAP-ICP. There are schools of thought that > >say > > > a > > > >30 degree head up position affects the MAP and will reduce CPP. There > >are > > > >also those that say a rising MAP will increase a bleed. > > > > > > > >What do your protocols say about this? > > > > > > > >As for your comments about " been there seen it and done it " I have > >phoned > > > >someone who is suspicious of your comments and says that I should ask > >you > > > > > > >to > > > >supply the date for the up and coming reunion. That if you have as you > > > say > > > >been there and seen it you will be able to confirm the date. Not the > > > >venue! > > > > > > > >Regards > > > > > > > > >> > > > > > Gordon, have a read back through what's been said and you see that > > > most > > > > >of what has been said relates to possible future new recommendations, > > > not > > > > >what we have on protocols. Now if you don't know protocols, where > >they > > > >are > > > > >and what they are, pray tell, what are you doing in this job? Gordon > > > >maybe > > > > >you should think befor you say some of the stuff you just did. It > >seems > > > > >you're not being very diplomatic. > > > > >. > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > > > >Get your FREE download of MSN Explorer at > > > http://explorer.msn.com/intl.asp. > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2002 Report Share Posted March 20, 2002 Hi Dennis, Excellent at the moment - same can't be said for the last lot of leave cos I hardly got on the new GSXR 600 due to the weather... As regds the thrombolytics, yeah I remember you taking me through that list on the first cover I did for you! Protocols for ours should be arriving shortly. as you're probably aware the list owner is my back to back and has kindly provided copies of Staffs Amb service protocols and suspected MI triage system patient report form. Hopefully catch up with you again soon Dennis - I'll need to cover for you again soon cos my boots are almost worn out!! Regds to all on Clipper, Bill RE: Cannulation and shock > > >Date: Fri, 15 Mar 2002 11:37:46 +0000 (GMT) > > > > > > > > > Ask your mate to go to the Med center and look on the wall, there is a > > >plaque dedicated to the Acton Bridge Preservation Society, if he can >tell > > > > >me what it's about and who's name is on the founder member list! > > >PS the dates on it too. It should be next to the fingers and toes in > > >plastic. > > >.MM > > > gordon scott wrote: > > >, > > > > > >thanks for your comments. I am aware of protocols. I am also aware of >the > > >array of diffent protocols and that they change. They are in the main >for > > >first world and not remote medicine, we can not ignore them but we must > > >take > > >everything into consideration. The scary thing is there are some people > > >who > > >follow blindly and do not look at the evidence base. > > > > > >Let's take your comments about the 30 degree headup position from the > > AHA. > > >I have been taught the CPP=MAP-ICP. There are schools of thought that >say > > a > > >30 degree head up position affects the MAP and will reduce CPP. There >are > > >also those that say a rising MAP will increase a bleed. > > > > > >What do your protocols say about this? > > > > > >As for your comments about " been there seen it and done it " I have >phoned > > >someone who is suspicious of your comments and says that I should ask >you > > > > >to > > >supply the date for the up and coming reunion. That if you have as you > > say > > >been there and seen it you will be able to confirm the date. Not the > > >venue! > > > > > >Regards > > > > > > >> > > > > Gordon, have a read back through what's been said and you see that > > most > > > >of what has been said relates to possible future new recommendations, > > not > > > >what we have on protocols. Now if you don't know protocols, where >they > > >are > > > >and what they are, pray tell, what are you doing in this job? Gordon > > >maybe > > > >you should think befor you say some of the stuff you just did. It >seems > > > >you're not being very diplomatic. > > > >. > > > > > > > > > > > > > > > > > > > > > > > > > > >_________________________________________________________________ > > >Get your FREE download of MSN Explorer at > > http://explorer.msn.com/intl.asp. > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2002 Report Share Posted March 20, 2002 Why do the Ambulance services keep their protocols such a secret when in theory they should be known by all ambulance service and emergency health care providers anyway. There are numerous US sites that place theirs online for anyone to look at and learn from, why is there such an apparent aura of secrecy over those in the UK, because every time I ask for a copy I get ignored, I would also like to know if this applies to Algorithm's of the " flow chart " or " decision tree " type? Carpenter RE: Cannulation and shock >> > > >Date: Fri, 15 Mar 2002 11:37:46 +0000 (GMT) >> > > > >> > > > >> > > > Ask your mate to go to the Med center and look on the wall, there is a >> > > >plaque dedicated to the Acton Bridge Preservation Society, if he can >> >tell >> > > >> > > >me what it's about and who's name is on the founder member list! >> > > >PS the dates on it too. It should be next to the fingers and toes in >> > > >plastic. >> > > >.MM >> > > > gordon scott wrote: >> > > >, >> > > > >> > > >thanks for your comments. I am aware of protocols. I am also aware of >> >the >> > > >array of diffent protocols and that they change. They are in the main >> >for >> > > >first world and not remote medicine, we can not ignore them but we must >> > > >take >> > > >everything into consideration. The scary thing is there are some people >> > > >who >> > > >follow blindly and do not look at the evidence base. >> > > > >> > > >Let's take your comments about the 30 degree headup position from the >> > > AHA. >> > > >I have been taught the CPP=MAP-ICP. There are schools of thought that >> >say >> > > a >> > > >30 degree head up position affects the MAP and will reduce CPP. There >> >are >> > > >also those that say a rising MAP will increase a bleed. >> > > > >> > > >What do your protocols say about this? >> > > > >> > > >As for your comments about " been there seen it and done it " I have >> >phoned >> > > >someone who is suspicious of your comments and says that I should ask >> >you >> > > >> > > >to >> > > >supply the date for the up and coming reunion. That if you have as you >> > > say >> > > >been there and seen it you will be able to confirm the date. Not the >> > > >venue! >> > > > >> > > >Regards >> > > > >> > > > >> >> > > > > Gordon, have a read back through what's been said and you see that >> > > most >> > > > >of what has been said relates to possible future new recommendations, >> > > not >> > > > >what we have on protocols. Now if you don't know protocols, where >> >they >> > > >are >> > > > >and what they are, pray tell, what are you doing in this job? Gordon >> > > >maybe >> > > > >you should think befor you say some of the stuff you just did. It >> >seems >> > > > >you're not being very diplomatic. >> > > > >. >> > > > > > >> > > > > >> > > > > >> > > > > > >> > > > >> > > > >> > > >_________________________________________________________________ >> > > >Get your FREE download of MSN Explorer at >> > > http://explorer.msn.com/intl.asp. >> > > > >> > > > >> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 20, 2002 Report Share Posted March 20, 2002 ----- Original Message ----- From: " JOHN CARPENTER " <JOHN.CARPENTER.SNR@...> > Why do the Ambulance services keep their protocols such a secret when in > theory they should be known by all ambulance service and emergency health > care providers anyway. Free Masons, mate! ) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 21, 2002 Report Share Posted March 21, 2002 I didn't know the Masons had been locked up mate, might explain why I can't get my favourite brand of Dandelion and Burdock anymore. Re: Thrombolytics > >----- Original Message ----- >From: " JOHN CARPENTER " <JOHN.CARPENTER.SNR@...> > > >> Why do the Ambulance services keep their protocols such a secret when in >> theory they should be known by all ambulance service and emergency health >> care providers anyway. > > >Free Masons, mate! >) > > > >Member Information: > >List owner: Ian Sharpe Owner@... >Editor: Ross Boardman Editor@... > >Post message: egroups >Subscribe: -subscribeegroups >Unsubscribe: -unsubscribeegroups > >Thank you for supporting Remote Medics Online. > > > > > Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.