RE: Too funny

["Brault, Charles" <cbrault@bechtel.com>]

 

-----Original Message-----
From: GDJollyGrog@aol.com [mailto:GDJollyGrog@aol.com]
Sent: Friday, July 11, 2003 6:24 PM
To: flightmed@flightweb.com
Subject: Too funny

Obviously, no one has ever dare ask what you would do if forced to think outside protocol and diagnose and treat.  If your so hypersensitive about explaining what it is that you would do if faced with an unknown situation, then I am sorry, I was merely inquiring about competency of Medic's operating outside their scope in reference to the original article about Medic's seeing NO as no big deal "QUITE SAFE."
[Brault, Charles] 

Oh !

I just spotted the combustible for the flame

Just to be clear

My remarks concerning the NO safety where totally general

And in absolut and complete abstraction of it's use by paramedics... as fictional as it may be

Since I can not envisage them using it as a primary provider (i.e. not in the presence of more qualified personnel)

You seem to be the only one on the other hand to think it's a possibility (albeight by a twisted manner all your own) 

My discussion as well as my "use" of NO is totally from the seconf line of the fiddle section

As very well it should be (It seems I can not over state this ! ?) 

I obviously know the stuff

For the same reasons and at the same level that it is worth discussing it on this list

For the general reasons

- What's the stuff

- What does it do

- How does it work 

- Why do we use it

And more importantly

If I have to transport a speciality team using it

- What are the logistical requirements

- Potential problems and risk

... and what can I do to optimize it's use and forestall any probs

This is where your contribution could have gained from been more contributory and constructive to the debate

Competence is better accepted when well demonstrated

Then merely stated

 

All the credential wanna be's like nurses trying to be doctors, medics trying to everyone and RT's being excepted to jump in on the band wagon and being asked to do medic, RN, and MD tasks is really what I was getting at. One example, a medic should not under any circumstance try to titrate Deprovan, yet they do it all the time, when does it end. Personally, I don't want to see Medics doing PTCA's or open heart surgery anytime soon....
[Brault, Charles] 

Falling in the realm of exageration does nothing to elevate the debate

Real and more nuanced examples would have been interesting to debate

As we all have to constantly justify and revise all our advanced (delegated) care practices 

Lighten up folks, these are serious issues that face all of us. If you take offense to my inquiry, please don't respond. I was looking for serious minded answers to my questions, not insecure babble about:

[Brault, Charles] 

I think we can all see pass the words

And argue more what is said

And less what is understood or infered

No offense yet taken from anything that has been said

"Actually the NO therapy is really simple

And would not be to hard to learn
And use it properly
Really 
It's not rocket science"

The responses to my questions are so easily overlooked by highly oversimplified statements like the aforementioned two that I have listed. I have no problem with anyone doing anything that they been proficiently trained in. The use on NO is NOT a rocket science but then again neither is ACLS, but it does require the understanding of ventilation and perfusion as well as the potential for toxicity and treatment of such. I read flightmed day after day, all I see is sour grapes and one line answers. This is the first time I have ever seen anything of substance trying to be discussed, yet my simple questions go unanswered, yet they are acknowledged by sour toned responses like:

[Brault, Charles] 

Really !

NO therapy IS simple

And it's dangers HAVE been initialy overstated

 

Heck !

A lot of things that we do are more complicated

Or more dangerous

Yet we do them because

- We are trained (we can argue the (in)appropriate level)

- And the benefices far surpass the risks (AGAIN... innapropriate for Medic practices)

 

 

"NO

Is like interhospital transfers
 
Really not complicated
Enough so
That your average nurse and Doc
Think they can do interhospital transfers well and safely
With no further training or experience"

That is my point, we should all stay within our scope of training. I would not expect for an EMT-P to be able to list all the toxcities associated with NO, (i.e. increases of methemoglobin, peroxynitrite synthesis, or impaired platelet aggregation and adheasion).  I would expect anyone who states again:
To know how to not only identify the toxicity issues but also to treat them as well and understand how these toxicity change the effects of ventilation and PaO2. After all, when there is a complication of No therapy, one cannot just simply D/C the use and place on 100% O2, in so doing so, that would most likely kill the patient due to hypoxic hypoxia.  Just ask yourself this question, if it were your loved one, would you want just anyone to transport your neo, child, or adult on NO who hasn't had the appropriate training. I would like to know from the person who wrote the following:
 
[Brault, Charles] 

Hey !

I'll take that for what it is

Your factual contribution to the subject of NO therapy

And ignore anything else you may have meant))))

 
Staying on the subject of usefull information

If you have any research documenting the environmental dangers

I think the medics on this list would appreciate this information

As it concerns them

More recent research would be more appropriate

As the initial ones were skewed more towards the therorethical dangers of environmental NO

 

 

Cheers

 

Charles Brault