Sunday, October 19. 2014
Thursday, October 16. 2014
Monday, October 13. 2014
Below I am posting a website which is being published by the Texas Department of State Health Services. I urge each and every student to open this website and read the documents contained within the site. We don't want anyone to not be prepared for any possible exposure to ebola or not be prepared to care for a patient who might have the disease. Your personal safety is of utmost importance. I urge that you read all of the document within the website. If you are on hospital or ambulance rotations, always use Universal Precautions. Be careful. We do not want you, or anyone else for that matter, to be come a victim of the disease. RICHARD ADAMS
Thursday, October 9. 2014
Friday, October 3. 2014
Monday, September 29. 2014
Sunday, September 28. 2014
It has always been the goal of the Percom Faculty and Staff to offer above average educational experiences in order that all students can better learn the profession of emergency medicine as an EMT, Intermediate, or Paramedic. The ultimate goal is to produce qualified, proficient, and professional EMS providers. Below will find a graph which reports the topic areas missed on the EMT final exam. They are listed in the order of "most" missed to "least missed". I have prepared and published this graph on 6 different occasions and posted it onto the EMT Announcement Page in order to give you, the student, information as to what topic areas are being most missed and in order to assist you in preparing or the final exam and ultimately the National Registry Exam. The interesting thing I notice, and the most down heartening is the fact that the top 3 areas missed on the final consistently has been (1)medical emergencies (2)pharmacology and (3)respiratory emergencies. This is true, even though I have published this 5 times before. It appears to me that the student is not paying attention to my graph and is not preparing properly for these areas. If you will heed what this graph shows and prepare appropriately, you will pass the final exam. The grades on the final exam have run from 47 to 98. Although most have passed the final exam, the fact that many are still not properly preparing is disgruntlying. Please read the graph, pay attention to the graph, and prepare for your final exam. To those who have passed the final exam I say a hearty "Congratulations, and Thank You!" You are to be commended. RICHARD ADAMS
Tuesday, September 23. 2014
Tuesday, September 9. 2014
Friday, September 5. 2014
Every student has a set deadline by which he/she is to complete
EVERYTHING in the course through final exam, skills testing, and clinical
and field rotations. This deadline was
stated in the initial course access email. While we try to work with
students because we know life happens, it is causing serious problems on
our end. When students exceed this deadline, it creates problems with
state and national reporting requirements. Also, your initial tuition
paid only covers a set amount for faculty and when the time frame for
the course is exceeded, PERCOM continues to expend money on your behalf
for faculty and other expenses. So if you cannot finish your course by
the course deadline and must ask for an extension, you will be charged
for this service. And remember, extension requests are due BEFORE the
deadline and are not guaranteed. The best way to avoid possibly not
being granted an extension or having to pay fees for extensions is to be
sure you complete all course requirements by the deadline. PERCOM is
not obligated to allow students to remain in their courses for longer
than the designated time frames as below:
Paramedic (20 months) - this is divided into a 9 month deadline for P1 and another 11 months max for P2
AEMT - 9 months
EMT - 6 months
EMS Instructor - 3 monthsThank you.
Thursday, September 4. 2014
Tuesday, September 2. 2014
Try this address to enter your MD questions. https://groups.yahoo.com/neo/groups/PERCOM_ONLINE_GROUP/info RICHARD
Monday, August 4. 2014
For tracking skills competencies as well as scheduling and submitting paperwork and documentation for rotations, PERCOM now uses Platinum Planner. You are required to enter all your skills competency data with this system and will receive an email with instructions prior to your first skills practice session. If you do not receive this email with instructions, email Jane at firstname.lastname@example.org to let her know. It is IMPERATIVE you have set up your Platinum Planner course and classes BEFORE attending the first skills session. This process can take several days to do so be sure and start the process as soon as you get the Platinum invite email and follow carefully each day until your course and skills class are accepted. You will not receive acceptance in Platinum for your rotations until you have successfully submitted all your required clinical paperwork and documents.
It is also absolutely imperative you do your data entry PROMPTLY following each skills session and each rotation. Failure to do so can result in the skills session or rotation being negated and forcing us to have to charge you for reschedule fees and you to redo the session or rotation. Do NOT delay in entering your data and submitting it promptly. Also be accurate and honest for your full credit. Even if you complete everything in the session or rotation as required, failure to submit correct and accurate data could lead to you having to reschedule again (and associated fees if any). Honesty and integrity is expected and dishonesty in data entry will not be tolerated and could lead to dismissal from the program. So be careful and complete as you enter your data.
Monday, July 21. 2014
I receive many homework assignments without the student's name anywhere on the homework assignment. This sometimes causes a delay in posting a grade due to not knowing who submitted a paper. Each of you were given the Student Handbook when you registered for your course. It is mandatory that you read the Student Handbook and follow the instructions contained within. I am gong to post below the portion of the Student Handbook regarding turning in of homework assignments. Apparently students are not reading it or if they do read it, they do not follow the instructions. Be advised that effective immediately I will deduct 5 points from each homework assignment which does not have the student's name on the paper, as per the Student Manual. RICHARD ADAMS
ASSIGNMENTS:The student will be expected to complete homework as assigned. The student is also expected to read the appropriate material from the course textbook or other assigned materials before class in order to be prepared for the class lecture. The student is responsible for all information contained in the textbook and other course materials, whether or not specifically assigned by the instructor. The student should be aware that the course is not specifically matched to any one textbook, and it is the student’s responsibility to match lessons in the online course with appropriate chapters of his/her chosen or provided textbook(s). Before the end of the course, all chapters and all provided textbooks should have been thoroughly read and studied. ALL students are required a minimum number of participations in the Medical Directors Forum and Chat Sessions. "Participation" means actual participation – asking a legitimate medical and class or profession related question, providing well thought and researched responses to questions by other students and actual interaction within the scheduled class Chat Sessions. Lurking or "showing up" on the logged in list is not adequate for meeting this requirement. Specific requirements are listed in the Welcome Packet and/or Student Announcements Pages for your course level. Lead Instructors and/or members of the Medical Director’s team will determine what may constitute lack of participation, and students who do not meet the requirements must continue to attend/participate until the requirements are met. All other homework assignments must be submitted to the course Lead Instructor in an attachment form, preferably in Word to allow for instructor comments, editing and grading. Each assignment must have the student’s name listed at the top of ALL pages and the file name must be listed in the following format:
Student Name – Class Number – Assignment name (for example: JaneDinsmore – 200A)
Wednesday, July 16. 2014
Can oxygen hurt?
Drug we use most often can cause harm if we give it without good reason
By Mike McEvoy
EMS providers began giving oxygen not because it had medically or scientifically demonstrated benefits for patients, but because they could. Yet, inarguably, hypoxia is bad.
John Scott Haldane, who formulated much of our understanding of gas physiology, said in 1917, “Hypoxia not only stops the motor, it wrecks the engine.”
Patients begin to suffer impaired mental function at oxygen saturations below 64 percent. People typically lose consciousness at saturations less than 56 percent, giving airplane passengers no more than 60 seconds to breathe supplemental oxygen when an airplane flying at 30,000 feet suddenly depressurizes1-3.
More recent studies suggest that hyperoxia, or too much oxygen, can be equally dangerous. Hence the drug EMS providers administer most often may not be as safe as originally thought.
Studies on benefits and dangers of oxygen therapy are not new; intensive care practitioners have long recognized the adverse effects of using high concentration oxygen4.
The Guidelines for Emergency Cardiac Care (ECC) in 2000 and 2005 recommended against supplemental oxygen for patients with saturations above 90 percent. The current 2010 ECC Guidelines call for supplemental oxygen only when saturations are less than 94 percent, perhaps in an effort to soften the impact of change5.
What is new are prehospital research studies comparing outcomes of patients treated without oxygen or with oxygen titrated to saturations versus patients routinely given high flow oxygen. These data are frightening; they invariably show impressive patient harm from even short periods of hyperoxia.
We’ve known since 1999 that oxygen worsened survival in patients with minor to moderate strokes and made no difference for patients with severe stroke6. In fact, the American Heart Association recommended in 1994 against supplemental oxygen for non-hypoxemic stroke patients.
The dangers from giving oxygen to neonates have also been long appreciated7. The most compelling outcome studies of neonates published in 2004 and repeated in 2007 showed a significant increase in mortality of depressed newborns resuscitated with oxygen (13 percent) versus room air (8 percent)9. This led to the current neonatal resuscitation recommendations for use of room air positive pressure ventilation.
In 2002, a study of 5,549 trauma patients in Texas showed prehospital supplemental oxygen administration nearly doubled mortality9. A Tasmanian study of prehospital difficulty breathing patients published in 2010 compared patients treated with oxygen titrated to saturations of 88 to 92 percent to patients treated with non-rebreather oxygen masks.
It showed a reduction in deaths during subsequent hospitalization of 78 percent in COPD patients and 58 percent in all patients10. New studies are showing a troubling pattern of worse outcomes associated with hyperoxia post cardiac arrest11.
Why would oxygen worsen patient outcomes? One mechanism may be absorption atelectasis. Gas laws mandate that increases in the concentration of one gas will displace or lower the concentration of others. Room air normally contains 21 percent oxygen, 78 percent nitrogen, and less than 1 percent carbon dioxide and other gases.
Nitrogen, the most abundant room air gas, is responsible for secretion of surfactant, the chemical that prevents collapse of the alveoli at end expiration. Premature infants often are not developed sufficiently to produce surfactant and require endotracheal administration of animal surfactant.
“Washout” of nitrogen in adult lungs occurs when high concentration oxygen is administered. Lower concentrations of nitrogen can lead to decreased surfactant production with subsequent atelectasis and collapse of alveoli, significantly impeding oxygen exchange.
Oxygen is also a free radical, meaning that it is a highly reactive species owing to its two unpaired electrons. From a physics perspective, free radicals have potential to do harm in the body.
The sun, chemicals in the atmosphere, radiation, drugs, viruses and bacteria, dietary fats, and stress all produce free radicals. Cells in the body endure thousands of hits from free radicals daily.
Normally, the body fends off free radical attacks using antioxidants. With aging and in cases of trauma, stroke, heart attack or other tissue injury, the balance of free radicals to antioxidants shifts.
Cell damage occurs when free radicals outnumber antioxidants, a condition called oxidative stress. Many disease processes including arthritis, cancer, diabetes, Alzheimer’s and Parkinson’s result from oxidative stress.
The concept of free radical damage suggests the old EMS notion that, “high flow oxygen won’t hurt anyone in the initial period of resuscitation” may be dead wrong.
Tissue damage is directly proportionate to the quantity of free radicals present at the site of injury. Supplemental oxygen administration during the initial moments of a stroke, myocardial infarct (MI) or major trauma may well increase tissue injury by flooding the injury site with free radicals.
Finally, consider this: five minutes of supplemental oxygen by non-rebreather decreases coronary blood flow by 30 percent, increases coronary resistance by 40 percent due to coronary artery constriction, and blunts the effect of vasodilator medications like nitroglycerine12. These effects were demonstrated dramatically in cath lab studies13 published in 2005.
Wonder why the 2010 ECC Guidelines recommended against supplemental oxygen for chest pain patients without hypoxia? Now you know: supplemental oxygen reduces coronary blood flow and renders the vasodilators ALS providers use to treat chest pain ineffective.
Where do we go from here? Knowing that both hypoxia and hyperoxia are bad, EMS providers must stop giving oxygen routinely. Oxygen saturations should be measured on every patient.
Protocols need to be aligned to reflect the 2010 ECC guidelines: administer oxygen to keep saturations between 94 and 96 percent. No patient needs oxygen saturations above 97 percent and in truth, there is little to no evidence suggesting any clinical benefit of oxygen saturations above 90 percent in any patient.
Modifications in prehospital equipment will be inherent in controlling oxygen doses administered to patients. In all likelihood, the venturi mask will make a comeback, allowing EMS providers to deliver varied concentrations of oxygen as needed to keep oxygen saturations between 94 and 96 percent.
Few patients will require non-rebreather masks which are prone to deliver too much oxygen (hyperoxia). CPAP (Continuous Positive Airway Pressure) devices will also need redesign as most conventional EMS CPAP delivers 100 percent oxygen. A study conducted by Bledsoe, et al in Las Vegas found that prehospital CPAP using low oxygen levels (28 to 30 percent) was highly effective and safe14.
Bottom line: the drug we use most often can cause harm if we give it without good reason. In the absence of low saturations, oxygen will not help patients with shortness of breath and it may actually hurt them. The same holds true for neonates and virtually any patient with ongoing tissue injury from stroke, MI or trauma. Indeed, oxygen can be bad.
About the author