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Kiwi- how farking IGNORANT can you get? Just because you can't treat him doesn't mean you shouldn't try to figure out what's all going on and how it would be treated... what are you going to do if he develops complications during your transport? Say "Oh well, we just figured we were the taxi ride?" I thought you were against having to rely on physicians for everything. Get your story straight!! I'll puzzle through this and get back to you, have to get to my A&P lab... Wendy CO EMT-B

Hello, Location: You are an ALS crew in a small town (population 5000). It is 1000hrs and you are dispatched for an urgent transfer to the local University Hospital. The University Hospital is 125km away. On Arrival: You are greeted by the ED staff and are given a report. Mr. Smith is a 67 year-old male with an extensive and complex medical history. He has had a MI in 1993 (NSTEMI),CABG in 1994 (4 vessels), PSVT, HTN, DM I, Dyslipidemia, Depression, Renal Insufficiency, Esophageal cancer that was managed surgically in 2008 with a Esophagectomy as well as Oropharyngeal Squamous Cell Carcinmona (OSCC)in 2009 that was managed with radiation and surgical interventions. Since 2008 the patient has had dysphagia and numerous aspiration pneumonia. He was made NPO. A PEG was insert in Dec 2009 and the patient was started on bolus feeds. However, he has still had trouble with aspirations. There were plans to advance the PEG in to the small bowel. For the past five days the patient has been feeling unwell. Chills, myalgia, fever, and a hacking cough with some think yellow sputum. His wife was concerned that he had a pneumonia. The patient has been refusing his tube feeds because he feels unwell. The patient did not want to go to the hospital and took some old antibiotics he had around the house. This morning he tried to eat. His wife started his tube feed at 0800hrs. Shortly after feeding began he started coughing and threw up. Gagged for awhile and trued 'blue'. He developed respiratory distress and was driven to the hospital by his wife. On Exam: The patient is sitting up in bed (75 degrees) and looks distressed but is lucid. Numerous old surgical scare are seen on the patients neck and jaw. He seems to have a poor range of motion as well. GCS 15 PEARL 4mm Strong x 4 BP 180é90 HR 120 Temp 38 EKG: Sinus Tachycardia with an old RBBB RR 34 SpO2 88% on 100% FiO2(humidified oxygen wide open) Lungs - course crackles Abd is soft Foley is in situ with 20cc of concentrated urine There are 2 IV. An 20 gauge in the left hand and a 18 gauge in the left arm CXR shows a white out on the right side and cloudy looking left side. Labs are limited. They show: WBC 24 Hgb 84 Na 137 K 2.9 Mg .85 ABG show (100% oxygen): Ph 7.45 CO 32 O2 64 BE 2.2 He has been Dx with Sepsis and aspiration pneumonia on a preexisting community acquired pneumonia. Treatment thus far: 1L NS bolus 40mEq KCL IV NS+20 KCL at 125cc Vancomycin 1gm Pip Taz 4.5 mg Zythromax 500mg Decompressed his gut via the PEG Zantac 150mg IV His medications are: ASA 80mg od Lopressor 50mg bid Lipitor 40mg od Ramipril 5mg od Sliding Scales Insulin tid Tyl prn Advil prn Lansoprazole po od Motilium 10mg po tid Cheers...

IDHS is the parent orginization for these comissions and boards: Boilers & Pressure Vessels Counter-Terrorism and Security Council EMS Commission Firefighting Personnel Standards & Education Fire Prevention & Building Safety Commission / Code Services Higher Education Advisory Board Homeland Security Foundation Indiana Emergency Response Commission Regulated Amusement Device Safety Board Search & Rescue Training Advisory Committee Also the State Fire Marshal, and I am sure several other agencies are represented by this office. IDHS

Again Atrovent liquid did not present an allergy issue for those allergic to peanuts or soy. The lecithin base used in the CFC propellant MDIs of Atrovent and Combivent (which is Albuterol/Atrovent combo) did present a potential problem. Atrovent is now HFA and the lecithin is no longer used in the product. Unfortunately Combivent still has not been able to reformulate so it still is CFC with lecithin making it a problem for those with peanut or soy allegies. New Atrovent HFA MDI insert: Note there is no mention of peanut/soy allergies. http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Atrovent+HFA/10003001_US_1.pdf general pt info http://fdb.rxlist.com/drugs/drug-93239-Atrovent+HFA+Inhl.aspx?drugid=93239&drugname=Atrovent+HFA+Inhl&source=0 The link I posted earlier. http://www.aaaai.org/patients/resources/medicationguide/saba.stm Note the Combivent information. There have been numerous changes to Respiratory medications during the past 3 years to be in compliance with the 1987 Montreal Protocol (treaty) which is why I posted the earlier links. In fact, just about every MDI had to reformulate. Combivent has been granted a stay of termination for now as it attempts to produce an HFA product. There is a chance that none of the MDIs are as they were presented in your Paramedic text book. I am actually still seeing EMS information with Bronkosol listed as a frontline med.

Thanks for the clarification. Sometimes I we call the combination of A/A Duoneb, but I would not document it as such as we don't carry Duoneb. It is nice to know Atrovent is no longer contraindicated with a peanut allergy. Learning all the time. How about soy allergy? It seems I need to pull out the sheet that comes with the drugs as they are delivered to our department, as I would assume they are up to date.

The thing that caught my ear was at the beginning where the newbie says "I didn't go to medic school to be treated like an EMT". Now before all the EMT's burn me.. I give it a point for that because maybe the public will figure out that there is a difference.

If you've ever been around the people who smoke a pack or so a day, they always have that smell on them, though gum may mask the breath, you cant mask the smell all over your clothes. I would think in the pt with minor illness or injury, they would rather have someone who doesn't smell like a ashtray

...with an ambulance.

As funding begins to dwindle more and more local goverment agencies will be looking at new ways to increase budgets. This will by no means be the last we see of this type of incident.

Hey Matt, welcome to the City! Usually, if your pt. is having difficulty breathing enough to call 911 and has a hx of Asthma, I'll bypass the Albuterol and go directly to a duoneb of Albuterol and Ipatropium along with 125mg Solumedrol IV, depending of course on my assessment of the pt. But, Asthmatics know they have Asthma and are very aware of an onset of an attack. In most cases they have already used their meter dose inhaler w/o relief, that's why they called us. It doesn't make sense to give them more of something that isn't working. With CHF pt.'s, I will avoid Albuterol like the plaque. You're correct in your assumption that they will get worse. The patient is basically drowning. What we need to do is get rid of the fluid somehow, not add to it. Pt.'s with CHF having a true respiratory distress crisis will need CPAP, and nitro for the hypertension, not a nebulized Albuterol treatment. Sorry for the short response Matt, I have a meeting to go to. Again, welcome to EMT City! Take it away Ventmedic!

I do not get it nor do I know your brother. Guess I'm plumb out of luck

I have absolutey no idea, I am going to put him on the stretcher and take him to the hospital; oh wait, he's already at the hospital mm ..... did I mention I have absolutely no idea? This is a transfer, so, if they want him treated then send a physician with the patient!