Leaderboard

Getting back to where I left off.... I was about too RSI/RSS. OK, so once I start a NRB, and splint this thing with a pillow (Not a circumfrential wrap as some may have been eluding too), I notice his SP02 raise from 91% to 95%. Some may be happy with this result. However, in watching the trending on my EtC02 go from 42-44-46-48.... Thats all I need, regardless of Sp02. To be honest, he probably has had no pain control by this time, since I have pulled the trigger on RSI in my 1st 5min of meeting him. Just to stress it a little more.... The ETC02 went on at first contact, I want trending! One number is not enough for me in a resp patient, that is how I could determine the need for a critical intervention so fast in this presentation. In all honesty... I do not want him breathing on his own at all, the more these ribs/chunks of sharp bone float around the better of a chance of shredding an intercostal artery and having another real problem. So I would choose my drugs based on hemodynamic stability PRN. Probably the standard Fentanyl/Midazolam. Succ to pass the tube, then rocuronium to continue paralysis. CAREVent settings.... ugh jeez ummm... *Squint patch* It is going to be whatever gets my Co2 near 40. Probably 600ml TV. RR 22 to start.... once excess C02 is blown off, rate can come down. I want to keep my volumes at the lower end to keep chest movement minimal. PEEP will be set at 5cm to replace physiological PEEP made at the vocal cords, and taken away by the tube, + 5cm extra (10cm total) for "internal splint". This PEEP aint no game, I need to be really careful of hypotension, and REALLY aware of the pneumo possibility (more like inevitebility). CPAP is not my first choice for a few reasons. 1) I have RSI 2) To give enough pain control, I will be sedating him past the "CPAP" limit. That is, he will not have enough drive to work positivly with the system. 3)Intubation is in his near future anyway.... proactive medicine is the way. 4)I would rather intubate him now, while he is still somewhat stable, I hate to wait till he's completely hypoxic. Just thought of another neat BLS splinting idea,,,, He needs spinaled, how bout a KED? Will assist with immobilization of the spine, and the flail segment.

Kind of EMS related... http://www.youtube.com/watch?v=b-JRQXYy9wk Not EMS related, but I like them...

You leave the lights on?

Paddy is planning to marry, he is, and asks his family doctor how he could tell if his bride-to-be is still a virgin. His doctor says, "Aye, Paddy, all Irish use three things for what we call a Do-It-Yourself.... Virginity Test Kit.... a small can of red paint, a small can of blue paint and a shovel." Paddy asks, "Aye, and what do I do with these things, doctor?" The doctor replies, "Before ye climb into bed on your wedding night, you paint one of your balls red and the other ball blue. If she says, "That's the strangest pair of balls I ever did see...", you hit her with the shovel. May I just say to those who will not read this as humour, or try to read more into it than they should, I never have & never will condone violence towards women.