scope2776

Somebody probably just made it up 100 years ago, and it was just grandfathered into all the textbooks and now it's regarded as LAW! Unfortunately, it probably requires a triple-blinded study to remove the myth b/c it's the "standard of care". Left lateral recumbent / right lateral recumbent doesn't matter! evaluate your pt's airway and determine the appropriate way to clear their airway. Typically in semi-conscious patients who will react to deep suction it will be on their side; on unresponsive pt's i will typically be able to clear the pt's airway w/ suction while i attempt to control it. Unfortunately, medicine has been boiled down into rigid algorithms in an attempt to teach the masses... it's easy to say and teach: "put all pt's on their L side who are vomiting" but hard to teach: "throughly evaluate your pt's airway and maintain it".

i lol'd

Well said, well said. Yeah that totally makes sense. I wholeheartedly agree. There certainly are substandard ambulance companies. And what our profession needs is less fragmentation. I just get so fired up when I read articles or hear news about a fire department taking over a successful or excellent ambulance organization and turning it into a mess. I just wish there was some way to counter all the propaganda coming from the IAFF and other organizations about fire based EMS.

How about "Advocates for Ambulance based EMS"? It could also be centered around improving professionalism and business development of ambulance based EMS services. Do you think there would be a lot of support for this kinda thing?

After a search of both the forums and the internet at large I was unable to find an advocacy group for keeping fire out of EMS. The topic of fire based EMS and its merits has been disscussed ad nausem on this forum. It is my belief fire based EMS is a method of delivering EMS care, but not the best or most efficient. And without dirverting into another flame war I was wondering if anyone is aware or knows of an advocay group or political action group that advocates for keeping fire out of EMS? The problem with NAEMT and associated organizations is that they won't take a stand against their fire department members because they comprise a large percentage of their membership (officers included) and the NAEMT depends on members for revenue. The fire departments have the "Fire Service-Based EMS Advocates" organization. This organization is frequently spreading false truths about EMS delivery models. Are there any candidates within the NAEMT or other organizations opposed to fire based EMS? I envision an organization that fights potential take-overs of EMS by political action.... any thoughts?

That's really cool. It would do wonders for your skill competency. Just imagine making runs on all the cadavers at night with a laryngoscope!

Always leave your ambulance running. Turn the heat on in the back before you get out to attend to the pt. Don't set your bags down in the snow, it will melt and cause the bottom of your bags to get soggy. Leave the cot in the ambulance until you are ready to use it or you see that you can take it inside, otherwise it gets icy cold and snowy. Getting IVs and clean 12 leads are hard if your pt is shivering. Steal loads of blankets from the hospital and hoard them. Wear your stethoscope on the inside of your jacket.

Today I had a typical call to the nursing home for a fall. Pt fell onto their R hip. My pt has 10/10 pn shooting down their leg from the R hip, external rotation and tenderness to palp over the hip/proximal femur and inability to make gross movement of the R leg, including lifting the R leg off the ground. The pt had fractured the R hip before, requiring surgery. My pt's pelvis is stable. This was a typical hip fracture based on my exam and confirmed with radiological exam upon arrival in the ER. My question is: would you apply a pelvic wrap or commercial pelvic girdle/splint to this patient? Particularity the SAM pelvic sling? It was my impression that pelvic splinting is for pelvic instability and may actually harm a broken or dislocated hip. I cannot find any literature or contraindications to pelvic splinting with a through search on Google. I ask because the FD was about to put this device on my pt before I said something, and, needless to say I was more concerned with pain management. FD was not mistaken about the hip either, they knew it was a hip issue and were going to apply the device anyway. So I thought maybe I was missing something....

We use the ResQPOD in our commercial urban system, if I remember correctly from the lecture I received on it the ResQPOD is the only class IIa CPR adjunct proven to improve survival rates... I haven't had a problem with them. If fact they are kinda handy, they have a red LED that flashes so whomever is bagging can bag when the light flashes and it reduces hyperventilation. From the ResQPOD® Impedance Threshold Device website: http://www.advancedcirculatory.com/resqpod...ct_overview.htm The ResQPOD is an impedance threshold device (ITD) that provides Perfusion on Demand (POD) by regulating pressures in the thorax during states of hypotension. Animal and clinical studies* have shown that during CPR, the ResQPOD: * Doubles blood flow to the heart * Increases blood flow to the brain by 50% * Doubles systolic blood pressure * Increases survival rates * Increases the likelihood of successful defibrillation * Provides benefit in all arrest rhythms * Circulates drugs more effectively

Just to play devil's advocate... Sometimes I think urban medicine is more difficult because you don't have the luxury of time. For example it's a challenge to deliver my patients to the ER with ABC's established, a through assessment performed, and treatment began. Sometimes the best medics can overcome this challenge, sometimes the weak ones do not. I believe that my assessment skills must be sharper, my clinical skills more precise, I often have to multitask, and I must always triage skills and diagnostic procedures. I have never worked in rural medicine, and I have a respect for those that do, but how nice would it be to have an abundant amount of time to explore differentials, perform multiple tests, have long amounts of time to consider and perform procedures? I take pride in keeping scene times low and beginning appropriate treatment even though the hospital is 10 minutes away. I'm not saying urban medicine is better, just different. Truthfully, short transports can be used as a crutch by weak urban medics; just as inappropriate helicopter transports can be used as a crutch by rural medics.

Would anyone consider adenosine for this patient? Or are you thinking more along the lines of an antidysrythmic? Our class has been told numerous different things from different instructors regarding adenosine to patients with WPW. Some belive adenosine will cause circus reentry by shutting down the AV node, abet momentarily, and force the impulse through the accessory fiber. Others say that adenosine is the treatment of choice for WPW, because it will break the circus reentry by effecting the entire heart. I know calcium channel blockers are contraindicated in WPW. Some claim because it forces the depolorization into the accessory fiber, and some claim adenosine is okay because of the short mechanism of action, but calcium channel blockers are contraindicated because they have a longer half-life.

Do you guys always secure with the over-the-shoulder straps? I know some people are really big on always using the shoulder straps, but it is rarely done around here. How about restraints for the attending in the back of the ambulance? How often do you buckle up in the back? I know our ambulances only have a lap belt for the capitan's chair.

Okay! Excellent responses! Thank you! He was in fact suffering from acute pericarditis. I didn't really come out and say it, but, he did have orthopnea, hence the pain got better after "getting up" to call 911. Tough call, I was wanting to see if anybody stuck their neck out either way, MI or pericarditis and your differential dx. From the website where I got the ECG: "Normal sinus rhythm at rate of 90. Diffuse ST segment elevations are noted especially in leads II, aVF, V2-V6, with concavity upwards. PR segment depressions are noted in several leads as well; very clearly in lead II. The above changes are classic for acute pericarditis. Only a scant majority of cases of pericarditis will have such a diagnostic tracing however. Differentiating the ST changes of pericarditis from those of ischemia and early repolarization may be problematic. The lack of reciprocal ST depressions helps with regard to ischemia. Early repolarization usually is not present in both the limb leads and the precordial leads. In V6 if the apex of the T wave is less than 4 times the height of the onset of the ST segment, this is a point against early repolarization. In this case, since the history is that of a 27 year old male with sharp pleuritic chest pain worse when lying supine, the diagnosis becomes somewhat less obscure! One last point: arrythmias appear to be relatively uncommon in these cases. " Thoughts?

The nurse is taken away in handcuffs by the police officer. You elect to synchronize cardiovert anywhere between 50 to 100 j (your preference). A 12 Lead immediately after the cardioversion shows: During transport you do another 12 lead, this is what you see: Vitals: P: 100 and regular, R:20 and a little more relaxed, BP: 108/70. Soon after you take the second 12 lead she complains of palpitations and you look over at the monitor and see this identical rhythm: Vitals remain unchanged, RR increases slightly. No other complaints/changes. You are 5 min away from the ED. What next? Would you have done anything differently looking back?

Yes, excellent questions, waiting for the answers, defiantly interested... In your opinion were the waves more like p-mitrale or two separate waves? How close were the waves to the QRS complex? (PR interval?) Was there a negative component to the wave? Did you check your lead placement and monitor settings? Just asking..... Maybe a second degree 2:1 block, or for some odd reason i'm thinking LGL if they were really close to the QRS.... Could also be the result of an accessory pathway... antedromic reentry? Really just stabs in the dark at this point.