whit72

Take their helmet from them too. That usually works

Do you understand O2 saturation? How it works?

1EMT-P Wrote: Sorry about that, but my pc crashed in the middle of my post. The patient's vitals were as follows: BP 140/100, P 78, RR 20, Spo2 94% on RA, SR/Paced 78. How about her lung sounds, any pedal edema?

We rehab the the FD. Most times though its not run correctly, the guys should be swapped out every half hour to an hour. Vitals taken, a certain amount of fluid taken in. Sometimes it isnt easy to pull a guy off the line if his buddies are inside. So we get a lot of flack depending on who the lieutenant is. I used to get pissed off and make a big deal out of it. Now if you don't want to come off the line. Thats alright but don't blame us when you pass out.

If such a hatchet job was done on you, everybody you named would have settled. Lawyers would be jumping at the opportunity to represent you. I sincerely feel bad for the pain and suffering you endured. You however chose to get on that 4 wheeler, and the consequences are now yours to deal with. We are not guaranteed a 100% recovery from anything. I am sure the MD didn't promise you that. Yes maybe their were mistakes made. I don't know I wasn't there I can only tell you what I would have done. I do however think you are confused at who is at fault here. A femur fx is a considerable injury. That being said. If your treatment was uneventful that does not guarantee you wont walk with a limp, or have accompanied pain.

As far as missing the tube. Its not a big deal, correct use of a BVM is sufficient. Let them try in a controlled enviorment. Take a shot, if you are unsuccessful move on to a BLS airway. As far as questioning the medics. What would you question? Why they worked the code. Maybe they don't have the ability to cease resuscitation efforts in the field. So if signs are not present, such as rigor or lividity then you get worked. We do ask when the last time the person has been heard from, however we don't base resuscitation efforts on that. Its pretty simple. In a medical arrest if there is no rigor mortise, dependent lividity you get worked. In a traumatic arrest if you haven't sustained injuries incompatible with life you get worked.

I am wondering if inserting the OPA stimulated her to begin breathing again? Just a thought.

I would agree with VS eh here. Within seconds of administration is unlikely. I have given it IM, and SQ with varying onset times. IM is much quicker. AZCEP Epi pens are designed for IM injection. In one area I have worked in you can give it IM or sq, drawing it up with a syringe and injecting SQ. Where I work now we only have the ability to give it IM. However the best treatment in a severe allergic reaction affecting the respiratory and cardiovascular system is IM. For less severe or early intervention SQ is fine. In later stages IM is definitely the preferred route.

I couldnt agree more canuck. My personal feelings do not factor in. Everyone is given the same opportunity. We work every viable arrest with diligence, unfortunately we know what the outcome most likely will be. Once in a while the stars align and your able to save one, We don't say oh god we must be on to something here. No. Everything fell into place correctly, that allowed that person to be resuscitated. Thats why we continue to do it. We are not failing because we are not trying. We thought ACLS would be the next great hope, well it didn't work. Then we put defibs on every truck. Taught BLS providers to use them, that didn't work. We have changed the CPR guide lines around multiple times. Nothing. We must continue to try. I just don't know how fruitful those efforts will be. Maybe somewhere down the line a combination of treatments or actions might prove to be successful.

Crazycanuck wrote: This percetage survival to discharge of 0% is false. Though the OHCA survival rate is poor, it is more constructive to do as Medic26 is here, to educate oneself on the definitions, process, and outcomes in attempt to improve it. This attitude sucks. Plain and simple. If you expect 0% guess what you will get???....0% I am thoroughly educated in the outcome of cardiac arrest patients. If your response times are not under 4 minutes and there isn't a bystander attempting CPR, then your survival rates will be around 0%. Put all the fancy dressing on it you want. People die, and if not for the actions of ordinary bystanders, with the ability to defibrilate or administer CPR, they stay dead. In the few instances where you witness the arrest or arrive on scene in 1 to 2 minutes, then yes. you have a good chance at a decent outcome, however those instances are rare and based on luck. We should spend out time educating the public on the importance of CPR and AED training. Educate them to understand they can be a significant help in increasing the survival rate in cardiac arrest patients. As far as my attitude sucking, its not an attitude its reality. Yes my expectations have everything to do with the outcome of arrest patients, give me a break. Maybe I should say a little prayer for them too, or work the arrest with my fingers crossed. That might help. We know what saves arrest pts. I explained it above. So if we are not going to put an ambulance on every corner, or educate the public. You will never see your arrest survival percentages rise.

I looked around a little I couldnt find any statistical data on save rates.

We don't work anyone for show. Are medical director wants them worked unless obvious signs are present. Sometimes it sucks, you do what you have to do. Some might be viable most are not. If she was truly pulseless for forty minutes I am guessing she was probably asystolic, but who knows. Nothing surprises me anymore.

Im not sure I get your drift but around here we don't shock asystole.

Medic26 wrote: My boss is very black and white, if he changes something he wants to be able to back it up with research, documentation, etc. If he is, he is in the wrong field. EMS and medicine as a whole are more gray then they will ever be black and white. As far as awards for saving peoples lives. I don't understand it. That is an aspect of your job. Now if he rescued a bus load of drowning children, alright give him an award, because thats not in his job description. Awards are for going above and beyond the the aspects of your profession. Not for performing whats expected of you.

No EMT or medic should be working in any facility as anything but a tech. Wipe ass, start lines, vitals, etc. If they are using them, its for a financial reason only. They don't want to hire, or cant afford to hire appropriately trained or educated individuals. As far as neuro exams in the field. Why not do them? We do them all the time, and then report findings to the hospital or intercepting medics. Everyone thinks because you have received emt or medic training it allows you the ability to just branch off into other medical areas without any other training or education. If you want to be a nurse go to nursing school. If you want to be a nurses helper go to nurses helper school. If you want to practice medicine go to medical school. Why don't we concentrate on our responsibilities as pre-hospital providers, before we start branching off into areas we don't belong in. We were trained for specific duties, we have a difficult enough time handling those responsibilities never mind ones we haven't been schooled in.

Well we had him supine from the time we got him, till we brought him into the ER. Maybe 13 minutes. Would that increase the perfusion, in that short amount of time to stabilize his vitals? It was just weird all around. They thank us for everything we did as we are leaving. Sometimes its better to be lucky then good.

This one is odd. We are dispatched to a person not feeling well. On arrival we find a unresponsive 70ish male pale, cool and diaphoretic, absent radial pulses, carotid of 40s and irregular. Resps of 8 and shallow. Wife states he has had bilateral shoulder pain for two days. Extensive cardiac HX. Cabg, multiple caths. Call for an intercept We quickly load him place him on a NRB for a trip down the stairs. We get him on the stretcher, into the truck, drop a NPA and begin to assist ventilations. Spo2 of 80%, lungs clear bilat. Fire drives. Unable to obtain blood pressure. BGL is 116, we place the AED pads on him. (if your going to do this, don't attach to the machine) We are transporting in 5 minutes. We meet up with ALS approximately 3 minutes later. I give him the rundown, they throw a line in him, connect our pads to their monitor, do a 12 lead. The medic is ready to switch places with me to attempt intubation. I look down and the guys eyes are wide open. I say hello, and he answers me, I ask him his name and he tells me. I ask him if anything hurts, he has pain in his chest and that he states about a 5/10. This is in the hospital parking lot. He pinks up, spo2 come up to 98%, we place him on a NRB. His heart rate is in the 70's and irregular, we get a BP of 92/54. Now we called this in as an unresponsive, with a cardiac hx, HR in the 40s. No BP. We walk in this guys talking with somewhat stable vitals. Come to find out this guy was having a huge septal wall MI, I believe they stated septal rupture, with a right wall dissection. I am not completely sure if thats correct but its in the ballpark. My question. How in the hell did this guy just wake up, pink up, and his vitals stabilize? I was certain this was going to be a CPR in progress when we arrived at the hospital.

I cant see any community or MD opening themselves up to litigation, by allowing their EMS personnel to treat and street.

Now how much fun would that be if we only transported emergencies in Emergency medical Services.

I never overlook ABC's its the essence of my job. Ambulate Before Carry In all honesty, it shouldn't be to tough to assess ABC's, that should take you all of 15 seconds on most patients. The presence of ABC's dosent assure the quality of them. Poor quality in any of the ABC's can be just as detrimental as the absence of them. I have worked with people who just assume tube someone then see if there is a less invasive solution to the problem. They have the "kill the fly with a sledgehammer mentality" Yeah, sure it will work, that does not mean its necessary.

Ruff wrote: "Michael, Marriage is a fine institution, it all depends on what kind of institution you want to live in. " I will have to remember that one as my D day is fast approaching

Yes, I agree can we move on to a more productive topic.

You cant find any info, because the minuscule percentage of survival to discharge without sever disability is about 0%. Give or take 0% Unless your response times are under 3 minutes, your public is trained in CPR and AED and not to afraid to assist a person cause they might get sued, and oh yeah you have a horseshoe shoved up your ass.

I would repeat that steps are not being skipped with experienced provider, they are just not being addressed as they were learned. There is class room application and there is real world application of said steps. The EMT is taught to detect a pt is short of breath, not necessarily why. Education and experience will hep you determine why they are short of breath. Is it COPD, CHF, pneumonia, asthma. Being capable of performing a competent assessment of both pt and surroundings will help you narrow down the possibilities. Can you make a definitive judgment? Sometimes, other times you cant. Will that change your treatments at the BLS level. If you administer medications it will. I have seen just as many ALS providers flash a pt, because they cant adequately asses a difficulty breathing pt as BLS providers. Actually the fact that the EMT cant treat the pulmonary edema they are usually a little more leary about giving the treatment. Albuterol can be dangerous in the hands of anyone who cant effectivly asses a pt. I had a call to assist a pb transfer truck with directions to the hospital. They had picked a non emergent pt from a nursing home, being transfered for an eval of pneumonia. We arrive to find a parked ambulance with both attendants in the back, with approximately 85 yof in acute distress, ancillary muscle use on a NRB at 15 liters, spo2 of 78%. Medic states he administered two breathing txs to pt. with no relief. I immediately call for an ALS intercept, lungs sounds are bilateral rales to the apecies. I note a 1000 bag half full, running wide open. I ask how much lasix does the pt take daily, I turn the bag off, take pts vitals, they are 192/70 hr 136 resp of 36. I state it isn't pneumonia its CHF. He states she had a temp orally of 99.1 I state thats not considered febrile. I lay the pt down drop an NPA and begin to assist ventilations. ALS arrives administers their treatments. We clear up I am not sure if she was treated with lasix or morphine, I believe she got nitro spray before I left. On arrival at the hospital the pt has a spo2 of 94% on 4 liter nasal cannula, is responsive, and lungs are clear bilateral. She avoids the tube and probable death in ICU. The intercepting medic asks the medic if he would like some remediation and offers him some ride time. The medic pleasantly declines and walks off into the sunset to save another life. The EMT is useless, and cant stay off his cell phone, long enough for me to figure out what the pts condition was before they transported. Keeps telling me to hold on a second. If I hadn't just finished anger management classes that finger would have been broken off and shoved up his ass along with his cell phone, and probably the end of my foot. These two were dangerous because they had know Idea what they were doing and had know idea they had know idea. This call began as a fairly easily manageable. It turned into cluster f@#k, because a couple retards, couldnt adequately assess the needs of their pt. and almost sealed someones fate. If your going to do this job make sure you have the information, education and experience to competently handle it.