Kaisu

mediccjh - I know it must be very tough. PM me if I can be of any help.

I would have thought that it was self evident - didn't think it needed comment - it is deplorable. I think if you would read my post, it mentions the hazing last - Maybe a little chip there on that shoulder ?

The infantile mentality displayed by those paramedics, not to mention poor judgment, and as later indicated in the article, bullying of students, demonstrates that they have NO place in health care. The part that concerns me more is the culture of an organization that fosters that kind of behavior. The entire service needs to be looked at.

Now who do you suppose educated that reporter? Nice to see that once in a while.

so... I don't understand what you are saying? Are you suggesting that we self-censor ourselves so that you won't have your credibility diminished by some reporter that calls internet snooping research? For a first post, you are doing a great job of trolling yourself.

Great posts people and thank you spenac for reopening the issue. You all make me proud of my profession.

OK - but you have to buy me dinner first

If Dust doesn't get back soon somebody better step up and run the wannabes, losers and posers off the forums. They are bringing down the quality of the site.

touche

We went on a call to a frequent flier. She was lying in her bathroom, covered in feces. I was the only woman on the scene. In the interests of defending the patient's dignity, I entered the crummy bathroom and began to clean her up. I did my best. We used a blanket to slide her out of the bathroom and onto the cot. At the hospital, the RN in charge complained to me that the patient was "dirty" and I should have cleaned her up. It was the first time (but not the last) that I wished they came along with us for even a few shifts. I work alongside of them in the ED, and I know the stuff they deal with, but they have no idea of what I deal with - it's an unnecessary roadblock to teamwork. I think this is an excellent idea.

spenac.. seriously tho.. there are disassociative disorders that give the appearance of faking when in fact the patient is not capable of responding - for example, eyelids will flicker, reflexive responsives will be atypical yet the patient cannot open eyes or respond to questions. Often, they will be unresponsive to pain - the patient feels it but has disassociated from it to the extent that they would NOT be able to protect their nose. It behooves us to remember that just because we don't understand it doesn't mean its not real.

I am sorry for your loss.

.. and you document this injury how?

Valour, courage and self sacrifice have no nationality. Rest in Peace.

LOL.. that cop aint the sharpest pencil in the box.... and don't worry about educating him because as all of us in EMS know - you can't fix stupid.... stay safe

Thank you google Duchenne muscular dystrophy (DMD) is a severe recessive x-linked form of muscular dystrophy that is characterized by rapid progession of muscle degeneration, eventually leading to loss in ambulation, paralysis, and death. This affliction affects one in 3500 males, making it the most prevalent of muscular dystrophies. In general, males are only afflicted, though females can be carriers. The disorder is caused by a mutation in the gene DMD, located in humans on the X chromosome. The DMD gene codes for the protein dystrophin, an important structural component within muscle tissue. Dystrophin provides structural stability to the dystroglycan complex (DGC), located on the cell membrane. Treatment # Intravenous administration of glucose and insulin, which promotes movement of potassium from the extracellular space back into the cells. # Intravenous calcium to temporarily protect the heart and muscles from the effects of hyperkalemia. # Sodium bicarbonate administration to counteract acidosis and to promote movement of potassium from the extracellular space back into the cells. # Diuretic administration to decrease the total potassium stores through increasing potassium excretion in the urine. It is important to note that most diuretics increase kidney excretion of potassium. Only the potassium-sparing diuretics mentioned above decrease kidney excretion of potassium. # Medications that stimulate beta-2 adrenergic receptors, such as albuterol and epinephrine, have also been used to drive potassium back into cells. # Medications known as cation-exchange resins, which bind potassium and lead to its excretion via the gastrointestinal tract. # Dialysis, particularly if other measures have failed

PS - I went back to the rhythm strip and sure enough, there was that peaked T wave on the first brady beat.... and the wide sine wave looking complexes for the next two... now I feel even dumber

Ok - so sucs - depolarizing neuromuscular blocker drives potassium out of the cells.. blood potasium levels rise like crazy.. result - hyperkalemia and histamine release - already a problem. AND tada.. sucs is contraindicated in neuromuscular disease.. which you have to uncover during the history.. DING DING DING.. now I feel so dumb PS.. thank you for the great scenario chbare. I won't forget this possibly lethal side effect of sucs. I feel like I should pay you tuition or something. :wink:

So this is related to a neurological issue.. the kid's not having a reaction to albuterol - like life threatening paradoxical bronchospasm? Or is it a hypersensitivity reaction to one of the RSI drugs?

OK.. so this is right out of left field but... Does the kid have a neurological problem? Could the B2 agonists have precipitated a seizure? Do we need to administer ativan? _ No raucous laughter allowed - its not polite.

double post

Ok - so I did some research - intubating a kid in status asmaticus is very risky. That is probably what caused the bronchiospasm and the arrest. (damn - killed another one). Non-invasive ventilatory assistance and IV Beta2 agonists would have been the better way to go. The thing is.. there is very little evidence and the treatment appears to be subjective. I am very glad you posed this scenario... if I ever run across this, I will be much more hesitant to intubate and will explore other options. What would you suggest for IV beta 2 agonist?

Any evidence of trauma and/or bleeding? temperature?

well, we've reached the end of my bag of tricks. As far as I can tell, this kid has arrested primarily due to respiratory failure, which is what happens to kids. I know this is the one thing I want to avoid at all costs because it is very difficult to get them back. Start working the code.. epi every 3 - 5 minutes, atropine, amidodarone. While this is happening, think about the Hs and the Ts - in this case hypoxia was the probable cause of the arrest - consider magnesium (last ditch). Now if there is something else (and with you chbare, there usually is) I will wait to be educated. Great scenario by the way - not everyone can write them like you.

OMG.. the kid brady'd down very fast and went into vfib... check pulse... begin CPR - pull PALS protocol out of your ass and prepare to shock - have someone check a pediatric device for proper dosages - Pediatric vfib is rare - initial shock at 2 joules/kg, subsequent shocks at 4 joules/kg. I've heard of about 100 kids being shocked - outcomes - 0 thanks a lot chbare