RomeViking09

No pics but... Majority of our units are dodge truck cab boxes, and a few Chevy vans. We also have 2 quad cab dodges 1 is used for BLS NET for Bari unit the other is used by ALS 911/CCT crew. We have a few older Chevy boxes getting phased out and I think the last ford went away around the time I started. Service I was at before flipped almost overnight from a fleet of ford vans & boxes to all Mercedes sprinters (except a limited number of fords kept for CCT & Bari)

Albuterol started (Atrovent not in the drug box), EtCO2 is 28-32 with shark fin w/treatment going. What we did: CPAP w/Neb, 20mg Decadron & 2gm Mag mixed in a 100mL bag given over 10min, PT was transported to the closer facility at his request, on arrival at the ER he was placed on BiPAP and given A&A Neb thru BiPAP and admitted overnight for observation. The fumes from the apartment below his was in fact the cause of his attack.

Real question is why is the patient having a desat... Is it the intubation attempt or the patho of why the patient is getting the tube? Not many stable patients get a pre-hospital tube. (Personal note: on "elective" intubations (i.e. Not in arrest or apnea) I place the patient on a NRB while I set up if there is no need to bag them and then intubate once ready. Has worked well so far (also look for a sat > 90% at all times while attempting to tube)

Sorry been busy... Scene finds an apartment with strong smell of paint fumes, patient only able to speak 1-2 words at a time. Hx- Asthma with 1 prior intubation 3 months ago and ICU admit, HTN. Meds- Albuterol MDI, Unknow name HTN med (and you can't find it on scene), NKDA VS- HR: 120 RR:30+ BP: 142/88 SpO2: 90% on room air BGL: 122 mg/dL ECG: Sinus Tachycardia with ST depression in all leads BLS crew places the patient on 15 L/min by NRB, your Paramedic partner gets an 18G in the Left hand for you Assessment LOC: A/Ox4 GCS 15 Head/Neck: Pupils PERRL, + JVD, Trachea Midline, No notes trauma or other abnormalities Chest: No noted trauma or abnormalities, Lung sounds: Bilateral wheezing in upper lobes, diminished bilater in bases, clear S1 & S2 heart tones, no noted trauma or other abnormalities ABD: Soft and non-tender in all quads, no trauma or abnormalities Extremities: + CSM x4, no trauma or abnormalities Patient unable to walk due to distress, weights 300lbs Treatment Plans?

Our protocols push for NTG in all MI patients with NS & DOPamine as a backup if their BP drops. Our criteria includes chest pain for determining symptomatic bradycardia, DOPamine to improve the rate at the low end of the dosage range (why I said 5 mcg/kg/min and not a 5-20 mcg/kg/min Titrate to a set BP) while the heart is damaged and we need to take that into account we also need to keep everything else perfusing including the heart, if the rate is in the 40s increasing the rate with a goal of 55-60 will help keep in perfusing the rest of the heart (I.e. left vertical that is keeping the BP in a "normal range") also note this patient has a history of hypertension so her body is used to working with a higher BP. I agree with the other treatments and plans and always follow your local protocols first but in the eyes of education let's look beyond the "norm" and look what is going to happen in the ER and if we can start those treatments sooner in a safe manner to benifit the patient. The ER (or cath team if the patient goes right to the cath lab as this patient should) is going to hang a low dose DOPamine or another chronotrophic agent to correct the rate and also hang an NTG drip to open up the arteries to aid on the cath and the perfusion of the damaged area of the heart (based on this 12-lead the RCA and right ventrical) My first critical care job we did a lot of cath lab stand by at a smaller hospital doing PCI that did not have cardiac surgery in house, I was surprised to learn how much the ER and cath lab do that we have the ability to do (assuming we have a dead on STEMI vs a NSTEMI or UA requiring a cath) to expidite care. One more side note: AHA criteria for symptomatic bradycardia Hypotension Acute Altered Mental Status Ischemic Chest Pain (I.e. STEMI) Sings of Shock Acute Heart Failure

Scoop & go vs doing a real assessment that mets the complaint. Last week I was double medic, went to a guy for 45 y/o male Chest Pain with no prior history, it was my turn to tech I did my normal and held on scene longer than my partner that day seemed to want to at first.... Inferior MI with HR in the 40s. I had the time to transmit a 12 lead get ASA, NTG, and have a line before transport, our total time from PT contact to cath table was 25 min (including transport and the elevator ride to the cath lab). Had we just scooped and run I would not have done the 12-lead until we where at the door had not time to transmit and guy would have been delayed in the ER because another crew had just arrived with ROSC on a code 3mon before us. After the call my partner noted that my "longer" on scene times benefit the patient because I have a real idea what I am working with (note: many times I have also got to the patient and had an oh shit he needs the ER not me and scoop and run and do what I can in route) don't let scene time goals or policies prevent you from doing a good assessment and any needed treatment (side note I have very short hospital times on patients I stay on scene with so if your worried about times for pay raises it all balances out in the end if you do your job)

I had a 97 TJ SE Soft top but it started to died on me in December of 2012 (right as I was trying to finish up Critical Care school) had to go finish the trade in on a lunch break one day