ERDoc

I would have to disagree. Given the presentation this guy needs decon. He fits an OP exposure much better than a PE. As you said, he has the salivation and defication but he also has bradycardia, hypotension, AMS/seizures. All of which are much more common with OPs than with PEs. PEs will generally cause tachycardia. They can cause either hypo or hypertension depending on the effect on the heart. It is uncommon to have mental status changes, especially seizures. The only things that argue for DVT/PE in this case is his occupational hx and the leg swelling. A PE in this case is definitely not high on the differential.

Don't forget the 1 medical control doc to take away the light bulb when the people that are using are given a test on when you can and cannot use it and fail, miserably. There will be at least 3 others that will point out what a run on sentence that is.

Congrats man. Good luck and enjoy the time off. Don't be a stranger around here. We need as many intelligent people as possible (but you'll do, lol) to keep this place on the up and up.

11 minutes from my post, 1 hour 47 minutes from the OP. Nice work Dust.

ERDoc sits on the side, eating popcorn, anxiously awaiting Dust's reply. This should be good.

Hypoethanolemia.

I would 110% agree with the explorer/student program. That is how I started.

No, you cannot make that arguement. This has been debated many times here. Just because you have decided to give away your services does not make you more dedicated. I have dedicated my life to taking care of people and given up a lot to do so. I have missed birthdays, christmas, soccer games and the like. During medical school and residency my wife was essentailly a single parent and it killed me to here about the things I missed at home (first steps, etc). I now have a nice paycheck, so what. Does that mean I am not dedicated? Absolutely not. DO NOT even try to play that game as you are ignorant to how wrong you are. I've spent more time learning about the anatomy of the hand than you did in your entire EMT course. If you were truly as dedicated as you want people to think you are, you wouldn't accept being just an EMT. Don't even go there. I've been on both sides and can tell you, doing it for free does not make you any more dedicated. That is the weakest argument I've ever heard. If that is the case, then they are wasting my time as they certainly do not need a doctor, but I seem them just the same.

Man, you beat me to it. No one under 18 should be responsible for peoples lives. Especially those that are critically ill.

I think we are missing a few facts from a brief Yahoo article. This probably wasn't one of those come into the ER, CT shows you are paralyzed for life, let's pull the plug situations. I can almost guarantee that this case involved the hospital ethics committee. These are made up of MD/DOs, JDs, bioethitists(sp??) and anyone else that may be interested. There were probably several exams to decide if this woman was competent. There were probably several meetings of the ethics committee with some of these involving going over legal cases to look for precedence. I can guarantee you that this was a thought out and researched decision. My feeling is that you cannot force treatment on someone who does not want it (as long as they have the capacity). She said no vent and to do that against her will is assault/battery.

What are his extremities like?

Anthony, I'd be careful self-deploying to disasters. I don't know who you work for, but if it is a private company (AMR or the like) it might not be in anyones best interest to deploy to an outside area. As stated, the federal govt has DMATs, which were about the only part of the Katrina response that worked properly. When they are called up by the feds they become federal employees and receive pay and other benefits. Check them out, there may be one in your area.

I agree with previous posters. Vitals and EKG would be helpful in this case. As an aside, the two most dangerous places to be are church and standing on a corner minding your own business.

What could you possibly mean? :wink:

12-lead shows NSR with a rate of 94. No recent illness other than having his lung removed. Only history is the lung ca. No other surgeries. NKA. BP 142/90, other vitals as stated.

I would just call it a paced rhythm with a rate of X. No need to find fancy terms, keep it simple. Arizona, I think celticcare was talking about pts he/she has been seeing at work and was not referring to the rhythm strip shown.

If this truly does turn out to be as good as the study claims, it will significantly change medicine. Obviously we need to see larger scale studies to determine the utility of the test. I was unable to locate the original paper after a very brief search. I would argue that the scanners are not as cheap as the article makes them out to be, especially at the smaller community hospitals where this would be ideal. It will be interesting to see the future studies.

He does not appear to be in much discomfort. He is able to speak in full sentences. RR22 with sat 94% on room air. Lung sounds are clear on the left. The right has mininal sounds except in the upper area where you hear some rhonchi. HR 98, regular. Skin is warm and dry, no diaphoresis. Mucous membranes are pink.

We have a winner. This is an iron poisoning. It can cause serious GI bleeding, electrolyte abnormalities, lethargy, coma and other not so pleasant things. Obviously in this case you are going to want a line or two. Be prepared for massive fluid resuscitation. There is not much else you can do in the field other than rapid transport and avoid metal detectors.

Heart sounds are good. The pain starts getting better with nitro. He gets his aspirin. His BP has come down to 120/70 but his heart rate is 139. You are still a good 20 minutes from the hospital.

You contact the babysitter as the pt has a large bloody BM. She is lethargic now. The babysitter says that she found the pt with a bottle of vitamins. She doesn't know how many she took or if she took any at all. She wasn't too concerned because they are only vitamins. Otherwise it was a pretty uneventful day.

I think zz was looking for evidence based info, not anecdotal stories. Check out Part 7.2 of the 2005 guidelines. There is some good info in there as well as additional references. Here is a link.

I know. :wink:

Just give the roids now. They're going to take a few hours to start working anyway.

Is this pt on beta blockers? Are we missing something (given that the stings occured 4 hours prior to the onset of symptoms)? IV epi can be given: 0.1 cc of 1:1000, diluted to 10cc, given over 5-10 minutes You can also initiate a drip by mixing 1cc of 1:1000 in 250cc (4mcg/ml) start at 1mcg/min and titrate to effect with a max of 10mcg/min That being said, follow your local protocols.