ERDoc

Sat 96% on room and and goes to 99% on NRB. Lungs are clear bilat. BP is 160/105 and HR is 124. RR 22 and slightly labored. You get a 12-lead that shows sinus tachy with unifocal PVCs (3-4 per minute). He has 5mm ST elevations in the anterior leads. You have a virtual pharmacy in you ambulance as well as a full diagnostic setup so you can get xrays, CTs, MRI and there is even a tricorder. What do you want to do for this guy?

I just want to make sure I'm clear on this. He was stung 4-5 hours prior and the bees are still swarming? They were taken care of by FD. He took his epipen just prior to calling? Did he take anything immediately after he was stung? Why did he take the epipen so late? What new symptoms was he having just prior to the epipen? What symptoms started after he used the epipen?

No PMH, PSH, meds or allergies. Mom is trying to contact the baby sitter but is distracted from the phone by her sick looking daughter.

Here is another scenario for you (yes, it is a slow night in the ER). You are called to the residence of a 42 y/o male who is c/o sob. He was released from the hospital 5 days ago after having the lower and middle lobes of his right lung removed due to cancer. The surgery was 2 weeks ago and his postop course was relatively uneventful. He started feeling sob earlier in the day and has noted some bleed streaks in his sputum when he coughs tonight. What do you want to know?

The child is quiet but does not seem to be in any distress. She has vomited 4 or 5 times. No liquids noted on the clothes. Mom will try to contact the babysitter while you load the pt. As you get her in the ambulance she vomits a fair amount of blood and becomes lethargic.

The pain is sharp, stabbing in the left side of his chest. It is constant and has been getting worse. Nothing seems to make it better or worse. He is nauseous and diaphoretic. He does feel sob. He looks pale and is cool and clammy. He appears very uncomfortable. He was arrested after he tried to run from the police for running a red light. They were able to use the spike-strips to stop him and there was no MVA. He attempted to run on foot and that is when he got into the altercation with the cops. It was 3 on 1 so it was a relatively quick incident.

We'll work on the history first and come back to the rest later. The pt denies any drugs. He has a h/o ADD but does not take any meds. No allergies.

You are called to the residence of a 3y/o female. The mother tells you that she began vomiting about 30 minutes ago. She seemed fine when she picked her up from the babysitter a few hours ago. Mom figured it was just a GI bug and didn't think much of it until she noted some bloody streaks. What do you want to know?

You are called to the local precinct for a 22y/o male who is complaining of chest pain. As you arrive at the precinct on officer meets you at the front door and tells you that they have a 22y/o male that they took into custody about an hour ago. They had to wrestle with him a little but not enough that they even broke a sweat. He was fine until about 2 minutes before they called at which point he started c/o chest pains. You enter the cell and find your pt clutching his chest. He tells you, "I'm having some bad pains. Get me to the hospital, bitches." Assume scene safety and all of that other stuff. Let's focus on medical management. What do you want to know?

Never assume that the meds that were in the bottle were actually what was listed on the bottle.

This guy is a traumatic arrest. You can fly him to the moon and back and then intubate him. The outcome is going to be the same. The best place to intubate is where you feel most comfortable. When you are comfortable, it should minimize the time it takes thus creating the least delay in transport. I've known medics that tube upside down in the dirty bathroom stall of a very small bar but couldn't hit the trachea in a nice controlled environment (ER, OR). It is all a matter of comfort.

What is his potassium?

I don't know much about Nassau County, so I don't think I'll be much help. I know Bellmore-Merrick has paid people, but I have heard that most departments have them. You could also look at NCPD EAB. Ruff, if you had any idea of the system on Long Island, you would understand and probably run screaming. I'll PM you a link to get an idea.

I hear this guy now has the ability to turn on major appliances from the next room. Wow, kudos to everyone.

There are a large number (probably most) that have paid personel. Where do you live and how far are you willing to travel? In Nassau you also have NSUH and in Suffolk you have SBU for hospital based services.

I've gotta go with 'zilla on this one. I have done a literature search and could not find anything about the cyanosis as described. It is probably one of those urban (rural?) myths that have been propogated. I think your instructors may be confused with central cyanosis. There is no anatomical reason why a blood clot in the lung would cause cyanosis from the nipples up. I challenge anyone here to find a valid reference, or even better, challenge your instructors to do the same.

Someone has obviously never been on the streets of NYC. Something like that would be considered a compliment.

After you complete your course, apply for medical school. This way you never have to worry about being called an ambulance driver again!

I would also avoid saying that EMS is the backbone of the community. It comes off as very egotistical as there is so much more to a community than just the ambulance.

So we have a hypoglycemic newborn with a temp of 100.2 (hmmmm). He looks sick so we've intubated him. We've given him an inadequate fluid bolus and he doesn't seem to be improving. What are we missing? What else are we going to do?

Hmmmm. Why would a 6 day old be hypoglycemic?

If you have signs of a tension pneumo that are this obvious, you should not be getting an xray. ABCs include putting a needle in the chest. You have lost vital time by getting an xray. I would say that in this case the dx was pretty obvious and should have been taken care of prior to the xray.

Provider incompetence A lawsuit

There is no such thing as a near drowning, so their question is invalid. PV=nRT :twisted:

See the post on drowning that I recently updated. I would like to know what the CT showed and an ABG might be helpful depending on CT results.