ERDoc

The differential is large. Which started first the abd pain or the vomiting? Could be gall stones, ulcer, perfed ulcer, gastroenteritis, colitis, pancreatitis, hepatitis, peritonitis, Mallory Weiss tear, Borhave syndrome, some other -itis and an assortment of other things.

That would be funny if it weren't real.

LOL, I hear ya. Wanna go break some windows in the gym?

After reading my post with their link, Danielle and Stephanie have already PM'd me, so I got dibs. :twisted: Dwayne, it looks like you and I are the only ones around on a Sat night, Sun morning. I'm at work, what's your excuse?

I think I would ask a different question after each call. Don't ask what you did wrong, but what could you have done differently. You might not have done anything wrong but there may have been a better, safer or quicker way to do something.

Back in the great state of Long Island, where the volleys run the politicians and care is far from adequate we used to have these creatures called badge bunnies. They were people (females usually, about 99.9% of the time) who would attempt to, shall we say, fornicate with those who wear uniforms and badges. I was wondering if other parts of the country/world were inhabited by such creatures and if so, what do you call them? Here's just an example: http://www.girlsofems.com/

Dwayne, you will have many lightbulbs in your life. I still get them from time to time. You will learn that you can tell a lot just be looking at the pt before you even examine them. One thing that I think you should take from that call is to never, ever, EVER let anyone else RMA a pt, especially the firemonkeys.

:bootyshake: With much love Dwayne!

Are you thinking Throckmortons sign?

Could be wrong, but it sounds like angina to me. :wink:

Here we go with the same old stuff. I think it has been said ad nauseum. Education is the key. Experience is useless without education. All experience is just another word for making the same mistakes over and over. To make experience a useful tool you have to have a strong knowledge base. If we are going to increase the education of EMTs, why not just educate them to the level of a paramedic? Do away with EMTs all together and require everyone to become a medic. Make it a college level degree. I feel like I've said this somewhere before.

](*,) Use the search function. Welcome to the city.

When you say an article review, are we talking an article from a newspaper or one of the popular science magazines or are we talking one of the scientific journals? Since this sounds like a college level course I would go with the professional journals.

Before I left New York that's where I thought it came from. I never knew any hunters and the only thing that got shot was people (and the occasional annoying dog barking a 2am). It is definitely a different world out here. If I had to kill and clean my own meat, I think I'd become a vegetarian.

I don't think it is a big issue with you when you are in the field, but here are some articles on the legal/ethical status of the children of JWs. http://www.ncmedicaljournal.com/sep-oct-07/brezina.pdf Link 2

I'm sorry I am coming into this so late. Any discussion with FF523 is interesting. It always makes me search the literature to make sure I am not the crazy one. As for the original scenario, I find it hard to believe that this was a true call. Bilat, nontraumatic tensions pneumos just don't happen. What stars and planets aligned to cause the exact same pathology to occur on two seperate organs at the same exact moment? I'm not saying that it doesn't happen, because there are cases in the literature, but these are usually sick people or pneumos that have been induced via some form of trauma. A quick pubmed search will turn up a few case reports. It also appears that needle decompression is not overly successful. It usually requires chest tube insertion. As for your run of the mill unilateral tension pneumo, the teaching is that if you xray it you might as well give the pt their malpractice check before they leave the ER. TENSION pneumo is a clinical diagnosis (especially by the time they get to the ER). If you are not able to distinguish a tension pneumo from a pulmonary contusion you need to go back to whatever school you graduated from for some remediation. Spontaneous pneumos, however, are diagnosed with xrays. There is no emergent rush to fix them, which is why we don't needle them. Get your chest xray, set up your chest tube under nice, sterile condtions, appropriately anesthestize your patient and make them feel better. As for the discussion of cyanosis and pulse ox, you need to have 5 mg of deoxygenated hemoblobin in order to become cyanotic. This means that the pulse ox at which you see cyanosis depends on their hemoglobin level. Anemic patients will require a much lower pusle ox before they become cyanotic. Let's us 15 as our normal hemoglobin level. This means that your pulse ox would need to be about 67% before you see cyanosis. Take an anemic person with a hemoglobin of 7. They would need to get there deoxygenated hemoglobin down to 2, which means they would need a pulse ox of about 30% before you would see cyanosis. Let's look at some one who is a heavy smoker or lives at a high altitude and has a higher hemoglobin level of say 25. They would be cyanotic with a pulse ox of about 75%. It is possible to be cyanotic with a pulse ox over 90% depending on your hemoglobin level as well as the cause of the cyanosis. Back to the OP, I guess when all else has failed, drop two needles in the chest. They will just end up with two chest tubes. Hope I have made the situation as clear as mud.

I was thinking the same thing. If that doesn't work the guy buys himself an immediate tube.

I don't really see a need for it. It seems like just one more thing to make your bag heavier.

I try to avoid eating anything with the word 'turd' in it.

You will not be able to purchase the most important piece of equipment for that much. Docs are much more expensive.

You won't be titrating Heparin or Integrillin in the ambulance. They require PT/INR/PTT to titrate so they will pretty much stay where they are during transport (unless the pt starts exsanguinating). Propofol is pretty easy to titrate. Is the pt waking up? Turn it up (yes, there is more to it, but it is pretty simple). The medics that do the transports should be educated in the particular drugs they are transporting.

You are close. Look up some more on the mechanism of action for Dig and you might find the answer.

Mateo, as smart as you may be, I hate to tell you this, but you are wrong. This patient has hyperkalemia. This is from her still taking her old dose of KDur but taking less Lasix. The EKG changes are purely from the high postassium. She deteriorated rapidly after a VERY SLOW push of IV calcium. Why? Mateo, I agree that had she gotten the calcium rapidly it would have vsodilatory effects, but this is not the case here. This is a patient with EKG changes from hyperkalemia. This needs to be treated immediately. Standard therapy is IV insulin, glucose, bicarb, calcium and +/- albuterol as well as PO kayexalate. In most cases the calcium helps stabilize the cardiac membrane. What went wrong in this case?

I think I see a presidential nomination in your future p3. You give the bicarb and albuterol. As you guessed, she continued to get worse. You push the calcium VERY slowly. The pt suddenly becomes short of breath. You hear rales from top to bottom. She rapidly deteriorates and buys herself a tube. Shortly thereafter she codes. The ED works her but she is pronounced dead. WTF???? What happened here?

Yes this kid is suffering from methemoglobinemia. For five points, someone discuss the pathophysiology of methemoglobinemia. For 5 more points, discuss why this kid has it. For 50 points (because you probably won't have it in your ambulance) discuss the treatment.