ERDoc

Yeah, must have missed that. Sorry 8151. Now that it has gotten through my thick skull it's pretty funny.

Assuming I am finally in the right thread, this is WPW. Those are some nice looking delta waves on the 12 lead. I think she could use a little more electricity since she has gone back into SVT, but I would also be getting a drip ready since she seems to like to go into this rhythm and she is only going to let us electrocute her so many times (though it has been fun in a sick sort of way). We could always call for the helicopter so they can perform a field ablation on her accessory pathway.

Yes, I do and here is the real Slim Shady:

I'm not saying it can't happen or that it hasn't happened, but think horses not zebras.

There is so much more to it than just the cost of the morphine. Drug seekers have an enormous impact on the costs to society (though I cannot speak for the system in the UK, only in the US). Who do you think pays for the ER visits for all of these people? Most of them will have medicaid (which the taxpayers pay for) or no insurance (the hospital will then pass the costs on to those who can/will pay their bills). Then there is the impact they have on the ER itself. They take up a bed that could be used by a person who really needs it. They take up the time and resources of the doctors, nurses, tech, etc that take care of them. When they call an ambulance they are taking up a ambulance that could be used by someone who truly needs it (and they likely will not pay for it). The US healthcare system is busting at the seams and is ready to collapse. These people are only making the situation worse. Their impact is much more severe than just the cost of the vial of morphine. I am not saying not to treat people for pain (read some of my previous posts and you will see I advocate just the opposite), but when you have been in the field long enough you can spot BS coming through the door. I explain to these people that the ER is an inappropriate place to treat their chronic pain problems. I also tell them that it would be inappropriate for me to treat their chronic pain with the 4mg of Dilaudid (which I feel is one of the worst drugs ever created) that they ask for. So, while it may not seem like a big deal to give a drug seeker their hit once in a while, keep in mind that there is a much larger picture than what you have to deal with in the back of the of the ambulance. I'll step off of my soapbox now and return you to your previously scheduled thread.

All of these cross-references to other threads is really beginning to confuse me (it doesn't take much sometimes). Some people keep bringing up a LBBB, but let's keep in mind this is a 16y/o girl. The chances of her having a true LBBB, or an MI for that matter, are slim. Edit: See, I thought I was posting in the thread about the 16y/o girl with the tachycardia. Go ahead and have a good laugh at my expense.

Always look to emedicine for some great information: http://www.emedicine.com/radio/topic639.htm

What makes you think this has anything to do with pelvic inflammatory disease? Why would you want such large IVs in someone so stable? What are the indications for narcan in this case. I sure don't see any (pupils are even dilated). I think you are a little off the mark here. I'm going with a seizure.

Why stick your pt with a needle when you can get the same job done with something oral?

P-mitrale perhaps?

I would have to agree about the helicopter. With hospitals only 20 miles away, it really seems unnecassary. You have just as much to treat this girl with as they will in the helicopter and in the ER.

I addressed the myth that you cannot give narcs to abd pain pts earlier in this thread (or it may have been the other one). It has been shown to not be true. It actually helps improve the exam and relieves your pt's suffering. Not giving them is cruel and anyone who tells you different obviously has not been reading the literature. Toradol is good for renal colic, but it is even better to give toradol and morphine. Again, recent studies have shown the benefit of using both. In the system I volunteered in, ALS personel carried morphine and valium, but needed medical control orders to use them (I think the exception might have been an initial dose of valium for seizures, any after that required contact).

Are we talking monophasic or biphasic? Starting that high, especially if we are not going to premedicate seems cruel. Let's start at 50.

All of this talk about food makes me want to go out and get a nice pie with some roni.

White rice is a good glucose load too.

I like the idea of giving this girl some etomidate or propofol (though I worry about the BP with propofol) and spark her up. After that I say we do the same to the nurse sans the etomidate or propofol.

I would be careful using toradol for abd pain. Surgeons get a little itchy about operating on someone who has had NSAIDs. I would say stick with the morphine. Your pts and any knowledgeable surgeon will thank you.

Think Papillon. Guaranteed not to loose them. :wink:

That is in NYS. There is also an EMT-CC. Other states have different titles.

Spock, my comments were in no way directed at you. If there is anything something from anesthesia knows, it's how to make you feel good. That's pretty typical of many surgeons (especially at academic centers). I won't even get into my rant on surgeons and anesthesiologists.

Spock, my comments were in no way directed at you. If there is anything something from anesthesia knows, it's how to make you feel good. That's pretty typical of many surgeons (especially at academic centers). I won't even get into my rant on surgeons and anesthesiologists.

Guilty of something are we?

I think the best part of some of these articles are the quotes from the people involved. "To be honest, you don't expect that" Really? Thank you captain obvious. It made me laugh.

I could be wrong, but you guys may still be barking up the wrong tree.

OK, so we have shortness of breath, some chest pain, a decreased pulse pressure that is getting worse and JVD despite the hypotension. The EKG seems to be swaying people to different directions. I think we all agree that there is ST elevation in more than just the inferior leads. Is there anything else you notice about the EKG? I agree, there is no evidence of hyperkalemia. What are the heart sounds? Any recent illnesses?