ERDoc

I don't know where the OP works, but aspirin is pretty much standard of care for cardiac chest pain. Sometimes I think it is given too much without thought. It's probably not the best idea to give it to someone who you think has a disection/aneurysm. I do agree that nitro is given way too much, but this I mostly see from the prehospital providers and the nurses working off their protocols in the department. I definitely agree that given the original scenario, nitro is not the correct treatment. The chest pain is most likely from the heart that is running a marathon. Slow the rate down first and see what happens.

I can't say for sure but my feeling is it did affect the short term outsome. The guy had stage 4 cancer (don't remember the primary). The pt had ROSC and hypoxia would obviously work against that.

The hospital I did my training at was approached to be on Trauma but they declined. They did have a case that made in onto Rescue 911.

I've heard you can also get them from Netflix, but I am not a netflix customer.

I wish I had the answers to those questions. We a fairly large city with a huge cachement area so we get lots of providers I don't recognize. I normally don't complain about things that the field crews do. I was on the other side for almost 10 years so I know what goes on but this one felt like it needed to be referred.

Needless to say, the county medical director is a partner in my group and a good friend. It has been sent for review.

I have to respectfully disagree, defib. I won't get into my political beliefs, but now is the best time. As a country we suck at remembering things. As time goes on, this incident, just like Aurora, Virginia Tech and Columbine will fade in our collective memory. Hell, we were singing Kubaya in the streets after 9/11 for about a month and then things went back to normal. These things are happening much more frequently and by the time we even entertain the idea of "talking about it" the next one will be happening. The time to truly discuss it has passed. That time was April 1999, Oct 2006, April 2007, Jan 2011 or when any of the other 20+ mass shooting happened after Columbine. This is becoming an epidemic and needs to be seriously discussed without all of the paranoia of the big brother govt coming for my guns. I would think that emergency responders, the ones that will see the brutality first hand and possibly be a victim of it, we are the ones that should push for a sensible, national discussion before it fades into our memory and we see the next group of funerals being planned. I also agree that we need to do something about the state of mental health in this country.

This isn't about me.

The only way I can describe it was it sounded like when you blow into a dogs mouth/nose. Same tone and volume.

I wouldn't exactly describe these airway sound changes as subtle.

Oh young padawan, you have much to watch to learn the ways of the medical jedi. You should begin your training soon and not stop until you have completed all 3 series (you don't need to complete ER, as long as you make it to the episode with Doug Ross in the helicopter, after that it's pretty much no better than Grey).

Ask the the typical chest pain questions since this is more likely to be something medical since it started before the trauma. Can she tell us a little more about the back pain? What was she doing when it started? Is she still having it now? What did it feel like? Is it worse after this accident? What is her general overall appearance? How about pulses, lung souns and heart sounds?

Most of the services around here have ETCo2, I'm not sure if they do but if they do, I do not think they were using it. I agree that these things can be chaotic, but that is no excuse. That is why you are trained to do this. I also agree about the tube. When you tube someone, it is your tube, your lifeline. You do not let go until it has been secured. Someone else can listen to the initial lung sounds to confirm placement. I had a resident the other day who let go of the tube before it was secured to grab her stethoscope. I cringed and grabbed the tube. We talked about it afterwards. The scary part about the original call was that they had secured the tube with one of the Tomas holders.

So, after a less than stellar performance by a crew the other day I was reflecting on what happened and wanted to share (as much as HIPAA allows) to help others not make the same mistakes. Feel free to make this go both ways as it can be educational for EMS/RNs/MDs/DOs. The purpose is NOT to bash but to learn from others mistakes. Think of it as an unofficial M&M conference. Paramedic "I'm not sure if the tube is in right." 60s y/o male who coded in front of family. FD first responders did CPR for a minute and got a pulse back. Upon EMS arrival, pt was still unconscious and they were able to drop a tube. 15 minutes out from the hospital the pt goes into arrest again. Asystole upon arrival at the ER. We hear a whooshing sound when we are bagging. At this point the paramedic makes the above comment. Take a look and the balloon is sitting in the back of the throat. Pt pronounced shortly after arrival. Take home point: If you are not sure the tube is good, make it good or get it out. NEVER have a questionable tube.

You're welcome. I'd also recommend Trauma: Life in the ER as well as Paramedics, both of which were pre-HIPAA TLC shows.

I have nothing useful to say as the only thing I can think of right now is WTF???

Why are you participating in your own scenario? Which came first the chest pain or the MVA?

As a doctor, he knows better. There is nothing right about what he did.

If you are really interested in pursuing this, you can start here: http://www.colorado.gov/cs/Satellite?c=Page&childpagename=DORA-Reg%2FDORALayout&cid=1251632503133&p=1251632503133&pagename=CBONWrapper

That's the video, though I don't remember the interesting music in the background. That sounds like a rough scene to have to deal with 1C. Some things will always stay with you, especially when it involves someone you know.

After reading everyone else's comments, I feel like I might be a little dead on the inside. My first thought when he hit was, "yeah, screaming and yelling and recording this is really doing a lot to help him." Once he was in the hospital I was thinking, "My respect to the guy who got the tube." In the field obviously there would not be much to do other than try to maintain his airway and c-spine precautions would be appropriate in this case. Hard to say for sure from the video but it looks like the split in the face is pretty clean so it might be easy to repair.

Sounds like Conversion disorder. Another thought is Todd's Paralysis but this usually resolves within 48 hours.

Did this happen in Colorado?

Here you go. They also sell each season individually. http://www.amazon.com/ER-The-Complete-Seasons-1-15/dp/B005J9ZFJ8/ref=sr_1_1?ie=UTF8&qid=1355294080&sr=8-1&keywords=er+complete+series

That began the repetitive helicopter dramas on the show.