Just Plain Ruff

I have my fallout shelter, 7 years of food and enough fuel pellets to power my futuristic electrical generator and I will make it through to the end of the world. I plan on riding this out. If anyone wants to come join me you have to pay your own way. I have 20000 acres in western colorado that I'll parcel out in 200-300 acre pieces. You have to agree that I'm the supreme leader of the cult er I mean community. But in all seriousness, I wonder what the mayan's thought would happen when the world ends at dec 24 2012.

as an aside again, I hit the quote button and that is what you got. Do you have any idea why quotes work for some while they do not work for others? Maybe this is a question for Admin instead. As for the allergy and zebra in the room. I've been doing this for a very long time and I've seen only a couple allergies to benadryl and I do not believe that any of those allergies were truly to benadryl but more based on the allergy to the dye. I'm not saying that the kiddo isn't allergic to the benadryl itself because he very well may be but... I'd be more inclined to believe it was something in the benadryl liquid rather than benadryl. But that's just my thoughts. but as for treatment - My treatment isn't going to differ from your treatment AK.

this scenario plays out thousands of times a day all over the US. Bad luck fell on Boston Fire this day. But it could have very well have fallen on Chicago or LA or Seattle or wherever else that fire trucks and ambulances respond together. Maybe something good will come out of this for the rest of the country

I mis-read that it was liquid benadryl rather than cream, but my question still stands, are we sure its an allergy to benadry itself or is it something in the benadryl liquid? And NO we have not gone to IM epi yet. Our protocols do allow for SQ or IM though.

SQ EPi or even in the veins of the area under the tongue High flow oxy Intubate I suspect that the allergic reaction is really to something that is in the cream rather than the benadryl itself. Is it truly the benadryl she's allergic to.

This is a prime example of what you post on the web can come back and haunt you. What you post on the net is found easily and quickly. A department can require anything they want for you to get hired. If they want you to have a masters degree in underwater basket weaving with a minor in PS2 system design and build then they can require that. Complaining will get you NOWHERE but what it will get you is blackballed from their future hiring processes. Your application comes in to their HR department and they say "Oh hey here's that complainer again, he's on the no hire list" So you can complain but be prepared to be told "you are not eligible for employment here"

Spenac, for you my good taxi driver, you can think whatever you want. Once you get your patch you can stop learning and just coast thru life. But seriously, I thought I knew everything but you know what Spenac???? I just found out over the past week that I know very little. I hope you know I'm feeding you your sarcasm back to you with a little sugar. ha ha areyou being safe and have you been getting tips from your taxi cab fares.

his rate was around 128 or so I can only speculate the congestion and rhonchii and some wheezes were either chf or pulm edema. I did not have a chest xray because we met the helicopter at the helipad and never made it to the ER

ok ERDoc, let me ask you this. 2 hospitals 1st hospital small in size, 6 bed ICU, no physician at that facility has really the expertise to handle a hypertensive crisis nor a MI nor pulmonary edema in the long run. (they ship most of these types of patients to the city) 2nd hospital - 70 miles away, cardiac care unit, heart center, stroke center and the like. They can handle anything and everything that they are sent. They are a major receiving facility from all over the Eastern portion of Kansas and the Western portion of Missouri. I assume I know the answer but would it have been appropriate to take the patient initially to the 1st hospital only to probably have the 1st hospital ship the patient on to hospital 2 or should a helicopter be utilized to take the patient directly to the 2nd hospital. I made the choice to fly him to the 2nd hospital and I don't regret my decision to do so. Your thoughts.

That's true CTX it wasn't a hypertensive crisis but with all the other signs and symptoms on this guy I should have labeled it Hypertensive MI CHF Pulm Edema you do the math. But then again the subject line does not lend itself to that long a subject. He truly was sky high on the BP and the MI and the chest pain and the pneumonia and the congestion andall that got me to looking for a htn crisis protocol in our book and there is none. So I have devoted the next two to three weeks to get this protocol set up. I've already received 2 protocols from people and I plan on presenting the best one to my medical director. I do appreciate all the responses. One thing I do question is what danger to the patient is there when his bp is so high, he's having an MI and we drop the pressure with meds. What happens to the heart and it's components when we drop the bp? Is it detrimental to the patient to go from 250/173 to 180/100 or 180/90? Our hospital does not even have a cardiologist so I think the patient was best served by going to the regional cardiology center.

I agree on the MI but what I've been finding is that LVH seems to make 12 leads un diagnostic based on the LVH condition. Every single shift I learn something new. I make it a mission in my work that every shift I find something I need to learn and learn it. This shift that this lady was on gave me two things to learn, LVH and MI and then Hypertensive crisis that I posted on earlier. If I ever think I need to stop learning I'm gettng out of this business.

i had a patient who called 911 with short of breath. we got there and there was no one to answer the door. The fire guys were all ready to break the door down. Line was still open Police refused to allow us to break entry because they didn't think that the patient was still there as there were no cars in the driveway but one in the garage. They said that they patient must have gotten a ride. We waited a few more minutes and I went next door to a neighbor and was able to get a key. I got in the house and found GUESS WHAT???? A lady in cardiac arrest. She died. An investigation ensued and the two officers who initially refused to allow us to break in were reprimanded based on the fact that the line was open and they dragged their hands on it. I cannot be sure if she would have been alive for us to help if the 15 minute delay would not have happened but maybe not who knows but it was one time I wish I had been more forceful.

well her pressure was good. But she really after talking with her much more with her grandson as a translator sinc of course she doesnt' speak a lick of english the pain was really not chest pain but pain on inspiration. So I ruled out nitro. Maybe that wasn't the right decision but I didn't feel comfortable with nitro. Plus, isn't nitro contraindicated in the presence of a RVI? I have no more information on this lady until I get back to work on wednesday night since I'm off work till then.

I did find an article from Circulation that said that Left Ventricular Hypertrophy can mask an Inferior/lateral MI. I guess I have some research to do

90 year old, speaks little to no english so history is crappy I did a right sided EKG and all leads look the same but V4R was NOT elevated. pulse ox increased to 96% on 4lpm oxy gave her 4 baby asa, IV, monitor, BP 160/80 or so I don't have the vitals in front of me. I was unable to find a previous EKG from our hospital records so I have none to compare it to.

well I've been on the losing team more times that I can remember in high school and grade school If' you've never been beaten as bad as that team was you have no frame of reference. In one baseball game our team got beaten 64 to 2. The 64 points were in the first 3 innings. I feel sorry for these kids who have not won in 4 years but this is life and even though I feel sorry for them I am not going to say for the coach of the other team to lighten up but honestly 100 to nothing. Did the coach of the other team actually take the first string out or did he keep some of them in to increase their stats? Did the coach try to limit the score or did the coach continue to tell their kids to keep scoring. There is NO lesson learned in this fiasco of a game. The lessons the kids learned are 1. They truly do SUCK 2. That the other team is better than them 3. The winning coach didn't seem to care about their team(whaaa) 4. Finally the winning coach and his school feel really bad about kicking their asses and they want to forfeit the game. Which they still lost but that school feels bad about beating a crappy team to begin with. Maybe these kids need to buck up but there is absolutely NO lesson to be learned in this whole thing.

fixed I believe. I can now see the image. I guess my question on this whole thing is this, What is the true significance of left ventricular hypertrophy and MI and what ramifications are there when you have both present at the same time. thanks for your help.

I had a difficult case this morning. 90 year old female, chest pain, short of breath, high high fever (103.0) and the following rhythm strips. if the strips don't show up then I apologize and I can send them to you. But she was no non-descript on the chest pain and the EKG was something I haven't seen in a while so I was very on the fence with either transferring her to a cardiac center of just bringing her to our ER. I've never been one to 2nd guess myself but I ended up flying her with the initial diagnosis of a MI but this was one of those cases where my GUT told me one thing yet logic said otherwise. If anyone can help me and have these strips show up in the post please point me in the right direction on how to do this. thanks Here are the strips http://s4.photobucket.com/albums/y136/ruffems/SCAN0001.jpg http://s4.photobucket.com/albums/y136/ruffems/SCAN0002.jpg

ok, We don't have a set protocol on this but I aim to have one soon if I have anything to do with it. We carry labetalol, lopressor, nitro in paste/spray/drip form. I started a Nitro drip on this guy. I also had started an inch of nitro paste which I removed on starting the drip. We flew him to the city and I have no idea how he did but I do know is pressure never went down even with Nitro at nearly 40 mcg/min. By the time the nitro was at that rate they were at the receiving hospital. He never experienced stroke like symptoms, no nosebleed and his headache only started with the nitro admin. Did I mention this guy was only 25 years old.

Can anyone quote me their protocol for hypertensive crisis. I just ran one, initial blood pressure 249/175 pulse 128 headache cough I went thru our protocols and found that we do not have a hypertensive crisis protocol. By the way the guy was also in CHF and having a MI to boot. Elevation in leads v1-v5

I never have understood why it takes a Fire truck (4 FF) and ambulance (2 ems) and maybe one or two other support units to run a basic call in a fire department run service. When I worked for a large metro EMS agency it was not uncommon for there to be one rescue truck (2ff) a pumper (4ff) a chief (1ff and maybe 1 driver), an ambulance (2ems) and maybe one supervisor (1 ems) to run a fall or a MVC. That is 10 people on scene for a mva or a fall or whatnot. I work right now in a service that has 2 ems people on the ambulance and that's what we get unless we are in an area where first responders are or a wreck which gets a fire truck. I always said that the more people on scene the more chance for someone to screw up or get their knickers in a bunch.

Why not have two levels of paramedic school 1. Top level for people who want to actually be a paramedic. Teach them how to do things right. (for those who advocate education) 2. Bottom level for the people who can't get in to number 1 and only want to be firemen. (for those who just need a certificate) If you have the certificate then you can only work as a firefighter medic with NO transport responsibilities. For those who want to transport patients and take care of them after those in number 2 get thru with the patient then they have to go to school number 1.

ok, so a quick google search - apparantly the EMT's there took pictures of Jett dying and are now asking 20million from the Travoltas to keep them out of the public hands. http://www.bild.de/BILD/news/bild-english/...g-son-jett.html

the article doesn't give much info but what I can gather is that there was some extortion plot regarding medical records and the like. There has also been some questions about the male nanny and his relationship (not sexual) with the family and especially the son. I'm looking into it more. and yes, tonight I don't have a life because all I'm doing is waiting for the 911 phone to ring. I'm sitting in the eMS room just waiting

It appears that the EMT who gave the interview after helping Travolta's son is in a bit of trouble. http://latimesblogs.latimes.com/thedishrag...ian-offici.html It seems that this emt and 2 other people (both members of parliament) have been arrested in an extortion ring. This EMT I always thought was a dirtbag and now it's true. (or isn't until proven guilty)