Just Plain Ruff

Ok, call me dense but I am not sure why you considered Rhabdo on this patient? Can you elaborate??? Here's a link for a good info article on Rhabdo http://www.nlm.nih.gov/medlineplus/ency/article/000473.htm

Yeah my training is endurance training, I'll jump out of the moving ambulance and hope to god my feet have the endurance and speed to match the speed of the ambulance going in the opposite direction.

If the house is next to the ER then I'll work it shortly at the house and then move to the ambulance continue the code and then go to the ER. But if they do arrest in the ambulance in the ER garage or near the door I'll work it a short time, let the ER staff know and have them come out to the ambulance for the extra hands. Either or, since it's a witnessed arrest I'll do what can be done in the ambulance, shock, cpr, intubate, first line of drugs and pace if needed and then move to the er room. but you need to do 2 minutes of cpr regardless so Maybe some would just do cpr into the ER and go from there. There is no wrong answer and many right answers. It all depends on the situation.

You are at the ER as I see it. If the person arrests you start the appropriate algorhythm and then move in to the ER. This is a witnessed arrest, why are we even arguing about working or not working this one? Just start the code, get your first shocks or cycle of cpr and meds in and tube in the truck if you can and then once you have that done you can move into the resusc room.

how about the hagen formula The larger the catheter the more fluid that can go thru the cath into the body. a 22 ga will give x amount while a 14ga will give a lot more. I'm not sure of the actual formula numbers.

some fluid but not much. I think that he ended having a hemopneumo (maybe but it's been a long time ago) but I think that the area I needled was too high anatomically to produce any fluid out. But I honestly don't remember.

Trauma to the chest or belly, kid looks like crap, o2 sat low, obtunded, hyperresonate chest sounds, you probably will not have absent breath sounds on either side, they will more than likely be very very diminished. The kid I needled had nearly absent breath sounds on both sides. The heart was also very muffled. When I did the needle we nearly had immediate improvement in lung sounds, color improved, child did not become less obtunded because he was a traumatic brain injury anyway. The child survived to need pemanent day care based on his injury.

yeah anything bigger than a 20 ga. will work. At least that's what I remember my last lecture that I had from a peds critical care training team.

I'd have gone for the shunt too Curse, there wasn't much to work with there I'll bet. You do what you have to do.

I have had one peds decompression in the field and I used a 20ga cath and followed it with a vaseline guaze over the catheter. I seem to remember that a 20 gauge will work fine for kids. The kid had a tension pneumo and I truly believe that my decompressing him initially saved his life, but the pediatric trauma center needs to take most of the credit.

I want one of those vehicles, where did you get it?

Nope not spoiled just prepared. I have actually put myself a small kit together of the items that normally either go missing from the trucks over time or get snagged. I have in my personal kit bp cuff pen light ballpoint pens calipers thermometer Calculator field guide protocol spiral binder Granted I only use the thermometer if the truck's is missing. Then I either sterilize it or replace it with a new one and put mine on the truck.

I'm getting a mixed bag of responses both here and outside this forum. A dialysis nurse who does acute dialysis says that yes you can access it but only like some have said as a absolute last resort. Others Like Crotch are adamately against it. Many are Go IO if you have to. Thanks for the responses and thanks to Curse who gave the best response of all.

recently we had a cardiac arrest patient who was on dialysis. If there is no available IV access or access is not obtainable not withstanding a Adult IO is it appropriate to place the iv in the patient's shunt? If it is appropriate to put the iv in the shunt, which side of the shunt should it be placed? I recently had a crew bring in a dialysis patient who had no available IV. It took us many sticks but we did get the IV but in a critical patient is it ok to use the shunt?

we've got both, a real thermometer and the calculator.

I agree. Our service has one single concentration of dopamine. We do not start this drug or any other one like it without a pump and without a drip chart. To do any less is to violate our standard of care. But we don't have pumps in the ems bags when we go in a house so I'll start the drip in the house and then put it on a pump and use the drip chart. but yeah, using the rule all the time and not using a pump is askiing for bad juju.

but it's been years since it's been posted so I guess it's relevant to go back and revisit some of the old rules and rules of thumb.

How about getting him a snuggly and then customizing it to his tastes.

http://www.wric.com/Global/story.asp?S=9633104

I just read this again and I agree Wendy. Many times I have taken care of a person who has cut themselves or injured themselves in some way or another and their response to when I ask them if they were trying to kill themselves is a no. That kind of conflicted with me until I was discussing this type of behaviour with a counselor for teens. He told me that many times the self injury is what the person uses in order to NOT kill themselves. They have the urge to hurt themselves and the urge may be to end it all but they resort back to a feeling that if "I hurt myself but in a small way that I won't have to finish the job" or something like that. A lot of times the teens he counsels are considered suicide risks but suicide is the furthest from their minds even at the time they hurt themself. He says that it is a coping mechanism that they use to keep the final result from coming true. I hope that makes sense because in my mind, (strange as it truly is) it does make sense to me.

Kudos to Bob Page on this one. We just were discussing drug drips and this jumped out at me while reviewing the 2001 Multi-Lead Medics workbook Credit goes to Bob Page Weight in pounds/10 subtract 2. This gives you the pump setting in ml/hr or gtts/min for dopamine at 5mcg/kg/min with a bag concentration of 1600mg/ml Example The patient says they weight 100Kg? Ha ha Yeah right. The patient weighs 220 pounds. That would be 220/10, which is 22 minus 2 leaves 20. Set your pump at 20ml/hr Bob sure has a way of making this painless huh?

I'm in total agreement, this was a good article. Lots of stuff to ponder and think about over coffee and bagels at the local Einsteins. Yes most of the CEU articles we are exposed to, the authors have less to brag about that this lady. I applaud her for working to find remedies to this troubling often frustrating side of life. I did enjoy the article. The comment I made was completely in jest. Was not meant to cast aspersions on this ladies character. My apologies. But I do have a higher degree level than she does though, only in a different field.

There are always exceptions to the rule, we've all had them.

It works the same way as a cardiac monitor on a bloody patient. Wipe off the blood and then use the adhesive prep pads to prep the site. Wiping the blood off the iv site area takes no more than 2-3 seconds at least in my opinion. Once the device is on the patient you'll be hard pressed to get it off without alcohol. I do know that blood does not remove the sticky glue, just alcohol. But that begs an important question, a really drunk patient who bleeds on the stat lock adhesive area might just be able to remove that stat lock if their alcohol level is high enough.

But just look at her GRE scores. She's way qualified