Kiwiology

I don't get it

Well I was planning on being a real boy when I grow up someday but then the cops and various Federal agents busted Jepetto, apparently he is a paedo, oh well back to the toy box for me

Hmm maybe but it would have to be significant pain so probably not I am more interested in haemodynamic compromise

A patient with AF shouldnt have ischaemic chest pain as the two have quite different etiologies, the exception perhaps is somebody with an anterior infarct affecting the atrial tissue sufficiently enough to develop ectopic foci In the absence of haemodynamic compromise or VT I wouldn't cardiovert Amiodarone for.AF is good stuff

For patients with tachydysrhythmia who are significantly compromised the treatment of choice should be cardioversion particularly if the rhythm is thought to VT "Significant" is subjective but requires more than "a bit of chest tightness or SOB" - basically think patients who are cardiogenically shocked or going to end up that way, so the small, elderly or other patients with limited physiological reserve Now sedation is a bit of a funny issue, in the hospital here the choice is midaz or propofol. In the pre hospital environment here we have midaz, fentanyl and ketamine. My personal preference is for IV midazolam and top it off with a bit of ketamine Paramedic Officers can give some IV or IN fentanyl then cardiovert now, for years (like nearly twenty years) they could cardiovert but not give analgesia but my take on that is if you are that bloody crook you need cardioverthing you wont mind a bit of pain for some extra years of life I do not think there is a role for prehospital blockers be they calcium, beta, sodium or otherwise; there may be a small role for beta blockers for MI patients but I am not familiar with the literature suggesting improved survival but I do believe some exists

but but but teh valiumz are Kiwi's little helper ... just like you and that hip flash in your lab coat pocket Yes, Ruff told me

For patients with tachydysrhythmia who are significantly compromised the treatment of choice should be cardioversion particularly if the rhythm is thought to VT "Significant" is subjective but requires more than "a bit of chest tightness or SOB" - basically think patients who are cardiogenically shocked or going to end up that way, so the small, elderly or other patients with limited physiological reserve Now sedation is a bit of a funny issue, in the hospital here the choice is midaz or propofol. In the pre hospital environment here we have midaz, fentanyl and ketamine. My personal preference is for IV midazolam and top it off with a bit of ketamine Paramedic Officers can give some IV or IN fentanyl then cardiovert now, for years (like nearly twenty years) they could cardiovert but not give analgesia but my take on that is if you are that bloody crook you need cardioverthing you wont mind a bit of pain for some extra years of life I do not think there is a role for prehospital blockers be they calcium, beta, sodium or otherwise; there may be a small role for beta blockers for MI patients but I am not familiar with the literature suggesting improved survival but I do believe some exists

They should have done a Trop-T and CKmb but even still probably would not have shown jack crap This is fucking mental insanity like seriously FOUR MONTHS later? OMG WTF Only in America ...

I think her pancreatitis is coming from something related to the pain when she eats which could be acidic digestive enzymes somehow in the wrong place or near equivalent

My doctor is a very wise Consultant Physician who keeps trying to convince me to become a GP

Dehydration is possible Symptomatic hypoglycaemia only occurs in diabetics (or somebody with a massive insulin secreting tumor orsomething) a person who is not diabetic will never get so hypoglycaemic they have significant symps; you might colloquially get a bit "wonky" but that is not the same. The body will maintain blood sugar at the normal level first by breaking down glycogen (glycogenolysis) and once all that is used up after about 24 hours will create glucose from non glucose sources namely ketones, denatured amino acids and fat (gluconeogenesis)

I am thinking pancreatitis This lady is sick, she needs to go to a large hospital with surgical and ICU capability; give her some pain relief, get her and husband in the ambulance and transport with an early RT call to the hospital.

You did OK My Kiwi sense tells me she has become nauseated because the increase in physical exercise has shunted blood away from her gastrointestinal system and she will feel better in a few minutes. The exact physiological mechanism I forget and I would go look it up but it is way more fun to get wasted on valium. Good work mate, If we got her she'd at most get "you'll be fine" or at the extreme end of the scale an oral ondansetron wafer and sent off on her merry way

So my doctor says if I keep eating dollar menu chicken burgers I am going to die of cardiovascular disease And apparently should I keep eating giant value chocolate chunk cookies I am going to get diabetes Perhaps it's time I found a new doctor?

I have also heard that, I learnt compound fracture so I just call it that NTG / GTN, epinephrine / adrenaline, hyperlipidaemia / dyslipidaemia, ERDoc / dickhead, same diff righ?

Yeah pretty much because I have little interest in starting a thing .... and may have been watching pronz at the same time Like I said, I have yet to be taught something that is "wrong" but I think what may be "wrong" is simply a grossly oversimplified approach to or misunderstanding of something based upon inadequate knowledge

Just because you can do something does not mean you should

Hmmm Her hypotension, cool skin, weak pulse and sweats could be hypovolaemia or PE Her abdo pain could be IBS or it could be some obstetric catastrophe ST elevation could be ischaemic or nonspecific and mean nothing Is the abdo tender or rigid, any discolouration? What is her vomit like? any blood or other abnormalities? Imp - PE or some sort of obstetric catastrophe causing internal bleeding but at 3 days preggo it is highly unlikely Plan - start a drip, give her a litre of fluid and some pain relief if she wants it

When did the pain start and what was she doing when it started? Has it changed any? Does anything change it? What kind of pain is it? Does she have pain anywhere else or does the pain go anywhere else? How pregnant is she? Has she been seeing the midwife/OB regularly? any problems? Any other pregnancies or births? Any vaginal bleeding? Race? smoker? does she have an IUD? PMHx Primary and secondary survey? Obs? ECG? My immediate thoughts are either PE or some sort of gynaecological catastrophe e.g. ruptured ectopic pregnancy or previd placentae

Unless the patient is in cardiac arrest, it should!

You were right mate, it is a compound fracture Sorry tho, we are all out of Wiley Gutrot the moonshine brewin' hillbilly's authentic homebrew grain alcohol so you'll have to have a gold star instead, I really am sorry I knew you would have rather had some of ole Wiley's finest I will bring some to our BBQ, which was are having at AK's house to avoid damaging our friendship by me befouling your carpet

I was not formally taught any of the above. When I did the Paramedic (ICO) modules it was suggested that frusemide in CHF may have a benefit as may morphine in pulmonary edema but both should be used with caution because of possible negative effects, both have now been withdrawn (as of 2011) I do not think things that are "wrong" are taught (although having seen the above .. I dno) but that certainly not enough is being taught.

Dude promethazine gives you wicked hallucinations I got some IV promethazine when I had gastro and next thing you know I was talking to flying purple elephants who were sommersalting through the air and sparkly dogs walking on the roof inbetween blank periods when i lost consciousness The Doctor said if my GCS has dropped any more they'd have tubed me

That is enough to make me stay south of the border in Hoosierland Let's see, Hoosierland has racing and yet Mittenworld has ... fat, braless women, hmm ... *leaps out of way of collapsing stage, phew, oh look another left turn, hey get me a hot dog or some chips or something bro? Motor city my ass ... Y'all might build em, but we know how to use 'em

The second patient is fine, just few cuts and a bit of gravel rash Uncle Jake is pretty crook, the Fire Service tell you they need at least an hour to get him out. The actual patient was fluid loaded, anaesthetised with ketamine and one of the Helicopter Doctors amputated his leg. I'm not saying it should be done, I would certainly consider it however and am interested in seeing what others think.