Kiwiology

In theory yes. A patient with renal impairment or renal failure may not pass as-large a volume of urine typically seen with DKA/HHNK so may not be as dehydrated. They should still receive intravenous fluid as there will be some degree of dehydration due to osmotic diuresis which requires correction. You want to begin to replace the water deficit so fluid is a good idea (these patients often require 3-5 litres of fluid). "A lot" of fluid is a subjective term; hang up a one litre bag of NaCl at TKO and start the process. Of course it goes without saying clinical judgement is required (damn that clinical judgement, makes them textbooks much thicker!) so if your patient suddenly develops massive SOB and crackles then perhaps turning the fluid off is a good idea.

The first thing I'm going to do is divide that number by 18 so I can get it in mmol/l which Kiwi understands I know I'm just gonna sound like everybody else but its either HHNK or DKA ... give him some fluid and transport No insulin pre-hospital

Stupid fucking arsehole medics, should have expected this from Bulletmore, Murderland; hell maybe the sepsis from FEMS is wafting over from DC.

Except me, I rely on one source for everything. I know everything so I rely on myself. Proton? WTF is that, get out of my way ... now, make sure we're on a good drip, where's that 20ml syringe gone, who's got my suxamethonium?

I have to agree with Ruff, if somebody can't grasp the material in their ambo book (probably because they're not given anywhere enough bloody time and they can't speel no goodz) throwing them a textbook aimed at somebody who has a significant understanding of basic and clinical science is going to spin their ass out even more. That said, I refuse to tutor my students (subjects, victims, whatever...) from standard Paramedic books because they are absolute rubbish written for dumbshits, firefighters, um ... yeah

Nah. Come on lets go out back sweet as no beached or ghost chips required not even stink bro That's sexual harassment

Nobody is comfortable around you Dwayne, esp not me not after you tried changing my B to a P .... Dwayne is a bad, bad man! Just taking the piss bro no ghost chips involved He is right tho (damn it all) you will learn far more right here than you probably did in school (it's probably coz I come by .. )

This book is God; even Consultant Emergency Physicians I know pretty much live and die by what it says Note: That book may not actually be God but Kiwi may and/or may not be a Consultant Emergency Physician ....

Advice? Stay the bloody hell away from that Kiwi bloke, he has a funny accent Welcome to the City, please feel free to ask any questions and we will try to answer them as best we can

Can I get an Amen? Wait ... *Kiwi sneaks out of sight to avoid getting struck down by Jesus for that whole 16 year absence from church Can I get an Amen?

There is the one giant Mosby (Bledsoe) Paramedic book It depends what you are looking for in a book, if you want a skills manual it is probably fine, if you want to learn the nuances of medicine applicable to whatever problem you are treating it's rubbish

More how to talk like a Kiwi sweet as legend no beached required coz beached is stink bro Strewth! Gotta nick off to this job at the bloody airport, reckon some wasted old bloke with a nunggered ticker keeled over, probably ate some ghost chips, not sweet as, pretty stink bro

I would have to highly recommend "passing yourself off as a Consultant Emergency Physician at the bar sweet as bro no beached required" by Kiwi It's shockingly easy .... *checks court date for Medical Council v Kiwi /taking the piss

Yes, stay the bloody hell away from that Kiwi bloke Hang on ... give me that, bloody hell, can't even trust anybody to do a thoracotomy in a ditch by themselves anymore!

We need a couple of things to seriously consider a PE 1. History of coagulopathy or risk factors for such e.g. smoking, HTN, AF, diabetes, recent pregnancy or venous structural defect (varicose veins in the calf most common) 2. Chest pain that worsens significantly with inspiration 3. Patients with a PE very often have a degree of being shut down and are hypothermic His history reads more like congestive cardiac failure but I don't see any evidence of an acute exacerbation here Hmm, he scoffs down coumadin but I don't see AF in his ECG so to me this sounds more like a respiratory problem

For the last two hours. X/24 (hours), X/7 (days), X/12 (months), X/52 (weeks) Yeah, no trauma here ... except the trauma his lifestyle has taken on his arteries, blood and heart Thinking some sort of rupture of something in the abdo area. I was also thinking a ruptured AAA but found it interesting that the abdomen was not firm/rigid, so not sure if there was blood loss in that region? But it is still high on the list for now. You normally do yes No he's quite overweight. He last ate about 7 hours previous sorry "tonight" in the note was written past midnight I suppose you can ask question, shucks .... No he has not felt the pain before The pain is lower right extending laterally to the flank, around to the abdo and and inferior to his right testicle No poo sample sorry mate, CBC normal yes, didn't do a BUN or creat, no leukocytosis no increased eosinophils/neutrophils/bands/segs or erythrocyte seds ... I would too but patients are pricks for not having read the textbook Aw come on man would I mess with you /sly look Nope I'm not messing with you mate Would anything be on the list of differentials besides kidney stones or a AAA? Where is one of those Consultant Physicians we have when you need one?

Flumazanil is right up there with Satanisim .... far better to provide good oxygenation/circulatory support and take to hospital I done about reckon we should be doing the same for most ODs and shouldn't really be waking them up with naloxone

59yom c/c back/abdo pain 2/24 PMH MI 2005 > CABG x 3, ischaemic heart disease, angina, HTN, NIDDM Rx Lipitor, ASA, GTN SL, isosorbide mononitrate, propanalol, coumdain, metformin FHx DM, CAD, HTN, CX SHx smoker, poor diet > fat/salt +++ Tonight onset severe back pain while at rest in bed, radiates abdo and right testicle, 7/10, ++ on exertion, described as sharp pain. No recent physical activity, no hx torsion or hernia. Vomited twice tonight, normal stomach contents only; last meal 7pm last night > beef, potatoes and vegetables. One episode ? faint approx 12am > self resolving. Ambo - hypotensive 70/40, abdo pain, 250ml fluid challenge, ECG brady (SR) Q waves, old infarct, no active ischaemia, BBB or axial deviation O/A conscious + alert O/E A patent and intact B tachypenic/adequate C shut down cold and clammy D GCS 15/15 No cyanosis, no JVD, b/s clear+equal no crackles/good air entry bilat, chest nonresonant, h/s s1/s2 no added, no rub, abdo painful to palp, soft/non tender, no masses, bowel sounds present (last BM mane), testicles appear normal, painful to touch, warm/good circ no sign torsion, no pain on urination, dysuric pm last urinated mane, urine clear. Distal pulses symmetrical. ECG SR brady, Q waves > old infarct, no active ischaemia, no BBB or axial deviation Chest/abdo/KUB film/ blood CBC/trop/CRP/U+E/coag/U C+S Plain films normal, bloods normal, hematuria+proteinuria 0045 obs BP 60/40 RR 20 PR 50 SpO2 91% BSL 8 (124) Temp 35.9° Cap refill 4s Pain 7/10 0050 IV fluid one litre NS 0050 morphine 5mg IV 0100 obs BP 85/60 RR 18 PR 60 SpO2 97% Cap refill 4s Pain 6/10 0130 obs BP 110/70 RR 18 PR 66 SpO2 98% Cap refill 3s Pain 6/10 0130 morphine 5mg IV fluid one litre NS 0200 obs BP 120/70 RR 15 PR 70 SpO2 98% Cap refill 3s Pain 8/10 0210 morphine 5mg IV 0220 obs BP 120/70 RR 16 PR 70 SpO2 98% Cap refill 3s Pain 4/10 0300 obs BP 128/80 RR 14 PR 70 SpO2 98% Cap refill 3s Pain 4/10 0400 stone cold dead What do you think killed this bloke?

Loma Linda University

Funny

So would you as one of them funny sounding Consultant Physicians tell them to take their kid somewhere else? Wait, you are a Consultant Physician aren't you? Now that we think about it, I am too, why not, it's not that hard right? What, they can't sit in Minors for 8 hours and see the dangerously overworked, underfed and fatigued House Officer with no training in paediatrics?

As much as I hate doing rubbish jobs or dealing with people's bullshit and think some people should be put down (I think its just human nature) I can't help but say there really is no such thing as a BS job. Some bloke who wants a lift home (literally) is a bit of an exception but some parent with a kid who has the sniffles at 1am or whatever y'know I suppose we can't really fault them for ringing up.

EMT clinicals are what, like 10 hours hospital and 10 hours ambulance total?

Problem is that "BLS" means so many different things - for example a "BLS" person in Australia can do more than an "ALS" person in the UK, a "BLS" person here has more high-value interventions than an AEMT in the US. These patients need to go to a tertiary referral centre; the quickest way for that to happen is by air so while the plane is on its way we are taking them to the small hospital having pre-alerted them. Intubated bloke goes with the ALS crew and the other fella can do with the "BLS" people after we give him some fluid.

With the utmost respect to your decades of experience mate, this type of mix and match system is not good for business especially when one considers the horrendous disparity between 120 hours (EMT) and 1,200 hours* of education (Paramedic) *give or take, except in Texas where 625 hours is acceptable