Thunderchild145

Yea, this is kinda a non issue for us because our stations have seperate bedrooms BUT assuming that myself and a homosexual partner had to sleep in the same room, it would be exactly the same as me and a heterosexual female partner sleeping in the same room. Keep it professional.

Sometimes. Not often. If I see a truly sick patient who is in a peri-arrest situation, then yes. Also, obviously if I'm going to pace/syncronized cardiovert, then I need them on to do that. This particular patient doesn't seem like they're too bad, but some patients do warrant getting the pads on before they code.

All I know is that if I don't have an IV in a code I'm screwed, but if I don't have a 12-lead in a code I'm not missing anything. 12-lead IS warrented though. Don't think that was a bad idea at all. My reccomendation: Start the IV while your partner gets the 12-lead set up. For a patient like this who looks like they are about to code, get an IV and get the pads on.

Eh. This is obviously an opinions question, and also slightly dependant on protocols. Our protocols say no nitro without an IV line, and nothing below 90 systolic. If it's 90, yes. If it's 88, then no. Since I'll typically give a nitro before I get an EKG, my first "To give or not to give" is based solely on BP. In either case, we'll administer fluid to a patient with a BP of <90 systolic, at this point I'll grab my EKG, and per protocols will administer nitro when the pressure reaches or exceeds 90, excepting cases where a diagnostic EKG can reveal acute right sided compromise, or the historian (pt or otherwise) can reveal chronic right sided compromise. Protocols here say no nitrates for people who are preload dependant. Same for morphine. As far as to what happens when you do give nitro to RVI patients, yes. It's been my experience that if bottoms them out fairly quickly. I'll typically pucker my buttcheeks and squeeze the IV bag as hard as I can. For chonic patients this drop seems to be less dramatic, and I've noticed that most patients who are chronically preload dependant are typically hypertensive to begin with.

I had a patient like this in the cardiac floor where I used to work. She started with 3rd Degree AVB and then she would tense up, pass out and have 30 seconds of nothing but P waves. Woke up and said she felt like she was falling. Happeneds like clockwork every 5 mins or so. Very strange.

Well actually, there typically is a junctional or idioventricular escape rhythm to replace the sinus arrest. This is more common. What's uncommon is where the SA node fails AND the junctional pacemaker fails AND the ventricular pacemaker fails and they go into asystole. That's typically a very bad sign of some serious conduction/automaticity problems.

I wouldn't try to mess with titrating prehospital. Personally (and once again I wasn't there) I would have bagged without intubation, and administered the naloxone bolus. In the 15 minute window I just bought myself where the patient is hopefully now breathing and maybe starting to wake up, I'd get him out to the truck and take him to the hospital. Due to shorter transport times here, I think were he in this area we'd have him to the ER before the naloxone wears off, but since I don't know where the rest of you are, that may be a thing that only applies to me. So yea, to reiterate: Narcan, then more narcan, and only then tube is what I've always been told.

EMS will almost never know if it's new or old. Your best chance of knowing in the field if a LBBB is new or old is if the patient knows that they have a LBBB. The odds are astronomically stacked against that, so I tend to treat anyone complaining of substernal chest pain according to our CP protocols, with or without presence of a diagnostic 12-lead.

Here, the scope says that a basic can administer nitro if there is medical direction to do so. Since a medic can give that direction, the previous case was totally fine here.

My question is that if the ACLS certified professionals aren't "experts" then who should we ask in the eventuality of needing "expert consultation"?

That happens here. All the time. More commonly though I'll ask the basic to set up a 12-lead while I start my IV, and as soon as I have a line in place I'll give the nitro. (If I tell the basic to give nitro and then I cant get a line in, I'll really be in for it; so I like to only give it to pts with lines established. Not partially, but all the way.)

Technically, the school at which the EMT-B/I/P student is attending should have a medical director and the student is practicing skills under the medical director's license. Least, that's how it works here.

I took my initial ACLS 2 months ago and I have to admit, it did seem really, really easy. I spent the two months before that hearing horror stories of ACLS megacodes gone wrong and entire classes failing only to not have a single person in my class fail. I thought maybe it was a fluke. Guess I was wrong. Anyway, it is dissappointing to hear that the education (if you can call it that) that I got in the ACLS course is "watered down". Course I also knew from day one that since ACLS-I was that easy I'd definately want to try my hand at ACLS-EP. Does anyone know if the experienced providers course has been "watered down"?

Now, if only they had a video of this on YouTube.

Here we are practicing intubation while doing chest compressions. That's the only thing I can assume he meant, because I can't fathom how to intubate and ventilate at the same time.