kevkei

Seldomly have I seen a systemic response to an ingested allergen. Usually it's angioedema. Assess the tongue, uvula and their voice. Do they sound hoarse or muffled? Can they swallow, breathe through their mouth and nose? Can they stick their tongue out? Decreased lung sounds is usually a late and ominous sign. If they complain of a sensation of their throat closing and you see evidence of such, believe them.

Historically, our highest success rates are in pulseless patients. Why is that? Could it be the right amount of anesthesia (sedation and analgesia) as well as flaccid paralysis?????

Since the first question has been well represented (the issue is with excess potassuim from cellular death and release) I'd like to add to the second. By treating with bicarb, the point is to alkanalize the plasma to force the free drug to become plasma bound. Alkanalizing the urine is a much better choice than non-potassium sparing diuretics. You run the risk of inducing significant hypokalemia. The bicarb will cause a shift in extracellular potassium intracellularly, plus the lasix will cause dumping of any remaining extracellular potassium through the proximal renal tubule. Keep in mind over 80% of the body's potassium is within the cells and that it shifts constantly via the sodium/potassium pump (this is why it's treated in crush injury/syndrome, because you get a mass efflux of the K+ as the cells break down and die - cellular lysis, plus the acidosis as well.)

I'm happy to see others aware of these propeties of Benadryl and how it and Gravol are quite alike :wink:

Yes, because we are prescribing that treatment to the patient, not their Physician.

The short answer is that they both act by similar mechanism, and combining them together makes things much worse. They both cause vascular smooth muscle relaxation by affecting calcium channels. Imagine it as being giving a patient 10 sublingual nitro's all at once.

Ace, I agree. My concern is that in pregnancy, it is normal for a BP to drop as opposed to increasing over baseline. From a physiological perspective, increase cardiac output and increased circulating volume is in compensation for placental engorgement, hence the comment. 90/50 may indeed be hypotensive and depending too much on quantitative data is my concern when there is qualitative evidence.

Aren't you confusing this with a COPD'er? With CHF, there is no dependancy on the vent, it's with hypoxia and hypecapneia in COPD where weaning becomes a problem.

I can't say I disagree, I was just trying to indicate the position (from what I understand) from ACP itself. For whatever reason, ACP just want's to be different than the rest.

Good luck Dave, break a leg :twisted: Nope. I don't think it's even in the plans to adopt this. The College is quite picky on not calling everyone a 'Paramedic' as it seems to be a desire of protected title. It's still EMT and EMT-P.

Yes we are. We either go to the cath lab or administer thrombolytics prehospitally. Here is our protocol for establishing which treatment the patient gets. [web:fddd0e3b53]http://ecity/EmpSupervisor/News/EmergencyResponse/EMSParade/ProgramDevelopment/VHRPrehospWorksheet.pdf[/web:fddd0e3b53]

Actually, BiPAP would be the preferred treatment of choice over CPAP. You need to be able to control and adjust inspiratory pressures to prevent autopeeping.

Question, what is it that a blood pressure of 90/58 makes a person hypotensive? Unless you have a trending of baseline vitals over a period of time prior to conception, you have no idea what her normotensive pressure is so you assume that she is hypotensive.

Actually, wouldn't it Medical Sector?

Jeep, it depends on the situation and circumstances behind it. If it got to the point where they restricted or removed your ability to practice, you would probably first have to retrain at your respective level and then need to be medically cleared by a Psychiatrist to say you are fit to practice. You would also probably have to have a Psychiatrist say you are not fit to practice in the first place. Try talking to ACP directly. The next question I guess is this about you or someone you know, or is it 'hypothetical'?

That's it, the border is closed to you now. IF you come up here, we'll pay you strictly in Canadian Tire money (my fellow canucks will know what I mean :wink: ) And I'll have you know, our money is a lot more pleasing to the eye than your green back's.

So Steve, where in your 'protocals' does it tell you how to treat the emotional aspects of our patients and their families? Where does it specifically say that you can or can not 'minister' to a patient. Or, for that matter, where does it say you can hold their hand, use touch, kind words? Do you have a protocol for displaying empathy? Does anyone? Didn't think so. The fact is, soft skills encompass' over 80% of our treatment.

It's not that difficult to observe trachial deviation. Place your index and middl finger on either side of the trachea in the clavicular notch, what was once unnoticable now should become obvious. Compare the proximal aspect of the trachea as it leaves the jaw line with the distal aspect where it enters the thorax, normally it should be fairly straight. Another trick is to use a pen and draw a verticle line (from inferior to superior) on the midline of the trachea and do the same on the clavicular notch. If they don't line up, you have shift, or, if it isn't present you have a baseline and in the event they don't align in the future, you have evidence of shifting.

Currently I'm making $30.13 an hour and will max out at $32.39 next year until our next contract is negotiated later this year (average pay increases have been 3% per year). This doesn't include shift differential, OT (double time) or stat holidays (12 per year). When you add pension, vacation and benefits the dollar value is ~ another $15-20 an hour.

Think of this, in the majority of our patients, >80% of our treatment is of their emotional needs. Just as we have to tailor medical treatment to each patient, likewise is true of emotional treatment. If your patient is a believer or Christian and you are too, then they would probably consent to you ministering to them as part of your treatment. My personal faith is not something I wear on my sleeve at work because I respect my patients personal beliefs and I do not try to force anything on them. Actually, it is very seldom that I share my faith with a patient unless they outright ask or other circumstances lead into it.

The literature they taught you was wrong, or misinterpreted. What might have been suggested is if you have ST depression in V1/V2, it may be a reciprocal change to a posterior MI, and is worth looking at inferior leads (II, III, aVf) and V4r (right ventricle). V1/V2- septal V3/V4- anterior V5/V6- lateral I/aVl- lateral II/III/aVf- inferior V8/V9- posterior V4r- right ventricle

Most likely would be realative hyperkalemia. If you think about a generalized seizure, it causes global tonic/clonic activity, both of which cause skeletal muscle depolarization. Thinking back to A&P, depolarized muscle cells cause a gradient shift in extracellular K+ because of the sodium/potassiu pump. Depolarization causes sodium to transfer into the cell and potassium to transfer out. The Na and K initially switch out much faster than they return. Cellular degredation and rupture (death) might be a contributing cause but probably to a much lesser extent than the Na/K pump. In the case of the Na/K pump, the hyperkalemia would self correct in a short period of time (which I would assume happened here) and in cellular rupture it would obviously be a much longer duration as the kidneys would have to compensate by excreting the excess K+.

Up here it has been used for over 10 years that I know of. We carry both fentanyl and morphine in our service but our medical director prefers morphine because of it's duration of action compared to fentanyl. Personally, I like to combine the two in certain situations, like fractures. I'll start off with fentanyl ( 1-2 mcg/kg) as it has faster onset of action and a faster peak effect. Then I'll reassess and repeat if needed. If I have the desired effect, I'll switch to morphine and give it 5-10 minutes after I last administered the fentanyl. I've found it is very effective and you get the combined positive aspects of both, quick symptom relief (fentanyl) as well as longer duration of action (morph).

So if a patient tells you they have 'chest pain' do you treat with ASA, Nitro, MS, just because they had chest pain or do you perform a differential and come up with a working diagnosis, regardless of the fact it appears it is non cardiac? I have and will continue to with hold analgesics from some patients. I think it is poor judgement to flat out give all who have 'pain', pain control. There are patients where their history, presentation and signs and symptoms don't match what they claim. Now granted, they are few and far between but it does happen and we have all seen them.

I am a Christian and I'm proud to be one. I don't boast and I don't "preach" but I will discuss and exchange dialogue with those that are interested. I don't "bible thump" but I'm firm in my faith. I think that if you don't want to believe, that's fine. If you went to church, but a certain congregation turned you off, then it was probably a bad church. Believe me, those that say they are Christians can be a wolf in sheeps clothing. Most of what society dislikes about Christians are due to perceptions based on limited knowledge or from personal experiences. You know, I had a bad experience and interaction with a couple of surgeions - does that make all surgeons bad? :wink: If you have never read them, a few good books to read to see the basis of Christianity, check out the books by Lee Strobel, The Case for a Creator,The Case for Faith, The Case for Christ, The Case for Christmas and The Case for Easter. He is an author that had spent time trying to prove Christ wasn't real and that Christianity is a farce. He was an Athiest that used his position as an investigative journalist and court reporter to prove his position. The problem was that the more research he did and the more thime he spent, the opposite happened. He became a believer and a Christian. The funny thing is, the Bible has not been proven to be historically accurate, actually the opposite is true.