AZCEP

I'm with P3 on the cardioversion. Fast/wide no specific cardiac history, I'm leaning to VT, but for now it doesn't matter. The slowing respiratory rate and drowsiness without any treatment reason for it is a BIG problem. Shall we say Sync at 100 joules? Versed if can be done quickly.

The peak effect you speak of is for the diuresis. Lasix is a most useful vasodilator, and achieves this rather quickly. Lasix can make the bad situation worse, but NTG by itself is not always a good answer either. Even adding some doses of morphine have proven effective in the cases that I've needed them. Nothing quite like working the nursing home CHF patient that has actually aspirated liquid nutrition (Ensure). Direct tracheal suctioning never looked so creamy.

"Global ST changes" The T-waves are not elevated, nor are they "peaked" I'm okay with the ASA and the NTG to this point, but this patient does not warrant fibrinolytics or a cath lab.

Too many variables not accounted for to be able to tell. As the oxygen supply decreases the body will try to compensate by releasing more epinephrine/norepinephrine to increase the heart rate. By doing this, it causes a relative hypoglycemia that is compensated by glycogen stores being catabolized. Since the metabolic demand is decreased by the time the glycogen enters the circulation, the blood sugar can elevate. With no other history, his body may return to normal in a few hours following an increased metabolic demand after the narcotics are out of the picture.

Why do you want to know more about disease processes that you will never likely have to deal with? Uncommon presentations of common disease is more likely than a common presentation of an uncommon disease. Focus on the things you are likely to see. Learn how to manage the basics to the point of automaticity, then concern yourself with the unusual. Pick up any medical text and you will find that they spend most of their ink talking about the things that are most likely to present themselves. There is a good reason for this.

The best thing about the ICS system was scalability. You could make it work for any size incident. The move to NIMS was intended to have everyone on the same page, and it is a good thought, but it is poorly executed. Each type of provider will interpret the information differently, and will have a hard time integrating into the system when it is being used.

I'm with Ruff on this. Pulseless/apneic with extended extrication is dead in my area. Add penetrating trauma to the chest to the mix, and I doubt many would be willing to work this.

You are being terribly short sighted in your search for information then. iPods are but one of thousands of devices with the potential to interfere with medical devices. Computers in an office, cell phones in a public place, or even the microwave at the convenience store are all capable of disrupting the ability of a pacemaker to sense and deliver an impulse when it is supposed to. No one considered this a problem due to the slim chance that the age group that will be at the most risk of having a pacemaker is also less likely to purchase an MP3 player, and carry it in a position where it is a legitimate threat. Worry about the grandmother that is using a 1980's vintage, less than adequately shielded, microwave to heat the water for her cup of tea. This is a much more likely situation, and no one is publishing articles about these because they are old news. Throw out the "iPod" and no one is going to care either. There is nothing to appreciate from this. A high school kid wanted to do a project that would get noticed for a science fair, and grabbed the attention of academia due to it's novelty. The principles of electromagnetic interference are well documented, and this does nothing to change what has already been learned.

It will depend on where the pacemaker is implanted. If it is located in the abdomen, then the standard abdominal thrust will risk damaging the underlying organs in the area. Abdominal thrusts for the conscious FBAO patient are being de-emphasized anyway. For most, they are ineffective and unable to remove the obstruction.

You do not USE an iPod to transmit to distant sources, as you do with a phone. When a cell phone is on, in "standby" mode, it does not generate the same field as it does when it is being used to make a call. Every phone is a bit different, but most are at or below 3 watts of power when transmitting. An iPod, or similar personal digital device, does not have a transmit capacity, so they do not have as wide a fluctuation in the field they generate. To demonstrate this, take your handheld radio near any operating computer monitor. Hold it in any number of different positions with the power turned on. You will notice nothing happens. Now, hold the tip of the antenna near the monitor, and key the radio. Notice what happens to the screen. Let me repeat my repeat of what I said originally, this is not newsworthy. The properties of electronic devices and their ability to foul other electronic devices has been known for a very long time.

If an electrical device is turned on, it is generating an electromagnetic field. Using your cellphone increases the strength of the field. This has been researched, but it has been roughly 60 years since anyone thought to report it in the news.

Yes, there probably is some truth to it. Like I already said, if you place a device that generates an electromagnetic field close enough to another device that does the same there will be some interference. I did not question the validity, I question the intelligence of the people that decide that this is newsworthy.

Let's all get worried about this. It is a real problem that couldn't possibly be in a search for media attention.[/sarcasm] Cell phones can crash an airliner, iPods disrupt pacemakers, whoa is us, when will it all stop? Any device that generates an electromagnetic field, can disrupt other devices if placed close enough.

Keep the tape rolling and you will see the large fellow assess his motor reflexes with a backhand. This commercial is a classic, but the humor is lost on the patient's I've tried it on.

Probably about the time that providers come to understand the shortcomings of each piece of technology they are currently using. Short of breath? You get the pulse oximeter and the cardiac monitor. The fact that neither will tell you what you need to know is immaterial. Some may even get the capnograph. Because it is so new, even fewer truly understand it's utility. For this patient, it would have been some useful information to obtain with the others. Chest pain? You get the same things, and the provider gets even less specific information. Unless you are one of the 40-45% of patients that will actually show ECG changes while you are having an MI, we've just wasted a couple minutes hooking you up, and asking you to remain still so we can get a useless strip. God help you if you have a complaint that falls in some other region of the body. Oh, we can push and prod on the abdominal pain, and perform our simplified stroke assessment, but we don't gather any clinically useful information from any technology prehospital. Just for fun, someone should study what happens when all levels of providers have their technological support eliminated from their application. I wager that there would be a great number of people sitting in corners, weeping.

Look a bit deeper at what happened to this patient. The tachycardia, was initiated by bronchospasm and worsened by a medication (Albuterol). Because the patient was still stable, they could have opted to just observe the patient until the effects of the medication wore off. This patient did not absolutely need any more cardiac specific treatment at that moment. Adenosine can worsen bronchospasm, and there are many documented cases of it doing so. This is a known side effect of the drug, and you don't really want to add to a known problem if you can avoid it. At the same time, the effect will not last very long, and most likely would not yield a therapeutic benefit anyway. Remember, this SVT was initiated by the albuterol, not a intrinsic cardiac problem. A beta blocker is not absolutely contraindicated for asthmatics either, but you must consider their mechanism of action. Lopressor is relatively cardio-specific, and should be safe for an attempt at slowing this rate. It would probably have a better response than the Adenosine based on it's longer duration. With the amount of history this patient has, I wonder if this response to Albuterol had been documented previously. This is a rather unusual first time response to a medication that she would likely be on at home. Knowing how many doses of her own MDI she had used would be useful information to gather, and might lead one to switch to Xopenex to begin with. Blanket statements about what to do should be disregarded entirely.

To paraphrase Monty Python, "She has ceased to be, she's an ex-person." There's no clock ticking for this one. She's dead, wait for the law enforcement to secure the scene, don't disturb anymore than absolutely necessary, return to service.

I would hope that all ACLS providers are capable of establishing an IV in the patients that would need them instead of relying on a device that buys into the decreasing expectations of providers.

I'll save the soapbox, but did you search first? http://www.emtcity.com/phpBB2/viewtopic.ph...highlight=adult There's one on the EZ IO alone.

Cocaine does cause coronary vasospasm. http://www.mja.com.au/public/issues/177_05...as10632_fm.html I agree that this is not Prinzmetal's angina, but a more broad vasospastic event. Perhaps someone was trying to simplify things and cut too much of the information out.

Do your assessment before you decide that the patient needs to be immobilized.

Narcotics can, over time, cause the peristalsis to slow or stop completely. This CAN worsen an obstruction. There is also the long held myth that the morphine will mask the pain, making it more difficult for the physician to assess the situation. Most will allow for smaller, more frequent doses if it is needed. We can medicate for abdominal pain, and I often do.

http://www.google.com/search?sourceid=navc...cture+reduction Here you go. Trouble with reading about it, you will not know how much force to apply, and when you have gone too far.

It was reported to have some adverse CNS effects. If I remember correctly, patients were at a greater risk of seizures. Combined with most drug seekers wanting only Demerol. I know the local receiving hospitals have removed it from their forumularies do to these issues. They've since replaced it with Dilaudid.

Just a bit dramatic there, don't you think? :roll: With that amount of time you should be able to perform a thorough assessment and still allow for some degree of modesty for your patients. Time/distance is not a determining factor of forcefully disrobing someone. Remove the clothing that is required an no more. Your OB patient should probably have undergarments removed if they are in active labor. Otherwise it is assault. Potential for injury is a poor excuse for doing anything. Sometimes it is the only reason we have, but that does not make it a good one. Bilateral IV's--could be bleeding internally, spinal precautions--could have a cervical/vertebral fracture.