AZCEP

Form a united front with his peers, so that he can better understand the seriousness of the situation. When confronted most will admit to the error, and at least consider changing their ways. Think of it as an "intervention". mediccjh is right though. We definitely do not need this type of representation in public.

The concern for using succinylcholine in the burn patient is admirable, but not directly applicable to the emergent setting as ERDoc mentioned. If the patient is more than 24 hours removed from the initial injury, you should consider another agent, as the cellular membranes have leaked the K+ out by that time. The laundry list of other contraindications for succinylcholine should be considered, but most are manageable.

Really depends on the type of system you are dealing with. The more rural, or distant from a receiving facility, the greater the need for ALS providers. Unfortunately, these places don't usually have the finances to support paramedics. The closer to a facility, the less paramedics are truly needed, but the urban centers can afford the level easier. Interesting conundrum you've hit on here. 8)

Now, now Asys, if you weren't in the hub of the decline of western civilization this wouldn't be happening to you, now would it?

I've had several partners say this to drunks we've had to pick up when they hear how much they've had to drink.

Asys, the new guidelines are actually much easier to implement. Find someone, 2 minutes of compressions, an occasional ventilation, get the monitor/defibrillator attached, assess the rhythm during a personnel switch, decide where to go from there. We've been doing it now for a few months, and have been able to get rhythms back from asystole. Have yet to have one walk out of the hospital though.

A non-communicative autistic patient.

This kind of bird, Or some other kind? Honestly, the issue of medical direction should not be this complicated. If you are working in an area that allows physician extenders (PA,NP's) give you an order then, perhaps you should make sure there isn't legislation against it. There is a very simple reason the title is "Medical Control Physician". We work under a physician's license, not a PA or NP's. Someday this may change, but for now don't go looking too far into it.

For most it will be supportive care only. Diagnosing the problem is a challenge, but appropriately treating said problem would be near impossible. The resources that are allowed in prehospital care just don't make much allowance for these patients.

Anything beyond the status quo initial education. Nobody is coming out of their intial program knowing what the information is trying to tell them. More critical thinking, and pattern identification.

No trips to McDonald's, and as little "handling" as possible. But on topic, I'm curious how the Stryker bariatric gurney can be considered secured if both guide wheels aren't in the catch. I've not seen the design, but that doesn't sound like a good idea. Bariatric equipment is a myth in west AZ. No one has it, and no one wants to consider getting it. Sorry guys, Southwest doesn't count. They are in metro Phoenix, and most don't consider them a leader in anything.

Echoing Rid and Dust, our diagnostic ability is limited by the educational level and the tools we have available. Consider that there was a time that doctors were diagnosing without CT/MRI/lab values. This is basically where we are now. Quite possibly the single most underused tool we have at our disposal is the thorough history and physical exam. Can't diagnose, can't treat. Can't treat, why respond in the first place?

MRL is still producing equipment, so you should be able to contact the company directly.

Some of this kid's organs may have fewer issues than his brain and lungs do. Keeping him alive to justify harvest might be the best thing this particular patient does for society.

The Hx added to the meds would probably be co-factors. The intubation didn't make him arrest.

You could consider treating it like any other sympathomimetic toxidrome. Benzo's are your friends. The anti-cholinergic situation would best be left to run it's course. Using a cholinergic agonist is really only intended for critically ill, and you really don't have any options.

Sorry guys, but I've got to disagree with Dust on this one. ECG interpretation needs to wait until you have a good grasp on pathophysiology. Knowing the identifying characteristics of a given rhythm, means nothing if you don't understand the underlying disease process. Spend the time/effort in figuring out how the body systems work when things are amiss. An A&P class will explain the where's/how's of body function, but most don't spend much time describing why dysfunction presents the way they do. Acid-base, fluids & electrolytes, cellular injury, & the immune response will be involved in every subject that you will cover. It is the base of information for you to build on. Trouble is, most programs give it lip service and move past it. Good luck to you.

Atropine can increase the heart rate in patients on beta blockers. The beta blockers tend to reduce conduction through the SA & AV node, and Atropine will reduce the influence of the vagus nerve on these portions of the conduction system. It may not be a great increase, but it can work.

The recommendation for defibrillation energy is the "maximum allowed by the device" Most monophasic devices this means 360 joules. Biphasic energy will vary by manufacturer. Some have a maximum of 150, some 200, still others at 360 joules (Physio control Biphasic equivalent). The energy delivered will depend on the intrathoracic resistance, and the type of waveform that the device generates.

16 hours post ingestion, I would expect her kidneys to be coming out with the urine. The metabolic acidosis should have created a Kussmaul respiratory pattern, and she should have been producing urine by the gallon. With those signs absent, it would be tough to justify giving bicarb. It's used to alkalinize the urine to help the kidneys with the acid load. Since they weren't working too well, at this point, you would need to know the pH and PCO2 before giving it. Rough call.

You didn't even need to try to incorporate a trauma situation into this one. She already had it done for you. A stroke/CVA/TIA is a traumatic event to the brain. Problem solved.

Come now Dust. The vacuum splints are great once you get the learning curve managed. Oh, and don't let a receiving facility try to cut them off. Styrofoam pellets everywhere. Almost worse than cutting through a down lined coat.

Worse, aside from the few LEO's that have responded, there would appear to be a definite "cowboy" attitude about the situation.

With the number of medications that are introduced daily, you have to just to maintain your base knowledge. Meds that I've not run across before get looked up, then of course the conditions they are used for if I'm not sure about them. www.Idon'thavethefoggiestclue.com.edu

Check the link I provided earlier. Excess sympathetic discharge occurs due to the body trying to compensate for the progressive heart failure that leads to the transplant. Once the transplant is done, the adrenal medulla is still producing an excess amount of catecholamines. The excess causes the new, presumably healthy, heart to run with a moderate tachycardia. It also creates a mild hyptertensive state.