AZCEP

You just might be making this more complicated than necessary. Check rxlist.com for more specifics on the pharmacology. Calcium chloride: -Hyperkalemia is a pre-existing condition that leads to cardiac arrest. The hyperkalemia that presents following cardiac arrest is a result of the typical acidosis, so the lab value is elevated, but the actual amount is not increased. Atropine: -It will usually be used to reduce the vagal activity that comes with the process of intubation. When using it to reverse Norcuron(vecuronium), the idea is to allow the normal mechanisms of acetylcholine transmission return. If you are using atropine to reverse Norcuron, it is because you have discovered that you can't get the patient intubated, and don't want to provide BLS airway management for the 40+ minutes until the Norcuron wears off.

Asys, Thank goodness that not all paramedics look for the patient to present like the book tells them they should. I've had a number of patients present with VT and not have any other associated symptoms. No shortness of breath, no diaphoresis, nothing. As a routine, I check a pulse with my initial contact, otherwise it would have been much longer until I decided to put the monitor on. :roll: One question, if the patient you describe had their rate slow and you could identify atrial flutter after the lidocaine, wouldn't that mean that the lidocaine was effective at controlling the ventricular rate? Oh well, you don't have to convince me that you did the right thing. Sounds like the patient improved from here.

NOPE

BARF

Thank goodness for functioning kidneys

CURT

Depends on the reason you are using it. In the strictest sense, oxygen is administered to alleviate tissue hypoxia. If this is why you are using it then yes it can. Apneic patients with a pulse, I've seen them stabilize following only oxygen therapy. Respiratory failure, some PPV can turn them around rather quickly. These things don't happen often, but for those patients that the only thing we give is oxygen, and a therapeutic response is achieved, then I would say that oxygen can save a life.

CAST

There are few medications as potent as Verapamil. Good or bad. There are times when it is the only drug that will work, and times where the best response will be a cardiac arrest. :roll: Cardizem has replaced it in most systems, but we still have it. For the patient with uncontrolled Afib, Verapamil is the drug of choice--since we don't have Cardizem. If the patient doesn't respond to Adenosine, and they are maintaining their vitals, Verapmil can and will work very well. If you are aware of the side effects, and how it works, it is just as safe as anything else. Projectile vomiting typically happens when it is given too fast, and cardiac arrest tends to show up when the patient is too compromised to receive it. I've had good luck using it, but haven't needed to in about a year.

The first day of class is typically spent getting you oriented to what the program will expect. Grades, interactions, layout of the facility, etc. Be sure to ask any questions you have. It is the only way your instructor will know what needs clarified. Good luck to you.

The nerve that was nicked, is really immaterial. Fact is, it sounds like it happened, along with some pretty poor securing of the catheter, causing the symptoms you describe. It still sounds like a spinal nerve instead of a cranial nerve with the numbness into the hand, but all academic at this point. :roll:

Here is a list of articles from EMS Responder for your subject. I didn't see any that were directly related, but I only glanced at some of them.

Just a guess, and I'm not going to show up in court to admit to it, but it sounds like they may have nicked the brachial nerve. One of many common complications of central line placement.

Not with an NPA, but with a nasal intubation. I wasn't really looking for it either though.

If you are pacing someone, you need to consider the discomfort that you are causing while you are doing it. None of the BZD's have any analgesic properties, they are good to help the patient forget, but do nothing for pain. As the blood pressure comes up, and the patient becomes more aware of what is happening, you need to treat the agitation and the pain. Fentanyl is the best choice for pain relief, Etomidate can work in this setting but has a short duration, Ketamine is another good choice if available.

It will actually be a bit of all three. The heart rate is slowing down because of the inability to perfuse itself, and damage to the SA node is a good possibility. The bradycardia can also be induced by a vagal response to the areas that are being damaged. The treatments that have been mentioned will help some with all three as well. Oxygen/ASA/NTG, maybe/Dopamine, possibly/Rapid transport to PCI or fibrinolytics. If the rate stays where it is great, if if slows further big problems. If it speeds up too much, the MI gets bigger. This is the best example of balancing good and bad responses in prehospital care. Our goal needs to be to balance the rate increase with the perfusion of the myocardium. Tricky at best. :wink:

http://www.emtcity.com/phpBB2/viewtopic.php?t=4822 Same topic is going on elsewhere. Take a look.

Spot on JPINFV! The provlem with evidence based practice is who is gathering the evidence. Much like any investigation, if you gather just enough to prove/disprove what you want to happen, it will. MAST suit anyone? Prehospital intubation of TBI sound familiar? Then there's the matter of who is sponsoring the study. Amiodarone ring a bell? Many issues, and none of them can be completely controlled for without increasing the cost of what ever it is you are studying.

Go to any of the video repositories on the web, and you will find thousands of videos of people in all manner of negative vehicular interactions. Whoa, that was a bit too PC, wasn't it? Lots of tape, of lots of people gettin' hit by lots of cars/trucks/motorcycles.

You are going to have to ask someone from South Africa to get a better idea. Consider that the individuals on the internet are posting about experiences all over the world that you probably won't be able to apply to you. The education you receive won't be a bad thing altogether, but you might not get what you want out of it. Most don't take an EMT class with the intention of actually using it. Look into the program you are considering, and their curriculum. That will give you a better idea, than anything we can tell you.

That sounds like a James Woods line, John Carpenter's Vampires?

I've found having more than one software package loaded on my PDA to be the best set up. ePocrates and Pepid are the one's I've got now. The combination works really well. Some things that ePocrates is weak on, the Pepid fills nicely. These are just the brands I'm using. There are thousands of others that will work just as well, and perhaps better.

Perhaps a bit "TOO" coincidental. Most people don't spend much time around the process of leather production, so hard to tell what she was reacting to. Good time to suggest she not go into shoe making as a career.

Quiz: How Old Are You Really? From the following list of 25 items, count all the ones that you remember -- not the ones you were told about! How to score yourself is at the end. Blackjack chewing gum Wax Coke-shaped bottles with colored sugar-water Candy cigarettes Soda-pop machines that dispensed bottles Coffee shops with tableside jukeboxes Home milk delivery in glass bottles with cardboard stoppers Party lines Newsreels before the movie P. F. Flyers Butch wax Telephone numbers with a word prefix (e.g., Olive - 6933) Peashooters Howdy Doody 45-RPM records ... and 78-RPM records S&H Green Stamps Hi-fi systems Metal ice trays with lever Mimeograph paper Blue flashbulb Packards Rollerskate keys Cork popguns Drive-in theaters Studebakers Washtub wringers If you remembered: 0 - 5 = You're still young 6 - 10 = You are getting older 11 - 15 = Don't tell your age 16 - 25 = You're older than you think!

Here is a quick bit from rxlist.com: