AZCEP

Come, come. Did you really think you could slide this by? Mother, Juggs, and Speed. That's not even the best line in the movie, but it will have to do I suppose. How about another easy one that hasn't been brought up yet: "And you will know my name is the lord, when I lay my vengence upon thee!"

No, no, no, silly hammer :roll: Hooding is the slang term that we use for the line of demarcation that goes along with pulmonary emboli. When working a code, or really sick patient, the "hood" goes from about the level of the pulmonary vein/artery over the face. Nice purple/flushed red color. You really can't miss it. I'm sure there is a more technical/professional sounding medical term for the same thing, but this is what we use.

I may have mentioned it earlier in the thread, but the biggest reason not to mix Amiodarone yourself is the need for a "special" container. The short term management doesn't present a problem, but over the longer period, the amount of drug that is lost, and the amount of plastic that is added to the solution becomes a more important concern. The typical mixing bag of 50-100 mL of NS, probably isn't going to create an issue of Na+ or Cl- overload in the 10-15 minutes it takes to finish the infusion. Over a couple of days it may, but again probably not if there is any semblance of functioning kidneys. For the most part we try not to mix the drug at all, just push real slowly. A good guide, I've found, is pushing the 150 mg dose slowly enough that the 10 gtt/mL drips don't stop during your pushing. Timed it out once, and it came out to about 11 minutes. Feel free to try it sometime.

But in the periphery, the vasoconstriction is due to a compensatory mechanism. It is attempting to keep more of the oxygenated blood in the central circulation by constricting the most distal arteriolar vessels. This takes place before the blood gets to the A-V shunt so the pressure that is available for the capillary bed drops, and the waste products build up, causing the clubbing.

One cardio-thoracic surgery team for table 2! Order up!!! Was there any cyanosis? Can't really say when it actually ruptured, but with the right to left shunt, wouldn't you expect some pumping of deoxygenated blood?

Okay patient intubated, capnography in place, value should come up here shortly. Due to the pressure, get some Dopamine running. Start at 5 mcg/kg/min, watch for better perfusion, prevent excess tachycardia. Consider some Tridil and Bumex, once we get the pressure up to the mid-90's. Might want to place a foley to watch how well the kidneys are perfused. With that done, a CXR, A/P and Lateral. Want to see how full the lungs are, and since our CT is out, we will have to imagine the third dimension. Might also consider an echocardiogram, or bedside ultrasound eval to see what the left ventricle is doing, since it apparently isn't pumping much blood.

Correct me if I'm wrong, but isn't CPAP only used if the patient is responsive? This patient just bought himself a tube/vent combo plate. Since we have the cool guy unit today, let's get an ABG and a chest CT

Capnography? What is the rhythm on the ECG? What is the frontal axis? Where does the QRS become mostly positive in the chest leads? Are the radial pulses equal? Are pedal pulses palpable, and are they equal? Any carotid bruits noted?

JVD? Hooding? Tracheal deviation? Oxygen NRB/IVs/ECG--12 lead if possible/BGL Move quickly to transporting unit.

Anything out of the ordinary for the neighborhood? Where is the patient found? What does he look like? Responsiveness? Respiratory effort? Skin color/condition?

We looked at them briefly, and just were not impressed. The King LT does a much better job, and is just as easy to place. The C.O.P.A and the Cobra PLA both have the issue of sealing the oropharynx from above, but not securing the glottis from below. The design looks like they were trying to find a way to have patients aspirate without getting the providers dirty. Good thought, poor execution.

It would appear from the thread in question, the last by Alert and Ace both got removed. Play nice boys or you will be sent to your rooms.

Jay and Silent Bob Strike Back "Gentlemen, you can't fight in the war room!"

Whoa! Where was the "attack"? Has any mass casualty incident ever gone as planned? You and your system can have as many pieces of equipment as you want, and the people managing the incident can be doing everything right, and things will still have to be improvised. System knowledge or not, the point is you can't prepare for every eventuality.

I think you may be looking at the end point as a cause. The increased PCO2 tends to be a result of the vasoconstriction. The cor pulmonale/right heart failure situation can also cause an increase in the CO2. COPD tends to constrict the capillary bed through the physical force that is applied as the alveoli expand against the capillaries. Check the EtCO2 thread for further.

92 year old female fall We arrive on scene ane are met by daughter and son-in-law, who explain the situation a bit. Shrugging it off we enter the house and find this young lady lying on the kitchen floor, head up against the base of the fridge, with and obvious anterior dislocated hip/femur. We ask the standard issue history questions, and discover, quite possibly the healthiest 90+ year old person on the planet. No meds/History/prior surgeries/NOTHING. My partner grabs the gear from the unit, while I'm explaining what I plan to do. Standard stuff, oxygen/IV/little "happy juice" This patient looks at me, and starts to give me a hard time, all the while laughing at my reactions. I was having a tough time deciding if she was serious or not. :? So, IV established, 5 mg of morphine in, and she starts to feel better. We carefully roll her onto the LSB with the MAST in place. Wrap her up, inflate enough to immobilize, and use 5 mg more of Morphine for the carry to the gurney/ambulance. So now we are about 25 minutes in, the patient is feeling a bit nauseous from the morphine, and we are finally on our way to the ER 40 minutes away. 12.5 mg of Benadryl for the nausea, 3 mg more morphine and we transport without incident. Turn over patient care to the ER, who is questioning why in God's name we used the MAST, and 13 mg of morphine. At this point, the patient wakes up enough for the entire staff to hear her tell us, "You boys are the best." I tried to thank her for the compliment, and she replied "Don't you let these nurses give you a hard time, they weren't there to help you." We thanked her again, and hoped we could have some more patients like her.

The gentleman that runs the DT4EMS site is well versed in pretty simple self-defense type moves. It is well worth the time/trouble to look into ways to protect yourself, even if you never plan on using any of them. Most pilots never plan on crashing, until...

A large corporate entity like AMR/Rural-Metro can and will make decisions based on the bottom line. They will tell you in advance that they are concerned with the well being of their employees, and of the communities they serve. Then they will tell you that they will cut jobs and service when they realize the corporate bottom line is being threatened. Are they any worse than any other organization, definitely not. Just don't go in with a warm-fuzzy because of what they told you in the beginning. The whole situation will hinge on the people that have to carry it out. If you know the people that will be given this job, you might consider asking them. If you don't, go into it with an open mind, and keep your guard up.

From the desert Southwest, very few things actually help during severe heat. When the boots melt to the asphalt, and helicopter skids sink into concrete, you can have ice water running down your back, and you will still be hot. The under armour type clothing helps when the humidity is less than 20%, after that the evaporative quality is severly limited. Cotton undergarments get drenched with sweat, and you actually feel hotter than usual. The cooling that you feel is the wet cloth attempting to evaporate. The long sleeves helps to insulate your body against the radiant heat, not so much the thermal conditions. Every little bit helps though. The neck wraps are a good short term fix. Anything over about 20-25 minutes, and they start to warm up. Keep yourself hydrated, keep some cold packs at hand, maintain due vigilence of how hot you are getting, and remove yourself from the environment as quickly as possible. When you are on scene, remember that your patient has been there for a while before you got there, and they will have some of the same issues.

Sulfa powder was a commonly used topical antibiotic that has been phased out of most places. There are plenty of other issues that are more concerning, but the question will remain until the "Sulfate" is removed from the packaging. As Rid said, the sulfite and sulfonamide structures are different enough that one causes a reaction, and the other doesn't. People that tell you they are allergic to "sulfa" need close monitoring if you use Lasix, and you might even want to consult with medical direction beforehand. The risk is slight, but very real. It is not a common problem, but you don't want it to happen either.

The safest way for the EMT to open the mouth is to have the fingers as far away as possible, but most medical directors frown on using a pry bar to do it. The scissor-finger technique is the easiest to perform, if the patient will allow you to do it. Some will have their jaws clenched tight enough that nothing will get them open.

We do aim to please! Some simple pathophysiology, sprinkled with a bit of pharmacology, stir in some critical thinking. Bippity, Bobbity, Boo! You know how something works.

Perhaps this might help. Sympathetic system is the gas pedal. Parasympathetic is the brakes. If you take your foot off the brake, but don't apply the gas, the best response you can get is to not slow down. Now, when the body releases histamine the sympathetic system responds by releasing it's agents into action. When this happens, the CNS becomes more active along with everything else. If the histamine release is blunted, then the SNS does not need to go to work. Therefore, no increased activity. Because the PNS has been activated, the body can more easily respond to the need for action, the brakes have not been applied.

We can, and we do diagnose on every call, for every patient that we encounter. Our diagnosis may be limited, might be "provisional", however, it is still a diagnosis. You palpate crepitus, do you need a radiologic exam to tell you the underlying structure is damaged? Probably not. You take a series of blood pressures. Do you need any other test to tell you the patient is hyper-, or hypo-tensive? Of course not. Your 12 lead shows you an AMI. Do you wait for lab tests that are less sensitive to tell you the myocardium is dying? Surely not. You perform a finger stick blood sugar, and find that the number is a record low. Do you need to wait until your arrival to diagnose, and subsequently treat the hypoglycemia? Why would you? Yes, we are limited in what we can diagnose, by the availability of testing resources. Will we be sure it was a pulmonary embolus that caused the arrest? Will we definitively know that the CVA was ischemic/hemorrhagic? Can we determine the abdominal pain was the liver or the gall bladder? Probably not for all of them, but we can use the information that we gather for those conditions to limit the possibilities.

The coronary arteries are perfused by the backflow of blood against the Aortic valve. The RCA and LCA are located at the base of the aorta and are covered by the aortic valve during systole. Once the contraction of the left ventricle ends and the pressure gradient falls, the valve closes and the coronary arteries are perfused. What is a Mallory-Weiss tear?