AZCEP

I will be the voice of dissent for this topic. I carried a pocket guide of one form or another for 10+ years and used it once to look something up. Even with the repeated updates, I never found one that I could rely on to have the information I needed when I needed it. Especially, with the number of new prescription medications that are released on a daily basis. If you want to invest in your future, might I suggest one of the numerous PDA's. Palm and Pocket PC are both decent operating systems, and for some you can incorporate the PDA functions into your cell phone, and eliminate one more thing to carry. There are a number of different downloadable resources that update frequently, so you can stay ahead of the curve. Yes, they are more expensive, but they are well worth the cost. Before you decide one way or another, you might give one a look.

You've just contradicted yourself. Maintain blood pressure, sedate--possibly RSI, secure an airway. Any strange odors coming from the patient? Acetone, ammonia, almonds, etc.? Might try some Thiamine while thinking of something else. Have we got lab values available? Consider some Narcan, if the history suggests some narcotic use since the surgery. Could this be an anti-cholinergic toxidrome? Need to find out what medications she was put on after the procedure.

I have no freakin' idea what movie this came from, and I've spent all day looking for it. :x It sounds like a line that Vince Vaughn would say, but I can't nail it down. Between the research articles and the obscure movie lines, do you ever see the light of day Ace?

A recent article on EMSresponder.com indicated the FDA refused to allow the Navy(?) to test Hemopure. It didn't really go into the why's, but there seems to be some concern about Biopure's ability to sustain manufacturing of their product. Right now the value of Biopure stock is just above raw sewage.

Considering most medics only know to use NTG/Lasix/Morphine for CHF from rote memorization, we really shouldn't be so quick to criticize. We had a discussion this last week in class about the proper management of a trauma patient. Standard issue multi-systems, unresponsive, airway compromised, blah, blah, blah. One of my students spouted out RSI shortly after finding out that the patient had a gag reflex, but their airway was full of fluids/foreign bodies. The room went deathly silent when I asked him, "Why?" His ego got bruised, but he was able to work his way through the minefield that was layed before him. Figure if we don't question them now, they won't be prepared for someone more important to question them later.

Okay, GA, after looking at the QA file for the last year, I can say with all assuredness that every patient that met the recommendations from the AZ Poison Center for the administration of Activated Charcoal received this drug. We had a total of 8 ingestions. Not many granted, but that's what we had. 5 were attended within 45 minutes of the ingestion. 2 of those were confirmed ingestions of substances responsive to AC, and 1 did not have an associated airway compromise. Each of them had the poison center contacted while enroute to the scene--long response times--and the recommendation was given as noted above. There you go. I hope that you are satisfied.

Careful your audience when you start throwing around how much you know. Some departments, prehospital included, can be quite entertaining to watch. The fact that they called for your assistance, does not in any way indicate they did not know what they were dealing with. Seeing how you didn't consider the causes of this patient's presentation indicates neither did you. I must ask, why no air transport? The drive time alone would have been a pucker factor of about 12 with this situation.

Amazing what a couple minutes in a dark room with Google can get you, eh?

EMS as a whole is taking little steps sideways, with an occasional stumble forward. Each individual service is as much responsible for holding things back, as they are for advancing them. Why don't more have 12 lead capability? Too expensive to justify. Why is capnography slow to take hold? Same reason. Why should providers be expected to pursue a degree program, when they get the nuts and bolts from their department for free? National administrative level leadership? Pipe dream. Local political backing? Not unless the mayor/town or county government needs you.

Wind: the pulmonary system is the primary source of fever in the first 48 hours. Wound: there might be an infection at the surgical site. Water: check intravenous access site for signs of phlebitis. Walk: deep venous thrombosis can develop due to pelvic pooling or restricted mobility related to pain and fatigue. Whiz: a urinary tract infection is possible if urinary catheterization was required Wonder drugs: drug fevers.

Fair enough.

Morphine and Fentanyl? And to think, I have to be content with Morphine and baby ASA.

AMR has a number of these units in service nationwide. You could probably find one of their offices nearby and stop in to check out how they did it. Many of the other larger corporate agencies have done similar projects. Southwest Ambulance in Mesa, AZ has one. Rural/Metro has a couple.

I saw this on the EMS responder site, and I'm having some difficulty understanding exactly how they are doing this. Maybe some insight could be provided by the learned among us. Study: Cardiac Resuscitation Can Be Performed with Constant Flow Insufflation of Oxygen Biotech Week via NewsEdge Corporation 2006 JUL 19 - (NewsRx.com) -- Constant flow insufflation of oxygen (CFIO) is a simplified alternative to mechanical ventilation (MV) for cardiac resuscitation, with favorable effects regarding oxygenation and fewer complications. According to recent research published in the journal Intensive Care Medicine, "CFIO through a Boussignac multichannel endotracheal tube has been reported to be an efficient ventilatory method during chest massage for cardiac arrest. Patients resuscitated for out-of-hospital cardiac arrest were randomly assigned to standard endotracheal intubation and MV (n=457) or use of CFIO at a flow rate of 151/min (n=487)." C. Bertrand and colleagues, Henri Mondor Hospital, wrote, "Continuous chest compressions were similar in the two groups. Pulse oximetry level was recorded every 5 min. Outcome of initial resuscitation, hospital admission, complications, and discharge from the intensive care unit (ICU) were analyzed. The randomization scheme was changed during the study, but the in-depth analysis was performed only on the first cohort of 341 patients with CFIO and 355 with MV, because of randomization problems in the second part." They continued, "No difference in outcome was noted regarding return to spontaneous circulation (CFIO 21%, MV 20%), hospital admission (CFIO 17%, MV 16%), or ICU discharge (CFIO 2.4%, MV 2.3%). The level of detectable pulse saturation and the proportion of patients with saturation above 70% were higher with CFIO. Ten patients with MV but only one with CFIO had rib fractures." The researchers concluded, "CFIO is a simplified alternative to MV, with favorable effects regarding oxygenation and fewer complications, as observed in this group of patients with desperate prognosis." Bertrand and colleagues published their study in Intensive Care Medicine (Constant flow insufflation of oxygen as the sole mode of ventilation during out-of-hospital cardiac arrest. Intensive Care Med, 2006;32(6):843-851). For additional information, contact C. Bertrand, Paris 12 University, Hopital Henri Mondor, Boussignac Study Group, Dept. of Anesthesiology & Emergency Medical Service Creteil, AP, Creteil, France. The publisher's contact information for the journal Intensive Care Medicine is: Springer, 233 Spring Street, New York, NY 10013, USA. Now, does this mean by using a special tube, we secure an airway, hook up the oxygen supply tubing and let fly with compressions? That just seems too simple.

Move to the transport unit, continue with above mentioned suggestions. Bilateral IV's, blood glucose, cardiac monitor, capnography, and pulse oximetry. Any pain meds in the shoe box? Could be pain reliever following the surgery. Untoward response to a narcotic can present like this. I'll agree this sounds like an infection, but there is the possibility of other causes. If she remains combative, we might consider sedation chemically. No reason to fight if we don't have to.

Well now, that sure explains a lot of things.

How is this not the same line? :?

Mitch Hennessey in "The Long Kiss Goodnight" "You're a regular legend in your own mind." "The Almighty tells me he can get me out of this mess, but he's pretty sure you're fucked."

First, let's make sure we post in the right place. Folks don't tend to look for great enlightenment in the Funny stuff forum. Next, is this a multiple choice question? If so, you can eliminate at least two of the possible answers. Does the question give you any specifics about the patient's condition. Vital signs, associated history, etc, will all give you clues as to what direction you should go. If this question is being related to your local protocols, then that will change some of the possibilities also. Some medications could be considered, but if your area doesn't have them, then you wouldn't expect to be tested on them.

When they tell me this, I like to ask them when they think they will be ready to get into the real game. How come cows don't lose their skin after they go through a wet/dry session, but any other leather product will? How do you know when sour cream goes bad? Does it start hanging out in shady neighborhoods, not answering your questions, staying out late and not calling? Interstate highways in Hawaii? I've yet to see the interchange so I can drive there. If laughter is spelled this way, why doesn't daughter sound the same? How is it possible to have "1 member chatting"? Who are they chatting with, and why do they need the chatroom when they could do the same amount of communicating in any other room?

That would be from North by Northwest. A bit obscure, I grant you. How about: "Have you ever danced with the Devil in the pale moonlight?" And from the same movie: "This town needs an enema!"

And some of those points are very good ones, I would have a hard time justifying some of the suggestions in my own mind, but I'd probably be willing to give them a go after some significant time to consider them. Thinking "outside the box" presumes that you have an intimate knowledge of what is inside said box. I don't recall seeing it mentioned, but wouldn't CPAP also be beneficial to this patient? Just another thought to further muddy the field.

I'm going to disagree with some of Ace's treatment suggestions. Low blood pressure, slow heart rate, wet lungs-->cardiogenic shock Milrinone would not be indicated, because it has the potential of vasodilation, and increasing the myocardial workload. It works very well for the CHF patient with an acceptable pressure, but I would stay away from it for this one. The glycoprotein 2b/3a inhibitors don't play a role in the early treatment of an STEMI. Following the cath lab, they might be considered, but not until then. Same with Plavix, although if there is an allergy to ASA, it would be the drug of choice. An ACE inhibitor isn't recommended for the emergency treatment of STEMI. Leave it for the cardiologist to deal with after we get her to the PCI facility. Tell me you were kidding about the beta blocker for this patient. If the heart rate and blood pressure can tolerate the drop in cardiac output, then fine, but I don't think this patient can. Lasix might be helpful, but again we are going to need to get the blood pressure up first. Dobutamine might make the heart rate increase, but it can also vasodilate, making the pressure worse. I would also be very hesitant to use Levophed, but it might be the only tool to increase rate, and pressure. The risk of expanding the MI is too big to be comfortable with. I do agree with the Dopamine, TCP, using Etomidate as the sedative (no analgesic properties), Vasopressin drip (a little unusual to be able to use, but why not?), and the consideration of Tridil once the pressure comes up enough. As I've said before, this is a great discussion topic.

:shock: That sure explains a lot of the questions that nursing staff ask, now doesn't it. :shock:

I have to agree with chbare on this one. Propofol is very good for sedation, but using it on a known head bleed is asking for trouble. Fentanyl/Versed would be a more common mix in my area. Versed would be the occasional IV bolus, with Fentanyl by infusion.