AZCEP

I'll throw it out there for grins, but I'm doubting it even as I type it. Diffuse Axonal Injury. Maybe it's the pessimist in me, but this doesn't sound like the run of the mill bump on the noodle.

Rescue is a fire department role. Understanding what it will entail should be undertaken by everyone that is involved. When the tools come out, let the FD handle it. When the patient comes out let the ambulance handle it. Split the jobs, share the responsibility. Now back to reality.

There are a number of online CE programs available, and the EMS based one's that I've participated in have been garbage. The useful programs are those that make you think about the problem that is being discussed, or make you consider how to apply the information. The EMS directed examples dumb things down to the point that little, to nothing is learned. Much of the included information is regurgitated from the EMS textbook of the month, so there is very little new and applicable information. Medscape and cyberrounds have some pretty good programs. Even though they present the information well above the standard EMS mindset, the applicable information is very useful.

The AHA 2005 guidelines have been in effect since January 1, way to go Whit. You got something right. Since that statement, you've accomplished nothing in the form of usable information. The AHA guidelines are the recommendations that most services use for cardiovascular emergencies. If your medical director wants to allow something that is not in the AHA guidelines, then that is the authority that you must follow. Your agreement or disagreement with your protocols is a non-issue. You follow your medical direction's wishes, or you find other medical direction. If your agency/department/medical control has enlisted in studying how the new AHA guidelines work, then most of the narcotic based cardiac arrest patients will be eliminated from the study. If you want to study the effects of Narcan, on a cardiac arrest population due to narcotic overdose, this would be the perfect sample to include. Don't you think? In an attempt to return to the original question, luckily, most of the southwest hasn't had a significant spike in narcotic overdoses. Our overdose of choice would be prescription narcotics, or homemade concoctions of items that are easy to come by. Jimson tea, and methamphetamine issues occur much more often. If you would like, I could send you a care package with my Narcan supply. It sounds like you have more opportunity to use it than I do.

Interesting idea, but from the description provided there are too many problems that would be caused. "Welding" tissue together? What happens when the healing process ends? Where does the "weld" go? Creating cavitation in the blood stream? How much free air are we willing to send back to the heart? Too many issues as it stands.

The intelligent mind will find all measure of ways to overcome even the most difficult challenges, up to and including winning a war with another human being. Sun Tzu I don't know Ace, just thought you could use some perspective. Cheers, pal.

You also might want to look into the approved uses for your area. Most regulatory agencies have a list that they make available so that you know what they want you to know. It is usually pretty basic, but will help guide you for your area.

:shock: Wow, this is pretty deep. :shock: Not all pain is useful, just as not all pain relief is either. Obvious, or oblivious stupidity usually responds to the education offered by pain better than, say chronic abuse of an organ system. The nice thing about the situation presented, is humans are the only animals capable of learning from other's mistakes. This doesn't happen often enough, but it is possible.

Hopefully, the providers that missed this day in class, or didn't have this day, will take the time to read through this information. Then hopefully, we will get some more educated discussions about these things that what has been going on recently. :roll:

I'm not giving you the answer on this one. I did that once, and you learned nothing, so you will have to find it for yourself. That is, if your ego will allow you to realize that you don't know something.

Not unless they all have specific jobs that they know they have to do before they arrive on scene. Otherwise, you end up herding cats.

I've used 0.1 mg of 1:10 000 before, but this is the first I've heard of smaller SQ/IM doses. Wrong or right, I guess it makes good sense if the wait time before the next dose is fairly short. Seems a bit restrictive from a treatment guideline perspective, but I don't want to bash someone else's situation. Too many unknowns for me to do that. Just look at the "glucagon discussion", and the ugly direction that took, for example.

If you look into it further, you will find that no one is buying into this "proposal" Yes, it was approved, mostly by department chiefs that don't understand the necessity of highly EDUCATED providers. This group would rather turn out large numbers of minimally TRAINED people, so that their numbers look better.

Remember this for the next time. Good job treating the patient and not the ECG! Excellent work staying ahead of the problem, as well. What type of industry is this in? Rather unusual to have that degree of medical staff onsite, that close to a receiving hospital. The progression of the twelve lead's would be interesting to see.

There has been numerous discussions about the prehospital triage/transport to capable facilities for each of these groups of patients. The AMI goes to a cath lab, the trauma patient goes to a trauma center, and the stroke patient goes to a neuro center, that simple. It does no one any good to transport to the "nearest" facility that can not perform the treatment that is needed when we come in the door. These patients have to be identified and transported directly to a facility that can fix the problem. If this means using air resources to justify bypassing then so be it. Very unusual to find medical direction that opposes patients receiving appropriate treatment.

The ventricles will provide an escape pacemaker site when the rate drops below their intrinsic rate of less than 40/minute. We would expect the junction to provide an escape at rates between 40-60/minute. In this case, my guess would be that this patient was on a medication to blunt this response, probably a beta blocker. Now, when the heart is in diastole the coronary arteries are being perfused. While they are perfused the heart is receiving freshly oxygenated blood. As long as there is some oxygenated blood perfusing the myocardium, the escape pacemakers will not become irritated to the point where they take over the rhythm. If this patient is on a SNS blocking agent, like a beta blocker, and the last contraction of the myocardium gives good perfusion to the coronary vessels, there is less reason to expect an escape pacemaker to take over. The fact that her mental status changed a bit during the pause, shows us that the forward movement of oxygenated blood was a problem.

It is reasonable, but unusual. If the patient needs Epi to attenuate the anaphylactic response, doesn't that usually mean that they need it to work more quickly? I'm just having a tough time wrapping my brain around the logic, but I don't make the decisions. Next question, how long do you wait to give the follow up dose?

I could be wrong, but aren't fibrinolytics contraindicated for patients that have had prolonged CPR performed? How exactly this is supposed to help the treatment of a progressive problem, like say, asthma or hypovolemia, I'd like to know. I'm willing to try anything once, but this one just doesn't make too much sense to me. :oops:

That is an unusual dose for Epi in anaphylaxis. Considering this patient is on a beta blocker, you need to consider that standard issue treatment might not be effective. Thus the consideration of using glucagon.

If he hadn't said he lied, would have you set him straight?

Reminds me of a line I heard once, "The doctor told me she died of a ruptured ventricular septum, but I know she died of a broken heart."

This issue is not about our Canadian neighbor's ability. It is entirely an issue regarding the lack of education that EMT's in the U.S. receive. Can they perform the procedure, absolutely. Should they, not under the current system. My biggest concern, is the lack of information that will be provided to these folks, in the course of their EMT class. There is no way to educate them about the way a disease like diabetes works, much less how a drug like glucagon does. I'm sure everyone would agree, pharmacologically, glucagon is a pretty complex medication. When it is used right, it is very good. When it is used wrong, it is very bad. If we are going to allow EMT's to administer any drug, besides oxygen, then we have to consider the amount of education they are going to need to do so safely.

Here's a system that looks pretty slick http://www.jems.com/jems/31-6/106692/ Instead of having a hang on the wall system, this device uses the pressure from the oxygen flow to generate the needed pressure. Much cheaper than other systems as well.

Race, It is off of an LP12 using the 50 mm paper. The monitor ID is on the bottom of the strip at the far right. I have a hard time thinking that this is AF. The rhythm is regular, and the "P-wave" that comes before each complex looks pretty similar. Even considering that it is only lead II that we are looking at. Looks to me like the pause is triggered by a blocked PAC. The downslope of the preceding T-wave looks a bit funky. Besides, the most common cause of an unexpected pause is a blocked PAC, to quote a local cardiology guru. The pause in strip #2 is ungodly long, but it is still being caused by a premature complex. I guess the adage holds, show 4 people one strip and you will come away with 4 different interpretations.

Try capnography.com