AZCEP

Yes, the administrators have to be a bit creative, but it can be done. Taking the L & S away is fuel for an entirely different discussion, but it does have merit.

I would suggest asking the preceptor for some clarification. I would bet that the answer they give will be along the lines of, "That is what it says in protocol, so that is what we do." This is the type of psycho-motor monkey bologna that gets us into trouble in the first place. I am encouraged that, as a student, you are taking the time to try to understand the process at hand, though. As Rid already said, you will not be using enough fluid to actually make a difference when dealing with the osmotic movement of fluids. In the event you are, D5W would draw fluid out of the interstitial space due to it's slight hypertonicity. This little bit of hypertonicity would not be enough to have a clinically significant effect. If you gave enough to get the effect that you mention, you would end up drowning the patient anyway. I would also recommend asking the medical direction for some updating of the protocols, or wait until you are done with school, and decide to go somewhere else.

You are going to have to give a little more information as to what your problem is. D5W isn't used very much for anything. More commonly, you will see it used as a mixing solution for medication infusions. For administration, you will be giving it IV.

Ace, I think you meant Korotkoff sounds. Korsakoff is a whole different situation.

No ECG will tell you that someone is having pain from a cardiac source. The ECG is simply a visual representation of electrical activity, or for a better description a $12K voltmeter. It tells you that the electrical system is/is not working, that's all. Your assessment will determine what is causing the pain, not an ECG that you might not be able to do anything about anyway. As inaccurate as this "toy" is, I have to wonder why you would want to base your treatment on what it is telling you anyway. Even the "lethal" rhythms that it is supposed to help you find need to have more than this applied in order to fix them. Save your money for something that might actually help you, because this really won't.

Check jems.com to start. The author was referencing the hypokalemia that can happen when patients self administer albuterol for an extended period. Potassium is maintained in a pretty narrow range in the body, so small changes in either direction can cause huge problems. Before Dustdevil weighs in, -5 for posting an ALS subject in the BLS forum.

My question would be, how exactly do you "dessicate" something to someone? Thanks for the sentiment.

Unless you want to glue their lungs completely shut, leave the Benadryl alone. Keep in mind that not everyone will respond the same way to the same drug. Some will have a full blown cholinergic crisis when you give them Benadryl, some will nearly stop breathing from the CNS depression. I would recommend you looking these things up for yourself though. Easier to remember the information if you do some work to get it.

Good stuff from everyone! I will suggest learning where the parts are first, then learning how they work. Most A&P courses are put together this way for a reason. Learn one system at a time, then you can figure how they will work together. The heart does this, the lungs do that, together they will do...? Once you get this straightened out, look into the pathophysiology. If you understand how the healthy works, then it is so much easier to understand how the sick/injured doesn't.

Seems to be one more tool that some will have, and some won't. Of those that will, they won't need it very often, or certainly not enough to offset the cost. For the patients that are described in the article, it would seem that alternatives already exist. I'm not really sure how the simplifying the technology to make it cheaper is going to help. The inventor mentions that it scatters the signal more than they would like, and that the beam is fairly narrow at the same time. This reeks of someone having too much time on their hands. How in blue blazes are they generating a 3D image without a video screen to look at it? If they are cheapening the manufacturing process, how will they maintain any level of durability? If this is only as big as a writing utensil, which crevice will it find itself lodged in when you need it? Nope, I think I will pass. Now if they could put a three color display in the works, they might have something, but that would wreck the cost.

You said "wood" Viagra/Levitra/Cialis all work the same way, with different life spans. I will agree that if you must seek answers, having them given to you is not a good way to remember the responses. I suggest you try rxlist.com for the knowledge you seek.

When you have elevations in leads that look at that many different parts of the heart, particularly with the little bit of a history you provided, it is either endo, or pericarditis. Did you listen to the heart? Did the patient have a fever? The "chronic" ST elevation sounds a bit fishy. The fact that the patient is an elderly female should make anyone nervous about the possibility of a cardiac event. Did you consider some NTG? Might have helped the lung sounds a bit. Any treatment option can make things worse, so yes you were right to carefully think about what you were doing. As long as you can learn from the experience it was a good call.

Come now Dust, you seem to be forgetting that crack and meth a very potent beta agonists. Swatting flies with a sledgehammer, but still... :shock:

At the risk of highjacking the thread, perhaps the patients would be doing better if we were to intubate them before they code. The information that I've seen indicates that regardless of what you do after the heart stops, your chances of resuscitation is still pretty poor. My thought is to prevent the cardio-pulmonary arrest from occuring in the first place. In the last 3 years, I've performed 17 ETI's. Only 2 of them on cardiac arrests. 1 of the sixteen ended up dying in ICU, the remaining 14 were extubated and have returned to functional living. Granted not a lot of skill performance, but the ones that have bought the tube, have recovered, so I'm having a hard time with the argument of needing dead people to practice on.

:shock: :shock: :shock: Don't let the US govt hear about this.

Careful with the reliance on the technology gents. I have been witness to several instances where the AED would "interpret" the patient's rhythm to be VF/VT and it wasn't. I know this because I had my manual defibrillator applied after the BLS personnel had their AED attached. AED's will deliver shocks to tachycardias, as well as ventricular rhythms. Tachycardias being over 130 beats/minute in most AED's algorithm, and ventricular rhythms being complexes wider than 0.14 sec. Good compressions are frequently misidentified by AED's as shockable. It is also possible for the AED to "identify" a shockable rhythm immediately following the stop of compressions. If the patient has no pulse, there is very little danger of making the situation worse with an AED. Just understand what the device is/is not capable of doing.

I've got to disagree with Doc. In the grand scheme of things, how much time do the lights and sirens actually save? Truth be told, very little. If the surgeons are forced to take call, then the parties involved should recognize that they will not be in house, and their response will be longer than if they were. I will agree that less time from the incident to the knife will increase survivability, but there are better ways to achieve this.

Know your limitations, and use every opportunity to learn. You'll do fine.

Anyone in Dallas that doesn't take advantage of the yearly SLAM course is not to be considered professional. I've made the trip for the last couple of courses, and it is well worth the bucks. Like I have said before, if the book is good, spending time with the people that write the book is that much better. This course also includes a pig trachea lab, and a cadaver dissection/procedure lab if you want. Take the course. It will do nothing but help you. If you can't be enthusiastic about airway management, then you shouldn't be doing patient care.

The VAR would probably be the better option for this situation. Since it is pressure sensing, it will stop the inspiratory cycle when the pressure is met. We use them, and really like the fact that they free up the solo medic to do other things for a short time.

Maybe I'm oversimplifying this, but where would the "just enough to get good chest rise" fall into this? Also, does this mean that any process that creates an inflammatory response in the lungs would qualify? That would certainly be more than the ARDS and CA that has been discussed. I've never been a fan of the NREMT standard of "800 mL per breath", especially when most can't squeeze the BVM enough to get it to happen.

I will probably be repeating myself, but here I go anyway. If you like the book that Dr. Walls wrote, take out the second mortgage and attend the conference that his group puts on. Yes it is pricey for the EMS folk, but it is worth every cent. Well, maybe not cents 48 and 975, but other than that well worth it. You just can't get all the techniques/tricks down without actually putting blade to plastic with the experts guidance. The best part of the whole program was the BLS airway management. I'll probably burn in ALS hell for saying so, but it's too late now. Most medical schools will occasionally offer up airway management labs/lectures, and these are good for the same purpose. Anyone that has any experience will have a slightly different take on how to do things. Listening to options makes for a good discussion, if only in your own mind.

Wow, 6 replies before it got mentioned. Let me first agree with Rid and Ace. If you don't do a good assessment, why did you bother showing up on scene. Having some idea of your ability to treat is based almost entirely on your ability to perform an adequate/thorough assessment. You may not be able to treat anything that you find, but if you don't find anything you aren't going to do any treatment anyway. The "vowel tips" mentioned above is a good start, but forgets a couple things. A-lcohol -pnea -rrythmia -naphylaxis E-pilepsy -nvironmental I-nsulin O-verdose U-remia -nderdose T-rauma I-nfection P-oisoning -sychogenic S-troke -hock If you are going to use a mnemonic, it can be helpful, but remember that when you find a cause under "A" that doesn't mean that you get to stop there. You can also use O-P-Q-R-S-T, and you probably should.

I don't know Rid, the codes in my hospital are raging clusters. As a BLS level provider, you will probably be expected to do the grunt work. Compressions, bag-mask-ventilation, running for more equipment, etc. If you have no field experience, the humor in the situation will be lost on you. If, and when, you do make it into a field unit, you will realize that having all those resources, doesn't make a better patient care setting. Give me an RT that can ventilate effectively, an RN that can get the drugs we need to have, and a doctor that is willing to listen to suggestions, and everything else will be okay.

If patients would do what they are supposed to, they wouldn't need you in the first place:D This is like saying, the patient started in VF then went to Sinus rhythm with a pulse, and we kept shocking them. Maybe ask the doc to explain his reasoning to you, so you can be better prepared next time. Although, it sounds like you were ready this time. Keep up the good work.