usalsfyre

I believe it's Rural/Metro.

Are you saying this guy is your boss?

A couple of thoughts here.... There's no point in trying to force a patient into a particular mode of transport (or for that matter transport at all) if they are in full control of their faculties and refusing. Just make sure they are VERY well informed of the risk and possibly consequences of doing so. Everyone has the right to self determination, even if the determination means they're probably gonna die (not this case specifically, but on occasion you'll see it). Raising oxyhemoglobin levels (SPO2 saturations) is not a reason to apply oxygen. Increasing oxygenation and reversing hypoxia is. If the patient is not "hypoxicly hypoxic" than O2 is going to be pretty well useless. Plain film x-ray is pretty notoriously unreliable at detecting c-spine fx (more unreliable in fact, than physical exam). Spiral CT is the standard.

Probably had a non-displaced fracture which y'all summarily displaced. Sometimes there's not a lot of helping it.

Bi Level is more comfortable for the patient, but last I checked had not been proven to be clinically superior to CPAP. Combine this with the fact that machines that can do Bi Level tend to be greatly more expensive than simple CPAP setups it's a hard sell to most EMS managers. I DO agree it's probably a better option.

Unless there's concurrent COPD exacterbation (very common) or the APE itself has induced bronchospasm which can and does happen. Sometimes, sometimes just getting afterload down will do. Very occasionally. A good portion of CHF patients actually end up DEHYDRATED. It's not usually a fluid overload problem so much as a distributional and hydrostatic pressure issue. Invasive vs non-invasive PPV Nitrates and ACE inhibitors actually do a FAR better job of changing the pressure gradients and treating the true cause behind a CHF exacterbation . If found to be fluid overloaded via diagnostics, than yes the patient needs to be diuresed. Other times they may actually need fluid. We just discussed this on another board and came to the conclusion with the help of a couple of very smart RRTs that this does not provide CPAP as there is no "continuous" part to it. What your actually doing is increasing the WOB. Remember, APE and decompensated heart failure are usually afterload issues, NOT fluid overload. High dose nitrates are the treatment of choice. However, if there is wheezing (not rales mistaken for wheezing) than that's indicative of bronchospasm and albuterol should be used to relieve the bronchospasm.

Ours used to be set up this way. It was moved into the first in bags because it can be hard to predict when you'll need it, and it's generally not something you really have time to run back and get. I complained greatly at first, as it added several pounds to our already bloated aid bags, but after having it immediately available at bedside on several instances in which I KNOW I wouldn't have carried it in otherwise I don't think I would do it any other way now. It's probably is a piece of equipment that needs to go in on nearly every "emergency" call.Just think, how often do you go in a hospital room where there's no wall suction?

Supposed to be two, but they have a habit of walking off here. Not only are they a comfort item, they work great for ankle splints and can be an important adjunct to intubation.

Reglan (and droperidol, for that matter) fell from popularity due to their respective black box warnings. Which may or may not have been fairly applied depending on who you talk to. Phenagren has some nasty side effects including phlebitis and a tendency to give older folks dystonic reactions (I've seen elderly patients pretty well flip their wig post phenagren, not sure why it seems to effect the elderly so badly). Xopenex is an expensive drug that does basically what albuterol does. It is more beta 2 specific than albuterol, but it's still under patent so that specifity comes at a price.Used primarily to prevent long-term sympathetic stimulation in people who don't need it and in kids who have behavioral problems in Ventolin. Ipatropium on the other hand is a great addition to any drug box as it helps with acute broncospastic events from an entirely different angle. Valium actually has the longest half life if all the agents listed. It's also the "weakest". I personally like midazolam simply because of the IN admin option and the tendency to induce anterograde amnesia, as usually when we're giving it something unpleasant is happening. Lorazapam is a perfectly ok agent and has less hemodynamic effects than midaz. IV NTG is the bees knees IF you have a pump. It's not a drip you can eyeball. It's also about a hundred bucks a bottle, so it's not the cheapest stuff ever. I've personally probably hung a few gallons of the stuff and through urban, suburban, rural and HEMS have never had an issue with the glass bottle other than Minimed pumps throwing a fit over sucking minute amounts of air. If your really worried about it, get a Koozie, cut a hole in the bottom for the bottle neck and carry the NTG in there. Works like a charm. Hopefully this was helpful.

Anyone else find it slightly concerning battery powered portable suction is not part of more peoples first in equipment?

Flight crews nearly universally wear helmets, and aircraft head strike envelopes are MUCH better designed than the back of an amblulance.