PCP

After reading all the posts, it seems as though I best be doing some more reading, and try to understand more on how SOB can be caused by chest pain and vis versa. As stated before, we do not have ALS available in our community, so I best learn and understand the complications of someone having SOB along with chest pain. Over the weekend I was called out for a lady with SOB, and we arrived and the lady did not look as though she was having any problems breathing, and was outside waiting for us. When we pulled up she walked over to the ambulance and just said that she had taken her puffers that day and they did not seem to help her. I had her get into the ambulance where I got my hx from her and she was very calm, and just stated that she has been short of Breath all day, and that she has some chest pain as well.( Hmmm I thought to myself I just posted a question on this exact scenario what are the chances eh!) The end result was I decided to give her Ventolin and transport her to the hospital based on her signs and symptoms from the questioning I did I felt her chest pain was because of her taking her puffer 4 times that day, and that the B1 effects had caused the chest pain. Later that night, I was back at the hospital with another pt. (Another story for later. It was a good One!!) I spoke to the Dr. and he stated that "Yes she was having a mild Asthma attack, and that her EKG was normal, and the chest pain was due to the effects of her taking her Ventolin." I felt good as that was my first SOB call as a licensed PCP and my first shift at my new station Now that does not mean I am going to treat every SOB call with chest pain as though the chest pain is being caused by the B1 effects of Ventolin, as I know that this is not allows going to be the case. One thing I learned from this call over the weekend is that, pt. do not present the same as they did in class with the classic signs and symptoms when they are experiencing SOB. My pt. was talking in full sentences, was not using any excessory muscles to breath, had good skin color, SPO2 reading was good, and when I auscultated her lung sounds they sounded clear. ( But I am still learning how to diagnose the different lung sounds, so maybe I thought she had clear lung sounds, when the matter of fact she did have some mild wheezes. All and all, it was a good call and I got her to the hospital where she could be taken care of and was able to go home a few hours later.

Okay, I see I have opened a can of worms No the patient has not taken any nitro, as the chest pain came on suddenly while you where treating him for his SOB. The patient is sitting in a chair by the kitchen table. I am just curious to know what is the best plan of action with a patient who is experiencing SOB and has a hx of Asthma and was exposed to dust and that is what triggers his Asthma. While treating this patient he suddenly develops chest pain. I am curious to know, do you discontinue with the Ventolin protocol give high flow O2 10-15 LPM and start down the chest pain protocol road. As well as where I am station we do not have ALS or can we atach a 3 or a 12 lead to this guy and monitor his rythm. So what is the best plan of action for a PCP at the PCP level without ALS available The pt. was cleaning out his basement and was exposed to dust which brings on his Asthma. Has been diagnosed with Asthma for over 10 years. His SOB was sudden When you walked in the pt is sitting in a tripod position, Lung sounds-Bilateral Wheezes to the bases, Initial pulse OX reading was 93 percent. There is no 12 lead EKG available (small town) No Pleuritic chest pain I dont have a medical control that I can call, it is left up to us and we need to decide the best plan of action

I agree this is a complex case and is a little out of my league, but this case was presented to me while taking my program a few years back and I have never forgotten this scenario as I found it very complex and felt there was some things going on with the pt. that I did not understand. Thanks for you input and yes this guy would be flowen out or we would be transporting him to Nanaimo with a nurse on board.

The breath sounds are audible wheezes bilateral to the bases. The patient describes the chest pain as "Crushing", The pt just tells you that he had an MI two years ago and has been prescribed Nitro, but has never had to use it before. The patient tells you that his Asthma is brought on by dust and that he had been cleaning out his basement when he started to find it hard to breathe. The town I am working in does not have ALS, so it is up to us PCPs to deal with this kind of situation. That is my thinking as well, is that the B1 effects from the Ventolin could be causing him to have chest pain, but on the other hand the chest pain could be causing his SOB. So, you state that you have never viewed running a nebulizer as a contraindication for nitro. I did not think of that, so what you are saying is that I could continue running the Ventolin protocol, as well as treat the chest pain with Nitro? Sorry people I should have posted this question in the forum for scenarios

Okay, going out on a limb here folks as I am new to the forum and still fairly new to the world of EMS. If you are treating a patient that is having SOB with the Ventolin protocol and while giving them the first dose of Ventoline they develop chest pain. What would one do? Now the pt. states they do have Asthma, but also have suffered two episodes of Angina within the last two years and are prescribed NItro. Should one stop the treatment of Ventolin, apply high flow O2 and then start down the Chest Pain protocol or do you continue with the SOB protocol while questioning the the pt. about the chest pain they suddenly developed? I guess my thinking is yes, they have a cardiac hx, but at the same time they have Asthma and said they have been exposed to lets say dust which brings on their Asthma and are having a hard time breathing and used their puffer that did not help. I feel I should continue with the Ventolin protocol and question my patient about the chest pain they are experiencing. Any comments good or bad are welcome! Sorry if my questions seems a little confusing. If you need any more clarification feel free to ask me.

Sorry I would have posted a picture, but computers and I do not get along

Has anybody used one before and if so, what are you thoughts good or bad? My personal opinion I find them a little too time consuming to put together and possibly not as stable to use as the regular SAGER splint that comes in one piece. This is based on me, just playing around with it in the first aid office, and never having the chance to use it on a patient. After playing around with it, I would rather have someone go and get the regular SAGER from the ambulance. As well, not sure if any of you use the pillow splint for a stable ankle fracture, but what are thoughts on using a pillow for a splint? I personally find that it works well, long as you get the trauma strap tight around the pillow.

OOPS!! Sorry guys, still trying to figure out how to quote something from a another post.

Sorry to hear about your luck. Hope it all turns out okay.

That is AWESOME I have never seen or heard of one of these being used in Canada. Hmmm learn somethig new every day

Yes, I watching TSN last night as well and they showed the interview with the two players that had been whinning about the locker room conditions and injuries. It is soooo brutal that they feel the need to complain. I guess they are trying to as you mentioned make excuses for losing already! 31 to 17 would be an awesome score lets hope that the score is that high or higher as I want to see Montreal get knocked off their high horse.

Thx for the information. That is way beyond my scope of practice and knowledge. when I was doing my clinical at the hospital I was able to maintain the airway of a pt that was given a milky white substance through an IV that would sedate him/her so that they could cardiovert their sinus rythm from being Tachycardic and irregular to back to normal. It was a great experience to have been able to help out and watch and learn from the ER Dr. and the attending nurse as to what was being done for this pt and why it was being done.

What is a vacuum mattress? In this scenario we would be using the clamshell for sure for the transport as stated it helps stabalize the pt and helps keeping the pt from turning their head and possibly becoming paralyized. If I was called to the pt. house and she was complaining of back pain along with the fall she would be getting the full package deal no doubt about it I enjoy having my license and I inted on keeping it!

Today is Grey Cup Sunday Montreal against Saskatchewan anybody care to take a guess at what the score is going to be or who is going to win? My guess is going to be Saskatchewan 24 to 17

Thanks for the information. It sounds like it is a little tricky when trying to understand the scope of practice for each level of care. I feel lucky that I can do as many procedures as I can working here in Canada as a Primary Care Paramedic. I would love to do a ride along one day somewhere down in the US just to see how things are done and to give me a better understanding of the level of care that can be done by each level. Have a good day

we use the clamshell 99% of the time and a spine board the other 1% of the time for extracation of a pt from a vehicle. At the mine site where I work as a first aider I have the ability to use the clamshell or the spine board. In most cases when I am called underground I use the spine board, but when on surface I use the clamshell just because when underground when called for an emergency when I arrive the workers already have a spine board there for me, as well as I find it easier to use a spine board on uneven ground compared to when working on ambulance I am usually working on a flat surface where a clamshell is ideal I am not sure what brands are the best, but I would have to say Ferno is probably the most popular brand out there.

Tough call for sure. For me it all comes down to if the patient has suffered any trauma. If there has been trauma to the area then yes we should expose, but remember we want to maintain patient dignity and the pateints wishes. So if they don't want us to take a look then we dont and document that on our report. If the patient said they have not suffered any trauma in that area then I would just ask more questions and try to find out why they may be experiencing some discomfort in that area. As Happiness mentioned this is a tough one. I dont care that it was going to be my last call of the day and I just wanted to go home, all my patients get the same treatment. I am thinking again that for me it depends on the hx of complaint and how they answer my questions and if I feel I need to take a look to get a better picture then sure I am going to look or as stated above in a previous post have my female partner take over the call if the pt is a female.

sorry for asking but what does RSI stand for and what is etomidate?

Yes, I do agree that appreciating the physiological implications of administering IV therepay is not easy and takes time to understand when you are giving an isotonic solution of sodium chloride or other medications through an IV. I RESPECT all ALS medics for their knowledge and understanding of the chemistry and physiology of these certain solutions that they administer to a patient, as well as their more indepth knowledge of anatomy and physiology of the human body. As I am only a PCP with just the basic understanding of anatomy and physiology and always striving to learn from the ALS medics or by reading text books, so that I can offer better pt. care due to having a better understanding of what that pt may be experiencing that day. I was just wondering about how come a BLS medic down in the United States do not learn how to initiate an IV and administer normal saline to a patient who is in need of fluid replacement due to hypovolemic shock, hyperglycemic pt., or to a pt experiencing some dehydration, just to name a few. After reading the original post, I was trying to think of ways that a BLS unit could generate more calls, as well as not have the medical director or whom ever may be second guessing their ability to handle the call without having an ALS unit respond just to initiate an IV for a sick pt. who is a little dehydrated, or as mentioned for a pt. with trauma that needs a fluid challange to up their BP and then maintain at TKVO. I agree with you (chbare) starting an IV is a skill that a monkey can do and in most cases does NOT save lives! Sorry for being so ignorant to the way the EMS system is ran down in the United States and what the BLS and ALS units are allowed to do under their scope of practice I have lots to learn about the EMS. Brian

Sounds like ALS is dispatched for alot of calls down in the US. I know for the most part the ALS crews usually only get dispatched out for SOB, cardiac and seizure calls here in Canada. Of course not all communities have ALS so it is left up to the PCP or I guess you can call us the BLS crew to deal with what ever the call may be. A PCP in Canada can start IVs and admin. pain medication (Entonox only) and admin. D10W IV as well as 0.4mg of Narcan through the IV port. In my opinion a BLS crew should be able to be dispatched out to any call and be able to call for a ALS crew if needed and if available. Is there a reason as to why the BLS crews are not able to learn how to start a line or give Entonox? I guess to me it just makes sense as alot of times the pt. needs a line or some pain medication. Brian

Thanks Happiness, I forgot that not everybody down in the United States knows about Tim Hortons. Tim Hortons is coffee shop. It's like Star Bucks, but BETTER Had a bizarre call the other day. We were dispatched out for a pt not feeling well. When we arrived and asked the patient what seemed to be wrong. He replied by stating that he was unable to sleep. when I asked how long he was unable to sleep for , he said just last night. He then also said he could not pee and that he had drank lots of water as well. I then carried on and asked how long he was unable to pee for? He said just last night. We took him to the hospital anyways I am thinking he just needed to talk with somebody.

Thank you all for your comments and helpful hints Our service does provide a stethoscope in some cars, but for the most part we all supply our own stethoscope. The way I look at is, I really don't want to be putting something inside of my ears that another person has been using and just so happen to have not cleaned the inside of their ears in the past six months. when I was taking my PCP program, everybody in our class decided we wanted to order our own stethescope and I after some carful consideration and what my wallet would allow me to spend, I decided on the "Littmann Classic 2 SE" I figured it was in the middle of the road and was not too expensive, but expensive enough that I should be able to use it for a while without any problems. Again thanks for all of your suggestions and comments. As a new person to this forum and not sure how one will be taken when posting questions or adding their comments I find it great to see that people actually take the time to try and answer a question or even add a few suggestions. I can see that there are some really seasoned medics on this site with some real great advice, along with some funny comments (DwayneEMTP) which I find very entertaining to read. Looking forward to some more great discussions with all of you