Arizonaffcep

Methylene Blue (I believe is how you spell it)

The last time someone (usually FD) did that to my wife...that person was LUCKY to walk away with their moustache intact!

What tastes better (*note*, the "drinker" should also have PLENTY of Jack Daniel's on board as well) and won't loose it's "Glowability" (you might need a black light though) is ethylene glycol... :twisted:

As long as it (extrication, light/med/heavy) can reach the patient in a timely manner, who cares who does it as long as they have the qualifications? By that same token, I would say EMS would have a greater ability to handle extrication in areas that are not covered well by fire, either poorly staffed vollies or ill trained FT ff's. I think the most important aspect of this is, that the patient not get lost in the "who's flapping the roof" contest. If there are separate fire/EMS, EMS must play a role in extrication, even if it's only passive and focused on treating the patient while everyone else is extricating. This opinion does assume everyone involved has the correct PPE to do their respective jobs.

I bet their lawyer to "joe public" ratio is much lower... :twisted:

No...it's not a myth. It depends on where the fx is at...if the fx is a process fx (transverse or spinal) or even a Dens fx (the swivel point between C1 and C2)...as long as it doesn't impinge upon the spinal chord...you really won't see anything. Of course, what that "myth" is really referring to (I think) would be the equivalent of an unstable C2 fx. This is much less common than other types of fx's, where the disk integrity is compromised. Thankfully...doesn't happen too terribly often.

http://www.emedicine.com/Med/topic1212.htm This link has some great pics of 12 lead of a junctional rhythm, including accelerated junctional. The one thing I don't think you are keeping in mind is, with a conduction delay, you will get widening as you say, but no real change in amplitude with the QRS. If you look at the QRS's in question...there is a HUGE amplitude difference, indicative of ventricular origin.

Agreed, it should be a "transport until proven otherwise" thought process. At least that's how mine has always been. After all, how many MVC's with reports of ejection do you roll on without transporting someone? Phx Fire does something very similar. Engines roll first and call for transport if needed.

Actually, Doc, I was thinking more on palpation than Pt perception.

What does it feel like (thinking a compartment sydrome thing)?

Wow...that's better than the order I saw the other day for "CPR PRN."

Just remember...there is so much more to learn than is taught in class. Keep learning! Pass on your knowledge...have fun!

Depends on the call. Some services run with the fire department, who can supply a driver if needed, or extra manpower in back, or both (if it's bad enough). Typically, there are 2 people on the ambulance. Depending on the service, it can be 2 EMT basics (a BLS unit), an EMT-Basic and a Paramedic (ALS unit), or 2 Paramedics (ALS unit).

To shut down the hypoxic drive takes a fairly long time, and really isn't a concern for prehospital providers. Can it happen? Yes...but unless your transport times are an hour+, you really shouldn't be running into this issue. Even if you do...intubate and bag.

The head of the cot does raise up. Just got to pad under it. All of the directions I've ever seen for use of the KED board is to also place the Pt on an LSB.

She needs c-spine immobilization. She's 80 and fell and obviously struck her face...huge load on her neck. Part of the whole KED board thing is...once they are in a KED board, they then get secured to a LSB (long spine board), so you get the same thing. It'd just be easier to roll this patient to a LSB and secure that way, rather than take the 5-10 minutes to do all the extra steps with a KED board, considering her VS and LS.

I would disagree with withdrawal issues. When this is present, people become very jittery, anxious and diaphoretc (Pt was reportidly dry). They also get hypertensive and tachycardic-neither of which was really present (at least not the tachycardia). The reason why I'd go with morphine post NTG if pain is unresponsive...is 2 fold...1-it will help with the CP. Second, I have only a limitted amount of things I can do for this Pt. I don't practice "cook-book medicine." The only drugs that I have that can treat respiratory stuff are: Albuterol, Atrovent, O2, Epi, Lasix, Benedryl, Solu-Medrol. With that in mind, if this is a respiratory issue (I also think there's a good chance it's a PE) how would I use them to deal with it? I've included a link to the ADHS drug list. The only things I don't carry are Succinylcholine and Etomidate, Recemic Epi, Vassopressin. Just keep in mind, as you look at the drugs, that some of the list given are for interfacility only (Aggrastat, etc.). http://www.azdhs.gov/diro/admin_rules/guid...Drug%20Profiles

Only my 2 cents worth...but remember the direction of the force on the spine...the spine handles forces (A/P) quite well, laterally, not as well, compression even worse, but the PULL force on this spine, I believe is the most vulnerable. C-Spine precautions are absolutely called for here...as well as very aggressive airway management.

Theft is an issue with nice stethescopes...it would be worth the $20 or so to get his name ingraved. I know Littman can do this via their website...

Except she was found in a prone position...KED not called for.

Morphine does come after NTG, but he does have CP...if unrelieved by NTG, Morphine is the next appropriate med.

Ya...c-spine precautions would be called for.

Why not? This guy-regardless of if he's a drug seeker or not-is having a very real event. Morphine would be an appropriate treatment if time allotted.

The AHA defines V-Tach as "Ventricular tachycardia is defined as three or more beats of ventricular origin in succession at a rate greater than 100 beats/minute."