AnthonyM83

Naw haven't seen it, but I'm sure it happens every now and then. Of course, I've been so many accidents that looked bad, but restrained driver's were fine and number of accidents that were only moderately bad...with unrestrained fatality.

I have been told that for traumatic brain injury tubes most definitely do save lives, as supported by literature. I would imagine that with proper equipment (unrecognized) misplaced ET tubes should be pretty much 0%. Enough confirmation devices and and observational signs on pt should make one pretty certain you did or did not get the tube, no?

THAT I'd like to know. Haven't had time to research it...gotta go study. Someone should research and post.

Damn, beat me to it. Would we want to give 2-PAM or a cholinesterase inhibitor like physostigmine?

I'd have to go with pacing. Digibind might fail, but pacing probably won't. At least we can have the symptoms corrected....

Remember very little history, but remember being first on-scene to an elderly female babbling, trying to speak, and drooling profusely. Able to follow commands. Right after my ABC's, paramedics showed up and I presented her as having expressive aphasia. The report sounded good, so they let me do arm drift and push/pulls. She was a bit weaker on one side. Treated it as stroke. As soon as we roll into the ER, nurse says "She's having a seizure, guys!" It apparently it was a focal seizure only to her mouth. She did have one-sided weakness and the rest of my assessment was good...but I got narrowed into the expressive aphasia thing. Probably b/c I had a ride-along and got excited about showing him something he learned in class. Could tell the medic was disappointed...probably at himself for going with what I had said. :-/

Good points. We got this scenario while going over antidote drugs, so we didn't get passed the "which of these six drugs would you give" question specific to that lecture. I don't know if it'd be enough, but what I was trying to get others to say say was look for those other signs of dehydration, sepsis, hypokalemia, etc which she would have been negative for...at least the ones one can look for in the field...but I suppose there's no way to really rule out in the field. What state would patient have to be in for people to try to fix dig toxicity in the field?

Ding Ding Ding One of the s/s of digoxin toxicity is yellow-green field of vision. The recently worsened Alzheimer's led to improper self-medication. I'm sure the Alzheimer's and lethargy from the OD led to her not being able to realize she'd been redoing the same task and realizing her own vision problems. Some other signs of digitalis toxicity include: Bradycardia, heart blocks, VT, VF, other vision problems (blurriness), confusion, H/A, N/V/D, anorexia, palpitations, SOB Good thoughts going down the psych route, but want to make sure the ABC's and physical stuff check out, too. So, to finish things off, how would we treat this? (with dosages and mechanism of action)

BGL=80 Only mental health hx consist of early stage Alzheimer's which she last saw her doctor for three weeks ago. Hx of HTN, but no prior episodes of hypotension. Says she ate breakfast when sun came up (it's a little after noon). What signs of dehydration are you looking for? 4cmk6, you're partnered with a medic. He's stuck, so up to you to save..errr help him out

Yes, you are. Now what are you going to do to help you narrow in on your suspected cause before initiating a treatment.

BP: 86/40 HR: 52, weak, irregular radial RR: 18 (good TV, regular, non-labored) O2 Sat: 95% Skin: Dry, pale, cool LS: Clear bilaterally Pupils: PEARLA Meds in cabinet: Lisinopril, Digoxin, Aspirin, Exelon, Cognex, HZTC, Magnesium Supplement Allergies: None family knows off. She says no. All negative findings on the Cincinnati Stroke Scale. ---------------------- Some good points Jessi. She did not used to be a maid, but she was always super clean and kept the house-hold tidy. She doesn't wear glasses and not known vision problems, but you're getting warmer in this direction of thinking. It's not the answer, but will lead to more s/s that will lead to answer.

The occasional inverted p waves could still be MAT if the foci is low in the atrium and fires in upward direction first, correct? I'm blanking on the term.

Good questions. She's cleaning with a basic soap solution and her heating system is working properly. Continue with the regular assessments/procedures you'd do on your patients.

-Negative UTI -Yes, she lives alone. It has been early stages of Alzheimer's. -Patient only complains of a headache and some nausea. You do notice her house is extremely well-kept. No recent stresses, except maybe recently stopped smoking at her family's request (no patch). Family is not very medical savvy, but tells you she had heart problems, high blood pressure, high cholesterol, and early stage Alzheimer's. The patient herself is oriented to name and location. Thinks it's 1978. She is a bit lethargic, too, but can converse with some prompting.

Taken from one of my instructors (and possibly modified). You are called to the home of an elderly female by family who visits her often. They tell you she has a history of Alzheimer's, but they think she is getting worse and needs to go to ER to be evaluated. You ask why and they state she keeps constantly scrubbing at the bathroom floor several times a day stating it's not clean (they tell you it's spotless). And her behavior has just been a little off. She's been a bit out of it, last couple days. Nearest ER is 45 minutes (so you have time to solve the mystery).

I mainly just have stocked water bottles (that I rotate out) and some canned food. Fewer amounts than I should of each. Carry the water in my car (I'll most likely be closer to my car than my house in a disaster). Also, recommend first aid kit with basic trauma stuff. At least for earthquakes (here in CA), injuries are mainly going to be lacerations, fractures, and such injuries from things falling (buildings, shelves, glass). And while they recommend 72 hours, realistically, it's going to be a lot more than that, ESPECIALLY if it's unexpected (like earthquake versus hurricane). 1-2 weeks seems more realistic for a major event.

Just as additional info for your research: My drug guide states dosages as: Adult: 2-4mg/kg as prophylaxis prior to calcium channel blocker admin 8-16mg/kg for hyperkalemia and calcium channel OD Pediatric: 5-20mg/kg all can repeat in 10 min as needed. So, while Ped dose doesn't differentiate which indication you're giving it for, max dose is higher, regardless. My county's specific protocol, though lists: Adult dose: 1,000mg Ped dose: 20mg/kg (max 500mg - single dose) Is it once specific drug book that made a mistake or gave a different dose a specific reason, but didn't explain it and then spread from there?

I'm pretty comfortable with using strong force when being assaulted, but in this instance (as best one can tell from camera angle), the assault was over. She kicked her show off at low trajectory while standing inside the jail cell and not poised to leap out. Officer would have easily closed the door. The take-down was not a simple one, it was slamming her into the wall. Also, seems that while prone, she received closed-fist punches to head or neck area. In addition to being yanked to ground by hair (after being slammed against wall, in a position where she could drop to ground because of toilet and quite frankly speed of the officer), she was picked up by her hair after being handcuffed and not significantly resisting. Also, take into consideration you can assume she had been thoroughly searched (weapons should be a problem), she wasn't of significant size/strength, two officers present, and backup probably close by. Now, having said that, who knows what wasn't on video, she could have produced a lethal weapon out of view of camera, and I would probably have responded in same fashion. But realistically, precipitating event seemed to have been the shoe tossing.

Where does this obligation come from? Do doctors have the same obligation? Grocery clerks? Should we never worry about people not calling 911 for fear of police? (Refer to my previous example of child not calling for mother's CP b/c daddy was taken by police once.) So, does that change your stance? Or still report everything? Lines have to be drawn somewhere. Out of all the things you might report, I just don't get why on earth you'd pick an illegal immigrant (especially without being sure sure). They're a dime a dozen. If LE was hurting to pick these up, they'd just raise our local hardware stores each day. They're not in demand and not immediate public threat.

Steve_EMT. Don't take it personally and don't back off because of such comments. Take them as opportunities to explore how others in EMS think and evaluate things. I appreciate you sharing your experience about Solu-Medrol. I believe people were responded to when you moved into adopting it and becoming a believer in it based one incident where we don't know what the outcome would have been otherwise (though I'm sure it helped in that incident). It's just a certain style of thinking about stuff. Really useful and the same thought processes I see in many EMS leaders and educators. I was taken aback when I first started...it was a change from EMT school...but it was actually really refreshing and gave me some faith in EMS.

Absolutely agree with VentMedic. Unite in medical terms and make that core very strong. Recruit shakers and movers. Gain influence. Then raise standards to point that only those who embrace EMS as their main profession will go through the rising hoops. Long-term solution...though can't take forever to do it, as fire-based EMS seems to be growing. Perhaps the new national committee and national website would be a first preliminary step in the right direction...as far as strengthening field.

I would consider time since the incident. Best predictor of a person's action is history of previous actions. You want a history of stability, since it was at one point questioned. Was there a precipitating event to their psych emergency? Maybe something that's mostly over and done with? If so, that might make it not as "big a deal" (someone having an episode after a family death versus just out of the blue). I've also never heard of someone harming a patient because they were once depressed, though if they're not thinking clearly on the job, it could be an issue. Tough predicament there. But I'd just go with prior history (last few years) as my main indicator. But see what others say.

Doing not Los Angeles. According to NEXUS, I would immobilize based on failing to meet normal level of alertness, as presented to me through the original poster. That's where I'd need to be on-scene to make a better assessment. If his condition improves later on, I could then clear it.

Its use for spinal cord injuries is still controversial for EMS, but according to PHTLS it has been shown to improve neurologic outcomes within 8 hours of injury. A common dose is 30mg/kg bolus, followed by 5.4mg/kg infusion for a couple days.

Out of all the things an EMS provider might consider reporting, an illegal immigrant would be ridiculously low on the list. Usually EMS only reports if an immediate threat to someone. It's part of that differentiating from PD, so people who are scared of PD (maybe they arrested daddy one day and kid thinks he should call for self or mom having CP) won't be scared to call EMS. Usually these types of posts have to do with finding massive amounts of drugs or something big like that were threat isn't immediate, but still a threat. For an immigrant? Come on, now. (And you don't even know for SURE he's illegal, just saying...I mean cops could also just raid the local hardware store for the workers waiting outside, if they really wanted the illegal immigrants.)