AnthonyM83

I usually do them for abdominal pain if it is combined with other signs/symptoms, such as tachycardia or several episodes of nausea/vomiting...

I don't know the correct answer, but do you carry any of the other items, other than glucose gel?

Agh, so I'm kinda lazy in finding the page where you gave the ETA's to the different receiving hospitals, but rationale is that she's showing signs of possible CVA. A stroke center would be more equipped to handle. One of the best things they have is experience and protocols set up to minimize delays. They tend to have a stroke team waiting at the door (I know, depends on the hospital), can get vitals and a quick stroke screen in a few minutes, followed by a CT in only a few more minutes, with neurologist consult pretty quickly. Speed and experience and equipment. What's her height and weight? Probably a Mac 4 or 3, and a 7.5? I'm picturing a not so large lady... I will say I'm going to take a moment to pause and think...I have a patient with adequate non-labored respirations, good saturations. While she lacks a gag reflex, if I tube her I'm now going to be trying to match respirations (no vent). Agh. BUT she also has a very high aspiration risk.... Just saying, it's something to think about...

It cannot be used for simple agitation, combativeness, or general chemical restraint. It is only to be used in the case of agitated delirium...which honestly I don't think we're trained thoroughly enough in. It's not just violent. It's not just altered. It's an unexplained delirious episode where the patient is working himself up physically....and at risk of sudden death. And we also use it seizures.

"I'm gonna tube her both to protect her airway and to increase my tube stats." - LOL, I just +1'ed you for that... I want to take a closer inspection of the throat and neck. I'm assuming the reaction to the OPA was pressure in the pharynx nerves interrupting brain stem function, though (and possibly food causing similar response). Does her oxygen sat improve with the nasal cannula? I'll move on to D. Pupils? Any sort of posturing? Also a quick head to toe exam. Signs of recent injury perhaps. Since she's on the cot, let's get her in the ambulance. I'd like to tube there and prevent further aspiration. I want to confirm the staff witnessed her go from normal to abnormal, so we can confirm the fibrinolytics window. Go to the stroke center. Try to find out why she's on prednisone (and confirm name of eye drops...they have some crazy meds in eye drop form these days). Once intubated she might also be a candidate for hyperventilation...but I'd contact medical control on this.

Los Angeles can use versed for agitated delirium. It's used pretty rarely, though. It's not meant simply for agitated or violent patients

A simplified answer: Call ALS on a trauma if there is a problem with ABCD's (and their ETA is closer than hospital). There are exceptions to this in both directions, I'm sure, but it's a starting point. For medicals, it can get a bit more complicated, since the patient could be stable, but still benefit from an assessment/intervention. Sometimes, counties provide a list of required ALS criteria

For clarification: Two forms of "triage" are being mentioned in this thread. There is MCI Triage in which we patients are sorted into severity levels to decide who gets treated first. START Triage is an example (probably what you learned in school - RED, YLW, BLK, GRN) There is also Trauma Triage. Criteria for sorting if a patient goes to a trauma center or regular local hospital. This might be regulated by your agency or by local EMS office. There is also a push to adopt National Trauma Triage Guidelines (where history of loss of consciousness isn't mentioned, but present decreased level of consciousness is mentioned - GCS less than 14) Regardless, the question that you get asked every time is a very common and reasonable one to ask. As far as patients claiming loss of consciousness...it's probably in how you're wording it. Also, realize that many people close their eyes during car accidents and might not remember the event exactly, but they didn't lose consciousness.

While left lateral would normally be my preferred position, I'd like to sit her up in a high-ish Fowler's position for better assessment access. If airway is clear, I'll attempt a head tilt, chin lift. Check for a gag reflex. Tell me about her breathing: rate, rhythm, tidal volume, effort. Based on that, I'll get her on oxygen via nasal cannula or BVM. Avoid a mask in case she vomits again. Additionally what are lung sounds. Then after, we can move to circulation and all those history questions...

Anyone else going...I gotta contact Ruff...may be able to get the day off if it's not full

Here's one from 2008...

Sigh....he was my biggest mentor in EMS. Forced me to go above and beyond. Set my whole frame of how I view my career. RIP buddy....you whacker, you...

Didn't read the article, but nope, I wouldn't. I don't see the benefit on my end. It's information that could potentially get misplaced. I also don't ever push it when a patient refuses to give it to me.

Getting on this one late. But most textbooks vary on what qualifies as orthostatic hypotension. It seems to vary between 10-20 mmHg and 10-20 BPM change when taking the BP 2 or 3 minutes (depending on the text) after a change in position (supine to sitting to standing). We'll usually consider feeling lightheaded or dizzy upon position change as a positive result and discontinue the test. Most times I see it actually used, medics don't seem to wait the full 2 minutes. I would recommend against taking an immediate BP after standing as you might get false positives. You're trying to find the individuals are who remain hypotensive even after a reasonable time to compensate. We all have a drop in BP when standing, but our sympathetic nervous system corrects it. To the nurse to questions its usefulness in prehospital care, I definitely see your point. But there are chief complaints that might otherwise go BLS (example flu-like symptoms or abdominal pain or frequent urination) where it not for the positive orthostatics.

Some agencies down here either have or will be switching to iPads.

The scenarios our students get all depend on how well their specific class is doing (though some are working to change this and just have them standardized). At the beginning, straight scenarios with a juicy mystery diagnosis can pull the students in and interest them. This gives them motivation to practice their assessment skills. Toward the end of class, I present only real life scenarios with a real life mix of classic signs and symptoms and extras that patients throw in. The chest pain with dementia, the legitimate medical emergency with a panic attack (so they don't answer your questions directly), the head injury with projectile vomiting that develops signs of herniation to see if they recognize it and hyperventilate (per their text), and whenever I can, I'll act as the patient recreating the chilling anxiety in my voice of someone who knows their going to die and pleading not to, some will be just combinations of signs/symptoms from a call where I never figured out what was going wrong. It all depends on what the students can handle, though. There's only limited time in the class, and while I could literally do life-like and critical thinking scenarios for 8 hours straight (my favorite thing), I would be doing them a disservice by not letting them get their simple assessments down first.

Yes, I do. We also teach the reasoning behind the strap orders as far as best practices. This helps to keep them following the procedures we teach for years, rather than making up their own without fully understanding the process. And as an EMT, I use it on every sitting, stable, spinal immobilization patient I came upon when ALS is delayed. Don't feel right teaching something, but not doing it myself in the field.

I would take a much more aggressive approach at those scenes. Stand back and yell with authority: I NEED EVERYONE TO GET WAY BACK BEFORE I CAN HELP YOUR FRIENDS. IF I DON'T HAVE SPACE, I CAN'T HELP THEM. I will literally stand back and wait until I have space, as it's a scene safety issue. There have been physical fights that have occurred in those crowds between worried family and medics or between bystanders and patient. I wasn't on the call, but an old partner had someone unload a clip into his patient's head while holding c-spine. We take crowds pretty seriously, as far as safety. ALSO, pick a bystander who looks like he might have authority of the group, pull him to your side and tell him that he NEEDS to have everyone step way back....like meters and meters back, because you can't hear your patient. "If you want to help you friend, you have to get everyone back for me. Understand? You're our security." (With eye contact...so now he feels the pressure of that responsibility and he's more likely to do it...and likely he's the Type A personality, so now he has task to exert his stress on) Did you have a partner? Sometimes one EMT/Medic does only safety / crowd control watch. So my advice is basically -Speak Up LOUD -Tell them you require space in order to even start treating patient -Get an ally from the crowd to help And if that doesn't work, get everyone in the ambulance for the rest of the assessment if you can. And call for PD early. Ask for emergent/code3 response for crowd control (since it's affecting patient care).

Take the class. It'll answer your true question more than reading the text

You can certainly do without 10 doses aboard the unit, but in a busy area you could certainly go through 5 or more ampules of D50 in just a few days (3-5 days perhaps), sometimes. On occasion 5 in a day (and it'd be uncommon...but not unbelievable or rare at all). I would also think there'd be a certain level of "reserve" supplies the ambulances would want to carry in case of disaster.

You don't address all point people make to you either...kinda pick and choose...

So I'm still trying to figure out if I'm racist or not for not having had sex with someone my own race.......serious, Crotch.

I should add that in my area, the hospitals are so overcrowded, we have had some very legitimate calls to the ER. One patient was vomiting blood and ignored. Her 911 call was ignored/delayed (forget specifics now). She eventually expired. That made people start taking the calls a little more seriously. But that's the minority of calls.

I'm good with intolerance....just depends what's not being tolerated things like bad medicine and sloppiness....

*Fist bump* The ancient Greeks were notorious for having homosexual relations...they didn't seem to see it as a mental illness. But I guess their other ideas like democracy were dumb, too. Did you really research all of history before you made that statement?