AnthonyM83

I heard a doctor order 2 breathing treatments for a pretty bad CHFer yesterday...but it was among a battery of other orders (80mg Lasix, 2inch Nitro, etc)...he said CHF'ers like that will often develop bronchospasms so he threw in the albuterol, but not that highlight of his treatment.

Naw, it can't be for sure, because you wouldn't out him like that if you knew without a doubt it was him. I've seen AK and admin correct each other's posts, which I first thought was losing track of what account he was logged into, but then I think I saw them both in chat together (which doesn't prove anything without a doubt, but makes it less likely). Anyway, thought it was funny that when I read the thread title, I immediately knew what it was about... But yeah, I've always assumed admin posted on different name, since admin usually doesn't get into deep discussions. I'm sure he has stuff to contribute, so much do it under a different name. Now that's funny right there! (but naw...too different)

Was he an older skinny guy? (let's not say names) If so, he's a very caring FF (maybe because of his age) and I always enjoy running calls with him.

Thanks. (And hey, maybe my friend was confused and talking about glucagon admin when he told me that "fact")

So, is the answer no? I know there's no clear cut answer, but what I was asking is: Is there a SHARP immediate spike RIGHT after D50 admin followed by slow decline, all within say 15 minutes for blood sugars initially between 30-60, due to insulin miscalculation, as a general TREND? Or is does it relate to exact situation (even within parameters listed in previous sentence) so much that there is no trend? Basically, I know initial D50 wears off rapidly and patient needs complex carbs to keep it up, but does it happen SO fast that when you re-take sugar a 5-15 minutes later and it's now 80ish, it's already going down? I ask because I usually don't see patients crash out again within the hour after arrival at ER post D50 bolus waiting for a room even without getting the complex carbs...so it seems it doesn't happen THAT incredibely fast... You'd think if it went back down to 80 after 15 minutes, patient would be back to 40ish and altered by the time we go to ER. Does that question make sense?

Yup. He went in and out of it a couple times on-scene and as we brought him into the ER. They called him there after a few minutes.

That seems right. One of the most tense scenes he recalls is when he was surrounded on all sides by people and he was calling for a signal zero on the radio and his inner aggressive seemed to come out to protect him and he realized that there's no way one could remain touchy feely at all times (before his experience he was a huge critique of police officers and their mentalities.).

Naw...from one of the busier areas in the county, actually. They had plenty of times to practice this. I guess they were so confused about what they did in the rig, they didn't even mention in the PCR that pacing was attempted or that he had intermittent pulses. Just brought it in as a full arrest.

Foose, 5150 is a local term/code. 5150 of the CA Heath and Safety Code that states when law enforcement, doctors, and psych teams can place someone on an involuntary 72-hour hold for mental evaluation (criteria is danger to self, danger to others, or gravely disabled). I've heard a rap song by Luniz where he sings "They labeled me 5150" and I heard it on Hanging With Mr. Cooper TV show when he says, "You're driving me nuts. 5150!" So, I guess it's filtered into street slang in CA.

Very true. . . if the medic gives a flip about what he does... but even then how long does it take to learn "IV, finger stick, 12-lead, sit back and do paperwork" ALS skills for LA and Orange Counties?

Thanks for sharing WM. Do you need special pad placement for either TCP or Cardioversion? I heard from someone it had to be front/back for one of them...

Other option might be to have the bracelet state that the meds are in your wallet...of course you risk the chance you might not have your wallet on you when an emergency happens. We go through wallets to get a name/age, but rarely go through the entire wallet to find medlists.

Lung Sounds are clear, equal, bilateral Heart Sounds were not taken (Medic was on-scene, so had to defer to him) She was driver in the MVA.

I imagine part of it is due to lack of availability of different scenarios during their ride-alongs. I've been an EMT for 2 years and have yet to deliver a baby (though many newer EMTs have). The school needs a way to know I would have a plan to follow when I encountered this situation in the field. It needs to see what kind of mistakes I might make and make sure I've corrected what I can before I hit the field.

I think the skills stations are of great use, personally. They need to learn a flow and a core. The problem comes when schools don't give students a chance to be dynamic with their assessments and scenarios. With the short course times, I can see how it's hard to fit it in, though. You can hardly get students to remember pertinent questions for child birth patient in that little time, much less provide various scenarios where they can deviate from core algorithm. If EMT had a stronger field/internship component, this is where they could practice this stuff. There are certain things they need to remember and do early on, like recognizing a patient needs ALS or applying O2. There needs to be a way to grade these things.

Yeah, it was LACoFD (I haven't worked with LAFD, but heard they're a bit better...big on being the best, so even if they dislike EMS, they have the drive to try to be good at it). Anyway, actually trying this was a step up for them. So, if the patient is at 40BPM. You wouldn't have to start slower than patient's HR, then slowly go past it? (This is one of the things they tried) I would just set rate to 80 BPM, then start at 0mV, and slowly turn the dial up. Eventually the HR and shocking will coincide and then every shock will result in a QRS complex? Is that the idea? Can we go over cardioversion next?

Interesting experience, Ruff. Does Southwest carry medical supplies on every flight? (BTW, Muslims believe in God, too.)

When there's not much I can do at the moment, I usually say something like "Well, you're safe right now. We're going to get you to the doctors and take care of you." I think people feel pretty safe at the mention of doctors in those situations. The only spontaneous rape statement I've had en-route she was very intoxicated and just muttering, so spent time trying to figure out if indeed a crime had occurred, what crime, and where...since she could easily pass out and go back to incoherence. Document what you can.

Exactly what I was going to post . . .

Are you talking about when you hear a beat all the way down until deflation? I hear this all the time, sometimes a couple times a day. We verbally report it 120, all the way down, since the diastolic isn't actually zero. We write it into our chart as 120/0, per company policy, but it's not really accurate. I was recently told when that happens, you should listen for when the thumps change. A real BP actually has 3 numbers, so an accurate BP would be 120/54/0 but we just leave out the last number.

Austin-Travis definitely looks like the most attractive system I've heard of...that and King County Medic One. I've considered moving to one of them...

I had someone tell me that when you give a hypoglycemic D50 via IV it almost immediately skyrockets their Blood Sugar Level, then it starts plunging down....so that when you re-take a sugar a few minutes after D50 admin, you're really getting a decreasing number...it's no longer going up. I haven't had a diabetic call since I was told this to check the BGL trend myself...but I always thought it was always slowly going up, then slowly down after several minutes (not an immediately spike, then drop). Any thoughts on this?

So, awhile back, we had a bradycardic ALOC patient from nursing home 911 call. He went into and out of PEA. Atropine didn't work, so we were going to just transport like usual. Then, I was truly impressed...a FF actually wanted to try TCP. You don't understand how huge this is that someone would actually try this in these parts.... I I give her points for that...but then both medics who rode in with us had no idea how to actually do it. Since I was closest to the monitor (Zoll), they had me moving both dials every which way. They had me turn each dial from really low to really high until they got scared and had me go back down...I felt like 3 new EMTs had been handed a monitor to play with. So my question is: EXACTLY how do you do the physical process of pacing? Where do you start your dials, where do you move them to, what do you look for on the screen, how do you know you've captured, etc etc.

Age: 63 HR: 78 (s/r) BP: 200/100 RR: 16 (none-labored) Skin: Normal color, temp, quality Pupils: Equal, Round, Reactive SPO2: 98% At original accident, EMT student impression she was going to work from home. Kept asking for a phone to talk to her son who leaving country that day. He doesn't remember it was being that bad of an accident. What else do you want to know about it? You board and collar her, though she seems nervous/scared and isn't very cooperative about it, only asking why she can't go home. You convince her to tolerate O2 and keep still for IV line. You do a physical detailed survey and find red bruising to her left upper chest area and bilateral abrasions to the knee (left one being a bit worse, but both being minor). Trauma center is 20 min away, closest receiving is 10. You're en-route to trauma. Your EMT student is willing to help you, but he's not sure what "as much history as possible" means. He's able to muddle through OPQRST though. Onset - Mild pain right after accident, got progressively worse. Still getting worse. Provocation/Palliation - Car accident, nothing makes it better Quality - Unable to clearly determine due to language barrier. Just keeps saying it hurts bad. Radiation - None Severity - Not great at following your questions, but in reply to 0-10 questions says it hurts really really bad. Time - 2 hours now 12-Lead shows NSR at 78, no ectopy.

Call Type: Chest Pain. On arrival, you find two women sitting in a parked SUV (in front of a shut-down ER). Driver tells you that her maid/nanny in passenger seat came home a couple hours ago after being in a car accident. She had refused transport at the time, but now has severe chest pain, not acting quite right, and seems scared to go to the hospital. She is mostly Spanish-speaking. Your source of info from last accident is an EMT ride-along who hopped units (responded to current patient's earlier accident where she refused transport) and speaks decent Spanish.