hammerpcp

Am I totally missing something here? What is "normal" for this pt? Her normal level of consciousness and function and ability to communicate? Maybe this is her normal state, other then the bloody sputum/emesis of course. BTW I would be having a high degree of suspicion towards aspiration for which albuterol would not be particularly helpful obviously. So according to incident hx 911 was called because the pt was 'unresponsive'. Lets get a bit of a description about what that actually means. i.e. has her LOC improved since the call was placed? because she isn't unresponsive now. So, how long did this episode last? was it witnessed? was there sz activity? etc. And what is this mysterious neuro disease? I just read the OP again. Why does the pt live with mom? To me this indicates an inability to care for oneself. Assuming the facial droop and dysphasia is new I am going to top my list of ddx with cerebral ruptured aneurysm, blood tinged sputum from the stomach ulcers brought up with the vomit. Either that or the pt had a sz and bit her tongue due to same ddx.

Awesome video! How much heroin did she do?

Yeah, WHY is his liver enlarged and apparently not functioning properly? What tx was prescribed? I was thinking small pox for sure although a dairy farmer should theorehtically be immune.

I do. I didn't get into this field to be a glorified taxi. I didn't invest time. energy and money into training to not use the skills and knowledge. That being said, I am not looking for all action all the time either.

I find myself thinking about the conundrum related to Asys' butt cyst while doing things around the house...weird. Anyway, here's some of my thoughts: Shivering is your bodies attempt to elevate body temperature both in fever states and when the core temp. is sub-homeo. So initially, when you were cold shivering your febrile state just hadn't registered yet on your temperature measuring device (I assume you didn't attempt a core temp measurement which may be more accurate although you might still have been subclinical, in the febrile dept.). So you had some kind of mysterious infection. At least the cyst is gone.

Offhand I am not sure if any actual research has ever been done regarding the actual amount of air required to cause problems when introduced by different routes (venous, arterial). I do know that every time I hear some one talk about it the quantity gets bigger though. It might be interesting to do some searches on that actually. Regarding the dental drill and risk of air embolism, here are a couple of links after a quick "Googling": http://www.cja-jca.org/cgi/reprint/37/1/112.pdf http://www.anesthesia-analgesia.org/cgi/co...tract/106/1/249 http://www.southernmaxillofacial.com/downl...ill-surgery.pdf http://findarticles.com/p/articles/mi_m0MKX/is_/ai_n11841559 From my reading it doesn't seem to be a big risk. Let me know if you find out anything else about this

Interesting case. I learned a new word too. I have always heard this phenomenon referred to as "R on T" (waves).

As an interesting side note, this scenario reminds me of something someone told me once regarding the risk of embolism related to drilling in the mouth by the dentist... Cerebral air embolism if I recall correctly. Otherwise I would have a high index of suspicion regarding anesthetics when responding to calls at a dental office. All death is fundamentally caused by cardiopulmonory arrest

lol.... the more things change the more they stay the same. :wink:

If they are hypoglycemic and symptomatic, yes. Why not?

You are contradicting yourself. On one hand you agree that it is an inconclusive test and then in the next sentence you say how useful it is. There are all kinds of stupid useless tests you can do in the field under the guise of obtaining more pt information, as if MORE information equates to BETTER information, which of course it doesn’t. I take issue with your implication that those that don’t conduct these admittedly inconclusive and therefore useless and time wasting tests, which are therefore more likely NOT in the pts best interest, are somehow less adept health care providers. This is what I meant when I noted your air of condescension. Good pt care occurs when practitioners use clinical judgment to direct them in what tests need to be done and what tests don’t need to be done. Let me make my position dead simple: More information does not equal better information, does not equal better pt care, does not equal better diagnoses, dose not equal faster or more effective treatment.

On the other hand smoking will kill you or make the life that you do have shit because you can't breath. And Michael did you read the website? Quote: "AVRT is simple, quick, and easy ­­ so much so, that it may seem "too good to be true." " No offence but everything they say in the FAQ is pretty much the exact opposite of what I said and believe. Yes, Buprion aka Wellbutrin aka Zyban are all the same drug. It can cause seizures however the more common side effects are insomnia and increased sex drive. Which med are you going to ask your doc for now? Admin: your spell check program is almost worse then my natural spelling deficits.

Or the US or Canada. Where did you find this article may I ask? The editor was having a nap when this one came across his/her desk evidently. It doesn't lend a whole lot of credibility to the article or publishing organization.

:roll: Sorry Mike, but not with you on this one. When you are done with this website be sure to give your house, your children and any income you will earn in your life to the nearest religious organization. Quitting smoking is hard. It takes the average individual seven attempts to be successful. That means that many people take more then that to finally get over the addiction. I have no idea what Chantix is but I suggest that you use any help you can get. We have a drug called Zyban (Buprion) which may or may not be the same thing??? Every time you try to quit you will learn more strategies on how to stay quit. Each attempt is not a failure but part of the learning process. There are many websites out there that will offer you suggestions on how to quit. They are mostly helpful, but of course lifestyle change is always difficult to implement because it isn't easy and we are all looking for the easy way. Start exercising.....you will notice how SOB you are. Believe that it doesn’t have to be this way. You can feel good when you exert yourself. Also, it minimizes wt gain and gives you some uplifting brain chemicals. Love yourself, your body. Treat yourself like a child that needs caring for...feed it the right foods....make it exercise even if it doesn’t feel like it...do the laundry when it needs to be done and clean the house....your environment has an amazing effect on your psychological state. And know that you are worth living in a nice and clean environment. Don't smoke indoors. It's nasty. its dirty you stink and you never get away from the unhealthy atmosphere- also your kids or pets or roommates don't deserve to be slowly killed by your self destructive indulgence. And if none of this convinces you know that you WILL die a horrible death. You will be unable to catch your breath...you will be panicked and as scared as you have ever been in your life...you will slowly suffocate and you will know that you made a decision, many many decisions in your life that brought this state upon yourself...and no one will be able to help you. I recommend the patch. 8) Don't waste your time on that hypnosis crap either. A good rule to go by is that if it appears to good-to-be-true it is. There is no 'easy' way.

LMAO at "ensure pt is in secure location". I have a mental image of getting Pt's to stand at the top of a long stair case prior to Adenosine admin. (AZCEP Is right about the sinus tach thing) Adenosine has a nasty habit of causing sudden death in pt's who are in Atrial Fib w RVR. So make sure the rhythm is regular! I had a pt who i suspected to be in an SVT, however the QRS complexes were wide. I thought this was due to a BBB..........the Dr rather than take a chance on Adenosine (althought the half life is so short it is relatively safe) he administered Amiodarone which is useful in both ventricular and superventricular tachicardias. Just a little tidbit for ya'll.

I don't have cable and I don't ever watch American TV so I have no idea what drug you are referring to. Glucagon is used to relax the esophagus when there is an obstruction there (for example a quarter). I don't think the mechanism of action is actually known. But it sounds like your Dr suspected you were experiencing reflux causing laryngospasm potentially? And therefore tried you out on glucagon which actually did the trick. Who knew? Also I think the usual dose is 1-2mg not 0.5mg, so maybe he was just experimenting on you.

You're right we do disagree. I don't know what your training is but that is so far out of my level of expertise as an advanced care paramedic I wouldn’t go near it. I also think you would be completely in the wrong if you did. We are talking about a stable patient in no to little distress who is completely capable of describing her symptoms to you, and you are performing a pelvic exam with no training, no experience, and really no idea what you are looking for or even what anything means if you do find it? What does your medical director have to say about your approach?

Why would you give narcan for Rohypnol? I wouldnt expect it to have any effect seeing as it is an opiod antagonist. EDIT: I forgot to say anything about the pt. Why does he have water on the brain? Is he perhaps an alcoholic? Maybe a little thiamine and dextrose will do him some good.

Question: Why did you administer an antiemetic to this pt? Was he (she?) vomiting or was it prophylactic? Sounds like a good call. Good work. Also, Theotherphil it sounds like you really saved that guys life, no doubts abut it. Congrats man.

There is now also a useful RainX antagonist which can be self administered internasaly. It is not a long term solution but it is an effective stop gap measure to reduce the over all harm done by RainX abuse.

There are no absolutes in medicine. Although it is fun to illicit a reaction by speaking in extremes on this forum I concede that in reality sometimes it IS appropriate to examine the genital. However, it is not ALWAYS appropriate. Many folks (read: men) are sick and desperate and would love for a paramedic- or anyone really- to handle their goodies, and thus are not beyond malingering to achieve this goal. Besides the issue of illegitimate complaints there are also several legitimate complaints involving the genitals or perineum that don't necessarily require an exam either. Vaginal bleeding for example. If the pt is not in any distress and has stable vital signs and can describe to me how much blood has been lost and over what period of time, there is no reason for me to take a look. (Unless I am suspicious that there may be babies head sticking out I guess) As far as the medical "team" goes.....I am skeptical that this even exists. Even when I do a full exam, and have a working diagnoses based on my findings, the fact remains that the hospital staff rarely even take what I have to say into consideration.....and that's if they listen to me at all. Perhaps that is just the situation here, but I doubt it. Also, pts are almost never sent to the waiting area if they are brought in by ambulance. Hence hours and hours of off load delays. So, to argue that taking a look at big Stevo's urinary catheter and palpating his testicles because he has had a little discharge lately is going to speed up his care is completely false. I think I have had my say on this. I am not a bad medic for making a judgment call on what assessments are necessary and appropriate for a particular pt and which ones aren't. You do the same thing every day.

Many of my pt's experience priapism when I examine their genitals. Don't get me wrong I appreciate a good prapism as much as the next guy, but there was no information I could not have obtained just by asking the fellow. And when was the last time you had an ingrown hair present like testicular torsion with or without exam? Puhlease. As far as the pt getting better care in the hospital, that is pretty much the murses and moctors job isn't it.

I have never heard of this test before....and before you get all self righteous and condescending let me remind you that I am in pre-hospital emergency care and this test is obviously not something one would generally do in the field. Upon investigation this test isn't even conclusive. Also, a bump in the road may prove just as useful as taping the heels in locating the pain.

Do you have to examin the testicles to suspect testicular torsion? How about vag prolapse?

I absolutely disagree with you both. It is NOT part of my job. It will have no benefit to the pt. Period. Absolutely non productive and inappropriate.