hammerpcp

I am curious as to how many of you would treat the rate immediately and how many of you would administer fluid therapy first to see what happened. Also, if you opted for fluid bolus, how long would you wait until treating the rate? Assuming there is no improvement with the pts condition of course. What is a reasonable amount of time to hold off other treatment to see the effectiveness of fluid alone? BBT = be back tomorrow

Why? BBT

Resp rate 10 bpm, eupneic no distress, lung sounds clear in all fields, no adventitiouls sounds, equal chest rise bilt. no chest pain or discomfort. 12 lead unremarkable. Equal grip strength bilat. pupils 7mm equal and reacitve to light. No peripheral edema, no pulmonary edema audible. No JVD.

Called to a residence code 4 (highest priority) for elderly male confused. On scene you are told by the Pt's wife that she and the pt - and elderly male - had just returned from the cemetery for the Remembrance Day celebration. Pt took his Levodopa and then had a glass of wine. A few minutes later pt became "incoherent" according to pts wife---> EMS activated. Pt found sitting erect in chair, very pale, cool and diaphoretic, Alert and responding to questions slowly but appropriately. Meds: Lipitor; Amiodarone; Levodopa; Pariet; NTG; Altace; Metoprolol; Levocarb; ASA; Trihex (sp?) MedHx: Parkinson’s; MIx2 5yrs ago NKDA VS: HR 48 sinus bradycardia in lead two, no radial pulses, no obtainable BP, Sat 87 ORA ->98 on 100% O2, CBG 9.7mmol How would you treat this pt?

Never mind defibrillating asystole. What? Do they work in Niagara?

I was having a discussion with a colleague this morning about an extremly obese pt she treated with NTG for pumonary edema. My colleague was syaing that the large BP cuff would not fit around the upper arm of this pt so whe put it around the forearm and got the SBP by palp. This made we wonder first, how accurate this is, e.g. is the cuff on the forearm more or less accurate for checking a palpable BP then with the cuff on the upper arm. And also, if one could put the cuff on the forearm and auscultate the radial artery, and how accurate this reading would be. Often when I have a pediatric pt whos arms are too small for our pediatirc BP cuff I will put the cuff on their thigh and auscultate the popleteal artery. I have found this method to work well although I really don't know if there would be a different reading on the arm. Does any one have any insight into this? Or any other techniques for attaining a BP on difficult pts?

In real life no one ever gives nebulized epi, so don't worry about it.

Is that you Asys?

He wants Some. :wink: Anyhoo, as usual you damn people are making way too much sense. I had a big trauma the other day and boy did I ever wish I had another pair of shears to give to the FF so he could assist in exposuring the pt. Sigh, so now I carry two pairs, as well as the hospital gown in the cupboard. 8)

Nicely put.

Testicles, spectacles, wallet and watch.

Okay so here's how you do it. Get a ten ml syringe and a vial access canula. Set up your "safe area", eg a table that no one is going to bump, and get out your sharps container of course. line up your little epi ampules, crack crack crack crack crack, draw draw draw draw draw, and empty syringe into neb. Alternatively you can do it crack draw, crack draw, crack draw etc. but then you have to ut down the syringe in between. I haven't found a better way to do this, and using a vial access or blunt plastic cannula minimizes the amount of sharps you are using.

I just meant that although yes, the situation you describe would pose a bit of a moral dilemma, the chances of this situation actually arising are pretty slim. So what are you going to do? Hold onto a controlled substance that you could get in deep doo doo for having just in case you happen to meet some poor civilian who is in a bind? I don't think that that is justifiable either. And Dust, as far as I am concerned there is no moral dilemma here. The ethical and moral thing to do would be to turn in the drugs to your supervisor, and do the appropriate paper work, and put up with the subsequent bullshit. My suggestion earlier wasn't about morality, but rather practicality. We must presume that no one would get hurt if you just locked that cupboard back up and never spoke of it again. This is a test of your character.

You use far too much logic to work in any EMS system I have ever encountered. And Becksdad, you are making a lot of assumptions about the situation.

If we are looking for the easiest solution to this problem and the least painful to you (hypothetically), you would lock that narc box back up, with the narc in it, and never speak of it again. A spilled or cracked vial is easy to explain but heaven forbid someone did a miscount somewhere along the way! Having extra of a controlled substance can often lead to more of a pain in the ass then having some missing. That supervisor or whoever is getting their ass chewed out for this is going to do his utmost to shift the blame to the underlings, namely you. PS Admin your spell checker sucks

#-o How could I have missed that?!

There are two opiod drugs that do not cause pupil constriction: demerol and talwin. Does anyone know why this is?

Hey now. Maybe he looks good.

In the real world this pt is a big whiney baby as far as I'm concerned. I am tempted to tell her about my encounters with migraines. I know that ERDOC wouldn’t do that to us though. It must be something legit. However, I don’t have a clue because the list of ailments that can cause headaches benign and otherwise is infinite (almost). The nausea is not a good thing. That much is certain, since it is indicative of increasing intracranial pressure. Has anyone asked about visual disturbances yet? And yes, pregnancy fucks everything up, so what’s her story with that? Allergies? New perfumes, detergent deodorizers? Any new chemical cleaning agents in the house? How about sleep apnea. Or a brain tumor. Oh! Maybe it’s a parasite. Trauma? Infection? Stress, anxiety? Was she expecting to have use of the car that day? I could go on and on, but at this point a cab sounds appropriate.

Why are pediatric pt's more prone to osmotic diuresis?

What are you stupid or something? You don't expect your health practitioner to monitor and diagnose and thereby potentially prevent any future mortality or morbidity do you?

Vitals, history, meds. Whats she look like?

There is nothing worse then a paranoid who actually has someone out to get them.

There are assholes everywhere you go. So don't sweat it, just don't be one of them.