aussie_rn

I'm going with a bundle branch block rather than VT, BBB's always hide what is actually going on too.....

Our codes run here in our ED run pretty smoothly I would say, of course you have those who act as chiefs and want to do everything, but as far as nursing goes, there are three of us, 1 to manage the airway, assist with intubation, mechanical ventilation, second nurse to draw up medications and give medications and the third to be scribe or scout. Usually our students whether they be nursing or medical students, we let get in and do CPR otherwise, they're the gophers and send bloods off, take ABG's to be checked etc. You'll know when you gotta start CPR, we normally hook them up to our defib machines straight away and as soon as you see VT then shock them, or if asystole start CPR, within a matter of seconds. Our resus' are fairly controlled, we've had ambos helping out with CPR quite often which has been good, "share it around a bit". Anyways, all the best for your new job, and training, let us know how it goes!

In the course I'm currently studying, we had a lecture a few weeks ago on seizures, here are a couple of points: - there are four classification of seizures - partial seizures, generalized seizures, unclassified seizures and non-epileptic sezires (the last being your pseudoseizures) - unclassified seizures are ALL seizures that cannot be classified because of inadequate or incomplete data and some that defy classification - non-epileptic seizures have no organic cause and are usually psychiatric based - may appear similar to epileptic seizures but there is no electrical discharge - these can be due to panic attacks, inability to cope with emotional demands, post trumatic stress, no control over behaviour, manipulative attacks. - activity is disjointed, non synchronous, non clonic, disco-ordinated motor activity, pelvic thrusting, back acrhing - even though presentation is not the same as "normal" seizures they are still classified as seizures. I was looking after 19year old female, presented with asthma, tachypnoeic, tachycardic, low SpO2, began to have a tonic clonic seizure, ABG showed respiratory and metabolic acidosis. Doctor persisted to tell us she was faking the seizure and it was a pseudoseizure, only because she was maintaing her own airway. However, she was unresponsive, had full tonic clonic motions, not responding to midazolam, and was in a post-ictal state for 2 hours post seizure activity. A good way to tell whether the patient is putting it in is by brushing over their eyelashes, if eyes move under the lids, and they open slightly than it is a good indication that the seizure is fake.

Over here we like to use amiodarone, but followed up with an amiodarone infusion, which I have found has worked quite well for patients following VF/VT arrest. One case, we had an elderly man, about 4 weeks ago, arrested on our doorstep, kept going in an out of VT, VF, brady, tachy, it was really bizarre, we defibed him once, and gave amiodarone with amiodarone infusion and it assisted with stabilising his rhythm. Of course we still get the doctors who prefer lignocaine. I prefer to use amiodarone, as there's not too many side effects.

Looks like NSR to me, could also look as though it has a lenthened QT interval, maybe a bit of T wave flattening, and MILD ST depression.

We use the Canadian C-Spine rule over here, I find it very useful in assessing those who I feel may need immobilisation. http://www.aafp.org/afp/20040615/tips/17.html

Where I work, we would use a 7.5 for females and an 8 for males. In burns pts we would use the same size but reinforced tubes, to allow for any oedema. We also use vec instead of sux.

exactly, a person's pain is what they say its is, regardless of what we think! We had a lady come in one day, a known drug seeker, in extreme pain, despite what we thought we gave her the pain relief!

Here here, finally I've found someone who agrees with me! I found here, in Australia that morphine has been used as the first line towards pain relief (esp. in Emergency dept). Dr's seem to think it is the only thing that can help with the pain instead of choosing something else first that may not cause so many side effects ie Buscopan/ Tramadol... Here we have a "pain protocol" towards giving morphine where it is titrated until the patient's pain is under control, I've given up to 60mg (over several hrs) of morphine to a patient with pancreatitis, and surprisingly the patient was still able to walk around (much to my dislike) and not have have any other side effects from the high dosage!