Ridryder 911

Actually, Mucumyst is only really helpful if initiated in the early onset usually within 6hours.. that is why I am a big proponent of carrying on EMS rigs in nebulizer form, although it does stink like sulphur. I had read at one time administration of mucumyst in the initial first hours reduces the acetaminophen level, quite a bit. The usual treatment for overdose is to monitor the level, and if very toxic dialysis therapy may be initiated. R/r 911

We are currently testing them and so far they appear to be great. I wish I would had them 30 years ago!.. We would had saved many leaving the field. As for lifting, yes, they do weigh more, but they do wheel better over grass, rocks, etc. better than Ferno's Most of the back problems occur with repeated lifting and this with stretcher this appears to reduce that often. As well, most of the patients anymore are not the same weight they used to be... so yes, the 700 pound patient load is nice to see. I agree, they are expensive but so are laminectomies.... R/r 911

A couple of things wrong.. first, were was this "concerned family" when they found her slumped over? ... It is usually and standard of practice to "re-triage and re-assess patients" every so often. I believe the major problem in this story is " discrepancies in paper work" .. time will tell. R/r 911

Yeah, I agree, we usually hire by gross weight ( it's cheaper that way).. I agree most medics party as well, but nurses usually over all have a better conferences with new and more informative information, where EMS just basically repeats itself. Yes, vendors do have better trinkets as well.. I remember my first nursing conference, I was in total awe .. I was so used to EMS conferences. R/r 911

The change is not to attempt to ventilate, remember that CPR is to be better even without attempting ventilatory support. This of course is for the laymen course, which assumes many does not understand the sequence. Check out all the changes and explanations here... http://www.americanheart.org/downloadable/...2Winter2005.pdf R/r 911

Here you are some links.. http://www.naemt.org/aboutEMSAndCareers/history_of_ems. http://americanemt.com/history.php There are many others, that do not include such pioneers such as Feildman, Nancy Caroline, etc.. that was instrumental in developing a national base EMS. As well, although many countries may have some good and even sometimes better system, remember where the technology came from.. "NASA". R/r 911

Sounds like a bad deal... nothing can be done. Finding the patient appears to always be difficult. I would had obtained the physicians name and as well wonder why he did not stay with the patient? If the patient really did "go under" this could had lead into complications. I ask if there was any ETOH involved as well? I agree, I doubt CPR was indicated and as well if he really went under that duration without any aspiration occurring. Like zealous rescuers, performing CPR, time is greatly exaggerated. Personally, I would not have done anything differently as well, from your clinical presentation and history. R/r 911

It depends what rhythm they are in .. there is no predictability. In fact they can be both in multiple rhythms. Example A-fib with conversion to SR or A-fib with some A-flutter. Yes, a lot of time though patent's with A-fib, have a higher degree of being in atrial fib, especially if their dig level is down. R/r 911

I remember on my CEN test, there were several questions on high power paint and grease gun injuries, which are apparently very prominent. (Not trying get off the topic to far) R/r 911

I would imagine with single small caliber such as a 22 does not have much tumble and aw, as well as not causing such fractures such as a comminuted fractures, like a large caliber. R/r911

As well, as with a hx. of A-fib they might be treated with Coumadin, and increase risks of bleeding etc.. Yes, MOI with clinical findings of sternal, chest trauma.. an indication for another assessment tool.

Let me as well, welcome you to this forum. We welcome your expertise and knowledge. We have several experience and multiple educational and license levels (as well as a few physicians). We are glad you are here and appreciate your posts. I am usually more aggressive of treatment of CHF, seeing the outcomes in CCU/ICU as well. Again, I am not stating that Lasix is not being possibly used wrong and inappropriately. I too see this too often in EMS and as well at the physician level. Personally, on presenting clinical findings of CHF: i.e. nocturnal dyspnea, increasing dyspnea on exertion, increasing weight gain or edema, as well as physical findings such fine crackles (rales) and possibility of gallop of S[sub:130fba0288]3,[/sub:130fba0288] S[sub:130fba0288]4[/sub:130fba0288]. Personally I think tere should be more empathises in assessment teaching and education. Along with a PMHX of CHF and and post- AMI. and poor ejection fractions. Personally, I have found the use of Lasix in patients with early indications, may decrease the pre-load pressure such as in the initial right side before the shift to the left side, if caught early enough. We have just started the use of Nitrates and yes, I definitely agree with the use of it, especially those of having moderate to high hypertension levels. I too agree, anecdotal that most true or symptomatic patients are hypertensive. I of course come from the old school of Morphine thoughts of promoting venous dilation, which has been demonstrated not very effective. Of course, when I first started, we used rotating tourniquets, in which I have read is being studied again only in a different approach. Our protocol is of course obtain baseline values, and after assessment and determination of degree and dept of CHF, the determination of treatment is made. The amount and degree of respiratory distress, the patient is then placed on CPAP if needed i.e. respiratory distress, such as tachypnea, restless, etc. If there is severe distress that patients needs true ventillatory support, and intubation (RSI if needed)is indicated we will perform that. Intravenous Lasix of 40 to 80 mg. (if patient is on p.o.) and of course if they are normotensive as well, and then 1/2-1" NTG paste topically. We operate in an urban area, but it is routine for us to have transport times of greater than 20 to 30 minutes as well. (I did work at a rural service that we used Inocor, and yes we placed Foley as well :wink: ). We have had CPAP for about 10 months and have used it about 40 times, all with great success. Many of these patients demonstrated those if treatment had not been initiated early, would had been probably been placed on a vent. I have even some that with dieuresis was actually discharged, instead of admission. So yes, this tool is one of the best piece of equipment (next to capnography). Like in ER where many have been diverted from aggressive intubation and ventilatory support. I do believe we are going to have to start examining and study aggressive treatment of CHF in EMS. With the gross number of diagnosed cases of CHF and the increasing percentile of "baby boomers" with potentially undiagnosed CHF, we need to look at more aggressive treatment. Footnote: BNP= HBNP the old way of saying immunoreactive human brain natriuretic peptide (hBNP or BNP)...LOL Again, welcome to the City... R/r 911

The common diluent is sterile water. Apparently not all concentrates are the same ingredients. R/r 911

I personally have never seen "car battery acid" but, I have seen other acidic junk injected. Like I have posted muriatic acid and other acid from the making of crank. Usually the veins will "burn" and hardened at the injection site as well as an upper portion of the veins. I am sure there serious cardiotoxic effects as well as phlebitis and potential endless complications of thrombus and embolus and metabolic issues, that we would not have enough room to discuss. One of the acidic patients I had to fly in had injected himself with "hot meth" (which did melt portion of the syringe" had missed the vein and infiltrated the site. On follow up, they were attempting to save his arm, as well with the acidosis his kidneys was failing as well. So there is much that could occur.. I suggest search engine "injection of toxic acid" for more details. R/r 911

I would say it is very easy to diagnose CHF with HNBNP and a CXR in front of me. If you have Paramedics administering Lasix in a septic patient something is wrong (unless they have both). More attention should be given to educating assessment techniques and history. As well, I do wonder how much and what truly had to be done to "save" a patient in sepsis with a single dose of Lasix. I routinely administer Lasix of those that do not meet the requirements or in the need of CPAP as well as those that have history of CHF, increased edema, weight gain and after a thorough H & P. It would be foolish for the patient to be administered Lasix immediately upon arrival and then have to wait an additional 20 minutes to diurese. There have been times, the patient has started diuresing after arrival to the ER, and this has prevented additional treatment. Treatments like Lasix such as CPAP, and NTG, can also prevent needless intubation, possible ICU and hospital admissions. Early thorough accurate assessment and history, should be the key in administering any medication pre-or inner-hospital. We may not have any "literature" at this times that proves Lasix has made any true difference. This does not mean it does not work or should be immediately deleted. Obtaining and performing quantitative studies, other than anecdotal reports is hard to perform in the prehospital arena. Let's not throw the baby out with the bath water yet... R/r 911

Duh.. apparently you have never seen or attempted to treat osteomyelitis. Do you really think pouring a bottle of saline is going to really going to cleanse an open fxr. Orthopedic surgeons scrubs for hours and debride around the bone and tissues. The chance of osteomyeletis is higher than a lacerated artery. Furthermore, traction on a open fracture is "actually reducing" it, and not stabilizing it from causing further harm, which strictly contraindicated. Please, read the NHSTA Basic EMT curriculum as well as the manufactures recommendation, unless you have "special" protocols, I highly suggest not to placing any type of traction splint on any open femur fracture, since this is what will be testified against you in court. R/r 911

Don't see nurses hopping into EMS units very soon... let's see, half the pay, longer hours, and uncontrolled environment..naw.. we can't even get to work in a hospital. Remember many nurses do not like emergency or critical care patients. R/r911

Never had battery acid, however I did have someone that injected themselves with muric acid. We initiated a NaHc03 drip and monitored...yes, he was a cranker... R/r 911

Mcburney's point is usually pin point located on the right lower quadrant, 2/3 from umbilicus to iliac crest, more indicative of an appy. I too was taught the 5 "F"'s of fair, fat, forty, family, flatulence for cholecystitis. R/r 911

Hopefully, they will not attack with coral snakes and scorpions... otherwise Illinois will be up the creek without a paddle. :shock: R/r 911

Hey at least we can read the posts now without an interpreter !! R/r 911

Yes, thank you. After proof reading, I had missed this. R/r 911

I am now really worried about this. I highly suggest either: Proof reading and making correction of typing errors when attempting to remove doubt, or to prove a point. Speak with your English teacher and have them review your work after typing, if you are seriously considering pursuing a professional career, and an upper level education. Continuation of such erroneous mistakes, display lack of understanding and proper usage of the English language. I do wish you the best of success, and please believe me I want you to succeed. Later in life you will understand my statement. R/r 911

I used to have several students would buy me..the spouse liked sleeping in them. I personally, never wore them in public. and I too thought they were a poke in the eye for PR in EMS. One of the funniest, was a picture of v-fib and defib paddles. Stating.."everyone needs a good paddling"... and Edison medicine. Ays.. I think you have seen too many whackers.. I wish we could place a surcharge tax on each item, then distibute the money to professional medics for a retirement fund... we all could retire early!! R/r911

Most medical direction prefer not to apply traction to open fractures. Mainly, when applying traction one can perform a reduction of the bone, thus causing an increase in possibility of infection and osteomyelitis. Of course, traction when there is no pulses to restore circulation is important.. R/r 911