Ridryder 911

Let my Rookie run the call.... Hey, Senority does have its' place.... :wink: R/r 911

:wink: Appearantly so is spelling :wink: Excuse me, but where did you determine that treating foci (actually it would be ectopic foci or irritable foci) is not the norm for the Paramedic? Ever heard of PVC's, V-Tach or how about A-fib, even V-fib?.. Those are can be caused by irritated foci.... ever heard of oxygen, antiarrythmic's? As well, I don't know what services you consider are at the hospital that might be different in inital emergency cardiac care?... I work at both, (EMS, ER & CCU) and really don't see any difference except for labs', which is really not going to change your initial treatment modality. The days of NOT THINKING, and load and go are gone!... If you wanted to be an ambulance driver, you missed it about 35 years. The problem is we do NOT think of the situation well enough, and most are not educated enough to know the difference! To answer the question, yes I would give her a bolus of Lido, I feel it is far better to, than have her go back into V-Fib again. Remember threshold levels of re-current V-Fib? The second time she might not be so lucky, to convert. In that short period of time, Lido levels will be slightly getting thereupatic level, so I am not going to be as concerned with the toxicity effects, as I am with possibility of recurrent V-Fib. This is a young person and "sudden death" syndromes occur and occur rapidly without any prior ECG changes. For example like PVC's, R on T, etc..You are right treat the patient, and part of that is help prevent the patient from having another period of V-Fib. Especially since we do not know the etiology. By the way, I don't play doctor... I am a Paramedic, and I treat emergencies, that's my job... if you don't like that, it's time to search a new career. R/r 911

Whom informed you of this ? R/r 911

If you need a powerpoint presentation check out www.Defrance.org and go into EMS instructor division, there should be some, and it's free. Scenarious, do a google search on this site, and you will find plenty, as well as other EMS forums. Good luck, R/r 911

Give him this website...www.americanheart.org tell him to look at the new standards, and to start learning to keep current. R/r 911

I am sure they appreciated your help and your professionalism of leaving, when things were under control. R/r 911

Good luck to you and the "new family"... R/r 911

As with any medical patient diagnosis.. hx., hx., hx... Great scenario! R/r 911

Like I said, I believe he was wrong in his assessment and follow up, by not assuming care and monitoring FSBS level. (Yes, I quite aware that basic not able to FSBS, a shame but that is a different post) As kevkei was describing, he admitted to it, as well as you had previously stated you chewed his butt, now admit more of a discussion. The main point is .. Yes be a patient advocate, ( I am and have no rear left) but since you are new and want to progress in the food chain of EMS, pick your battles very wisely.... wrong or right this business, can be ruthless... Good luck, R/r 911

With the outstanding history, and rash I highly suspect Lyme disease, Early progression although it is unusual to see such symptoms (joint) until a few weeks or even months later, description of rash (if possible from patient). I would order a Lyme titer- to confirm dx. Western Blot, Inmmuno- again confirm stage Possible fluid from joint if needed after confirmation CSF- if needed Sounds like a aggressive early disseminated Stage II Lyme .. yet again, I may be wrong, I have been before... R/r 911

Okay.. I know different in Denver!.. Load and go, is not highly recommended. As well driving fast went out with Mother, Jugs, and Speed. Diesel medicine KILLS! Hint: http://www.emsnetwork.org/ambulance_crashes_2000.htm R/r 911

I have worked with several ortho's that suggest some good insight on "hip fxr.'s"... First I have learned if one actually reaches under the gluetal fold, and can palpate the "surgical neck" of the femur, just anterior of the ischium, it does not take much pressure on palpation to elicit pain, to see if it is "hip" versus traditional other fxrs. A pillow row or towel roll slightly under the hip, with the leg flexed (if possible at a 30[sup:d8db2fbf0d]0[/sup:d8db2fbf0d] ) it tends to relieve pressure on the neck area. As well all fractures, after confirmation of adequate circulation, splint accordingly and analgesics. R/r 911

I highly suggest you talk to a a poison center, just like any medication Activated Charcoal has its' indications and also side effects as well. It is not a carte blanche' medication. There is a lot of difference between treating accordingly and appropriately. I work part time in a large metro area as well, with an attached state poison control unit about 10 feet, with 3 full time pharmacist and 1 toxicologist personal, manning the center. I can assure I can count the number of times when we give activated charcoal, (hint maybe your ER is giving it in inappropriate or prophylactic, or simply following the standard guidelines.) I highly suggest before announcing to the world of under usage of activated charcoal, one would have a full understanding of toxicology and full understanding of the a) drug that was ingested breakdown and metabolism & absorption of such drug 3) if adsorption will be truly beneficial to such patient, not just an indication to treat with AC. Yes, it might be one of the lacking treatment modalities, but yet again, scientific studies need to be performed to justify such statements, and if there really is a difference, outcome when & if AC was used. Again, without Sorbital, the meds sit in the GI tract, and still is absorbed from the adsorbed AC. As well, one should know Sorbital causes diarrhea, within about 30 minutes, to remove such contents. Again, one has to justify each and every medication, not just because one has seen differential treatment in ER, than the field. If that was the case, working ICU/CCU verily ever cardioverts V-tach, PVC's etc.. because of the difference in setting, and patient presentation, history, as well differential in treatment modalities. R/r 911

Good points, you are right it only acts like " saw dust" and adsorbs (not absorb) the poison, and then excreted. Far as NG with irrigation, we no longer even perform those unless it is a tricyclic or something similar. As well you better have activated charcoal with sorbital.. and then I would expediting to the ER.. (non-sorbital for ped.'s and O.B.'s) ... As most have described, if ingestion of the poison occured > 30 minutes to an hour pta, then the treatment should be supportive and monitoring, the posion has hit the G.I. tract... R/r 911

Sounds like to me that the Paramedic probably seen that the patient was on some Beta Blockers and probably had a history of atrial fib, not atrial flutter. As well, since he was not hurting he is asymptomatic, and really there is nothing to physically to do. However; he was definitely wrong on his examination, assessment and even treatment skills. For the patient was a diabetic, and had history of of some symptoms, then your obligated to assess the patient. Yes, he is definitely wrong if he did not cardiac monitor, and at least perform a FSBS and yes he should had transported!. For as oxygen therapy, that is good, but really unless it is ectopic beats, caused by hypoxemia, it is not going to change anything. Sure at shift change, I could be grumpy too if the patient denies any changes, or has a preceding history of this, just by looking at the med.'s.. then have a basic to tell me how to perform my job, when they were not aware of the med.'s is for this condition and that >10% of the population has an irregular pulse! Some helpful hints.... don't call me out to take care of your patient, (when you are not able to) then tell me how to do it! For as a butt, chewing, I would hate to see the remainder of you after you attempted to chew my butt out.. and you were the one who called, and lacked the knowledge, experience, and skill to do anything but slap oxygen on him.... be forwarned, your name will be remembered! EMS is a quirky thing, and there are appropriate ways to handle things, and as one that wants to advance one career, you might learn what we call "diplomacy".. offer assistance, smile, thanks guys, etc.. will get more further results. It might the same medic next time, trying to save your butt on a full arrest, trauma, etc.. as well be your preceptor, testing examiner, etc.. be careful of throwing stones ... R/r 911

See if that pie is done yet?.. I would also asked what position she was in checking the pie, bent over, carotid bruits, heart tones, etc.. of course as CHBare described, ECG, IV, FSBS, etc.. Have the describe the pain, sharp, dull, palpitations, associated with breathing, producible with pressure?.. It sounds more like palpitations.. How warm is the room, gas or electric oven?.. R/r 911

A weight... so I can see if I have to walk him or I will need the squad to assist me.... Okay, good H & P ... Knee pain huh? Any other associated symptoms? Occurrence, time, activity, PMHX, any OTC treatments, NSAIDS abuse, related history of this occurrence, trauma, arthritis, change in pain, limited mobility, substance abuse, Diabetes, old sports injuries, Diet, exposure to chemical, sexual activities or Hx. of STD, smoker, hx. of gout, tick or insect bites, previous surgeries ? etc... Exam: joint character, swollen, red, femoral, popliteal, distal pulses, if no trauma- pain upon movement, R.O.M., orthostatic v.s. check, check skin turgor, conjuntiva for possible anemia, sclera for icterus, hepatic reflex to see if there is liver flap, perform a pretty darn head to toes thorough assessment. Okay Test & rationale. Baseline v.s . won't know his beginning without Tilt-test- a change in points may indicate fluid shift, or loss from anything form bleed, anemic, to hx. of diarrhea, or vomiting. A real thorough physical exam with as much hx. you can obtain, although this maybe a routine B.S. call, it could also be a 101 other ailments....NEVER ASSUME ( and we know assume stand for right?) FSBS- check his glucose level, not unusual for onset DM to have these symptoms, of fatigue, general malaise, even joint pain Lab- Let's start with a U/A to check protein, specific gravity, uric acid level, CBC- have to see what this H & H is, as well as his white count and if there is a shift or not (Bacterial versus Viral- right versus left) CMP- metabolic profile to check all those cation and anions that all you Paramedic & Intermediates thought was not important. UDS or Tox. screen- be sure our gentleman may be hiding something Cardiac Profile- strange yes, but if he has a outstanding history ... who knows? PT/PTT/INR- to see how fast he is clotting or diluted... oh, what the heck let's get an ammonia level as well... If we do find tick bites, fever.. do a RMST spot ... Mono -spot... ************God, I feel like a resident ! Of course, this all dependent on the exam and history.. probably eliminate a lot of the test. after recieving more H & P. Knee x-ray ... dependent on the exam if others... Treatment.. probably start out with a liter of fluid. Dependent on BP as well.

Yeah, like Pilots really care what a Doc says, when it comes to their livelihood. There is already sometimes friction between med crews and the pilot. Now this. I do agree this needs to be VERY closely monitored, and yes, there is a ton of abuse going on, as well as flight services "popping up" every where. I know in my state alone we went from 3 five years ago to 9 or 10 now. It sometimes like vultures overhead, to see who gets the next flight... R/r 911

Don't have to have Unions for that attitude.. I too have some that USED too do that ..They were the first to bitch and gripe about NO education as well.... :? ... Hang on Nelly! Now they are going to get some... so far there will be at least 70 to 100 hours worth of CEU's that they will be able to get between now and the end of the year... new philosophy, don' have enough CEU's at the end of the year to recertify, automatic dismissal!... One better watch what they bitch about...LOL :wink:

It was the damn blunt end...LOL.... Are you sure it was Radar or Father Mulcahy?..LOL Okay .. who was the voice on the P.A....? No it was not Radar... > > > > > > > > > > > > > Answer: Sal Viscuso

First welcome to the city... continue your close observation skills. Now, with the question. Some services do not use AHA guidelines at all. Many EMS physicians feel that they are antiquated, are not efficient enough, what ever the criteria might be. I work occasionally at a state of the art, Cardiology hospital that performs world wide cardiac research, and AHA /ACLS is considered ajoke and similar to what Red Cross first aid is to Paramedics. Second, the new criteria is just now being distributed. New ACLS text has not yet been distributed as well as the new ACLS tests, so many have not had a "transition" course yet. As well, even the NREMT will even take both criteria until early 2007. Give them some time... Good luck in school, R/r 911

Oh, C'mon the most famous of them all..."Can your basics intubate?"....Ruff, maybe we can start, my mom can beat your mom or out drink your mom?..LOL R/r 911

yeah, it must be ... maybe equal to management level..

Yep... there was protocols for alcohol administration. The problem was medics.."..self medicating themselves"....

Yeah, used to carry in the city, when we had many drinking "warm" radiator antifreeze, as well as rubbing alcohol. We used to carry & mark it each time used, funny thing it got more clear each week.. finally pulled it. R/r 911