Ridryder 911

Okay.. your thinking.. but remember Frank Starlings Law is : "the fundamental principle of cardiac behaviour which states that the force of contraction of the cardiac muscle is proportional to its initial length. The energy set free at each contraction is a simple function of cardiac filling. When the diastolic filling of the heart is increased or decreased with a given volume, the displacement of the heart increases or decreases with this volume." Okay.. see something wrong... contraction, chambers filling... In CPR and death.. there is no contraction.. In compressions you are forcing the blood out by squeezing the heart. Let's find out why a poor heart or dead heart has no blood return and arterial tone!.. Okay Boys & Girls: Let's have some fun !! It's Anatomy & Physiology Time !.... All right we remember the systemic circulation system (arteries, veins, venules, cappillaries... etc..) right. Now, do we remember the 3 muscles found in each wall the artery & veins ? Thats Right, let's say them together ! : Tunica Adventitia Outermost layer. Made primarily of loose connective tissue. Anchors the blood vessel to the surrounding tissue. Tunica Media Consists primarily of smooth muscle and is responsible for vasoconstriction and vasodilation. Usually the thickest layer in arteries. Tunica Intima Endothelium overlying the bare connective tissue. It acts as a selectively permeable barrier to blood solutes (wow!). Secretes vasoconstrictors and vasodilators (later lesson). Provides a smooth surface that repels blood cells and platelets. *Note that capillaries contain only a tunica intima. Arteries Let's begin by discussing arteries. They are constructed to withstand surges of blood pressure associated with ventricular systole. They're more muscular than veins and appear relatively round in tissue sections. Remember there are 3 basic categories of arteries: Conducting (or Elastic) Arteries These are the largest. Examples include the aorta, pulmonary arteries, and the common carotid arteries. Their tunica media contains a great deal of elastic tissue. Now this elastic tissue allows for expansion during ventricular systole (contracition) and recoil during ventricular diastole (resting). This helps create continuous flow from a discontinuous pump. Th following pics, please look at the elastic tissue within inside the artery wall and how it functions to maintain blood flow. Distributing (or Muscular) Arteries Smaller branches that distribute blood to individual organs. They typically have 25-40 layers of smooth muscle cells. Examples include the brachial, femoral, and splenic arteries (now you know why the spleen is full of blood!) (among many others). Without tone or nerve reflex you loose the muscle tone.. thus pooling and the only return would be what little circulation from compressions (which is very little) I can add more if interested... on physiology of why loss of muscle tone of circulatory in shock if there is an interest on another post.. R/R 911.. .

Okay your on the right tract, however 5 grams or 5000 milligrams of sugar per 1000 ml is very little and if the pancreas is working correctly you may not even elevate the glucose very much. Remeber some consider D5W isotonic, with little no gradient in osmalirity. Okay a little patho for those that don't know about much about diabetes. Normally glucose absorbed during or after a meal and is not metabolized at the normal rate and therefore it starts storing or accumulating in the blood (hyperglycemia) to be excreted in the urine (glycosuria). The glucose in the urine causes osmotic diuresis, leading to increase urine production (polyuria). The glucose is usually >180mg/dl for the sugar/glucose to be excreted into the urine. Then a stimulation of a protein breakdown to provide amino acids for gluconeogenesis (always loved saying that word) results in muscle wasting and weight loss. These classic symptoms occur only in patients with severe insulin deficiency, most commonly in type I diabetes. Many patients with type II diabetes do not have these symptoms and present with one of the complications of diabetes of the Type I. That is why Type II is more difficult to dx. the 3 P's Polydispia, (increase thirst) polyphagia (increase hunger) & of course polyuria (increase urination) may be absent. Generally fatigue, weakness, malaise is some of the common symptoms. Theoretically correct.. however clinically to place someone in hyperglycemia to dieurese someone is not proper choice.. Glad you are looking at it patho-physiologically .. R/R 911

Again, another going with the trend... one thing about them vollies they are proud of themselves!.... Part of being professional is not to brag on one self, it is a job.. short & simple no heroics no banners, no citations, no medals .. no lights, or sirens, whistles etc... You take care of sick & injured people until they get to the hospital. Go to school and get the education, do it right with a caring attitude.. that's it ! .....short & simple. R/R 911

That would be a lot of cellular activity.. I find error in this because of the water would be following sodium and as well as the rate of cellular activity. with only the amount of 5 grams of Dextrose per 1000 ml of dilution the glucose level is neal. P.E.T. scans use high glucose to detect cellular activity for cancer markers because of the activity level,but it is at a higher level of glucose, that enters the cell, not draws the fluid to the interstitial spaces. R/R 911

I too agree. I have seen this posted on other EMS forums and from the jest of it, the EMT's is the one with the problem of the death. Giving family false hope is cruel. Yes, the family is now your patient and your attention should be shifted to them. Contact a chaplain, counselor to assist them in this tragic time. Being careful on what, how things are asked, said is important as well. I ask why, would someone want to attempt ? Again, the chances are the family realize it. Now, you are playing like you are resuscitating their child. You not only have caused false hope, but shown lack of creditability to our profession as well, when that physician tells them it had been way too long. This will only make you look foolish as well. Then there the statement of the EMS charge if you did attempt. Why charge the family $300 -800 ? I would like to see the view on why someone would go ahead and attempt on an obvious death ? R/R 911

I cannot locate where it is contraindicated, although concern if GI bleeding and if bowel obstruction Then again it is used for post surgery abdominal. Like I stated,we use it routinely for N/V all the time and pre-op, the concern I am sure is for the increase motility and dopa effects. But the dose and amount may not be enough to see changes. Here is a link with some info for others : http://en.wikipedia.org/wiki/Metoclopramide Inapsine, although a good antiemetic and pain med, has been under scrutiny the past 5 yrs and is not administered very much due to related cardiac problems and death. Although, I believe this was blown way out of proportion, and the dose that was used was max dose... it still has been tainted and not used very often. Good luck on our research and Welcome to the City... R/R 911

Okay, to prevent another post from being hijacked. Should resuscitation measures be made on obvious SIDS case with conclusive death findings ? Let the results begin...

I started another post to keep this from being hijacked on resuscitation of SIDS Resucitation of SIDS: http://www.emtcity.com/phpBB2/viewtopic.php?t=4129 R/R 911

We use Reglan routinely and actually our ER Doc's prefer it over phenergran and the cost is so much less than Zofran. If the patient is nauseated with hematemesis, sure I give it to them. It is a routine drug given with GI bleeds and pre-op as well. Usually, hang some Pepcid or Zantac for H[sub:e2ad41996e]2[/sub:e2ad41996e] blockers to help the GI system and especially if they have to go on a vent. Be sure not to give it too fast, and it has some nasty side effects of acute onset of anger, panic attack, dyskenesia, abdominal pain etc.. read s/e. As other anitemetic be cautious in asthmatics.. etc.. Be safe, R/R 911

Again, evaulate our patient. I would not be so scared in givieng Benadryl to a known asthmatic if that is not the problem. Although, I be more concerned giving to a pregnant female. Be, cautious, be prepred for side efffects, and adverse reactions. Agai, of the S.O.B. was related to asthma, I would hold off (if I was to give some ?) ... R/R 911

How long is too long to wait for an Ambulance? Ideally 4- 6 minutes, rural 10 minutes: realistic in rural areas sometimes up 30 minutes. How far is too far for populations to be from an Ambulance? Any population that has an established community that can show that run volume of 3 calls a day, can pat for a unit. So any population over 1000 in general area How far is too far for populations to be from a receiving hospital with a certified ER? Certified .. hmm we don't certify ER's here. They have trauma level ratings..but that is all. In metro areas there does not need to be an abundance of Level I Trauma Centers, research & studies has shown not much outcome between Level II and I for the amount of money. I just wished to see ER trained physicians in most communities. Most non- metro areas get what physicians they can get.. usually family practice. This is not a paid/volunteer question, it applies to every location in the United States. Obviously, in some cities, people wait a long time due to lack of units, caused by "bull Ca Ca" runs. I remember going through a list the whole shift, in a fairly large city, people were on there for hours... everyone. There was no specific order, except cardiac and pediatric patients held priority. What can be done to free up units from BS calls? Better medical control to consult with. Allow certain Paramedics (i.e. Field Supv.) some creditability to contact & get approval not to transport. Deemed non-life threatening, no need for stretcher transport .. call a taxi What can be done to prevent patients from being put on waiting lists, excluding times of disaster? Wait list... ?.. Level 0 with no units, we have the field supervisor to respond for assessment until transport truck available or a local squad will maintain until EMS arrives. Be safe, R/R 911

It can be the beginning... Good luck, R/R 911

Unfortunately, Basic EMT has been watered down to the Advanced First-Aid level. Do a comparrision check.. College preparation has never harmed anyone. R/R 911

Might ask AK.. brrrr..... I prefer to be warm.. too much shrinkage... R/R 911

As long as it is not the evil voices.. Ace... R/R 911

"hysterical". The only things that are hysterical are out of control females and psych patients.".. There's a difference ?... now, that's hilarious !! R/R 911

There you GETrrrr done ! Do both ! R/R 911

Good posts guys... I have so many Paramedics that actually do not kow how to measure EJVD appropriately or know what the normal is. Yes, engorged EJ is clinically significant, but is not the same as EJ distention. Be sure to note on your PCR of measurement as well. Such as EJVD @ 6cm in height @ 45[sup:81c3fbd8aa]o[/sup:81c3fbd8aa] angle. Be safe, R/r 911

Cool.. it is a shame that your guys got in trouble.. it appears that medical control maybe a little anal on following protocols rather than treating the cause and effect. I do understand.... R/R 911

Hey Zippy .. you must have been tired.. try spell check next time..wow!

True size does matter.. (as a man did I say that ?) but as well it has to do with your population income level and tax level is as well. Some smaller communities have sales tax and land tax that allows a nice revenue is some small communities. Oklahoma has had a advolrem county tax for several years allowing counties to vote a 522 state bill in at a low rate high interest. Most services in smaller communities are able to operate of the interest and the taxes does not increase to about $20 -50 yr per household. It has been successful in some of the lower socio-economic areas or areas that have a decreased industry area. I know many states have adopted or placed similar taxes. These are ear-marked strictly for EMS operations only.. so it cannot be dispensed to other departments. Be safe, R/R 911

Yeah, go to the Dr. and let them evaluate you and be sure that is what it is. If so they may place you on some NSAIDS and suggest resting to allow the inflammation reduce. Good luck, R/R 911

Wow !.. Haven't seen D5W used on protocols in about 20 years! The theory of using D5W in the early years was because the glucose molecule was easily crossed the cell membrane, thus medications etc. should be used for such. This theory has basically been abandoned. Since D5W is still really considered an isotonic solution (5g of glucose per 1000ml of dilute) dependent on resource some might classify it slightly hypertonic. AHA and the ECC changed solution(s) recommendation back in the early 80's of using NSS. It is not so much of what fluid you use, but how much you are infusing. People were scared of using NSS because of the sodium level and actually increasing CHF, but closely monitoring fluid levels is the main importance. You do not have enough glucose in D5W to cause osmotic diuresis or should not be giving that much, you will be drowning your patient and causing an overload. Like my EMS, most EMS only carry D5W for the ability to mix Cordorone and Dialntin purposes. It is foolish to spend extra money for extra fluid (s) when really most EMS have a short patient time. Again the amount of fluid (i.e KVO <25 ml/hr) is not going to change anything. In fact most ER's, CCU, etc have promoted not using any fluid and maintaining saline lock for med administration. If the patient is severely over hydrated, they may be placed on fluid restrictions IV & p o. Besides, the treatment should geared at increasing oxygenation at cellular level. I am wondering does your service utilize BIPAP, use of Lasix or Demadex, Nitrates in CHF. This would promote a faster and more therapeutic regime & decrease preload thus afteroad. If not, I highly suggest your protocols be reviewed and brought up to national standards. Again, I doubt your protocol for using D5W for anything but to keep the vein open and the amount you will be giving is really of no concern in changing osmalrity changes. You could be hanging Ringers if it is 10 -20 ml an hour and if you only administered 15 ml you would not see a change (although I would not recommend that .. the ER doc would think your crazy) Be safe, R/R 911

Okay.. let' s all define what a trauma doctor is ?... I am curiously awaiting the responses we will get... hint their not usually traumatologist. Again, most do not really understand what true trauma care is... only what they have seen on E.R. or some TLC show.. R/ R 911

The theory is that the "air bubble" will be possibly be entrapped in the chamber and not be perfused increasing the embolus. The same is true for P.E., DVT etc.. It is still widely used, have not seen recent citations of studies of it. Ace ? R/R 911