chbare

CPR started. You place two NPA's and an OPA and are able to perform effective BVM ventilations with equal bilat chest rise and fall. Stat pads are placed and your partner can choose to place whatever airway device tickles his/her fancy. No need to call for ALS as you are the ALS crew today. The patient did not say anything in the minutes prior to the event in question. "he was stretching and suddenly collapsed." His wife denies any history of heart problems. He is 32 yeas old. The following rhythm is appreciated on the monitor: Take care, chbare.

Appears pale. No spontaneous respiratory activity noted. Absent radial and carotid pulses noted. Skin is cool and very pale. Take care, chbare.

This is a track and field event. He is down next to a set of bleachers. People who witnessed the event tell you he was cooling down after completing a set of sprints, when he suddenly collapsed. His wife is present. Take care, chbare.

Consider it done. Anything else? Take care, chbare.

You are pulling medical coverage at a track event when you are called to assist with a male "that is unresponsive." Take it from here. Take care, chbare.

Smoker? Obesity? Oral contraceptives? HRT? Take care, chbare.

Yep, had a patient with one about 2 months ago. Needless to say, the outcome was...less than optimal. I have generally used Octreotide and blood products in the ER. The real problem is with the portal venous pressures and loss of clotting factors. Unfortunately, with chronic liver disease, both will continue to be problematic. Take care, chbare.

I have been to many places where EMS reports are literally minutes long. I remember a recent report where the EMT literally gave us an entire run down of a sick patients day at the nursing home. Woke up feeling sick, fever on and off, staff called doc, orders for tylenol, did not work, still has fever, called doc again, bla, bla, bla... Give me the down and dirty over the radio, and we can talk details face to face at the bedside. Fellow nurses hate my style. When I call for a bed admit, I immediately ask to talk with the receiving nurse and give report after receiving a room assignment. I tell them the down and dirty and then I am headed up to the room. Many nurses want a full name, entire med list, a 5 paragraph expository essay on the patients psychosocial background, and a few sensless questions thrown in for the heck of it. I say, you will get all of that in a face to face report. It is simply faster to get the room and get the patient out of the ER. IMHO Take care, chbare.

As stated, compartment syndrome is related to elevated pressures within the various facial tissue compartments. While a crush injury will increase the risk of compartment syndrome, many other injury types can precipitate compartment syndrome as well. Pre-hospital treatment of the injury above will likely revolve around supportive care, pain control, and isotonic fluids. With massive tissue disruption, byproducts of dead muscle will be released into the blood stream. This is the Rhabdo that Ridryder911 talked about. Renal failure, acidosis, and electrolyte abnormalities are primary concerns at this point. (assuming the ABC's are intact) Unless we have a highly progressive system, our treatment will still be supportive. Placing a foley catheter in addition to the other interventions if not contraindicated would be a very helpful intervention. Bicarb can be considered; however, without labs I would hesitate to use bicard in the pre-hospital setting unless we are looking at prolonged transport. Take care, chbare.

I have to say that in my experiences, female nurses tend to be much more petty and territorial. As a travel nurse, I love being detached from the day to day political atmosphere of staff nursing. As far as interaction with EMS crews, it is hard to say. Now, that I have had a chance to work with and be around crews from all parts of the country, I have to say EMS is quite disorganized and really does lack any type of continuity. So, I have to customize the way I interact based on the area. Even if a crew screws up, I do not have the time to make a big stink. It is easier to simply take the patient and carry on. I do not see how some nurses find the time to wage petty battles in the middle of a busy ER. Again, I find it easier to take the patient and do my job. One thing I constantly ask EMS crews to do is to screw the radio report if they know I am on. I think radio report is generally useless and prefer a bed side report face to face with the crew and patient at the time of care delivery. All I care to know is if the patient is ok, bad, or dead. Other than that, no dissertation on the radio please. I know more than a few EMT's who have been taken back by this concept. Take care, chbare.

Fontanelle assessment? Pulse oximetry may be difficult at this time. Do we have a core temp? Any abdominal masses or abnormal findings? We need to provide some blow by oxygen and start working on vascular or IO access depending on the situation. Pull out the good old Broselow scale. A full term kiddo should be around 3.5 kilograms Take care, chbare.

Color and skin condition, signs of trauma, history of present problem, any past medical history, problems during the pregnancy or during child birth? Lung , heart, and abdominal assessment? Any history of vomiting, loose stools, or fever? Need to have the resuscitation equipment ready to use and we should abtain a blood sugar. Take care, chbare.

Size up of the scene and general patient impression? Assess responsiveness and then move into the primary ABC survey. Take care, chbare.

DwayneEMTB, I agree. NREMT-Basic, you have had some great posts and many times I have enjoyed reading your conversation. Brother, I think you need to take a little vacation and find your happy place. Remember, at the end of the day this is just a public forum. And comparing Dustdevil to Bill O'Reilly? I always though Michael Savage was a better comparison. Take care, chbare.

I cannot make any comment about his statements on other sites, and perhaps that is a conversation best saved for a different thread, as this one is about the EMS Solutions podcast. I think we must have listened to a different podcast? I do remember Dustdevil going over his background and educational experience; however, he was quick to point out that he believed his own level of educational preparation was "barely adequate." This is in reference to having a two year degree for entry into practice. Again, I think you are upset about something that is not related to the original topic. Take care, chbare.

Many things can lead us to suspect torsion; however, the physical exam can provide evidence to support our theory or provide evidence to disprove our theory. For example, a prepubescent male complains sharp and intense scrotal pain. This information alone would lead us to suspect torsion. However, during the exam we appreciate a small hair follicle scrotal abscess. This changes the entire course of treatment and urgency of the patients condition. While you could argue that this does not directly effect your care, it in fact does. You fail to perform the assessment and provide the ER with an incomplete picture. The patient ends up filling a bed that should have been filled by a patient experiencing an emergency. It is difficult for some of us to appreciate; however, the assessments and decisions initiated in the field do ultimately effect the disposition of our patient and other patients. We must look beyond our little box and realize that we are part of a much larger picture. In addition, we can appreciate problems such as phimosis, para-phimosis, penile fracture, and priapism with a physical exam. All of the following problems require urgent treatment and your field assessment of the findings can help these patients receive the care they require. Take care, chbare.

I understand it may be a bit more difficult in the pre-hospital environment to perform these assessments. Always make sure your partner is present and can back you up should somebody say you did something uncouth during your assessment. In the hospital, I am able to grab a female to act as a chaperone when I perform an assessment on a female patient. Take care, chbare.

I have been watching this thread with some interest for a while. Allow me to weigh in? Why would we not perform a focused assessment of the genitals? This is the patients primary complaint and part of our care involves performing a physical exam. We should have ruled out and treated any life threats during out primary exam. Now, we can perform a focused exam. I remember having to do this at the medical station back when I did my NREMT-B, so the concept is not beyond the basic EMT. True, the stupid stations usually require you to focus on a chest pain or poisoning and call for you to help with a self assisted med; however, the concept is still intact when we hit the real world. Why would we not perform a brief physical exam and ask a few specific questions? I took care of an elderly lady a few weeks ago who was taken to the ER for vaginal bleeding. The EMT refused to perform an exam and told us that kind of assessment was outside of her scope of practice. If she would have simply taken a look and performed a brief exam of the area, she would have clearly noted a prolapsed uterus. This is a pretty significant finding to miss IMHO. There are a few simple things that we can do: -First, look at the genitals. Note color, swelling, the presence of any skin abnormalities, and look for discharge or blood. -Next, get hands on. Gently palpate and note any abnormalities to the best of your abilities. The text book finding know as the Prehn Sign may provide us with some tangible information. (Elevation of the teste decreases pain with epididymitis, while pain increases with torsion) -Finally, ask detailed questions about the history. Time of onset, dysuria, chills, fever, sexual history and possibility of STD's, and surgical history to think of a few. True, you may not be able to treat these conditions in the field; however, your assessment findings may prove valuable to the receiving facility and help expedite definitive care. People can easily slip through cracks in the ER and emphasizing key findings may expedite treatment to a person with a suspected serious problem. Torsion for example. You cannot treat massive internal hemorrhage in the field, but you let the ER know your findings and emphasize the possible critical nature of the patient based on you findings. While GU complaints may be less glamorous, assessing a suspected emergency should not be based on the system involved. Just one last thing to add: Testicular torsion is considered a true urologic emergency. If the testicle is not de-torsed, it will die and necrose. This will result in the loss of the testicle. Last I remember, we are in the business of emergencies. Sadly, I suspect most EMT schools spend very little time covering the GU system. Take care, chbare.

A while back, I remember a story about an incident that occurred. A team was called to a hospital to provide transport to a larger facility with subspecialty resources. The patient was intubated; however, the patient was moving about the bed and fighting the staff. The crew asked if the patient had received any sedation, pain meds, or paralytics. The staff told the crew that they were giving Vecronium without any effect. A little investigation by the crew led them to find the hospital staff was actually administering Vancomycin. Take care, chbare.

Hmm, I am not sure I would put a hard time requirement on how long I spend in somebodies airway. This will vary greatly from patient to patient. Do you remember your OR rotation? A healthy and properly preoxygenated patient can go several minutes before they desaturate. Again, this will decrease with illness, obesity, and age extremes. If I have a well oxygenated patient with a good LEMON assessment and all of my equipment ready to go, I am going to slow down a bit. If we pull out of an airway every 30 seconds, we will create a failed airway situation when one does not exist. Most people say 3 attempts and you are through. Why not take a little extra time to position, do a little ELM, and perhaps suction. Then, make every attempt my best attempt. I never bought into the whole hold our breath thing. This IMHO creates undo stress and distracts you from the task at hand. Have somebody watch your saturations, vital signs, and the patients overall condition while you are in the airway. Let the patient's condition decide when you need to stop and bag them up, not the fact that you are out of breath. Take care, chbare.

I think you may in fact be able to attend as an officer. (At least through the National Guard.) As I understand, you would need to reclassify into the SP Corps prior to the start of the IPAP course. In addition, your rank may change; however, it should be possible to go into the IPAP as an officer. Take care, chbare.

Are you still in the military? You may want to consider the Interservice PA program if that is an option. Dustdevil, are you looking at the Interservice PA program? Take care, chbare.

What specifically do you want to discuss regarding RSI? Take care, chbare.

The focus of the RN is different, I would say the foundation of sciences is much stronger with an RN versus a shake and bake medic. (A&P, core science and math courses, microbiology, etc.) I am not sure that an RN would be able to challenge the NREMT-P exam process as a new grad. The focus of core nursing care is so different from that of the paramedic that most new grad RN's would not be successful IMHO. Edit: I would not compare an ER RN to a paramedic. Again, the focus of care and environment is very different. Understand, this observation is from somebody who has several years of ER experience in addition to EMS experience. Take care, chbare.

"well, I agree. Dirty black socks has no field experience. If he did, he would realize just how lacking RNs really are. No, Paramedics don't need extra training, they already have a base knowlege above what RNs do. Ivasive, goss life-saving skills, every day. It's what we do." Sure you are not confusing skills with education? You can teach anybody to perform an "invasive life saving skill." Take care, chbare.