chbare

I have taken care of patients involved in MVC's that sustained blunt chest trauma, (Impact to Steering Wheel) that developed tamponade. Take care, chbare.

In addition, microvascular changes and the immune response to injury can lead to additional fluid acumulation. Take care, chbare.

Wild-atheart, do a search through the threads for "polyheme." I think you should find a good amount of information. Take care, chbare.

I do not see any attraction in killing somebody either. I am a live and let live kind of person; however, I value my life and see no problem with using lethal force to protect my life. I do not see increased violence as a result of CCW laws. Perhaps I am incorrect in this assessment. In addition, states that have CCW laws have many other laws regarding where and how you can carry. For example, you cannot have a weapon in any establishment that serves alcohol. I also think a comprehensive program of instruction is required prior to obtaining a CCW. I agree the use of lethal force should not be taken lightly and the implications of carrying a weapon can be quite severe. On a side note: My wife and I are alive today in part because where I lived had a CCW law. No, I did not use lethal force; however, I was able to extricate us from a very bad situation without having to use lethal force. Take care, chbare.

Vs-eh, the use of force is not to be taken lightly. You have to make the decision when to utilize lethal force. I think people who have weapons should be required to complete an extensive program that teaches mindset, law, and use of force in addition to weapon handling. It is not as static as saying somebody waving a broom cannot be shot. Each situation is unique and should be taken as such. For example, a 90 pound 5 foot female is brutally attacked by a 250 pound 6.5 foot male. Let's say the male did not have a weapon other than his hands. You could argue that this is a hand to hand fight and the use of a weapon is not warranted; however, the victim is obviously not able to fend off the attack with her bare hands and may need to use her concealed weapon to stop the attack. Take care, chbare.

Vs-eh, what constitutes an "average citizen." In addition, I would like to see hard statistics that prove concealed carry leads to increased violence. Take care, chbare.

Kristo, the criminal does not care about gun laws and will obtain weapons in spite strict gun legislation. In addition, if somebody intends to kill me or inflict serious harm to myself or others, a fist fight may not be effective in diffusing the situation. Remember, we are not talking about a school yard brawl when we mention the use of deadly force. We are talking about taking measures to stop a person from performing an action that may kill somebody. In addition, doubling our numbers of law enforcement resources would still not ensure protection of the population. The United States is populated with over 300 million people and is a massive country with a large criminal population. It would be impossible to have resources immediately available. In addition, I believe that we as people must take personal resposibility for our own safety and security among many other things. I do understand that this may indeed seem foreign to you. I am glad that you live in a country where you feel so safe that you do not see the need to have a weapon. Unfortunately, I cannot say the same of my country. In addition, guns have been a routine part of my life and I have never lived in a situation where I did not own a weapon. You must understand that some of us have grown up with weapons. In addition, I spent several years in the military and have had the chance to attend many shooting schools and spend allot of time shooting and hunting. However, I do understand that you have not lived in an environment where guns were commonplace. Take care, chbare.

Kristo, no offense taken. In fact, it is actually nice to have a cordial conversation with somebody that has a different view. One of the issues that must be considered is that the United States is a huge country with millions of citizens, and unfortunately a large population of criminals. In a situation like this, we cannot expect the law enforcement resources to be readily available. I think it is reasonable to allow the citizens to protect themselves, keeping in mind the concept of accountability. While I would love to live in a world where we can sit around the camp fire and sing John Lennon songs, we must accept the reality of our country. I see no problem with allowing a law abiding citizen to defend him/herself or others. As I understand, Jón Sigurðsson was a well know scholar and played a crucial role in the development of Iceland's constitution. Take care, chbare.

I will try to remain as objective as possible. Kristo, the United States has an amendment to our constitution that allows for right to bear arms. The interpretation of this right; however, has been an ongoing debate. I do not think the people of Texas are bloodthirsty vigilantes. However, I think citizens that use force legitimately to protect themselves or others from harm should receive protection under the law. I do not think these laws should allow anybody to shoot somebody for committing a crime. In addition, if force is used, the Texas citizen will still have to prove that the force was justified. In addition to criminal charges the citizen will most likely face civil charges. Even with these laws in place, the use of force will still need to be justified. Take care, chbare.

I honestly do not see a problem with this. If this is how Texas chooses to interpret the second amendment, far be it for me to judge. I do not think this applies to shooting a rowdy drunk at a bar. I think this allows for more legal protection of Joe citizen should he/she use lethal force. (Used properly) I agree with your other point however, I think it would interesting to study the states that have similar laws. Take care, chbare.

Nremtp, try not to take comments personally. I think it is reasonable to ask for clarification. People are simply looking at the situation, asking questions, and utilizing critical thinking to question your statements. Take care, chbare.

CBEMT, I think we are on the same page. It looks like our terminology is a little different, but I think we agree on the cause. Take care, chbare.

Good job everybody! The medication was in fact Benzonatate or Tessalon. This medication is chemically similar to many local anesthetics and has sodium channel blocking action. This accounts for the neurological effects of this medication. Think of lidocaine toxicity and the neurological side effects associated with that medication. I hope everybody enjoyed this scenario. Take care, chbare.

It was not Tussin. It was one of the other medications on the list. Follow up on this patient: During his stay in the ER his tox screen and CT were negative. He was transferred to the ICU and continued to receive ongoing sedation to prevent seizures. The next morning his neurological status returned to baseline and he was successfully extubated. The patient was subsequently discharged and returned home with an intact baseline neurological status. He went on to have a full uncomplicated recovery. Take care, chbare.

Yes, that is what the medication in question looks like. Think about some of the patients symptoms. Focus on the neurological symptoms and think about the mechanism of action of the suspect medications. This is a hard scenario to solve and knowing the cause will do little to change our treatment; however, it will help us understand the patient's signs and symptoms. Take care, chbare.

The patient's brother comes foreword and says he took these. Take care, chbare.

Second IV is placed and a bolus of NS 250 ML is administered. The blood pressure stabilizes after the bolus and you give careful doses of benzos to maintain sedation and control the seizures. Upon arrival at the hospital the patients hemodynamic status is much more stable. The grandma arrives with all of her medications. The medications she takes include: Lisinopril 10 mg po q day Lasix 40 mg po Q day K Dur 20 MEq po Q day Albuterol MDI 2 puffs Q 4 hours PRN Albuterol SVN 2.5 mg Q 4 hours PRN Zithromax 250 mg po Q day (3rd day of the pack) Benzonatate 100 mg tid Tylenol 650 mg po Q 6 hours PRN Tussin DM OTC 2 teaspoons PO PRN MVI PO Q day She is not sure how many pills may be missing and the bottles are all in bulk, so you are unable to get an accurate count of the meds and determine what was taken. What med is the culprit and what do we do? Take care, chbare.

The patient is RSI'd and an age appropriate ETT is placed with confirmed subjective and objective findings. You are enroute the the hospital. Take care, chbare.

A prior poster wanted an order for glucagon from med control. Typo on my part. The patient does not improve following the narcan. We do not have to give glucagon, just note that if we did, the patient would not improve. Take care, chbare.

We may end up using medication drips or meds from a sending facility if we are on a transfer. In addition, we may use a blanket or seet depending on the patients condition. My employer supplies everything I need to provide patient care however. Take care, chbare.

No changes following the prior interventions. BGL is 112 mg/dl. B/P is 58/30. No changes following glucagon administration. Take care, chbare.

Temp is 98.4 F. Take care, chbare.

"It seems that once again, nursing hasn't gotten the message yet, just like hypoxic drive." I would be careful regarding sweeping generalizations. I think the problem is much like the problems discussed regarding EMS providers. You have individuals who are stuck in one mind set and refuse to change their practice. This is a problem that is not isolated to a specific group of providers. Take care, chbare.

You have all of the ALS interventions at your disposal to care for the kiddo. SpO2 reads 88%, ETCO2 reads 50, and you note sinus tachycardia at a rate of 110 with an occasional unifocal PVC on the monitor. Take care, chbare.

The parents are screaming in fright. The patient continues to seize after 1 minute. You take the standard seizure precautions and position the airway to the best of your abilities. IV access is established and 0.12 mg of narcan is administered IVP. (Estimated pt weight at 12 kg) During the procedure your partner administers a dose of rectal Diazepam. The patient continues to seize following your interventions. The pupils were about 4 mm bilat and slightly sluggish to react. Take care, chbare.