chbare

FL_Medic, I agree with Spock. We rarely administer fibrinolytics in our ER. If we can get the patient to a cath lab in time, all of the cardiologists in this area prefer that we not administer fibrinolytics. They tell us there are allot of complications during the procedure and CABG could be a nightmare. Take care, chbare.

ReD, it sounds like he died from a high grade C-spine injury with injury to the spinal cord. ( C1-C2 area ) Take care, chbare.

ReD, I know surefire puts out top of the line lights if you are willing to put out the money. I agree, however, that the mag light conversion is worth while and saves on batteries. Take care, chbare.

FL_Medic, I agree, however, my "murse" training is starting to show. I am already thinking about what things I need to teach the patient after surgery, identification of a cause so I can help the patient and his family understand and cope with his condition, and just plain curiosity. :wink: Take care, chbare.

FL_Medic, again, I think Primacor like Natrecor, would be pretty limited to flight teams and critical care transport teams. It is a potent drug that requires close observation for hepatotoxicity & thrombocytopenia. I would want invasive monitoring with this drug as well. Take care, chbare.

TechMedic05, no offense taken. Take care, chbare.

FL_Medic, check with your state EMS board. The NREMT web site has a page with links to all of the state EMS boards. I would not expect paramedics to administer this medication with the exception of flight teams and critical care transport teams. However, I do not have allot of transport experience outside of my area. Here is a link for people who have never heard of this drug. http://www.rxlist.com/cgi/generic/natrecor.htm Take care, chbare.

Itku2er, The Flying Spaghetti Monster is a deity created to poke fun at religion. As I recall it was designed as a protest against the teaching of intelligent design. Take care, chbare.

FL_Medic, no history of ETOH use or h. pylori . In any event, it sounds like bread and butter for the surgeon. Take care, chbare.

It looks like he has a problem that cannot be fixed on scene. Does the hospital have surgical capabilities? Start large bore lines with NS and blood tubing attached. I would be very cautious about fluid boluses however. Are there pedal pulses present? Difference between R and L blood pressure? Take care, chbare.

Vs-eh?, I do see your point, and agree , you could argue that virtually anything could be God. I have a belief, and my rational of faith may see silly or not based on logic to other people. I do not think that anybodies beliefs are more or less superior to my own beliefs. I am glad however that I live in a country where you can believe whatever. I do not hold any ill will toward people who believe in something different from myself as long as their actions do not hurt or impose on other people. I actually enjoy reading how people articulate their beliefs, even if they differ from my own. We live a subjective life in a subjective world. I guess we will find the answer in the end..if there is an end :wink: Take care, chbare.

Pale with a sat of 92% while on a NRB with NPA inserted, not good. PPV with cric pressure if tolerated. Compliance with PPV? Observe and palpate the abd. (Bowel sounds are worthless in this scenario.) Agree with the other interventions. Take care, chbare.

FL_Medic, can you clarify the airway? Unable to maintain the airway, but breathing is normal? If the airway is compromised, I would like to insert a NPA and start high flow oxygen. Lung sounds? If his breathing is shallow or very labored, we need to look at PPV. Lets put him on the monitor after taking the steps needed to maintain the airway and perform a rapid head to toe survey. Base line vital signs? In addition, get a BGL and have somebody spike a line. Can one of the first responders talk to the SO and obtain more history while we are working the patient? Allergies? Surgeries? Recent problems or complaints? Cannot find the meds? (Do we know what the meds are for?) Past medical problems? Take care, chbare.

Scene size up and general impression upon arrival? Does the patient respond and are there any indications of trauma? Is he breathing? Does he have a pulse? Take care, chbare.

FL_Medic, good scenario. I would bet fluids would help this patient as well. It sounds like it may be a ruptured ectopic. Take care, chbare.

Agree with ACE 844. I would consider a fluid challenge as long as the lungs are clear and there are no indications of heart failure. Nitroglycerin may be considered if we can maintain a stable systolic blood pressure. Lets see if the rate comes down with fluids. Stay away from beta blockers. Take care, chbare.

How long ago did the pain start? Rebound tenderness? Does the pain radiate? Lung sounds? JVD? Hepatojugular reflex? hepatomegaly or actual distention from another cause? History of ABD trauma? Dysuria? Base line vital signs to include a temp? We need to pin down her LMP 12 Lead ECG? BGL? Height & Weight is possible? Allergies? Taking any meds or supplements? Any recent illness? Supplemental oxygen. Position of comfort depending on the hemodynamic status. Cardiac monitoring. Vascular access and isotonic fluids, rate depending on vital signs. Monitoring and transport. Additional treatments/assessments based on hemodynamic status. Once we arrive at the hospital, there will be a few more things that I wold like to do. Take care, chbare.

"I believe in a higher being. I don't believe my definition of a higher being fits everyone or even anyone else. And nope, I'm not here to sell this to you. This works for me, I hope your way works for you....." (DwayneEMTB) That should about sum it up. I also agree with Richard. It is a waste of time for me to push my views on you and visa versa. At the end of the day we can agree to disagree. Take care, chbare.

Yes, I believe in God. Take care, chbare.

"Do I agree with the post? No, I think it was inappropriately placed and is simply an excuse to belittle nursing staff. Each has their own place in the medical chain and they fit well there. Each person brings their own strengths weakness and baggage to the situation. Some are more educated in certain areas than others. I chose not to say anything against the poster, because I know just as I speak, I will say something stupid and the tables could be turned to me." Fire911medic, I like your point of view. We all say stupid things and make mistakes, however, like Dustdevil stated, having the strength to admit to the mistake and learn from the error is another thing. Take care, chbare.

Shauniedarko, welcome to the city. I do not know about the Seattle area, however, most of the areas that I have seen are tight on EMS employment. If you are serious about a career in EMS, I would recommend you stay in school and complete paramedic. (Get a degree if possible.) Nothing against EMT's, however, I have found that newly minted EMT-B's have a hard time finding employment in many areas. Good luck and hope to meet you on the forums. Take care, chbare.

I have seen this confusion occur many times. People have a bad habit of grouping all controlled substances together an calling them narcotics. However, a narcotic is just that, a narcotic substance. While a benzo is a controlled substance, it is not a narcotic. We are talking about two different substances with completely different mechanisms of action. Take care, chbare.

Ace844, great table and I agree with AZCEP, good acid base information. Take care, chbare.

Thank you Ridryder 911 everybody else. This a worthy topic in and out of the hospital. Take care, chbare.

I am glad that people are finding this scenario interesting. JackMaga, nearly all of my scenarios are of actual patients. I do have to change some of the specifics and details to help guide people toward a diagnosis. (ie; the "dogs keeping me up all of the time" comment and the asking if "my time out in the field could make me sick" comment, and making sure to give some of the classic indications of an illness/injury) In addition, I have to create a patient response to a treatment that may not have been given in the actual patient or visa versa and try to tailor the scenario toward an EMS provider. Take care, chbare.