chbare

You are called to the scene of a male complaining of general malaise and "just not feeling right." Take it from here. Take care, chbare.

The XII lead is characteristic for a possible sine wave pattern. This is highly suggestive of severe hyperkalemia. Add this to a history of renal failure and we need to assume severe hyperkalemia. The team demonstrated poor understanding of the pathophysiology of renal failure and overall knowledge of their medications when they decided to use suxamethonium. (Succinylcholine for those of us who speak proper English. ) Edit for emoticon.

Awesome, it's about time my state was in the news! Take care, chbare.

I am not quite sure of your question. However the Somogyi effect is more of a rebound hyperglycemia when the body tries to raise blood sugar suddenly. It may occur at night in people who develop hypoglycemia, then wake up hyperglycemic. The hormone mechanisms do involve glucagon release and glycogen utilization however. Take care, chbare.

Since one of the many actions of glucagon revolves around mobilizing hepatic stores of glycogen, it is reasonable to expect people with significant pathology such as starvation or perhaps liver problems would not benefit much or at all from glucagon. Take care, chbare.

I can logon via my Iphone; however, none of the recent post activity or blog activity sections are available and the recent post button is not available (bottom of the home page). Therefore, I cannot easily browse new posts and threads. Take care, chbare.

Dwayne, if I read you correctly, you arrived on scene, ensured a patent airway with breathing and a pulse, and decided to load and go while performing additional interventions en-route. You did a "medical triage" as opposed to a "trauma triage" load and go. Take care, chbare.

It takes a significant amount of education to identify normal anatomic structures such as Morrison's pouch, and then identify free fluid collections. In addition, the FAST exam does not give us good retroperitoneal information. Therefore, I am not sure field use of current FAST technology for trauma triage is a particularly worthwhile endeavor. Are there solid studies on this topic? I know Austin uses ultrasound technology; however, I am not aware of any large studies that show significant benefits to pre hospital FAST exams. Take care, chabre. Edit to spell "of" properly.

I am hesitant to call somebody out on choice of pressors in such a grave situation. It sounds like your interventions helped and even cleared some of her lactate. You at least improved tissue bed perfusion and oxygenation. The LVAD and BIVAD approach is becoming quite popular. So popular in my area, I had to attend a conference on the Heartmate II and interact with a person who had this device implanted. Many people are going home on destination therapy with these devices. I know Mayo in Phoenix is very progressive with their VAD program. (closest VAD program in my area) All things considered, it sounds like the patient may have a chance. Take care, chbare.

Anecdotally, vasopressin would not be my agent of choice for cardiogenic shock. Then again, we are in essence robbing Peter to pay Paul when it comes to using any kind of adrenergic agent (I say vaso is adrenergic in a way; however, vaso effects are not via adrenergic receptors. Therefore, you can call me out on my statement.) in the setting of cardiogenic shock. Vasopressin is a great agent for refractory forms of distribution types of shock. Mainly because vasopression has it's own V1 & V2 receptors separate from adrenergic receptors. This is quite handy in the setting of a patient with down regulation of adrenergic receptors. The typical example being a septic patient on long term vasopressor therapy. Hence the reason some people advocate for stopping vasopressor drips on septic patients for a period of time. You may have herd the term "pressor holiday." I digress however. Unfortunately, you are screwed regardless in the setting of cardiogenic shock. This is especially true with LV impairment. Your patient most likely lost a significant portion of their LV given the localization of the ECG changes. Not much "medically" will really help this patient. You can increase SVR or try to increase contractility with pressors; however, a dead LV is still not going to work. Was an IAPB placed? This would be a potentially viable option. I assume a PAC/Swan was placed given your mixed gas comment? What other vales did you note (PAP, CI)? Take care, chbare.

This is absolutely NOT an American Heart Association policy. I can say this as a current ACLS instructor. Neonatal Resuscitative Program (NRP) is going through some change over with their instructors. Many medics and nurses will be unable to obtain NRP instructor status because now only people who have frequent newborn exposure can look at obtaining instructor status.

A good point. You can have a "normal" pulse oximetry reading; however, be experiencing significant hypoxia. If you have low amounts of circulating red blood cells, yes the remaining cells may be well oxygenated; however, there may in fact not be enough oxygen reaching the tissues. This is known as hyphemic hypoxia. Another consideration. Pulse oximetry tells us nothing abut tissue oxygenation. Hemoglobin may be well saturated; however, if hemoglobin has a high affinity for oxygen, AKA a left shift on the oxyhemoglobin curve, it will be reluctant to release oxygen to the tissues. Of course, abnormal states of hemoglobin are always a consideration. One more point to nit pick: SaO2 & SpO2 are not exactly the same concept. Take care, chbare.

So, while you were laughing, did you ever consider the differentials for syncope? Quite a list, being that syncopal episodes in many cases do not simply occur. In some cases there is actually a cause. While I agree, it is a real treat hounding on nurses, you may need to look at your own practice. I guess we can add this to the capacious list of threads about nurses who mess up. I am not sure what good will come out of another EMS versus nurse debate; however, I have been proven wrong in the past. Take care, chbare.

Yes indeed. Take care, chbare.

As some may know, after nearly a decade, I am once again a student. I am working my way through an allied health program (Respiratory Practitioner). However, I continue to run into a recurring theme on the job. Medics and Nurses who I work with continue to question my judgment regarding going through such a program. The most common question I am asked is "how does it feel to take a step backwards." Anecdotally, it would appear that many people are really not aware of what other provider (allied health in particular) go through in terms of educational preparation. Not only RT, I would also include radiology, sonography, and other allied health providers in this mix. My first class was pharmacology, and on the first day of the first semester, our instructor went into the energy production cycles of our cells; however, the depth was quite impressive. I am talking about explaining the functions of cytochromes and talking about how FAD is reduced. At the end of the class, he stated this discussion was simply a preface and the core concept of what we do pharmacologically relates to the adequate supply of oxygen to this cycle. Additionally, the first semester will be nothing but focused anatomy, physiology, pathophysiology, and patient assessment techniques. Skills taught will be rather minimal, and we do not even learn CPR until the end of the semester after all of the A&P and pathophysiology. Yet, even after explaining the curriculum to people, they still do not understand. While I am not one to take things personally, I think this is important because much of what we do is inter-related and for the sake of continuity of care, we must be aware of what other providers do to include a basic understanding of their educational curriculum and role in the health care environment. We in EMS take offense when people call us ambulance drivers; however, how knowledgeable are we about other providers? Take care, chbare.

Again, my point seems to be taken out of context. A helicopter is in fact designed to fly and flying can be safe. However, it is the human condition in most cases that make it unsafe. Therefore, I am not assuming safety. I am simply stating the problem is not typically with the helicopter, it is with the people in the helicopter and on the ground. Take care, chbare.

However, we are not comparing RW to FW aircraft. Take care, chbare.

It will be at least a year before NTSB releases an official report on the probable cause of this incident. (Typical timeframe.) Regarding the helicopters are dangerous comment: helicopters are not inherently dangerous. The aerodynamic principles are sound. A properly maintained rotor wing aircraft is not dangerous and turbine engines are well known for reliability. In fact, most of our HEMS related incidents are not a result of pure mechanical issues. Typically, human factors are to blame for most of our crashes. (Pushing weather, CFIT, wire strikes, and so on...) Glad everybody made it out in good condition. Take care, chbare.

Yeah, I am a bit confused over taking a comment personally. Sometimes people call you out when you state something as a fact. Should not be a problem. However, some sources state that procainamide is an agent to consider. A few emedicine articles discuss this medication. It is also true that sources consider amiodarone. The truth is, WPW is complicated to treat medically,and cardioversion may be the best route in many patients. WPW treatment ( with chemisty ) can be even more complex if an arrhythmia such as atrial fibrillation is present. Take care, chbare.

Take care, chbare.

Yes, you have a valid concern. While adenosine can interrupt accessory pathways, if you decide to use adenosine, you need to anticipate additional problems. Take care, chbare.

Para is a well known term within the hospital environment in the United States and outside of the country. The term "para" is actually an abbreviation for the term parity. Parity in medicine obviously is a count of how many times a mother has given birth. However, most will agree that gestation beyond 20 weeks meets the requirements for "para." You may even hear the term nullipara. This refers to a mother who for a variety of reasons has been unable to carry a baby beyond the 20 week mark. To make it more complicated, I still know a few people who break the "para" concept down into what is called the TPAL format. T: Total births, P: number of preterm births, A: Abortions (most will include spontaneous and planned), L: number of living children. For example; a mother has been pregnant two times with one spontaneous abortion and one preterm child that is still living. The TPAL score may look like this: 2-1-1-1. Clearly, this can be quite confusing. Take care, chbare.

This is a topic that often causes confusion. Gravida simply means the number of times you had a bun or buns in the oven. Twins only count once. Para can be a bit more on the complicated side. Para means that you were able to carry that bun or buns long enough to be considered viable. The exact definition of para varies somewhat from source to source. However, most would agree that para is at least 20 or more weeks. Take care, chbare.

Been a while, how are you? I spent several months in Afghanistan working with several of your countrymen. Had a blast! Welcome back. Take care, chbare.

The pig cognition concept was a tough one. Apparently it took the team six months to figure out a way. Pigs apparently have color vision and a Russian scientist on the team devised a way of testing the pigs. They took different colored boxes and put a tasty snack in the blue box. Over a period of several weeks the pigs learned that they could go directly to the blue box for the snack without turning over the other colored boxes. The time it took for the pigs to find the snack was timed before and after resuscitation. From what I understand, this pig cognition and survival study was somewhat inadvertent. The initial study simply had the team members bleeding the pigs out, doing an open thoracotomy with the "preservative" infusion and cross clamping, and repairing the wound. However, with resuscitation following the wound repair, the pigs regained ROSC. Somewhat of a surprise to the team. They had to hastily turn their area into a pig ICU and recovery room. Apparently, they had a hell of a time keeping chest tubes in the pigs post op. The pig survival led to the team developing ways to test pig cognition. Since this was military research, I presume the tax payers paid for this specific set of studies. I am not sure of this large multi centre study that is in the works. Take care, chbare.