chbare

D50 may be harmful with a head injury; however, you have to treat a blood sugar of 22 mg/dl. So, are people thinking about going down the route of RSI? In addition, what ortho problem should you suspect? Take care, chbare.

No worries, it was called "recovery room" when I was a nursing student. I found the experience similar to your experience. Take care, chbare.

After a bolus of 50% Dextrose in water, you note a BGL of 8.8 mmol/l or ~160 mg/dl. You also note decreased diaphoresis, decreased heart rate to 88, and a BP of 150/100. The respiratory rate remains rapid ~24/ min. However, there is no improvement in mental status and the patient continues to have the trismus. Take care, chbare.

Speed per prior post, IV's in place, sinus tachycardia lead II, Diminished lung sounds throughout, no needle marks, BGL: 1.3 mmol/L or ~22 mg/dl. Take care, chbare.

You note continued trismus. SPO2 increases to 92% after inserting the NPA and the snoring resolves. No additional information from the RTA with the exception of diaphoresis. Take care, chbare.

He has a medic alert tag that states "diabetic." He continues to have snoring, rapid respirations. You are unable to visualize his oral cavity because of the trismus. VS: P-108, RR-25, BP- 180/100, SPO2-88% on partial rebreather. Head to toe is significant for a contusion to the patients forehead without crepitus and you note right hip flexion with adduction and internal rotation of the right foot. Take care, chbare.

Patient is unresponsive to verbal command but withdraws from painful stimuli. You note rapid shallow respirations at approx. 24 with snoring and trismus. You note a pulse of 100 strong and slightly irregular. Patient is a 29 year old male who was "driving erratically" on his motorcycle. He was chased by the police and eventually did an up and over at about 30 miles per hour. Take care, chbare.

It is early afternoon ~1400. Weather is clear, sunny, and warm with a temp of ~30 Celsius. PD have secured the scene and no hazards have been identified. You have a single patient. Transport to nearest hospital is ~ 15 minutes & ~22 minutes to the trauma centre. No need to extricate. Take care, chbare.

You are called to the scene of a motor vehicle accident. Take if from here. Take care, chbare.

Another concept to consider is taking discussion personally. I find many people take what is written on a public forum personally. As Dust has stated on many occasions, "this is nothing personal, it's all about advancing the profession." However, many people take these topic to heart, especially the EMS provider levels and educational aspects of the discussion. People may actually learn and possibly change their practice if they separate their personal feelings from a discussion at hand. A prime example is when Dust argues against having the EMT-B level provider provide pre-hospital care. Many people interpret this to mean that Dust personally does not have any use for the specific person. Again, nothing against the person; however, the level of training is the issue. If people could separate these concepts, less feelings would be hurt. Take care, chbare.

Then, either your preceptor cheated you out of a good experience, or you did not try to make it a good experience. PACU is a great place to hone your assessment techniques. Assessing neurological function and dermatones following spinal anesthesia is a great exercise. Monitoring post surgical mental status, airway issues, and hemodynamics is also a great exercise. This is also a great time to learn about pharmacology and physiology. You can talk about the different anesthesia techniques, learn about inhaled gasses. Do you know what a minimum alveolar concentration of an inhaled anesthetic is and how this relates to your patient? In addition, this is the perfect time to review the pathophysiology and management of malignant hyperthermia. The PACU staff should be well versed in managing this condition and you can learn how the treatment works (Dantrolene). PACU is a great opportunity to learn. Take care, chbare.

Sounds like a poly-substance over dose. Therefore, any number of things could have caused his signs and symptoms, if we are not absolutely certain of every substance that entered the patient's body. In addition, SSRI's have been known to cause dystonic reactions. True dystonic reactions are not even dose related in many cases, so this guy could have taken a small amount of something else and developed the said problems. Take care, chbare.

Depends, how "technical" do we want to take this? Do we talk about calcium ions, the sarcoplasmic reticulum, and the actin/myosin cross-bridges? Unfortunately, the level of education in this forum is all over the place. Therefore, a balance can be tricky to accomplish. Take care, chbare.

So, death by hemorrhagic shock causes somebody to die with their eyes open? Take care, chbare.

Absolutely, it is possible to intubate an infant. Who told you this, and what was their reasoning? Take care, chbare.

An underlying AVB is possible; however, it could be obscured by an escape rhythm. Take care, chbare.

Hard to tell with what I see. The baseline is fairly rough and it is difficult to identify P waves. In addition, differentiation of RBBB versus LBBB without a XII lead is difficult, along with axis, or the determination of fascicular blocks. Large Q waves in the the inferior leads are highly suggestive of an old MI. Clearly, inferior wall (RCA) pathology can definitaly lead to SA node dysfunction and AV blocks, along with atrial fibrillation. These could even be escape complexes with an underlying AV block, or we could even be looking at sick sinus syndrome. The patient did not have a pacemaker place at the time of this ECG? Take care, chbare.

In addition, part two of the JEMS article is here: http://www.jems.com/news_and_articles/colu...t_Part_Two.html Some of the concepts of this case are discussed in the said article. I think it is a bit presumptuous to say definitively that the PM in question is guilty of abandonment. Clearly, many factors come into play, and it is not as cut and dry as he left the back of the ambulance. From what I read, the PM initially thought there was a potentially critical patient in the police car, and stated this as his reason for leaving the back of the ambulance. So, he made a judgment call. Without knowing his agencies policy or OK EMS policy in addition to specific case law that applies to this scenario, I am not comfortable concluding that abandonment occurred. Take care, chbare.

Or, maybe he did get those statements but the fake ID was well done? Yeah, there was that whole cocaine thing, but everybody makes mistakes, right? Take care, chbare.

Not always. Take care, chbare.

Not a problem, this is tricky, as measuring serum iron will actually not be very useful. A few tests to consider;Transferrin saturation, Serum ferritin level, and genetic testing. (The first two are not definitive, as other condition can cause elevations.) A liver biopsy may be performed as well. With the family history, this is most likely an inherited form of hemochromatosis. I think you would be safe to evac this guy after noting the elevated LFT's. This is an adaptation of a scenario I experience while overseas. Fortunately, for me the patient reported that his brother had similar symptoms a few years earlier. After minimal investigating, we pretty much knew the problem without tests. However, I drew blood and sent off for labs. Unfortunately, the blood had to go to Pakistan and it took about two weeks for results. The patient refused evac but agreed to follow up with his PCP in the USA when he went on leave three weeks later. He went home with the results and was officially diagnosed with the disorder. Weekly phlebotomy was ordered with follow up testing. The patient refused to stay home and returned to the sand box. Unfortunately, blood collection equipment was not readily available; however, the patient had some local friends of his acquire several months worth of collection bags. How and where I do not know, nor do I want to know. Obviously, sex, age, and actual demographics may be different in order to preserve patient privacy. Hope you guys enjoyed this scenario. Strong work. Take care, chbare.

However, this patient has limited urinary output, or we would not have lab studies performed on the urine. I suspect the cause is endocrine in nature. Take care, chbare.

Holy cow, look at that sodium! Assuming no drug abuse, we have to look at the possibility of a pituitary problem or perhaps small cell carcinoma. Take care, chbare.

In addition, some people think MDMA can cause increased levels of ADH. This will cause the body to retain water and set the person up for "dilutional hyponatremia." Take care, chbare.

Potentially, the creatinine is elevated; however,I would like a BUN as well. My concern is the serum osmolality. This is in fact a significant lab value. Like ERDoc, I would like to see at least a chem-7/BMP to get an idea of the electrolytes, specifically the sodium. Additionally, we could use the additional findings to calculate the predicted serum osmolality, then compare to the actual. If a significant gap exists, we need to look at causative substances. In addition, a drug screen may be helpful. The history and limited lab data along with ECG findings lead me to believe that an electrolyte imbalance is the potential cause of the seizures. The root cause may be related to the use of certain illicit substances. Take care, chbare.