chbare

Sorry bro, hope you are feeling better. Take care, chbare.

All things considered, the Oxylog 2000 does a reasonably good job. However, I find the sensitivity is not great and this can be quite problematic. Not sure why; however, the 2000 seems to be the most popular model over here. This vent is exclusive to the military hospitals in their ER's and ICU's. Obviously, the most popular ventilator among the locals is the Twohandbag 2009. Take care, chbare.

The cheaters way to look at QRS axis: If you look at the top of your XII lead, you should note a line that reads something like: "P-QRS-T Axes." This should be followed by a set of numbers such as: "55-37-17." The entire line will look like this: "P-QRS-T Axes: 55-37-17." The number in the middle is the calculated mean QRS Axis. In this case, the mean QRS Axis is 37 degrees. Then, just write the Axes down in your notebook or guide for safe keeping: Normal: 0-90 Physio LAD: 0 to -30 Patho LAD: -30 to -180 Physio RAD: 90-120 Patho RAD: 120-180 Right Shoulder: -90 to -180 Another easy method is the three lead QRS picture method. Bundle branch blocks for dummies: Identify the presence of a BBB then look at the QRS complex in V1. Draw a line through the complex and perform the "turn signal criteria." Google should give you pictures that easily show you down and dirty BBB differentiation. Take care, chbare.

It boils down to three concepts: 1) Lack of neonatal intestinal bacteria 2) Undeveloped liver 3) Limited transfer of Vitamin K from mom to baby Obviously, this is a rather rare disorder, especially with newborn Vitamin K supplementation. There are three groups of Hemorrhagic Disorder/Disease of the Newborn (HDN). How would you classify this patient? What about the other problem? Take care, chbare.

Not much we can do in the pre-hospital setting I suspect. Control external hemorrhage, patient positioning, supportive care, and rapid transport. I have had a few cases that were somewhat similar. I Remember caring for a patient who perforated their rectum/colon with a round stick that had a screw attached to the end. The patient was hemodynamically stable and required the usual pre-surgical prep work. Another patient managed to perforate their rectum/colon with a finger while attempting digital removal of hard fecal matter. This patient presented in acute distress. Altered hemodynamics, in great pain, with minimal external bleeding however. The other similar case was in Afghanistan where a guy took a 7.62*39 round to the pelvis. Obviously, there was heavy bleeding that simply could not be completely controlled. Quick Clot was used without any effect. Direct pressure was applied and a level of quasi hemostasis was achieved. The team opted not to do a 5 hour flight to Dubai, and rather divert to a military hospital about an hour away. Hemostasis was achieved along with blood product administration, then the patient was evacuated to Dubai. Take care, chbare.

Actually, a valid question. Obviously, hemorrhage will be a primary concern. Treating this patient in the field will be rather difficult and hemorrhage control could be a problem if serious bleeding occurs. In addition, safety will be problematic as you are dealing with sharp glass and body fluids. This patient is most likely in a high risk category for having blood born diseases. Take care, chbare.

Nailed it. Now, what about the other problem? Vomiting, nothing to eat or drink, elevated BUN/Creat, and Ketones in the urine? Take care, chbare.

Not in this case; however, it is always a consideration. Think about the home delivery without any care following the birth. What kinds of things are done following delivery? What things did were not done to this patient? What about the Pt and a PTT? Take care, chbare.

Heheh! Our flight/response bags & medication bags are on a shelf to the right and a tank of oxygen sits on the left of the bed. Major Items: -Philips MRX monitor -Heart Start 4000 backup -Suction with foot powered backup -Glucometer -Urine test strips/HCG test strips -All the typical ALS equipment in our response bags -Oxylog 2000 ventilator -Most of the typical ALS meds to include assorted primary care meds and antimicrobials Take care, chbare.

I have to disagree. Unfortunately, it is not as simple as saying, "yep, it's a STEMI." Many conditions can masquerade as STEMI. LVH, Brugada syndrome, Pericarditis & BBB among many others. In addition, identification of other conduction defects can help us plan and provide appropriate interventions. For example, what would you expect somebody's LV ejection fraction to be if they had a rather significant BBB? What problems could you anticipate with significant axis deviation and say a bifascicular block? What could occur if we loose the other fascicle? We also need to identify drug and electrolyte effects and anticipate interventions or even use the findings to narrow our list of differential field diagnoses. I could continue to ramble; however, I would hope you get the point? Additionally, MONA is not a catch all phrase and it is certainly not how we should treat every patient experiencing an ACS. Take care, chbare.

You are on the right track; however, look at the labs. Is thrombocytopenia present? Let's say your coags come back: PT- 65 & aPTT-140. Somebody may have touched on one of the potential problems. Take care, chbare.

This is exactly why I advocate for a year of A&P as a prerequisite for paramedic student candidates. Good question to ask however. Your basic theory is correct. However, I suspect you have confusion understanding how CO2 relates to acid/base balance. Obviously, acidosis is actually the concentration of hydrogen ions (H+), so the obvious question is how does CO2 equal H+ or acidosis? To understand this, you first need to understand how the body transports CO2. The body transports CO2 in three ways. 1) CO2 dissolved in the plasma: Approx 6-10% of CO2 is transported as dissolved CO2 in plasma. 2) Attached to hemoglobin: Approx 20-30% of CO2 is transported attached to hemoglobin in the RBC. 3)As bicarbonate: Approx 60-70% of CO2 is transported as bicarbonate. So, it is safe to say that most of the CO2 in our body is transported as bicarbonate (HCO3-). However, this still does not explain the CO2 to H+ relation. Let's explain how this occurs. When CO2 combines with water H2O, the substance carbonic acid is formed (H2CO3). Carbonic acid; however, is very unstable and quickly splits into a hydrogen ion and bicarbonate ion. So the formula looks like this: CO2 + H2O = H2CO3 ---> H+ & HCO3- Of course, when this reaches the alveoli of the lung, this process is reversed, and CO2 is released via exhalation. I hope this helps explain these concepts. Additional concepts to know include the role of carbonic anhydrase. While these reactions can occur in plasma, most of this actually occurs in the RBC. Carbonic anhydrase is present in the RBC and allows these reactions to occur much faster than within the plasma. Now, throw in the chloride shift, and you will be an expert. Clear as mud? Take care, chbare.

Hmm, so why exactly are we asking for coags? Take care, chbare.

I mean looking at lead groups for "localized changes." For example, II, III, AVF changes would be localized to the inferior wall. Take care, chbare.

This is the typical pattern I follow when I look at any XII lead: Rate: Rhythm: P for every QRS: QRS: PRI: QTc: Axis Deviation: Q waves: Localized Changes: II, III, AVF: V1, V2: V3, V4: V5, V6, I, AVL: Right Ventricle: Posterior: Additional Notes: Impression: Take care, chbare.

Shaken baby is a consideration. However, lets say shaken baby has been eliminated. Is there anything else in the history that could point to another cause or other causes? Kidney disease may be a consideration; however, with a history of not drinking, vomiting, elevated BUN/Creat & ketones in the urine, could we consider another common problem? Take care, chbare.

Kayexalate would not be my primary choice in a suspected hyperkalemic arrest situation as described above. It's action is much longer than calcium chloride, albuterol, or dextrose/insulin. I would go with stop gap measures to hide the potassium and stabilize the membrane potential first. Obviously, kayexalate will be very important in the elimination of potassium in the long term. Take care, chbare.

No nut kicking intended. I was simply challenging you to look at the science and the big picture. As I stated, I am not saying it is wrong; however, always consider the science and evidence behind what we do. Sometimes people are going to call you out on your ideas, you are going to need evidence to back your thoughts up in some cases. In fact, Spenac called me out earlier in this thread. Instead of taking it personally, I looked at the evidence and had to agree with his stance. This makes me a better provider and also makes me look outside of my little box. Nothing wrong with challenging somebody, if done in a professional manner. Take care, chbare.

One incident of anecdotal evidence made you a firm believer? One must consider the numerous complications associated with using steroids for SCI and the fact that there is limited definitive evidence proving that steroids cause measurable functional improvement. I am not saying do not use steroids; however, try to look at the big picture rather than isolated anecdotal cases where the treatment may or may not have been an actual factor leading to a positive outcome. Take care, chbare.

We will say Caucasian. Yes, high BUN and Creat. Further history from the parents state around 3 days of not eating well. Or, "hardly anything by mouth for three days." In addition, they report a few episodes of emesis. Take care, chbare.

This could explain some of the hyperventilation, altered thermoregulation, and changes in sensorium, and obvious metabolic derangements. Take care, chbare.

Yes indeed. In fact, recent article reviews does indicate outcomes are not improved with steroid use. So, now I wonder how this will all relate to the etomidate, adrenal suppression, "stress dose" with steroid arguments with RSI and septic shock patients? Still up in the air for now. Take care, chbare.

Are you able to obtain any additional follow up? Take care, chbare.

UDS: Urine Drug Screen. Take care, chbare.

Hard to say. What was the sodium? Was a UDS performed? Take care, chbare.