chbare

Looks like you guys nailed it! What kind of dystrophy do you think this little guy has? Hyperkalemic arrest has been documented in little guys with an undiagnosed form of this dystrophy. You go to RSI, push the sux, and suddenly you are running an arrest. Hint: sex plays a role. So, now that we know what is going on, how will we treat this arrest? I am glad you enjoyed this scenario and hope you all had fun with it. Take care, chbare.

You guys are very close to the answer. Take these three concepts and see if you can make something fit. 1) Some sort of neuromuscular disorder perhaps a dystrophy? 2) May be related to the RSI medications? 3) May involve an electrolyte? Take care, chbare.

You are on the right path as far as how you are looking for a problem. This is not related to seizures. Take care, chbare.

Wow, we are talking total aorta replacement. Take care, chbare.

Not activity induced spasm in this case. Let me add another part to the puzzle? While you start to work the code, one of the ER nurses goes out and talks with the parents. She asks them if they have any more information about their child. The mother replies, "it's probably not important but he has a hard time getting around sometimes. walking up stairs is nearly impossible some days and we are planning on having somebody check him out." Take care, chbare.

I like the way you think and a very good consideration. Bronchospasm, pneumos, and barotrauma are going to be very real concerns with this little guy or any little guy with asthma this bad. However, the problem is something else with this patient. Take care, chbare.

Nothing to indicate trauma temp is 99.9 F. Take care, chbare.

Ok, I think an important question to ask is the following: Do I suspect a sudden onset problem or something that took some time to manifest? Prior to the intubation, this little guy was teaching right along, then suddenly we have cardiac arrest. Could the cause be respiratory? Possibly. Could the cause be something else? Maybe. A good review of the H and T considerations is a good idea. I want you to take it a step further than what you learn in ACLS however. Think out side of the box when considering the H&T considerations. What kind of pathophysiology could we be dealing with? Most importantly, how will we manage it? Take care, chbare.

Yeah, $550.00 for a one time deal is not bad. You do not even want to know what I paid for books when I was in nursing school. However, I think JPINFV most likely spent more. And that was several years ago. In addition to the other suggestions, you may want to try Amazon as well. Take care, chbare.

Ok, so we are guessing something bad happened? One of the nurses checks a pulse and cannot locate a radial, femoral, or carotid pulse. CPR is immediately initiated. So, how are we going to treat this kid? Are there any problems we should suspect? I like the critical thinking so far. It is not tracheobroncho-malacia or a chronic heart problem. Take care, chbare.

Good call on the fluids. If no contraindications exist, giving fluids can be quite helpful. The ER staff prepares for RSI and one of the RN's gives the following: Premedication: Fentanyl 57 mcg IV Atropine 0.2 mg IV Induction: Ketamine 19mg IV Paralysis: Sux 37 mg IV You intubate with style and skill placing a 5.0 ETT without difficulty. You see the glottis, while one of the nurses notes lungs sounds and chest rise and fall. Capnography detects carbon dioxide and a nurse places an NG tube. Seconds after placing the ETT tube one of the nurses states, "what the hell?" You turn to the monitor and note the following. You guys did not think I would give you a simple respiratory call? Take care, chbare.

The doc is happy to tube the kid in the ER and your partner Bub is an RT who happens to specialize in pediatric ventilator management. Take care, chbare.

Transport time will be about 20 minutes. You have no air-medical resources. The sending physician is a family doc who works the occasional weekend. Not a bad doc, but he is clearly very concerned about this kiddo and wants the patient at the other facility ASAP. He does agree with an ABG however, and if you want, the patient can be intubated prior to leaving the ER. ABG: PH-7.3 PCo2-62 Po2-68 HCO3-24 Chest X-ray: narrow mediastinum, flat diaphgram, and hyperinflated lungs. He was given solumedrol. The patient is starting to develop lethargy and his respiratory rate looks to be slowing down, lung sounds are decreased throughout. Good discussion so far. Take care, chbare.

You can provide any therapy you see fit. The sending physician reports the following: Four year old male (5 tomorrow) with a several month hx of asthma like s/s. Three prior ER visits and one admit. Other episodes responded well to rescue meds. (inhaled) However, he is not responding well to therapy currently. Past hx is negative except for the current problem. Pt has albuterol nebs and unknown oral meds at home. Parents do not know. Treatment so far: Hour long albuterol tx, weight appropriate dose of steroid, weight appropriate dose of epinephrine 1:1,000 IM. Current vitals: RR-54 shallow, labored, retractions, and the pt appears fatigued, P-155 narrow complex tachycardia on monitor, B/P-102/50, pulse oximetry-94% on a mask. (currently on a hour neb tx, that is placed to oxygen). Pt weight: 18.5 kg. Take care, chbare.

You are a member of an ALS unit that has been called to a rural ER to transport a 4 year old patient diagnosed with status asthmaticus to a larger facility with pediatric pulmonary resources. Take it from here. Take care, chbare.

Was it a dissection, an aneurysm, or did she have both? Take care, chbare.

XII lead? We should look for cardiac contusion and consider the potential for developing tamponade. Stabilize the pelvis and ensure we have large bore vascular access. Take care, chbare.

In this case, dry would be much better. The OP stated the patient was hypothermic, so we would want to avoid anything that could decrease the temperature. Do a head to toe exam and full neurological exam to include pupil/EOM assessment and distal neuro assessment. Did she have LOC? Was a BGL obtained? Did we check her temp? What about medical/surgical history? Continue supportive care, keep her dry, and try to keep her thermoregulating adequately. Take care, chbare.

Fracture is simply the separation of something into two or more parts under the strain of stress. Many parts of our body can fracture; however, fracture is often used to describe orthopedic trauma. Pre-hospital treatment will be limited. Even the physical exam will provide us with limited information. Typically, a history of acute sports related traumatic MOI and sudden onset extreme pain should indicate a high index of suspicion for testicular rupture/fracture. The scrotum may be swollen; however, it will be very tender to palpation. If you have great assessment abilities, appreciating the fracture line is rare and occurs in less than 20% patients with this injury. Beyond that, an US will be needed for the definitive diagnosis. US is about 100% sensitive and 80% specific. This is considered a true urological emergency like testicular torsion as necrosis of the testicle is likely. Salvaging the involved testicle is much less likely to occur if surgical repair is not initiated within 3 days of the injury. Take care, chbare.

I still think this is something that should be covered during the clinical experience. I know in nursing school, we had to be involved with at least one delivery. If we were not involved in a delivery during scheduled clinicals, we had to take OB call until the requirement was met. Take care, chbare.

They should learn their core assessment knowledge from the clinical experience. They should be graded during their clinical rotations on critical interventions and assessment techniques. I do not disagree with setting up hands on station in class and running scenarios; however, I fail to see how making somebody go through a "canned" "skill station" at the end of their course is of any benefit. Take care, chbare.

I think the real issue is the fact that people have to ask themselves this question. Why should we accept this job as risky? Yes, you can drop dead getting out of bed in the morning; however, when people are asking these kinds of questions, perhaphs something needs to change. Take care, chbare.

This is why I think the whole NREMT psychomotor skill stations are of little use. We simply cannot expect to treat every patient the exact same way, yet you are expected and taught to treat every situation the same way. I can see how people can have difficulty translating didactic knowledge into delivery of patient care. Take care, chbare.

That's it. All to often I see people write statements such as "they are heroes the job is dangerous" and "they died doing what they loved." Since when was our job dangerous? Why do we continue to accept this type of thinking? Ever had a close call with your life? I am not sure many people die doing what they love. I pity friends, family, and the people who will not come home at the end of their shift as well. This is truley unacceptable IMHO. However, perhaps it is more appropriate to focus on supporting friends and family and dedicate another thread to discussing the problems and solutions of the industry. Take care, chbare.

This is absolutely crazy! How many more of our brothers and sisters need to die before people wake up and realize we have some serious issues that need to be looked at. Take care, chbare.