chbare

Good points. This is yet another concern I have regarding all of the EMT training I have completed. The scenarios and situations are canned to the point that you literally have to follow one path to the letter or your patient dies. I understand that giving a novice a set of standards and guidelines to base care around can help with learning; however, at some point we need to take into consideration reality. I find there are three patient types: 1) Patients that will do poorly regardless of your interventions. 2) Patients that will do well regardless of your interventions. 3) Patients that can go either way. Take care, chbare.

The title of this thread did indeed provoke me to assume a very negative first impression. It is very important to provide specific information and ask specific questions when looking for a specific answer when on line. It is very difficult to interpret concepts such as tone and intent when online, so, the importance of a good first impression when thinking of a thread title cannot be emphasized enough. If I understand the "actual question," then the answer should be quite simple. Yes, it is appropriate to question the delivery of care. However, I suspect much of the problem may be related to the fact that some EMT's may not see the big picture. For example, a COPD patient may have A-fib or a paced rhythm and receive a breathing treatment. I could see how somebody who cannot appreciate the situation could develop concern and think the medic was wrong for "giving a breathing treatment for an arrhythmia." With the information I current have, I do not understand why this is an issue. Good communication with your partner should solve the problem or bring to light the fact that a real problem with care delivery exists. Either way, the answer to the question is in fact related to the title of this thread. Communication. Take care, chbare.

I have a quick lube sticker that tells me when to change my oil. Does that count? Take care, chbare.

I have yet to feel comfortable in my practice. Take care, chbare.

I tend to agree. The surgical option in spite of our reservations is most likely the safest. In the hospital setting, fiberoptic techniques may be considered; however, this guy will more than likely require a trach. I would C-spine simply to prevent compromise of the airway and prevent movement of injured tissues and blood vessels. Take care, chbare.

With the bubbling, we can assume a penetrating laryngotracheal injury. The actual integrity of the the trachea it's self is compromised. A backup airway will be of little use because the insult is most likely subglottic. This also puts us in a sticky situation regarding ETI. If the injury is low enough, even oral intubation may not secure the airway. Additionally, we need to worry about the possibility of a rapidly expanding hematoma and entertain the possibility of a complete transection if we are too aggressive in our delivery of care. To answer ERDoc, this patient IMHO, does not meet criteria for RSI. In fact, with the information given so far, I have to assume he is unresponsive and possibly near death. I would assume a crash airway at this point. So, the real question in my mind is this: do we attempt to secure an airway via oral intubation or do we transition into a surgical option? Both options will present with significant risk and if we choose to go surgical, we may find ourselves altering our technique depending on the location of the insult or insults. Food for thought. Take care, chbare.

I am not sure the DOT mandates a maximum amount of hours. They simply mandate a minimum amount of material must be covered, and anything beyond the minimum is simply that. For example, my class was in New Mexico and covered the NM EMT-I curriculum. Additional cardiac modalities, additional airway modalities, and pharmacology was taught. However, since the DOT minimum requirements were met, we were able to test at the NREMT-I/85 level. Actually, NREMT-I/85 was the goal since the course was a pilot program for military medics who needed to transition to a new MOS. With that said, you would do better to take a year of A&P and go to paramedic school, or look at a good paramedic program that offers an AS or AAS degree upon graduation. At least, you will have a foundation of knowledge. (A&P, biology, and english) Take care, chbare. EDIT: Wow, post number 1000.

Of course, without additional information, we cannot rule out narcotic induced pulmonary edema. I guess we are all in the same boat waiting for the follow up. Take care, chbare.

"...even though chbare, one of the smartest people on the City, thought it was relevant." Thank you, I have a few lucid moments here and there; however, most of it related to my mad ninja Google and E-medicine skillz. Obviously, we have many problems to rule out with this patient. I simply answered the question asked by the OP. Narcotic induced pulmonary edema is not a common problem, and it is seen more often in herion users, so, there are many other problems that need to be considered as well. Take care, chbare.

As far as I know, the exact mechanisms are not known. The pulmonary edema related to narcotic use is non cardiogenic in nature however. It is known that increased pulmonary capillary permeability is noted in patients who develop this problem. I have also herd of flash pulmonary edema developing when apneic patients are given reversal meds and experience sudden changes in airway pressures following narcotic reversal. Take care, chbare.

That is messed up. At least I feel better about my life. Take care, chbare.

Hard to say. Much depends on the school and the specific school policies. I know some schools have teachers who are first responder or EMT trained and can provide basic care IAW specific policy. Other schools will only allow the school nurse to deliver any type of medical care. In addition, many special education teachers receive training and education regarding how to deal with the various health problems and challenges they encounter with their students. I could not give you a honest and well informed opinion on your dilemma without more information. Take care, chbare.

I wonder if she needed an ERCP? Take care, chbare.

I am finishing up an ER contract in Nevada. The hospital is pretty good and does well with the resources they have available. Where I am located, EMS may as well not exist. Nearly all members are vollies and operate as basic EMT's. The only ALS service is a helicopter based at the airport. More days that I can count, they could not fly due to weather. In addition, their range is very limited. I have stories that would make you cry. The level of care is absolutely pathetic. I understand parts of the county are rural; however, the town is not small by my standards. With casinos and a workforce that makes pretty good money, I am appalled not to see any type of professional EMS in this area. Take care, chbare.

+5 style points. :thumbup: What about administering some of the class I agents? Help, hinder, none of the above? Protocol aside, will amiodarone actually be helpful in the management of this patient? Take care, chbare.

Ok, then. Is this really a global problem? Are EMS providers constantly having to remove nurses from the scene? It seems that only in medicine do we have to debate this problem. If somebodies car brakes down on the side of the road, you do not see off duty mechanics fighting with the wrecker crew over how to take care of the problem. Nor do I see off duty garbage men or hamburger cooks fighting over how to provide me with their services. Yes, I see what I do as a service. When I am off duty, I am not a nurse. It is that simple. I am more than happy to let somebody else deal with the emergency. I have stopped a couple of times in my career to provide BLS care, then promptly left when help arrived. It seems that we are getting carried away over something that in my mind should not be a problem. Take care, chbare.

Looks like we nailed the diagnosis. Thank you everybody. I will hand out style points for the ICD-9 code for this disorder. This is one of those imposter cases where strictly considering 12 lead ECG evidence without looking at the entire picture could lead us down the wrong path. The field treatment for this problem is limited; however, our assessment and history taking abilities could really help the receiving facility make the correct diagnosis. Will antidysrhythmic medications be helpful in preventing the recurrence of ventricular tachycardia or fibrillation? What medications could actually exacerbate the disorder or the findings associated with this disorder? Think about repolarization when considering this question. Take care, chbare.

So, if I was a betting man, what race would I bed on? (Ethnic race that is.) In addition, if his wife told you he had a history of "bad nightmares", would that provide evidence for or against your diagnosis? Take care, chbare.

Unfortunately, you are ordered to continue driving around the block until you can nail the diagnosis. With all of the ER crowding, your state adopted a new protocol where the EMS crew cannot deliver the patient without a diagnosis and direct admit orders. Oh yeah, the ICD-9 code needs to be correct as well. But, I am in a good mood, so I will let that one slide. :wink: Ventilations are adequate with your airway device of choice. Take care, chbare.

What other findings and or information would support your diagnosis? If this is Brugada, what is occurring physiologically? If this is Brugada, what type is presenting? If this is Brugada, what is the common treatment modality for the diagnosis in question? Take care, chbare.

No spontaneous resp effort noted. Systolic pressure of 80 by palpation noted. XII Lead: Take care, chbare.

Many services are no longer using stacked shocks and simply shock once then go to CPR if a non perfusing rhythm persists IAW 2000 ACLS recommendations. However, I understand every service is a little different with their guidelines. Following your DC counter shock you note a weak carotid pulse of 110. You note the following on the monitor: What next? Take care, chbare.

You administer a DC counter shock at whatever setting your guidelines allow for such a scenario. Take care, chbare.

Ventricular fibrillation it is. What do you want to do about it? Take care, chbare.

What makes you think it is something other than ventricular fibrillation? Do not worry about right or wrong, the point of this scenario is to learn. Take care, chbare.