akroeze

You quickly assess her responsivenes and get a GCS of 13 (3-4-6). Airway is patent and there is no JVD or edema. While you take a pulse and SpO2 reading your partner gets a BP and resps. HR: 40 weak/regular BP: 98/68 SpO2 RA: 88% R: 24 T: 38.1C tympanic A/E clear = bilat The nurse hands you a history sheet which states increased cholesterol, NIDDM, Heart bypass in 2000, dementia. You throw the limb leads on her and get a sinus brad, no ectopy noted. Same on the 12-lead. You grab your glucometer and find it to be 26.1(469.8 ). There is no known history of trauma and she is in a private room, no room mate.

You don't have to be a PCP to do this.... it's open to anyone, so give it a shot! I just want to know what you'd do at a PCP and an ACP level.

You and your partner have had a nice shift so far and are just sitting down for a well deserved lunch when the base pager goes off. 1234, code four to XYZ Nursing home, code four You sigh as you quickly go through the grieving process at your loss of lunch. Having gone through all the stages of grieving in seconds you head to you and your partner head to your truck and book on the air. 1234, you're code four to XYZ Nursing home for an 87 y/o female patient who has been unwell all day, decreased LOA with a heart rate of 40 and a blood sugar of 16.1mmol/L (289.8mg/dl). Also has cyanosis to the legs. As you are both Primary Care Paramedics on this truck you ask if ALS backup is available. Dispatch advises you that the only ALS truck that has a chance of getting to you is on an off-load delay at the hospital but if they get clear she'll send them your way. It's a quick 3 minute response to the nursing home and you're met at the elevator by the RPN. He tells you he is a part time nurse who doesn't normally work this floor. When he went in to assess Ms. Johnson he was concerned by her decreased LOA. The health care aides said she normally isn't totally responsive but he trusted his instincts and did a full assessment. He then decided to continue to trust his gut instinct and called EMS. As you eneter the room you see the patient supine in bed, she seems to be breathing slightly fast and on a scale of looking not sick to sick she would rate a sick. What do you do? This is a scenario one of my instructors put to our ACP class today and it is one that a crew did the other day. I have taken some creative liberties with the backstory but the facts are unchanged from the real case. Although this crew never had ACP backup, I'd like to know what you'd do at both a PCP and ACP level. For a rough guide for those who aren't familiar: PCP * Glucometer * S-AED * 12-lead * SpO2 * Epi 1:1000 * Nitro * ASA * Glucagon * Oxygen * Ventolin (Salbutamol, Albuterol) * Glucose paste ACP * advanced airway management equipment * orotracheal and nasotracheal intubation equipment * lighted stylet intubation equipment * LMA's * SPO2 monitoring * Side stream ETCO2 monitoring (capnography and capnometry) * mechanical ventilation * laryngoscopy and removal of foreign body obstruction using MacGill forceps * intravenous therapy * 12 lead ECG interpretation * needle thoracostomy * intraosseous and external jugular IV starts * manual defibrillation, synchronized cardioversion and external transcutaneous cardiac pacing * treatment of cardiac emergencies according to Heart & Stroke Foundation Advanced Cardiac Life Support (ACLS) guidelines * administration of the following emergency medications: Adenosine, Amiodarone, ASA, Atropine, Dextrose, Diazepam, Dimenhydrinate, Diphenhydramine, Dopamine, Epinephrine, Fentanyl, Furosemide, Glucagon, Lidocaine, Morphine, Naloxone, Nitroglycerine, Salbutamol, Sodium Bicarbonate, Midazolam.

Just to clarify, above 7mmol/L is getting into a hyperglycemic state. You generally want to be between 4 and 7.

Here in general the attendant determines the priority to the hospital as the medic who is driving likely was not there for the entire thing (gathering equipment, meds, getting stuff ready). Saying the priority just tells the driver how quickly you would like to get there, it's up to the driver to decide what they actually drive like.

I've never heard of the driver being the one to decide what priority to go. That's different.

I dunno, all the spenacs I know are man whores

Where I went to school we would go L&S all the time but where I got a job we would rarely run L&S.

Ok, I have enough headaches already studying my ACP material.

So what is decided here? Does an ambulance company decide what first aiders should be taught or something? I'm confused

First call as a PCP student was renal calculi First call as an independent medic was a chest pain frequent flyer who I found out generally does it to get a ride into town. First call as an advanced care paramedic student.... let you know when I get to ride outs.

Very nice, where did you get it?

Have you tried e-mailing them?

It may have changed since I was hired... I heard a rumour it was changing but for me after my interview and everything I had to go to get the ARCON testing done. There is one company in the province that does it that I know of and I managed to do it in London. I would suggest contacting them to inquire due to the possibility of changing.

Having worked for them in the past I HIGHLY recommend anyone go up there if they are looking for a unique EMS experience. Feel free to ask me if you have any questions.

What is the legality of transporting these kids in their car seat but the car seat having to be on the bench because there is more than one? That is not proper position for it... against manufacturer's recommendations.

I'm wondering what you folks would do in this case. You are at a residence of a male patient c/o mild SOB. You have assessed him and figure he definitely needs to get seen sooner rather than later but not a huge huge kill us getting there rush (put him at a 3/5 in "sick scale"). You tell him you want to bring him in and then he lets you know that his two young children (both 5 and under) are in the house. He is a single parent and has no family in the town. This is a rural community and the regional police advise they are 60mins away. How do you proceed? Do you take the kids with you? Do you wait for the Police? This is a slightly modified version of a call I had a bit ago.

ahhh, I see. Well by that point I might as well hold off and get hired as ALS as I'll be close to done.

Do you mean they are just starting the process of hiring? Or they just hired them? I'm looking for a job...

If asking a simple question is considered trolling then I have nothing further to say to you. Good day.

A question for the ER docs: Many anaesthetists feel that ER docs do not have sufficient experience or knowledge to use RSI. How do you feel about this? Is it appropriate for ER docs?

Lighted stylet would be a good choice

Hugh G. Kalk at your service

Perfect. Tx as above: Nitro 0.4mg q5min ASA 160mg Continue high FiO2 Initiate high flow diesel

Actually, I'm going to go ahead with the nitro regardless of what I hear in his lungs but I'd still like to know what I hear as it may effect other Tx.