BEorP

Hopefully the attachment works! Sorry that the quality isn't magnificent. I am interested in hearing thoughts on the rhythm since this generated a bit of discussion. Basic clinical details: 67 year old female complaining of chest pain radiating into her back with associated shortness of breath. Reports a history of a previous MI and angina. Thoughts?

AHA says 160 mg to 325 mg Source: http://circ.ahajournals.org/content/122/18_suppl_3/S787.full

Time for the obligatory post-CAP Lab report. The EMT City representation quantity was less than previous years, but the quality of participants was high. The day was even better than previous years, with many of the similar stations as discussed previously but with various tweaks and new aspects (for example the added realism and challenge in the pig trachea station of having simulated skin and blood). As always, all of the doctors were eager to teach and to answer any questions. Definitely something to watch for next year if you missed out this time.

It is good to hear your thoughts on this. So if the patient had been brought to you in ED and presented exactly as Kiwi outlined here, do you think that there would have been any difference in outcome?

Does she want the blankets over her head specifically?

Welcome, Jay. It is wonderful to hear of your enthusiasm. What I would suggest might not sound as exciting, but it will make you a better EMT or paramedic in the future if you're really looking for some concrete way to take a small step in the direction of your desired profession. I would suggest that rather than worrying about a first responder course at this stage (when you won't be able to be in a position where you could use any of your skills), focus for now on learning the science. So many qualified EMTs and paramedics lack a solid knowledge of anatomy and especially physiology that can be so important to understanding what is going on in our patients (and figuring out how to best help them). So this isn't probably the type of thing you were thinking of, but I'd suggest working on learning about anatomy and physiology bit by bit. Much of what we deal with is shortness of breath and chest pain (possible heart attacks), so learning a lot about how the heart and lungs function in health will make it much easier to learn about how they function in disease at some point down the road. Unconventional, I know (and I'm sure someone else will call me out if it is a bad suggestion), but if you were to go ahead with it I'm sure that someone could recommend a good textbook and that there would be lots of help from the forums if you had questions about anything you're reading. (On second though, it is 2013 so you could probably just use things like Khan academy videos to learn about this stuff... though a traditional textbook is still nice to have!) Good luck!

Registration is open. It is sure to fill up, so if you're thinking about attending I'd suggest getting registered soon. I'm going to try to make it for Dec 3rd (the first day).

PM me with the details if not.

Thanks, sorry I didn't notice the little error to switch the picture at the top.

Interesting! Any pictures of the inside?

For us non-Americans who can't remember the conversion, is that blood sugar high? Also, is the room bright? (just trying to confirm whether that pupil size is concerning) In terms of immediate interventions: - With GCS 3 and respirations like that, I would suggest an OPA/NPA and ventilating. - I'd also like IV access to give some fluids to try to get that BP up to a more reasonable level. For trying to sort out what is going on: - I'd like someone to gather the medications for us so I can take a look. - Can the boyfriend tell us anything more about the history or does it seem like a lost cause? (I'd especially like to know whether anything like this has ever happened before and even if we might just know what kind of specialist doctor she's been seeing for her medical issues that could be helpful) - If we have the hands, a 12 lead would also be nice.

Anything else about the house that catches our eye as we walk in? (signs of medications, recreational drug use, any medical equipment) What does she look like as we approach? (position? where on the bed? clothed? pallor/cyanosis/jaundice? obvious breathing or not?) Confirm that she is unconscious Check ABCs (may need to consider an airway adjunct or getting her on her side if there's been no trauma) Vitals (HR, BP, RR, temp, SpO2) Also GCS, blood sugar, pupils, ECG (and taking a peek for MedicAlerts while obtaining vitals) While we're doing this, can we get a story of events leading up to this as well as medical history, meds, and allergies for this patient? That should be a start at least!

"Do you?" and "Should you have to?" are two distinct questions in this. If your service's policy is that you do, then it probably would be wise to follow that (while also trying to prompt change). In terms of whether this should be the policy, I think it is clear that driving lights and sirens is something that adds significant risk (often with little benefit) and should not be taken lightly. It seems unlikely this patient would benefit from the time saved.

Thanks. Sorry, yeah "you" meant paramedicmike, PA-C in the ED. I wonder whether the D-dimer could end up leading to more confusion than clarification though given the lack of specificity?

Surprised I haven't come across this before. Interesting stuff! Does this have any implications for how you investigate COPD exacerbations, especially when there doesn't seem to be an infection or other obvious cause?