jwiley40

I've worked a few codes myself, had some make it and more that didn't. One thing I learned when I started this career is there are two rules of EMS: 1. People die, no matter how hard you try to save them. 2. You can't change rule number one. Sometimes, you work a code, knowing that what you might be doing isn't helping the patient, but is telling the family that you are trying to save their loved one's life. There are times when your interventions do something and you have a living patient. Take the good with the bad and do the best you can. At the end of the day, for me, that is most important.

What I know of DVT is that they can be excruciatingly painful and potentially fatal. I know that because that was the cause of death for my mom ten years ago. Don't mess with this: go to the ER and get treated, even if it's a bare minimum of treatment. Anything is better than nothing at all.

On shift: Stethescope EMS guide for ALS Tarascons Adlut Emergency Guide 2 pens Shears wallet iPhone Wedding ring Off shift: Stethescope (only because I'm too lazy to take into the house!)

I practice in Missouri and I was required to have the NREMT test for both EMT-Basic and Paramedic. Once I had my state license (and it says license right on it!), I could let the NREMT certification go. Now, I really think I should have maintained my national registry because if I choose to be an instructor, which I am seriously concidering, I will need to have it. I am now having to jump through hoops to get it back. My fault for letting it go. And if I plan on working in another state, I should have it to forego the state requirements, depending on the state. I found the conversation here very enlightening. As I mentally kick myself, I plan on re-certifying and maintaining that "worthless" certification. I by no means mean anything hostile of belittling to anyone here. For me, I believe it's not "worthless."

Yup! They open up just fine. My wife loves them! Thank you for posting them.

Then there's the parapalegic that screams in pain when you touch his feet after his fall during a seizure in which he isn't postdictal! And his wife tells the dr said he has "wandering hemipalegia!"

My wife.....

I have Windows 8 and run Office 10 but I can't get it to open. Probably Windows 8 (don't EVER get this version! It's horrible!!!)

I tried to download the files, but MOD 3 and MOD 6 wouldn't download, stating there was a problem from the origin source. Is there anyway of getting them through another way? My wife and I will use these PPT presentations in our teaching. Thank you.

Something fishy with all of this!

I was following the conversation and began to look it up. I found this on the JEMS mobile website. Friday, September 7, 2012 Adenosine is the drug of choice for paroxysmal supraventricular tachycardia (PSVT) and is once again Advanced Cardiac Life Support-approved for differentiating PSVT with aberrancy from ventricular tachycardia (v tach) in patients with monomorphic wide complex tachycardias.1 Adenosine is a potent and safe antiarrhythmic when used appropriately. However, its use in the wrong patient or rhythm can prove fatal. This article focuses on how to expertly use adenosine and to know when this “safe” antiarrhythmic can be dangerous and contraindicated. Pharmacology & Mechanisms of Action Adenosine’s mechanism of action can be thought of as a “temporary paralyzing” of supraventricular tissue. Pharmacologically, adenosine hyperpolarizes the cell by stimulating an inward potassium current and temporarily inhibiting calcium migration.2 In doing so, the pacemaker activity of the sinoatrial (SA) node, spontaneous atrial activity and conduction through the atrioventricular (AV) node are dramatically slowed or temporarily stopped. Adenosine has no effects on accessory pathways, such as those seen in the Wolf-Parkinson White Syndrome (WPW). Mild side effects of adenosine are common. They include a transient sinus pause that usually lasts less than five seconds, chest pressure or tightness, dyspnea, facial flushing and the feeling of impending doom (see Table 1).2–4 Rare, benign side effects reported include anxiety and dizziness. In one large prehospital trial, 11% of patients had a minor transient complaint, with chest pain being the most common complaint seen in 4% of patients.4 Chest tightness was induced by adenosine administration in 83% of patients in one large in-emergency department (ED) study.5 Side Effects Side effects from adenosine administration that are serious are extremely rare when used in healthy patients with PSVT (see Table 1). Adenosine may cause mild bronchospasm, which is almost always short lived. However, adenosine can also cause severe bronchospasm and should be given carefully to those with a history of asthma or chronic obstructive pulmonary disease (COPD).6 It shouldn’t be given to patients who are already wheezing. Adenosine has also been reported to cause prolonged sinus pauses, syncope, seizures and even asystole, although this rare side effect has been described almost solely in older patients with preexisting conduction disease and/or second- or third-degree heart block.7–9 Adenosine is the drug of choice for PSVT in pregnant patients.1 The biggest dangers with adenosine are seen in two groups of patients: 1) those with atrial fibrillation or atrial flutter, and 2) those in sinus tachycardia and not PSVT. Numerous studies in the literature report serious rhythm degeneration and even death when adenosine has been inadvertently given to patients with either atrial fibrillation or atrial flutter. Adenosine can convert relatively stable atrial flutter with 2:1 conduction and a heart rate of 150 to 1:1 conduction with a heart rate of 300 and cause rapid clinical decompensation.10 Adenosine slows or blocks antegrade (atrial to ventricular) conduction through the AV node but doesn’t affect accessory or bypass tracts like those seen in WPW syndrome. Because of this, adenosine can be dangerous when given to patients with atrial fibrillation, especially if they have a bypass track. Numerous reports show patients degenerating into rapid atrial fibrillation with rates at 250 or greater and becoming hemodynamically unstable.10–13 Thus, an absolute contraindication to adenosine exists in patients who have either atrial flutter or an irregular rhythm in atrial fibrillation. Because rapid atrial fibrillation may seem regular on ECG monitor, paramedics are urged to run a rhythm strip and verify true regularity. We find this easiest by making marks on a piece of paper that match the peaks of the QRS then moving the QRS-marked paper a few beats over to compare it to three to four new beats on the rhythm strip. If they line up, then the rhythm is regular; if they don’t, then the rhythm is irregular (and likely atrial fibrillation), and adenosine shouldn’t be used (see Figures 1a, 1b, 1c). The other absolute contraindication to adenosine is in sinus tachycardia. Dehydrated patients, especially the elderly with fever, failure to thrive and/or an infection may appear to be in PSVT when in fact they’re barely compensated with a sinus tachycardia with a rate that may be greater than 150. These patients are at high risk for morbidity and mortality if adenosine is administered, and they have a prolonged sinus pause (see Table 2). In cases for which there’s any chance that sinus tachycardia is the etiology of the patient’s elevated heart rate, a rapid fluid bolus of 250 cc should be administered. Any slowing by just a few beats per minute (rather than a dramatic conversion to a normal sinus rhythm) confirms the diagnosis of sinus tachycardia due to volume depletion. This is also true in heat stroke victims with PSVT at rates approaching 180 beats per minute. EMS providers should rapidly hydrate and cool these patients before administering adenosine. If the patient’s pulse begins to fall with therapy, the diagnosis of sinus tachycardia due to heat illness and dehydration is confirmed, and adenosine is contraindicated. Table 2 lists the rhythms, rates and patient types in which the diagnosis of PSVT should be considered unlikely.

I transported a patient with an LVAD. Hers began slowing to the point of syncope. Interesting device! My wife (CV ICU RN) guided me through all of the little idioscracies of the device. She asked me if I was able to hear lung sounds. No, all you hear is pump buzzing. I took my V/S with my monitor and decided that since they looked odd, to do manual V/S checks. Nothing was right. I decided to stay with manual because at least I knew those would be accurate. I was never taught about those devices. I have found that much of my training has been void of necessary information and knowledge. So, my advice to anyone that sees something they have never seen before, look at it, ask questions, research it and don't be afraid to be a little nosy. Hell, it's what we get paid for anyway, right?

Hello from Missouri! I work at a small, rural service. I have been a medic for five years. I'm here looking for knowledge and professional development. Y'all have a great and safe evening!