mark

What do you think about running in L&S with caustic ingestion pts? It seems like most of the damage would be done rather quickly with Drano, but what about other chemicals? Any treatments the hospital could do that you can't in the field (protocols allowing of course)?

I've also seen it used for treating airway burns/inhalation injuries. -Mark

Had this sent to me by a friend the other day. The CDC is working on updating the guidelines for trauma triage in the field. Looks interesting. http://www.cdc.gov/mmwr/pdf/rr/rr5801.pdf http://www.cdc.gov/FieldTriage/

I did my medic internship in Portland, OR and we carried them there. http://mchealth.org/ems/protocols/2008_procedures.pdf If memory serves, I believe Ada County (Boise) carries them as well.

I don't know why I come to this site anymore. I guess it's because I want to learn something or discuss work-related topics with like-minded people, but it seems like most threads with any potential end up turning into this "He said, she said, I'm right, you're wrong" crap. It's discouraging really. I understand there will be differences in opinion, but for the sake of the site, it would be nice if all the bullshit could be minimized to allow whichever thread it is to continue on in the direction it was meant to go. If you feel strongly about a particular post or must confront someone else's opinion, Private Messages are an effective way to convey your feelings. If you feel strongly about a thread in general, would it be possible to start another thread debating the professionalism and/or quality of that topic? It would provide a good avenue to express your feelings, and allow others who aren't interested in the validity of the topic a way to avoid sifting through all the drivel that accompanies these little disputes. All in all, I think it would be a more effective and organized way to get everyone's points across without forcing them on people who aren't as concerned about with whatever disputes there may be. This posting is not a reference to any particular thread, but instead a comment on a pattern that has been emerging on this site for quite some time. I find myself visiting the site less and less, mainly because it takes so long to sift through all the arguments and back-and-forth one-upping that getting any useful information out of a thread isn't worth the time it takes to get it. I've said my peace. Do with it what you will.

Really? I agree that it sounds like the AED was applied, but that's as far as it goes. Basing any other assumptions about workable rhythms and the like on this news article which was written off information gathered from the plaintiff's lawsuit may just leave you with a bad taste of foot-in-mouth if you're not careful. Just saying.

Whether or not the EMT was negligent in his role, the fact remains that this woman's chances of survival were slim to none before 911 was even called. From the sounds of the article, she was pulseless and apneic on EMS arrival, and due to her age and Hx of cystic fibrosis, she wasn't long for this world anyway. I know making judgements about medical treatment off an article like this is flimsy at best, but I don't believe the suction cap would've made the difference between life and death. However, regardless of the situation and the pt, it is still the duty of whoever is operating a piece of equipment to make sure it is ready for pt use, and that EMT should have checked the tip before suctioning. I don't think this part actually needed to be said, but we all know that if I left it out, someone would come down on me for it and told me I have no place in this profession.

Ugh. Of course it's a Montana service too. Way to represent guys. We have our fair share of rahrah volly services, but I promise we're not all like that up there.

Don't personally know of any medics FROM the Middle East or Saudi Arabia, but there are a few of us who are working in the area.

I've got a good one from one of my coworkers. She was working with a part-time medic who was also a full-time cop and a medic on the city's SWAT team. They got dispatched to a stabbing, got the pt loaded, and she started backing up get going. She backed into a patrol car which just so happened to be the one her partner uses!

I can vouch for that!

It's amazing how quickly a thread can get hijacked around here. :roll:

firedoc can you send me a PM telling me a little about the US Marshall service? That sounds interesting. Thanks.

If I am correct, I believe AK is coming over to play with me and my crew. We'll find a spot for you somewhere around here. I believe one of the AB units isn't used very often.

Some I'm sure you can all relate to... -If you didn't sleep well the night before, you get slammed all morning. -If you are well rested for your shift, you won't get a call until it's time to go home. -Nothing all day, and when you finally get into the truck to go for food, you get hammered for 4 hours straight. Now a few that are more specific to my service and me... -Lately, if I notice a drug is about to expire, we end up using that drug (usually on the first call). So far this month, We've used Adenosine, 1:1000 Epi, and Mag. No good. I have my partner check the drug pack now. -We have an indian reservation about 45 minutes south of town and we're the closest service. This is one scary place. No cell service...no radio contact...nothing that even resembles Law Enforcement for close to an hour (due to jurisdiction and other crap), and it always involves at least two of these factors: ETOH, MVA with ejection/rollover, assault, horrible directions b/c the streets aren't named, and occasionally some sort of code/immediate life threat with flight/first responders not available. If you didn't get a good picture from that, then come visit me and I'll take you with me on my next trip. Anyway, we call it the P-word. It never fails, if someone calls it by name, a truck is going down there.

Sounds like I'll be heading over with AK and chbare. Next stop...the Middle East.

On my first day of medic class, we spent the entire day just going over taking vital signs. It was a very in-depth look at all the things that you can find just from taking vitals, and one of the things covered was a diastolic pressure that never goes away. I can only recall 2 pts that I've heard it on. There are 5 different sounds you hear while taking a blood pressure. 1) The first Korotkoff sound is the snapping sound first heard at the systolic pressure. 2) The second sounds are the murmurs heard for most of the area between the systolic and diastolic pressures. 3/4) The third and- the fourth sound, at pressures within 10 mmHg above the diastolic blood pressure were described as "thumping" and "muting" 5) The fifth Korotkoff sound is silence as the cuff pressure drops below the diastolic blood pressure. Now, I was taught that you will occasionally run across a pt that doesn't have the fifth Korotkoff sound. In these pts, the diastolic pressure is indicated by the change in tone (third and/or fourth Korotkoff sound) even though you continue to hear the pulse.

Anyone here work for/familiar with Austin/Travis County EMS? I'm looking at applying down there and would like to talk to someone who knows the system.

So here's our answer. As we move the pt to the truck, the wife runs out of the apartment building with the pt's shoes. She catches up with us and says, "He might need these. Oh, and I forgot to tell you...when I found him in the bathroom, I went to the kitchen to get some honey and put it in his mouth." Of all the things you wish you could have known right away. It was a hypoglycemia-induced seizure, no new neural problems, and no narcotics on board. By the time we got to the hospital, the pt was answering questions and coming around nicely. Oh...and just to let you all know, I took and passed my medic test this week! I'll now be saving lives Disco Style!

So following our ALOC unknown cause protocol, we push .4mg Narcan IV. We still have no have no med list but we figured we'll give it a shot and see what happens. Sure enough, he starts coming around. He begins opening his eyes to painful stimuli and starts moving arms and legs trying to get out of c-spine, becomes verbal to yes/no questions, shows signs of short term memory loss. He is an obviously post ictal state. At this point, you begin preparing pt for transport and move him to the stretcher and then to the truck. What's next? This will be my last post before I fill you in on the answer.

Sorry. I forgot to mention in my last post that 1 FF was holding c-spine and a collar was put on. He also was incontinent of urine. Unfortunately, meds (recent scrips/changes and the like) are unavailable as we did not get them. The fire captain said he had a complete list for us (see above) and we didn't double check. No excuse, but unfortunately how it worked out. First CBG of 205 was obtained via finger-stick. With all of this and the above information, what is your treatment plan? I know there are always more questions to ask, but at this point in the scenario, you have all the info we had.

All right. Here we go from the top down: AVPU- pt responsive to deep painful stimuli with groan and flexion, Eyes-1, Verbal- 2, Motor- 3. A- snoring resps stop with 32 NPA, no foreign bodies. B- resps 12 and regular, NRB at 15LPM in place. C- skin pale, cool, diaphoretic, slightly cyanotic but improving with O2, no bleeding, good pulse at 128 bpm. Vitals: BP- 108/62 HR- 128 bpm Resps- 12 non-labored O2 Sat- 93% HEENT- No obvious signs of trauma, PERRL 4 to 3, no JVD/deviation. Chest- chest wall intact, no obvious trauma, clear lungs bilat. ABD- soft, nontender (as best you can tell anyway), pelvis stable. Extremities- +pulse=x4, no response to verbal commands for motor/sensory, - Babinski. Back/Spine- no obvious trauma/stepoffs noted. Monitor- Sinus tach staying around 130, no ectopy or abberancy. CBG- 205 mg/dl (Sorry. I know that's not what you wanted to here, but if it was, it wouldn't be worth the post.) SAMPLE (according to wife) S- pt hasn't been feeling funny, running a fever, or anything else out of the ordinary. A- Sulfa drugs M- Unknown. Wife states pt recently changed to a new diabetic drug, unknown which one. Fire Captain said he wrote down all meds, but gave us the list after we loaded the pt and it had only 1 med on it and was misspelled beyond recognition. P- DM Type 2, hypoglycemia induced seizures, rest unknown (wife poor historian). L- Pt ate breakfast this morning ~0900 (now 1130), normal sized meal. Took morning meds. E- Wife states she was in kitchen, heard a bang, and went into bathroom finding husband on floor between toilet and wall, seizure was not witnessed, toilet base dislodged from normal position. Fire spikes line for you, IV access obtained, another CBG taken from stick is 224 mg/dl.

You are toned out to respond to a 78y/o M for a seizure. On arrival, you take BSI precautions, note that the BLS engine is on scene with 2 FFs and captain. WIfe meets you at the door, states that pt is diabetic has Hx of hypoglycemic seizures, she found him down in bathroom against toilet, and seizure was not witnessed. You enter the apartment building, and walk down a flight of stairs finding pt supine in bedroom (fire moved pt from bathroom). Pt is 6'3", 260lbs, responsive to deep painful stimuli, snoring resps at 12, NRB in place at 15LPM by fire, good radial pulse at 128. Begin!

I remember my first call. My EMT FTO, her medic partner and I got sent on, of course, a no-code response to a nursing home for an 82y/o F who had an elevated white count. We totally saved her life.

Thanks! These are all great ideas guys. Keep 'em coming.