Mateo_1387

intrathoracic pressure would decrease the cardiac output.

This should have been noted in the general impression. I don't understand how the man can have a tension pneumo (especially a bilat. one) and still have a strong and full pulse while not moving air. If he is not getting enough air and its compressing his heart I'd expect signs and symptoms of shock, To me this would be some signs found early...... thats just my thinking... I enjoyed following/participating in the scenario

I'd say go ahead and give 1mg of epi 1:1,000 IM. Obviously the patient is about to code without any breathing, and we'll be giving 1 mg IV when he codes in a minute. Besides if he is a tight asthmatic it will start helping to open his lungs and also will increase his BP. I know most people are thinking OMG, he should only give up to 0.5 mg IM, but nah, give the 1 mg....

why use calcium for a hyperkalemic patient who you used succ. on?

I've got to make a correction to the rules..... Rule # 2, part b should now read........... It is OK for a man to cry ONLY under the following circumstances: ( The moment Angelina Jolie starts buttoning Up her blouse. Thanks for complying with this new rule...............

ok, I agree about WPW. But here is my question. is it safe to cardiovert with an irregular rythm. The monitor will not be able to syncronize. How have people been told to deal with these types of problems?

Stumped me...........I thought I knew this one, and did not do any research. Since I have done some research i have a new opinion of what the problem is. From what I can tell the digitalis is affecting her extracellular potassium levels by blocking the sodium potassium pump. I'm not sure how this affects the calcium in the cells and why extra calcium proves to be deadly. I'll definatly learn from this thread. Am I on the right track?

I had to put some pants on before I showed up onscene, the smarty pants were the only pair left !

From what I've seen of cardiac arrests in many different hospitals they are not too much different than what we do in the field. I have seen one team shock asystole. But as far as running the code it is about the same. especially where I am we have the same meds that the hospital will push. we do the same cpr the hospital does. thats why codes are worked onscene, its much safer, more effective, and we have a very high resuscitation rate. Never did understand the logic of risking lives running emergency traffic for a dead person.......... But again I've not really seen a difference. the only think I could think of that would be different is for a trauma code the hospital can give blood, and do other evasive procedures we can't in a rig.

Here is how I feel about it. Rules to not carry knives to school are good for safety. I agree, ten year olds might not be the best people to let use knives unsupervised. children don't always think about their actions (as do certain adults too!). Ten year olds would be likely to do things like say run with sharp objects, maybe slash the knife around playing like a swordsman, or other various unsafe activities. But I think the rule should not be absolute. Let me explain. If the girl was actually responsible with the knife, used it for food, and never created a problem, she should just be warned not to bring it, contact the parents and discuss school policy, and drop it. Also when are they going to require bulky pens and poncils so that its hard for kids to stab other kids with the sharp objects??? Ten year old charged with a felony, yet superstars can get away with so much............ neither makes sense.............

Hot grandma here was having left ventricular failure, noted by the left BBB. The decrease in work load of the left ventricle caused her BP to get low. On top of that she was treated for a metabolic problem that she probably wasn't having. Her low BP to begin with, plus calcium (which will cause peripheral vasodilation) caused her BP to drop even more. With the lack of pumping action of the left ventricle the right ventricle was pumping blood to the lungs which caused the pulmonary edema. Had I been here to intervene earlier I'd have had a dopamine ready for if her perfusion is decreased, not given any calcium, and have given some ASA, and high flow O2, and rapid transport to a hospital. The nausea, dizziness, and what appears to be a resolving MI in the left ventricle is what I think her problem was. Not the a-fib or a metabolic problem. Also since My agency can afford field serum marker tests I would want to do one on her.

I don't always rely on the NIBP, I realize that it is just a tool. But it is a good tool if you and the machine are getting the same answers. Its nice on calls because it will take them continuously,a nd you can use the information it provides and patient information to evaluate your patient. The patient still got the same treatment even without knowing the BP, I couldn't hear it going down the rode doing emergency traffic on I 40 in raleigh. Still though my patient presented to be in shock and thats how she was treated.

I agree, be prepared for the worst. To fix his rate problem I would start an amio drip, 150 mg of 10 minutes, and also give a fluid bolus. As far as the rythm, the patient appears to go from a sinus tach, to v tach, to possibly a fib, if i saw a twelve lead at a slower rate i'd expect to see a LAFB and probably another block.

Had a Lifepack twelve give a pulse ox reading on the truck antenna of 89%, so we put a NRB on the truck and it brought it up to 98%, :wink: jk about the nrb, but the pulse ox did read at 89 on the antenna. had another lifepack at the same agency i was riding with on clinical break when we put it on a patient in hemorrhagic shock due to an abortion go bad. the sucker wouldn't do blood pressures or read in lead II. POS, we actually had to do a manual BP (OMG, thought I was gonna die, jk) But it was a good call that I got to run cuz I had to work around equipment failure and still treat the patient accordingly.

With 1 Million dollars to spend on my EMS agency I would increase the training of the paramedics to be able to understand patient conditions better. With the new understanding of patient conditions they would then be able to tell which conditions require transport by ambulance or by taxi. Part of the money would go to buying taxi tokens. When a patient does not meet transport criteria by ambulance, they can get a taxi token to get to the hospital. With this program the ambulances can transport patients only needing ambulance transport and not waste time with the patients who don't need it !!! With the money saved every year there should be enough for better things like even more education and lots more taxi tokens !!!!!!!

Now that I am a secret agent looking for terrorist I want a raise and a federal retirement plan......

Case 1, Unsafe scene, Cardiac arrest, probably wouldn't work in the first place. Case 2, No LSB, he needs a truma surgeon, not a long spine board....

There is a chance of a compromised spinal cord injury due to penetrating trauma. If you do a complete and adequate neurological assessment then you can find a spinal injury or the absence of one. Like I said earlier if the patient is not showing the signs of the injury then he most likely doesn't have one. Statistics prove this. Spinal immobilization has always been a "standard of care" and it is being researched. The findings show that too many people are back boarded unnecessarily.

I have been taught this in my medic class I am currently in. I agree with it whole-heartedly. We use the BTLS book, btw. In the trauma situation we are taught as medics to deliver the patient to the hospital as rapidly as possible. Trauma is something we can try to manage, but not something we can fix. It takes surgeons to fix trauma problems. When we encounter a patients say with a GSW to the Left side of the chest and he is A/O and no neurological deficits, we can safely assume there is no immediate spinal injury. At this point what is going to help your patient is a trauma surgeon, not a backboard and C-collar and 3-4 extra minutes on scene to package the patient. Every second used unnecessarily is time the patient is possibly developing one or more of the deadly dozen. In the cases where the patient shows neurological deficit or possibly AMS, ETOH, Significant MOI (the drunk guy who falls from 2 floors up) then spinal immobilization is necessary. He still needs the surgeon, but he also needs the backboard. But there are still times where I would move a patient who meets backboard criteria without immobilizing the patient. For instance if the patient is in a tight spot and he has a pulse but is unconscious due to trauma, and not able to be immobilized, at that point it would be life over limb.

If the system is so great' date=' how come you don't see prerequisites about lower level work in medical or nursing schools? There's nothing stopping paramedic schools from requiring/being required to offer longer clinical periods. Several of the things you mentioned apply to physicians too. .[/quote'] I can see vaguely what you are saying. In EMS there is definanatly a shortage of Medics. Since our schools do not require us to work EMS and gain a ton of experience like physicains, then we need to be able and experience some of it at a lower level certification in order to obtain a knowledgebase. If we each worked for a year as a student, and I mean working it like a job every week then we'd all be great technitains. Doctors do that in their resedency.

Even Angina can cause false positive in the bloodwork. Troponin can be released due to ischemia caused by angina.

Think of it this way. If you can't figure out who gets the patient based on each one's assessment (which should be the same) then put it on a doctor's shoulders. You both answer to one, so present the picture to them and let them decide. Should you not be in Contact with Medical Control then I say the decision rests on the First patient contact crew. I don't care if it’s the RN or the MEDIC. You both have the training to identify and deal with injuries, and the if the MEDIC got onscene and cancelled the helicopter, then there is no difference than if he cancelled him before he landed or after he arrives on scene. I say let the first onscene decide if yo can't reach medical control.

For good reason doctors train longer than basics do. They do everything basics can and then 1000+ times more. If your solution to making EMS more professional is to make everyone take more schooling then I think it will backfire. If everyone went to school two years to just start in EMS, and everyone comes out as a paramedic, then the system would fail. Sure they would have the education, but they would lack good experience. Clinicals can be great places for experience, but not enough. Because everything in EMS goes back to the basics, we need to have a strong understanding of it. When you are new to EMS and take that first EMT-Basic course you are overwhelmed with information. The course needs to teach the fundamentals and then let the graduate get out and experience the whole deal. They have to start out small then grow. Without that initial experience when they become Advanced Learned Technicians, they will be lousy. When basics are first starting out riding they are taking in a lot of information. Not only are they worried about their patient care skills, now they have to worry about how to drive an ambulance, where to find everything in the ambulance, how to call for backup, how to deal with other personnel (fire, police), how to deal with certain patients, and how the whole system works. If people came out as medics with lots of education and we got rid of basics (just because they are not as advanced as the medic) then we would really be kicking ourselves. The technician would have to have extended On The Job Training (covering at least a year) just to be comfortable with their skill. Also we would have to worry about losing a lot of people working EMS. We always need people and losing basics would hurt us. I am confident the loss would be due to increased demand on education and time. As advanced technicians it is our job to be a team player. When we find any technician who is not knowledgeable in an area, it is our job to help that person. That concept will only help EMS. To get these "wacker" basics fired up it might take a guiding hand from someone who sees the whole picture.

It won't be too long until the EMS system is way overtaxed that its impossible to keep up with. Especially with people always leaving EMS for bigger and better things its going to be hard to have employees. Mandatory overtime will be all too common. Something will have to change and I am sure it will be that we will have to deny transport. I also think it will also include EMS rendering treatment on scene.

This discussion brings up an interesting issue. I also think it leads to another issue which is why should we transport people who can walk to our ambulance. Although walking to the ambulance should not always equal no transport, it should make us think about whom we do transport. When a patient can walk to an ambulance what always goes through my mind is "why did they call in the first place" why not get in the car and drive themselves. Too often we have this view that "you call we haul." Just like we decide to give treatment to a patient because of their clinical presentation we should also be able to decide to deny transport based on clinical presentation.