mobey

Fever? Nausea? Back the f up! I am putting on a gown... and maybe another pair of gloves! of course I always wear eye protection too..... mostly because my Oakley's look frickin cool

Hope I'm never in your remote area when I'm in a perfusing v-tach, or silent MI, or,or,or.......

I think there is still going to be some great discussion here. To be clear, I am not hiding any great mystery about this dude's cyanosis. I ran this call as if my SP02 was innacurate, although I am quite aware it may not have been. He is Hypercarbic, confused, and cyanotic - yet no tachypnia and a Sp02 within normal limits. (Did I mention I was looking for a squint patch?). Would love to hear what some others would do for treatment before I post mine. To sum up Cyanosis of face/hands/lwr legs. Hypercarbic. Sp02 normal. Resp rate 18. Little chest wall expansion. Slight wheezes in apex's but over all too quiet to hear much of anything. Confused/slight combative. borderline tachycardia,normotensive.

Sorry I do not have an exact # for you, however it was within the normal range. I WAS planning on posting this all while it was still fresh in my mind and have specific answers, so I didn't write them down, but since then I have had a few looong critical transfers, and the data has slipped away. I DO however know that PvC02 and WBC were the only abnormal lab values. I am wondering if HGB "within normal range" for the avg adult male was actually low for this chap? Hmmm

I realize everyone has an accent. I specificaly stated I have never heard a "Gay accent". Only a lisp, and yes... I am challenging that some can turn thier lisp off at will.

I realize you were abbreviating.... so was I What is an EMT-Specialist? We don't use that title here. Is it similar to EMT-B? EMT-I? EMT-P? BTW: Cudos on properuse of spelling and punctuation. That is not usually seen here with new members, and it did not go unnoticed!

I have never personally heard a gay accent. i have however heard a lisp.... a very exaggerated one too. Anecdotally though, the lisp seems to disapear at times of formality, and is nearly never present until one is "out of the closet". Just my observation though.

Welcome to the City! What is an EMT-S? Looking forward to what you have to offer, tell us about your program?

Right after I made the original post, I got brutally slammed at work. Now that I have had a good nights rest 'll try be more thourough. appoligies for leaving things out on this one, I was not doing it on purpose. BTW Squint: I was looking for your # during this call! LOL "Squint patch" Yes well... rural hospitals. I am sure you have dealt with this one before. Give you a hint, The Walmart is full of army brats

If you have an iphone/Android, you can download AHS EMS protocols app. (Alberta healthservices). All your answers as well as evidence will be in there from my area.

Forgot one more thing, when the patient first presented he was hyperkalemic. Had insulin to decrease it, and is normal now. I dunno how high it got, wasn't in the reports.

OK, before we get too advanced, I'd like to hear from some of our newer BLS/ILS providers..... then chbare/Squint can come school us all Called for interfacility transfer 66 y/o male longstanding history of COPD, persistant smoker, CHF, non-med compliant. Meds: Dosen't matter.... He has not filled prescriptions in years. (ventolin/spiriva/Prednisone/Metorolol/Lasix few others I can't remember but all related to CHF and COPD) HxCC: Pt presented to ER 2 days ago with shortness of breath. Worked up for pulmonary embilism with spiral CT - Negative WBC count slightly elevated at 15. No other abnormal blood values ECG normal, no chest pains. Over the last 12 hrs pt has turned quite cyanotic, he is becoming disoriented and combative at times. On arrival: you find him semifowlers in no obvious distress. He is blue as a smurf. There is a simple mask at 4lt on his obeise belly. He tracks you as you enter the room, but is disoriented. There is a 22G in his right hand and a hydrocortisone infusion just finishing. He has also had Cephalexin about an hour ago. Vitals: HR96 BP 148/90 Respitory rate 18 non-laboured, Sp02 96%, Temp 35.9C, What else would you like? BTW this is from memory, so there may be a few thing I forget. 1800th Post!!!!

Just to add my 2cents. Also remember your monitor's numerical readout is just grabbing a few seconds of data from the strip and formulating a rate., That is why we see rates jumping from 30-200 in patients with a-fib. To accuratly count the electrical rate you see on the monitor, you need to print off a 1min strip and count the QRS complex's. Good question! Nice to see some critical thinking at work!

Wow,...... Dude that is a piss poor school! Forget Axis deviation for now and concentrate on ST mimic's, and DD of widened QRS. My suggestion is to find a 12 lead course and attend it! You can dredge through all the websites and self-learn if you like...... Of course that means you will be a "self-taught" Paramedic If I were you I would attend a class and attempt to send the bill to the school as they have not prepared you to work as an ALS provider...... That is what you payed them to do right?

Have you tried squinting?

I am sure you did... But elevating the legs/lwr torso can help, as well as turning the pt's head 30degrees, Too far and it flattens, too little and the skin is too loose. Other than that..... well, go IO

Gone through CPR on our loved ones? Nope I cannot stress enough that you are at the wrong place! If you are having a hard time emotionally dealing with this mental trauma you have incurred, you need to seek a mental health professional. If you want 'cause of death' answers, you need to speak with the medical examiner. If you want someone held accountable, you need a lawyer. We here are none of the above! I hate to be so blunt with you, but you have been all over the map with your posts, first accusatory, then sincere curiosity, now sheer desperation. I really don't know what your story is (nor you're grade level judging by you're english writing skills), but again... we cannot help you. This is a Prehospital Emergency Medical forum.

Pretty sure it is just the way we are wired as far as men go. I don't know that you will find an official answer from us, however, I stand by my position with either sex. There is a big difference between jeffree Star and Ellen Degeneris, and no... I am not talking about genetalia. I will say though, I know of a few women that watch male-on-male gay porn and love it. I suspect it is common but not publicized.

Perhaps I am misunderstanding you. Marde Gras is an all out party with no real message to the public except "We are partying" Pride parade is supposed to have a different message and therefor it is unfair to assimilate the two.

1st A good read, thank you! Don't take offence to our silence, I do appreciate the file.

merginet.com/index.cfm?pg=cardi...fn=CPRstretcher By Bryan E. Bledsoe, DO, FACEP March 2006, MERGINET—We are learning a great deal more about cardiac arrest. We know now that victims of blunt trauma who are in cardiac arrest when EMS arrives are dead and resuscitation efforts will be futile. Likewise, we are learning that if CPR and defibrillation are not applied soon after the onset of cardiac arrest, the chances of survival decrease by about 10 percent per minute. By the time the patient is 10 minutes out from cardiac arrest, without emergency care their chances of survival are dismal. In many countries, CPR and ACLS measures are provided in the field. If unsuccessful, efforts are terminated and the patient pronounced dead and left for the mortuary. This is a good practice. There is little an emergency physician can do for a medical cardiac arrest in a hospital that a paramedic cannot do in the prehospital setting. Now, this may change when we start inducing hypothermia in cardiac arrest patients. But, until then, we really ought to stop transporting dead people. I have always questioned the quality of CPR provided in a moving ambulance or on a moving stretcher. Many times in my paramedic career I “rode” the rails of an ambulance stretcher while attempting CPR. But, how effective was that practice? Now, researchers at the University of Pittsburgh have studied the technique. Using a prospective, randomized crossover design, volunteers (EMT students, paramedic students, EM residents) were assigned to two-person teams. Each team performed two 6-minute bouts of CPR on a recording Resusci-Anne either placed on the ground or placed on a moving ambulance stretcher. One team member provided bag-valve-mask (BVM) ventilations and the other provided chest compressions. After three minutes into each bout, the roles were reversed. There were 62 subjects and thus 31 teams. They found that the difference between the rate of compressions on the floor and on the moving ambulance stretcher were not statistically different. The tidal volumes delivered by BVM were not statistically different between the positions. However, compression depth and percentage of correct compressions were better when performed on the floor than on the moving ambulance stretcher. In addition, the percentage of correct ventilations was better for the floor position. They concluded that chest compressions and ventilation quality of CPR on the ground was superior to CPR performed on the moving ambulance stretcher. One point that was clear from the recent 2005 American Heart Association CPR guidelines is that uninterrupted chest compressions are very important in terms of patient survival. This study showed that the practice of attempting CPR on a moving ambulance stretcher resulted in compromised CPR. I think every EMS system needs to revisit their protocols and positions on field termination of CPR in medical cardiac arrests so as to minimize transport of patients needing CPR. Reference Kim JA. Vogel D. Guimond G. Hostler D. Wang HE. Menegazi JJ. “A Randomized Controlled Comparison of Cardiopulmonary Resuscitation Performed on the Floor and on a Moving Ambulance Stretcher.” Prehospital Emergency Care. 2006; 10:38-70. _____________________________________________________________________ http://www.ncbi.nlm.nih.gov/pubmed/19477573 CONCLUSION: CPR quality was sub-standard both before and during transport. Early decision to transport might have negatively affected CPR quality from the early stages of resuscitation

No, with my 4 years of emergency medical education, I cannot see in any way, how slamming you're chest into a steel steeringwheel could possibly cause an injury. As was started, there are meny causes of Pericardial effusion, you are not going to get what you are looking for here, as it puts us in a medcal/ethical conundrum. EDIT OK, after reading squints reply, I can see i'm being an a$$hole. It appears you are looking for an answer that cannot be given without specifics of the accident. If you did give us specifics of your huband and the accident and we formulated an opinion we are opening ourselves to ethical and possiblt legal ramifications. We have lots of people who come to this site asking these types of questions and not always real sincere, so excuse the short post above. You see, if i were to answer "yes, hitting the steeringwheel could cause a pericardial effusion", I would expect a PM asking if I would testify to that as an expert witness.... then maybe a sobpoena. sorry for the smart ass remark