mobey

Good job It was a allergy to cloths....Spandex to be exact. I did not hear the exact name but it is one of the chemicals used in treating the rubber spandex is manufactured from. The patient would have been fine if she would have washed her new sports bra before she wore it. The hardest part of this call was trying to talk the 22 y/o virgin to take her bra off after I found out it was new - never washed.

Awesome question...but nope no pills. This has never happened before. What would set off the latex allergy during a run?

Gettin warmer...run with this, what else can we do? What kind of questions can you ask?

i had heared of that prior to this call and thats what I had stuck in my head. Except that she excersises every day, and this has never happened before. And now the symptoms are recurring and she is lying down. Good thinking.....But not this time

You remove her shirt and pants and inspect her for bites or rashes. Dammit nothing. The welts are clearing up and you don't notice a bunch of mosquito bites. You pay careful attention to her ankles but see no abraisions or needles of any sort. No Hx of detergent or deodorant changes. Re-read your third paragraph. You really have to think outside the box for this one. Remember she ate lunch 2 hours ago, and she has had chinese before, even at that restaurant. You now have a young girl down to her underwear, feeling uncomfortable in your presence. Since you are a 27 y/o male. haha. I got very frusterated on this call and ended up asking a very open ended question to which her responce gave me the answer that probably saved her life in the future with the mongolia trip coming up fast. Another hint: The allergen has been specificaly mentioned more than once in this scenario.

LMAO.... No there is no object. This "Lump" was there then left after the meds, but just came back. And she seems to be breathing faster again.

You start a neb of Salbutomol and the chest loosens right up. Pt is getting more and more comfortable as time passes. Sats are up around 96 now. You load the patient and start the trip to the hospital 1 hour away. This patient is heading to mongolia in 2 days to go on a horseback expedition. You feel a moral obligation to get to the bottom of this episode. You have an hour....Let the detailed history begin. Oh ya she says there is another lump in her throat about 5 mins down the highway. Same feeling of swallowing "Around" something as before.

Holy crap that never even crossed my mind.....Thanx Ruff

No recent illness, Can't remember the name of the pneumonia med, it's been gone for 2 weeks. The brother fetches the shampoo, Pert Plus she has used it for years...Smells like pert plus. She did not enter the barn, just grab some bales off the stack, put them in the half ton drive to the pen and dispence. At the restaurant the family had "Meal for 5" included everything you can imagine, Ribs, Chicken balls, Rice, Deep fried shrimp, noodles etc etc. No family alergy Hx. Her running route is the same as always, through the yard, down the lane, down the road 1/2 mile and back. She came in contact with a few plants along the side of the lane...But she says she always does. No chemicals being used on thier farm right now. Neighbors could have been spraying although it is not too likely because it had rained yesterday and now it is too hot to spray.

Just appear to be welts. None on her hands. No pustules. You give a dose if IM Epy and IV diphenhydramine. Sorry no solumedrol in the ALS kit (gotta love rural services) A few minutes pass and she begins to cough less, and is starting to talk. Resps seem to be deeper now. Reasess AE, Wheezes throughout and still some stridor....A vast imrovement though.

Her family states she said it feels like she is swallowing "around something" she is not talking...Too busy trying to move air. This is her primary residence. She fed horses this morning at 9 like every other morning. This started while jogging.

Nope it's been a while since they cleaned the shower. I like that thinking though....Gotta admit I didn't ask that She shows you the mosquito bites on her chest (although she seems pretty hestant to do so...good catholic girl and all). They look like red welts, too big for mosquito bites. there are lots of them and she is scratching them. You check her back...yup more there. You think to yourself "Can a mosquito bite through a t-shirt and sports bra?" S Difficulty breathing, Red spots on chest and back, AE= Silent in bases wheezes in upper lobes, Stridor in upper airways. It is hard to assess because with every breath she gags and coughs. Puffy hands, lips, eyelids, etc. A Peniccilin M none P Pneumonia X 1 month ago L Lunch @ chinese restaurant at noon E Jogging PQRST See above.... SOB is rapidly progressing nothing the first responder did helped,(O2 that is). Pulse ox 90 Monitor = sinus tach Pulse 115 BP 100/70 Resp hard to assess around 50 very shallow

Family states she was out for a jog and came back sooner than expected because there were too many mosquitoes (multiple bites). You ask her about stings and she shakes her head no. Family states she came in, got in the shower, came out of the bathroom panting with shampoo still in her hair and told them to call an ambulance. No chemical exposure

This is my first scenario so bear with me!! OK this is a simple scenario based on an actual call I did. The pourpose is to take an accurate complete history, this will prove to be the only way to definitavely treat your patient. You work for an ALS service in a rural setting. You have a 1 hour transport time to the nearest hospital. You have all the treatments a normal ALS service does except 12 lead. It is july 2:00pm and you are called to a farmhouse at a horse ranch 10 mins out of town. Dipatch information: Respond to 22 y/o female, difficulty breathing. Caller states it is getting worse fast. You recognise the land location as being the ministers of the church. ALS will arrive at the same time as you. You arrive on scene to find a clean yard with lots of cattle, horses, chickens..etc. The house is fairly well kept considering there are 5 children in this family. You see your patient sitting against a wall in the kitchen, a first responder is holding an NRB on her face telling her to keep breathing. Your patient is in obvious distress, you can hear coughing, and choking from the porch. Her tidal volumes suck...seems everytime she tries to take a breath she chokes and coughs. Ok keep the questions to 2 or 3 per post, I hate it when 1 person asks every question there is and the scenario ends in 3 posts!

Back in Sask we had a "Team" of stupid kids that were good for buisness. The dumbest must have been a 22 y/o in a shopping cart being pulled by a truck. They got around 70km/hr and the front wheels came off (big surprise). He wasn't seriously injured that time, although he broke his back a while later while riding in the back of a truck that was cruising ditches. Now he has vertabrae fused and multiple pins and such holding him together....Thank god for tax payers to get him through life now that his back is screwed!!

Simple answer....NO You have to consider what causes the deviation and JVD. Increasing interthoracic pressure on one side pushes the mediastinum to the opposite side. The same can be said for the JVD. Think about what causes Jugular veins to distend? How can a pneumo cause this? Simple Pneumothorax S&S include chest pain, Dyspnea, Anxiety As it progresses you will find hyperextension of the chest wall, decreased air entry on one side, Cyanosis, Trending decrease in BP, percussion tone changes between the 2 sides. Tension Pneumo will show further hypotension, JVD, Mental status change,Pulsus Paradoxus, abdominal distension, possible deviated trachea toward unaffected side. Remember you have to feel trachea deviation, you cannot see it. You must feel down the trachea as far as you can. I once was involved with a trauma victim that was deceased from other injuries, his chest X-Ray showed huge mediastinum shift but you could not even feel tracheal deviation although you could see it on the x-ray.

Deathonline.net/decomposition says Rigor sets in approx 3 hrs after termination of blood flow. Deathreferance.com says 2-6hrs www.deathreference.com/Py-Se/Rigor-Mortis-and-Other-Postmortem-Changes.html My personal experience tells me it's definatly not within 1/2 hr, I have transported bodies for the coroner from scenes before and never have seen rigor. Where do you get your info?

I have never heard of that before today. I googled it and didn't get much smarter!! Could someone simplify this syndrome and it's significance for us??

God I hope this isn't a dumb question. A co-worker showed me a strip from a 3 lead which had a very prolonged st segment. I can't remember exactly what the measurements were but it was definatly > than .20 between ths end of the QRS and the start of the T wave. I am wondering what causes such an anomoly? BTW I have no idea what her history is other than she is 104 yr old. (the Pt. not my co-worker)

I have often wondered about how the stretcher mechanism would hold up in the event of an accident.....now I know! Has anyone had experience with a milder crash than these? Just wondering how much force it takes for the stretcher to become dislodged from it's brackets.

WOW way to hold back firemedics as proffessionals. I see what you all mean about FF's. The point Dust is trying to make is that although these ALS tasks are being assigned to BLS cars they are not BLS at all. Hmmmm how do I say this in FF talk?? HEY IDIOT, just because you are authorised to perform an ALS procedure that does not make you ALS. When you sit in your captains chair in the firehall does that make you a captain? In AB I can do IV's as A BLS provider....Does that make IV's a BLS procedure? Or does that make me a BLS provider performing ALS procedures?? :roll:

We are debating BLS. When we say "Paramedics" we are discussing Canadian Primary care Paramedics aka EMT's I have no opinion on Canada's Advanced Care Paramedic vs US EMT-P. I have never been led to believe one is superior to the other. But a Canadian PCP is far advanced over an EMT-B in the US

Better than talking out of her a$$ Yes I would still run an EKG, but I would first get a BGL (IDDM + acting inapproprate).

Masta I totally agree about comparing apples to oranges. The point I was attempting to make was not EMS education comparisons within Canada, it was EMT vs PCP only. If you browse the first post you will see I am just supporting the idea of AB EMT's calling themselves PCP's. Bleep stated that AB is rejecting the PCP title because EMT's in AB are so far advanced compared to the rest of Canada that they will not degrade themselves to the lowly PCP name. That is the reason for the comparison, to drive the point home that really they are not! Not that they are inferior to the rest of Canada, but they certaintly are not superior ( this excludes you of course ). If anything we should have some Ontario PCP's pissed off that provinces like Sask call themselves PCP's with less than half the education.

Something to chew on..... Kanyo college PCP program - Fort Mac AB Didactic 10 weeks Practicum ambulance - 192 Practicum hospital - 48 Nait (Alberta) Didactic 300 hrs Practicum ambulance - 200hrs Practicum hospital - 40hrs SIAST (Saskatoon Sask) Bidactic 396 hrs Practicum ambulance - 200hrs or till competencies are met Hospital rotations - 48 hrs or till competencies are met Ontario Didactic - 1600hrs (enough said) Malispina University college (B.C.) Didactic 211 hrs Hospital rotation - 44hrs Ambulance practicum - (Not specified competency based) Maritime school of paramedicine (Nova scotia) Didactic 10 months full time Hospital & Ambulance Practicum 386hrs Hard for me to believe Alberta is a "Leader" in education in Canada :roll: