fiznat

It probably wouldnt kill the guy. There are, however, more creative ways that this VT patient could be killed! -Using 10cc of 1:1000 solution Epinephrine (which is 10mg) IV push instead of the correct 10cc of 1:10,000 solution (1mg). Pretty sure that would kill your patient... and while it would take a pretty stupid medic to do it-- I dont doubt that someone somewhere has done it. -Undetected esophageal intubation (supposedly happens all the time) -Ineffective CPR (not really fancy, but this does kill people) -Unrecgonised pericardial tamponade or pneumothorax - etc

I learned the six rights as: Right Med Right Dose Right Time Right Patient Right Route Right Documentation

LOL that would be great, to have THIRTY police officers show up on scene, each one holding their own AED haha. Thats a good idea though. I'm a big fan of having AEDs ready at hand like this. I dont like the termonology you guys use as it can -- obviously -- be confusing, but whatever works I guess. In my service we generally just tell our dispatcher that it is a confirmed code and usually we get an extra ambulance or two to help out with stuff.

Woah, wait a minute! This forum isnt for discussion of Electromagnetic Tomography (EMT)?!?! Ohhhhh it all makes sense now!! lol My favorite acronym would have to be TUBE. The Totally Unnecessary Breast Exam. hahaha

A few weeks ago my service took care of someone who actually consumed the contents of a sterno can, in an attempt to stave off the DTs.... Can you imagine that?? *shudder* In class the other day, our instructor told us that you can actually buy sterile drinking alochol in IV-bag form for these types of people. Not that we carry it (for obvious reasons), but its interesting nonetheless that the product actually exists. Imagine the possabilities!

Yeah, pretty much all of our drugs are clear in color. ...Sometimes we have to reconstitute drugs from a powder and it comes out a little milky-ish, but thats pretty much the closest you get to a "colored" drug. Like the above poster said, the colors of the boxes the drugs come in are different, but not everyone goes by that really-- a lot of services (including my own) take the drugs out of the boxes and put them into a kit instead. If you want to make your story accurate, I would suggest you check out the ACLS algorithms (ACLS stands for Adcanced Cardiac Life Support). The algorithms are easially found online, and will contain the step-by-step interventions a paramedic will make on lots of patients such as tachycardias, bradycardias, heart attacks, cardiac arrest, etc etc. Thats probably your best bet. Good luck with the story-- post it here when youre done!

Dammit I'm gonna have to get me that 12 lead. I know what ambulance the patient came in on, I bet I can pull it out of the lifepack's archives. I'll give it a shot tomorrow at work haha.

Yikes.. you'll be needing on-line medical control to give lasix to patients without a previous Rx for it? Thats kinda scary! Whats the reason for that, has there been evidence of abuse/misuse of the drug? ...Are they not sure you folks can tell the difference between rhonchi and rales or something? ...Not like on-line medcon is going to help that at all. I dont get it. Etomidate is a sweet drug. In my system, medics arent even allowed to sedate prior to intubation, but are given standing orders for versed once the tube has already been placed. Odd, I know.

Well, why not? I'm interested in hearing the why... thats how I learn about this stuff. I suppose it didnt matter as much in the ED, as Amio would have worked for either WPW or VT. Would be nice to know what the rhythm actually is, though... Thats why I phrased the question spicifically for EMS, where - in my system at least - we dont carry amio yet. My initial impression was "why didnt this guy get lidocane from EMS?" ...But that was before someone pointed the possability of WPW out to me. I will try and get more followup on the patient if I can. Last I heard is he slipped back into the VT (or whatever it was), which was resolved by upping his dosage of the amio. He remained with stable VS throughout, and was admitted to a cardiac floor.

No no! haha looking back at the strip I can see why you guys think that but no, the patient never arrested! The top line in the last EKG is his new rhythm, showing with very low amplitude. You can actually see the tiny pacer spikes in there as well. The bottom line, as I guess I should have explained haha, is simply a pleth wave from the monitoring of his respirations. lol The patient felt "much better" with his new rhythm haha... not worse! I wish I could have got a copy of the 12 lead but I couldnt. The doc made this judgment based on a rhythm strip only, so thats what we have.

Yes! I didnt see this at all the first time I looked at the strip. ...Pretty much it got a glance and, "oh yeah, thats VT." Nope. ER Doc took a look at this, noted those delta waves and called it a transient SVT with WPW. 150mg of Amio over 10 minutes and then 1mg/min infusion converted the patient's rhythm to this: The reason I posted this is because I beleive it is questionable whether this is WPW or not. I was convinced it was runs of VT at first glance, but even with a closer look I wonder if that "delta wave" is just the specific morphology of that particular ventricular beat. ...The fact that the tachycardia is transient is also a point against WPW, I think. The fact that Amio converted the rhythm is of course of no help at all. I was looking at this and wondering, since my service does not have Amio for all our ambulances yet, would this rhythm get lidocane? Watcha think? EDIT: also, yes, I know that 1mg/min infusion is not the correct dosage for Amio maintenance (its 0.5mg/min)--- but the doc gets what the doc wants, I guess. haha

You might already be set, but try out this formula I made for drip-rate calculations. ...And yes, I take full credit for it: call it the "fiznat formula" haha. (CC/MG * MG) * 60 Thats all you need to know for drip rates! haha I'll explain. The first CC/MG is what is in the bag of medication you have. Say you have 100mg Lidocane in a 500 bag of NS. The first part of the equation will be 500cc/100mg Be sure to use those units. The second MG is your order. Say your order is 10mg/min. Now your formula looks like this: (500cc/100mg * 10) * 60 Be sure that this number that you use for order is the actual amount in milligrams AFTER any weight based calculations. The last 60 is your drip set. Use 60 for a minidrip (60 drop) and 10 for a maxidrip (10 drop) set. Do the math-- divide, then multiply by 10, then take all that times 60. That is your answer in drops per minute (gtt/min). CC over MG times MG times 60. Easiest thing to remember ever. Hope that helps!

Its going to be extra tough for you, as someone with no field experience trying to become a medic already. Not only will the job be harder for you, as you dont really know what to do and what to expect, but you will be given a hard time by your coworkers as well. Its fairly common knowledge that you must be a good EMT before you can become a good medic- that takes time in the field, face time with patients, and an understanding of the job that can only be found through experience. The medic program I'm in right now doesnt even accept people that have less than a year of experience as an EMT. Even that, I think, may be a little too lax. There is a LOT to learn as an EMT besides the academic stuff-- dont sell that short I'm not saying its impossible for you to take what you have now and do well with it. I'm just saying that its going to be much, much harder for you. That said, this experience that you have is absolutely VITAL to how well you are going to do this job. Take every second you have in the rig and try to learn as much as possible with it. Practical experience on the job is probably the single most important factor of your education. You need more, not less. Stick with it.

Heres more of that since you mentioned it: The ICD, I beleive, did go off a number of times. I dont know why it didnt in this particular strip, but I overheard that he had been shocked in excess of 70 times based on data removed from the device. It may have only been transiently functional. The R and T proximity are worrysome, but I actually posted this because of an anomoly in the rapid section of the strip that was a topic of discussion in my post-clinical meetings. See what I'm talking about?

haha yeah I was going to look through it ....till I found out it was a 106 page .pdf file haha. Lazyness has taken hold. Anything you can pick out thats particurally controversial or that youd like to discuss?

Take a look at this guy. 76 y/o male presenting to the ED (I was doing clinical rotations there) with "a fluttery feeling in my chest." VS: BP 137/82, RR 20, HR: see the strip. AOX4, skin warm/dry/pink. Pt has a pacemaker/ICD placed 2 years ago for "this same thing." Prehospital interventions were limited to IV/O2/Monitor. Heres the strip: He was constantly coming in and out of this rhythm. Sometimes it would run for 6+ seconds, then break, then come back. We treated this rhythm in the ED, but I'd like to hear what you guys think about it first. Consider that it might not be as obvious as it seems.

Alright then, I'll concede the point. Admittedly I have not worked outside of the Northeast, and where I come from EMT-B c-spine clearing is totally unheard of. ...Not that I dont think it would be a good idea. Still, care to explain your requisites that this member first: -memorize all of the bones of the foot? -achieve 100% on her EMT-B exam? -learn minatuae about various non life threatening ABD pathologies? -understand the precise differences between wheels/rales/rhonchi as an EMT-B? -memorize ottawa rules for the ankle and knee? Like I said, there is much more in my post above that you managed to ignore. I agree with you that good BLS comes before ALS. I said that multiple times, and I dont think this is really what we are discussing. You came off as VERY arrogant, seemingly suggesting that this member is unworthy of learning about EKGs simply because she may not know things that EMTs are generally not expected to know. I agree with you that EKGs arent exactly the next best step as far as providing better patient care, but then again, neither is memorizing the foot bones either. I hope we can agree on at least that.

You mentioned the Ottawa ANKLE rules in your post: http://www.ohri.ca/programs/clinical_epide..._ankle_rule.htm And as far as the c-spine, your system allows EMT-Bs to clear c-spine based on Ottawa rules? You must work in a pretty progressive system, because I have worked in quite a few different areas and I have NEVER EVER seen protocols that allow EMTs to clear c-spine at all. Therefore, I fail to see how this should be either a necessary component of the EMT-B education (NREMT agrees), OR a requesite for EKG training. There was much more to my post above than simply my criticism of your Ottawa requirement. Picking on spelling in an internet forum like this is equally shortsighted. How about we discuss the issues instead, eh? Also... Of COURSE you did! You cant demand that someone learn certain things before moving on to EKGs, and then at the same time - as an ALS provider yourself -- admit to not knowing those very details!!

LOL well done sir!!! hahahahaa best reply yet! :notworthy:

Absolutely! I dont think anyone is saying that A+P isnt important. ...Just that there is a point where "good working knowledge" becomes "ridiculous minituae." Also for the record, Dubin does a pretty decent job covering basic cardiac anatomy + physiology. He starts with A+P, then to 3 lead, then to 12 lead, then to the "extras." It is this stepped approach that is at least partly responsible for how good this book truly is, imo.

Wow, what an assenine post! Get a grip on reality there buddy. Who gives a damn what the name of every freaking bone in the foot is? Theyre goddamn tarsals and metatarsals, thats pretty much all ANYONE really needs to know, unless you are an orthopedic surgeon or trying to impress someone. Cholecystitis and diverticulitis? Yeah, I know the difference. Yeah, I could probably tell the difference between the two. ...But who cares, really? Paramedics have no way to precisely determine that diagnosis in the field. Thats why its called a clinical impression, NOT a diagnosis!! ...Not to mention the EMS treatment for both conditions is slightly more than nothing. The Ottawa rules?? Are you freaking kidding me? Those are guidelines used by radiologists in order to determine the specific location of injuries! Guess what youre gonna do about it, paragod? STABALIZE, and maybe treat the pain-- no matter what freakin bone is broken. I could go on and on. Advocating for education is one thing. Setting up an impossible and impractical barrier of knowledge is completely another. I'm not impressed by anyone who can rattle off all kinds of trivia, and I'm not impressed by paragods who think they're better than everyone else out there. I'm impressed by providers who know their protocalls, know how to deal with patients, and know how to perform well within their scope of practice. I know tons of fantastic paramedics that probably would not score 100% on an EMT-B exam. They would score high, no doubt, but 100%? Gimmie a break. If you want to learn so much minatuae, then go to medical school. Seriously. You're not doing anyone any good by pretending that such rediculous detail has anything to do with good patient care. If this guy wants to go out and learn about EKGs, fine. Good for him for his interest in the field and his desire to learn more. The only warnings he should get are the ones he has already recieved: BLS before ALS, and do your best not to piss people off. Thats IT.

Cool idea! Ruff, how come you're picking that book in particular? I happen to be just about to bridge that gap myself... is it a good read?

One of the major things we've learned in medic school (I'm just finishing up over these next few months), is to "treat the patient, not the toy." While your newfound knowledge of EKG interpretation will no doubt help you understand what's going on in the back of the rig, also keep in mind that the paramedic's greatest challenge is to determine the "unstable" patient from the "stable" one. In truth, this determination is most often made based on BLS assessments. Vital signs. Skin color/temperature/circulation. Mental status. A patient could have the most wacky rhythm ever seen on a lifepack 12, but in general, if he is presenting well and stable- a good medic probably wouldnt do much other than IV/O2/Monitor. Paramedics have a lot of cool toys, no doubt. ...But it is a solid, consistent BLS assessment that truly makes the difference between someone who knows whats going on and someone who doesnt. Learn the EKGs- its fun to know, but keep your BLS sharp.

+99 for DUBIN! For some crazy reason my medic program decided to go with a different text, but Dubin is definitely the one you want to read. On a side note, be careful about learning EKGs as an EMT-I. I read Dubin before I started medic school as well, and I think I pissed off a few medics pointing at the monitor with annoying "isnt that a-fib" or "do you see ST elevations there" type comments. No big deal, but just be careful that your medic wont take offense to your excitement about the EKG. Some will, some wont: just be particularly mindful and use good discretion.

Heard this call go out over the radio yesterday: Unit 919, please respond to the cross of _____ and _____ for the reports of an open sharp on the sidewalk. Please obtain the sharp and put it in your sharps box.