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Good point, in fact DHI (Dynamic Hyper Inflation) is in my opinion one of the least discussed or recognized in the EMS field when the topic of PEA surfaces. Just reversing the pressures (as opposed to the normal patient) in Positive Pressure ventilation can be a complex study (and boring the crowd to tears) with the pulmonary mechanics topic ....zzzzzzz! cheers

Yes I too wonder about this too, in animal labs with an intact aortic valve we attempted to produce a retro flow as suggested in the CPR lit studies although the coronary artery are distal to the aortic valve the question remains with autoregulation of BP and subsequent loss of control (of the container) and darn near zero for SVR in an arrest I suspect. It does become a quandary that the brain survives on occasions really with such low CPP. Perhaps more alpha specific drugs would be adventitious to a positive outcome ? Do I dare suggest Levo ? Duck, weave and runs for bunker Sure wish I had a Doppler US to take a peek of what is really going on. cheers

Taking the OP at face value ... does anyone else smell ass burning ? A very similar event occurred in the UK news as of late .... the Medic is now asking would you like chips with that battered fish, mind you tips in the pub do add up and the hours are better ... nuff said. As for MS of 4mgs, hard to say without actually having patient contact, body mass and degree of pain will help guide you mobey I know off topic but with a patient in severe pain I have frequently given 5 mgs IV and then 5 mgs IM (not advised with cardiac) due to fact can screw up labs enzymes, but then WE are dealing with longer transport times MCIs and ERs that are less than optimal in treating trauma, say like in FT MDs in rural AB That said I have given 25 mgs of MS total in a 1 hour period with a foot fracture with dislocation (sans MD advice)that was in a King Air 200 @ 23 G, no contact with any medical control btw but kudos from receiving Orthopod, make the patient comfortable (I quote)I was very concerned that post reduction the ER staff would be looking for narcan, but that did not occur. Look to the patient when you treat the pain, not the protocol, but baby steps are not a bad way to do it until one gets a good handle on dosing. Heck the equinanalgesic dosing of 2.5 mgs MS is equal to 3.75 of Percocet and 10 mgs of that don't even touch my back pain on a bad day. cheers . And herein lies the problem, to reiterate when will EMS everywhere stop this nonsense .. ever hear of an any other profession in medicine adopting this "attitude" of the "stepping stone"? Conclusion: If there was a Paramedic on the initial truck, would there be any controversy ? cheers

WOW harsh words there LS ... Agreed. My opinion for what it matters is that Dwayne can walk away with his head held high for doing the morally correct thing, anything else is a cop out no matter how wants to spin it. Dwayne is the type of Paramedic that I would want to treat me or my family, a rational caring individual that is sensitive to the patients needs. The laws of the land ARE subject to interpretation their not all black and white,one must look to the intent of the law I just cant see a court case stemming from his actions in the slightest, we often confuse the "patients rights" with what is the "right thing to do" and if living in fear of the law and negative repercussions then one should reevaluate what we actually stand for. Did the Good Samaritan have a refusal form ? just saying ........ cheers

Ok DAD The tenor of your post Mr Lack of Bacon: I find almost distasteful and smacks of one typically "burnt out" but then that is just me. Perhaps I am missing something from this thread but I did not read in any information where the patient actually refused transport, but I may be amiss, this was just a presumtion. That said this call did not escalate to Bobby involvement, good grief why go that route unless it is warranted, agreed the patient does have the right to refuse to stay in Hospital, let them sort it out I say and what the patient says may or may not be in the best interests of that patient. Ever have a third degree concussion patient that could be a slow bleed and tell you to shag off and you left the patient on scene ... not me I attempt to convince them to seek medical help ... gosh then I must be an ass then with that attitude ? In my hood (one of those other backward colonies) we can independently action the Mental Health Act (sedating those that are sub therapeutic) but implementing some tempered compassion is considered a strength rather than a perceived form of weakness, so I must state rather succinctly that this EMT city site is one of a support system for its membership not an opportunity to bash. Yah know: My father always told me if you can't say something intelligent don't say anything at all. cheers

Nonsense: No hard feelings either finnat but this is flawed rationalization IMHO, one has deducted that hypoglycemia is the root cause of this decreased LOC, so just to throw a wrench into the works what if the event was not purely diabetic in nature ie petite mal, sepsis, or TIA ? Not to consider other pathologies in decreased LOC a error. The IDDM patient is notoriously a complex multi system disease and the assumption that the patient(after being treated) would then refuse transport folly, as this information was based on hearsay only. I can't recall of any successful legal actions resulting from transporting a patient to a definitive health care facility, the worst case senario in that situation is they just don't pay the bill cheers

"Implied consent is a form of consent which is not expressly granted by a person, but rather inferred from a person's actions and the facts and circumstances of a particular situation (or in some cases, by a person's silence or inaction)" Honestly I don't see why your beating yourself up with this situation and where you chose to treat this patient is of little consequence unless after treatment and a GCS of 15 then you continued to transport against his wishes. IMHO you did the right thing. So my conundrum would be ... is it wrong when treating a "lady of the evening" bartering to receive a discount for bring your own bed ? cheers

+ 5 on the dustdevil scale there Dwayne

Best check again the OZ imported every dang critter they could find wandering about to drink with

WHAT ? No shag rug ?

Siff I believe you forgot the Camels ? Agreed the province taking over in AB has put a relative hiring freeze in place, I would suggest with your background that you explore the safety aspect of the oil patch and far more lucrative giving yourself more options and a means to make the cash to advance and deal with the regulatory body we have come to love. cheers

PEPID website.

There is actual 2 varieties of this battle dressing: 1- as seen above. 2- with an additional sliding gauze pad (movable for entrance and exit) cheers

Well AKs computer is not the only issue right now I have received 8 "notifications" on this post ... hello Admin ?

Ah I cant get into photo bucket and Kinda off topic anyway. So Night VRF operations, no flight plan filed, single pilot and 2 needed to use night vision glasses in case of flash then a BS IFR approach using an auto pilot within 800 ft ASL ? hell in bad weather at 500 ft here and no visual its time to "go around" and its not rocket science why they hit the water ... just damn luck no one died. She also stated she thought she "pulled power and cyclic" when she saw the water; again BS pilot flew directly into the drink ! cheers

Now thats one Heavy Lift Bird ... and Reasoner is incorrect one can auto rotate and "a modified concept of Gliding ... provided that the tranny is not the issue and lock up. Hey maybe get a few of these birds bucketing long line in LA ... looks like they need some help there ! Biggest I have flown in is this one seeing as were are on whimpy chopper topics ...LOL. Insert imaginary pic of MI 26 and me standing beside it ... apparently the help advisor says my file size too big for upload. Oh well.

V/S would be nice and meds too and what she actually looked like ... anyone notice the plastic brain saying NSR ... that is kinda a stretch for P wave interval in my books for first degree block, then again who am i to disagree with the programmer ...lol. Anyone notice the escape beat in the first record ? Would you hang your hat on that as a PJC, PAC or PVC ? An interesting suggestion/concept was discussed by a prominent MD and myself concerning the relashionship to a certain type of bacteria found in the mouth, presently being studied and an atypical increased occurrence with MI but a trend nevertheless . His opinion was that many of the demographic group that present with M.I. also have other factors as poor diet and exercise routines in addition to high cholesterol, his suggestion was that poor dental hygiene also a factor due socioeconomically status, in many cases dispelling the suggestion of a oral bacterial infection being directly linked to M.I. Point being this woman could have an abscessed tooth as well as the initial complaint, but seriously just posting a complaint and an 12 lead ... what direction are we supposed to go with this thread ? cheers

Jeepluv77: Just one med at a time memory wise ... you will do fine ... for kids the HUGE thing is estimation of weight with Rx dosage. Sorry Spenac: I hate that stoopid Brainless Broselow Tape "so what if you can't find it ?" Your hooped. Its back to basics and with it "Brainless Broselow Tape" length equates to WT ONLY with it and just averages. We know EBM that this is NOT the way to go in real life practice, as under dose vs over dosage with Epi as is a big area of error in the Paeds population studies in hospital prove it. So, here is what I do. I walk around in grocery stores make contact and with every munckin I can, make small talk with the MOMs ... then guestimate age and weight, Moms usually know and its great practice and when you tell the MOMs why your asking ... they are usually MORE than helpful. Yea Ok "initially" the MOMS think I am an axe murderer but then I use my Paramedic charm and explain WHY I am bugging them and thier Kids, they open up huge It works awesome and picking the kids up does't hurt either, DO NOT TRY TO PICK UP THE MOMS a recipe for a good sound BEATING! te he but "lifting" the kids that can be too much to ask, so being a Male, I try watermelons, pineapples and sweet potatoes, as there is always a scale in the store to see how accurate you are. The Palm Pilot program called PEPID studied over dose vs under dosage extensively and in hospital it prove conclusively that plastic brains are far superior. (Rosenbloom et all) FIRST get the dose mg's per Kilo in your memory, THEN use a reference chart and if you have a plastic brain/ chart in your pocket thats the way to go. So .... ETT look at the little finger (forget the math when it comes to real life) and start at 4.0, for any kid over "shinyand fresh" mind you I have worked in NICU and Paeds Units so that comes easy to me. Length of the ETT at the upper lip far more challenging, talk to an RRT to get your tape method down pat ... as you don't want to loose that damn tube! Trust your ears and if you have capabilities of side stream ETCO2 sampling and knowing the mls per minute rate as a sample volume, hence know your monitor too, as rapid changes in ETCO2 are awesome indicator. SpO2 ... use the big toe, or the heel. BP for the exam ok ... real life its a waste of time most cases if its not NIBP and serial (like q 1 or 2 minutes) cap refil way better indicator bedside. Lines: IO is absolutely the way to go ... FLUID is a huge deal with kids resus ... 20 mls per Kilo x 3 or 4 as it winds them up like a toy doll REALLY, REALLY. Be confident as kids are far more rate dependent than force. Steal a "practice" IO and while your in that grocery store chatting with the MOM's, pick up a few chicken legs and thighs ... THEN after practice your off to the BBQ ... honey mustard is my fave. Controversy: I just recertified in PALS ... this Epi S/S for all suspected Croup BHAH ! ... as an RRT I am so NOT an advocate Epi S/S inital rx, as it is a huge hammer, as it can make kids more tachycardic (affecting preload, and dumping B/P) it short acting it can be refractory and can because your sitting beside the Kid ... AFFECT YOU TOO ! The last thing one needs as a provider. I will go Albuterol and throw in some Atrovent and observe. For exam quote epi but in real practice .... well its your call. Passing the exam is one thing ... passing the real life exam, Really Sick Kids are the Hardest Challenge that you will face ... IMHO. cheers

Well just happended to flip channels and am watching MTV and Michael Jackson in his performance in Bucharest the "Dangerous Tour" ... MAN what a performance, the moves, the choreography, the music .... what a huge STAR he was, the over 60 thousand crowd screaming nuts crazy. What POWER he had and the energy simply amazing ... a true American Icon and now a legend, I will never tire of Jacksons Music. I have had the extreme pleasure of working for some of the biggest names in the biz .. um yes, Depp, Bloom, Swank, R. Williams, KD Lang and The Stones ... blah blah blah who really cares. BUT Never "made" the opportunity to watch M.J. LIVE and will now will aways regret that. Actually, I don't care how the man died, he is gone now the efficacy of Diprovan is dose dependent and individual tolerance besides it would not be a bad way to go actually, I can think of many far worse ways to transition to the next journey. Many in this area of entertainment are judged by media and influencing public opinion, I try to blow off the Tabloid B*** S*** and look to the mans accomplishments. Just Don't Matter if Your Black Or White .......... cheers and RIP M.J. your music will Live ON.

Cardinal Tombstone "T"s

Yea Rid you tell that young pup AK .... Should we tell him about the LP 4, one needed an small army just to pack that boat anchor around, good monitor though and in its day we were dang happy to have a monitor at all.... when the LP 5 came out we thought we were in heaven. I always wonder why the LP 11 never took off as that was a nice machine (long battery life and internal charging) and 12 lead capability was great too. I hate these new fangled (and expensive gel defib pads) give me real paddles or give me death, my motto.just try getting resupply in Nigeria or Chad. But Hey THANKS AK .. I printed it out and parchment scroll came out of my printer WTF ? The LP 10 C is still SOP in most Industrial EMS settings in my hood, the real trucks and birds use the Zoll or LP 12 (they are a spoiled lot) cheers and thanks again.

Good grief the only thing aminophylline is used here for is with cardio stress testing in Persantine challenges as a reversal agent ... very rarely is it used as a Bronchodilator as it is such tight therapeutic margin ... and epi S/S is a big hammer for one that is already tachycardia and in extremus. Is your Medical Director from the Jurassic period ? .. no offence intended. cheers