Doug

Ok, as luck would have it, in my many years as a Medic I have never had to sedate someone to intubate them. THEN twice in 2 weeks I have had to attempt it. Hears the thing, we don't RSI here. We have Versed, Valium, Ativan and Morphine. NOW during our MedCon conferences/refreshers/conEDs the MedCon Dr's routinely say in these situations to call but generally you can go with 4 of Versed and 8-10 of Valium, BUT when you do call (yes the SAME EXACT Doc's) and suggest that, they tell you to just go with 2-4 of versed. Latest call was for a 100kg + pt unresponsive but clenched, MedCon only approved 2 of Versed...guess what...didn't do squat. Other pt was the same 2 doses of 2mg each....nada. So I open the doors to you...What would you do?

Yes, I know. That is not my question at all, my question was since the pt was on a vent they would not be breathing the pressureized oxygen from the chamber, they will be breathing the 100% oxygen provided via vent, so what would be the benefit of being in a presureized chamber. That being said would the gas mixture have to be 100% oxygen at all, since he will not be breathing it, and by having standard AIR you could have a tech in with the pt without having to worry about oxygen toxicity. The question is not about risk. These are questions I had intended to ask the techs but they were not available to me at the time.

Ok, perhaps I am being misunderstood. This pt is on a vent, he is not breathing the surrounding pressurized oxygen present in the chamber. He is already recieving 100% O2 at pressure sufficient to overcome normal atmospheric pressure to expand his lungs (as opposed to the normal way of breathing in which throaxic pressure is decreased with chest expansion resulting in the filling of the lungs to compensate and equalize internal and external pressure.) So here is my question reworded. If the pt has a tidal volume of 500mL and is on a vent, if the the external pressure is raised 2-3 atmospheres can the pressure being delivered be admin at the increased pressure as well (what would be 1000-1500mL at "normal" pressure) and thus the benefit. What adverse effects have you never heard of? I am aware of how they are used for divers as well. The adverse effect would be related to trying to force 1500mL of volume into a 500mL volume pt. at normal atmosphere.

I had a severe CO poisoning pt. this weekend. Completely unresponsive other than clenching his jaw. He was RSI'd and intubated by the ED after which the search was on for a hyperbaric chamber that was open. HERE'S MY QUESTION: If the pt is already on a vent and being given 100% O2 what good is a hyperbaric chamber? He is already recieving "targeted" hyperbaric treatment by haveing the vent breath for him, no? Despite what new age quacks may say our skin does not "breathe" so no gas exchange happens there. The only thing I could think of was that by surrounding the body in a high pressure environment you could increase the pressures that the O2 is being delivered at without as much concern for pneumothorax/sub-q emphy. (blowing a hole in the lungs) Am I on the right track?

Before we all jump on the "aren't we horrible people" bandwagon, I would like to suggest that the proportion of people who are spiteful in our job is no greater than any other field. Time and again I hear residents complain about attendings, ER nurses complain about "those idiots" up in Tele, ALL of those people complain about us or repeat patients. I actually think we do pretty well for ourselves actually, especially when compared to Law enforement and FD. EVERY job from retail to CEO has folks who are spiteful. How many times have you had to listen to the cashier complain about the customer before you? I've had a bank V.P. complain about other people who came in for loans while I was finalizeing my own mortgage.

If it means anything you still beat out all of Ireland...

I would agree about the paycheck thing..I worked 40 hours a week..no more no less..and yet my paycheck varied by up to $40/paycheck..I kept getting told it was a "Rounding glich in the software."

Honestly, please find another company to work for. I worked for AMR for 12 years in Western Mass. The North East division is possibly the worst to work for. I was foolish enough to stay with them even though their "Labor Relations" exec Dave Banelli told me "I can tell you where to be and what to do. We own you," and the official stance was "We don't have to say thank you, you get a paycheck." Ct AMR was also recently caught filming and recording union negotiations. AMR finally closed local operations here a little over a year ago. I work for another company now and can't believe the difference. I find myself saying "If I had only known.." all the time. I can honestly say I don't know anyone lower than a Manager that actually LIKES working for them, they tolerate it.

I'm lucky if I remember to grab my scope when the tones drop at 2am...now you want me to remember to strap my sidearm on? Yeah, no.

And yet again, no discussion about making PD into EMS first response. Guess we just want to boost FD numbers. Hell, why not require all public servents to be EMS? Mailmen, sanitation engineers, PD, FD, town clerks, meals on wheels, school bus drivers.

My life is complete...Dust agreed with me.

Eric, you avoided my point about crosstraining PD instead. No new vehicles. Most cruiser trunks have enough room for airway, IV, moniter and 1st round meds. And again they are on the road already. What's that? PD doesn't want the job? Tough. In my area we are not allowed to cancel FD.

Think about why you would be giving Epi. The person most likely is in shock and is "shunting." The first area the body shunts from is from the skin. So a SQ injection doesn't have the circulatory support to be absorbed. Muscle, especially the larger muscle masses you would be giving the IM injection to, shunt later. Somebody correct me if I'm wrong but shunting starts with skin, digestive,muscle, kidney, resp, heart then brain.

We are going to be truly intellectually honest here, eric, if you are going to argue crosstraining it should be PD and EMS. They are already on patrol no need to get up and out to get enroute, smaller vehicles that won't block streets and people actually pull over for them when they have lights and sirens. Or, better yet, have more AMBULANCES in those stations. I work in an area that does the duel response, on EVERYTHING, literally includeing "splinter in finger", and it's horrible. What's amazing is that in surrounding towns covered by volenteers 2 people often show up and transport. Don't ask me why my city feels the need to send 6 people.

Sorry, one last comment then I'll stop. THIS IS A BLS RIG!! That is all.