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Well, don't leave us hanging! Getting into this late...so, assuming no equipment malfunctions, why was he cyanotic with a normal SpO2? I'm stumped.

I've done a similar experiment. There are so many variables that you are never going to be sure how fast the infusion will go. But the point really is, so what? Any gravity drip infusion is not intended to be very accurate, and the point is not that you "set and forget," but that you keep checking how fast the infusion is going. Just set your stop watch, and if if seems to be going a little to fast or too slow, just adjust the rate.

Great thread! I also don't have RSI. I've never used Versed for a patient with trismus, but it's been my understanding that it is supposed to be effective for that. USALSFYRE wrote: "I seriously doubt midaz will a)release the neurologically caused trismus and b)do anything but screw up your CPP if given in adequate amounts to release the trismus. In the scenario above I'd be holding a scalpel if RSI wasn't available. Pharmacologic airway control should be an all or nothing proposition. Using sedatives only increases aspiration risk and sets up the can't intubate/can't ventilate scenario. Either your good enough to use it all, or your not. Halfassery has no place in airway management." Can you elaborate on this? So, Versed will drop the brain perfusion pressure because the drug is lowering the systemic BP? In a system where you don't have RSI and can't do a surgical airway, would you not try Versed to relieve trismus? We can do nasal intubation, but I don't think it would be such an easy thing to do on bad trauma. I'd love to hear more from USALFYRE and others who have experience with this situation.

But could Florence Nightingale intubate in a ditch in the middle of the night in the freezing rain like medics so often do? Specially trained nurses on ambulance sounds like a good idea. And so does greatly expanding a medic's scope after requiring them to get a lot more education. The problem is, how do we pay for all that? Healthcare just keeps getting more and more expensive, and at the same time it doesn't seem to be getting any less wasteful.

Terrible news. I knew he was sick, but I didn't know he had this terrible disease. That's just not fair. I met him 5 years ago, and I was surprised how different he was in person than online. Yeah, he is really going to be missed. It's nice to see that he influenced so many people here.

Sorry to hear that you are having so much trouble getting a job. It's tough nowadays. The only advice I can give you is to find out what are all the ambulance companies operating in the counties near you, and to then apply for them all. You will need to keep re-applying as well. It may help you if you hand delivered your resumes. Although it's tough getting a job, the good news is that there is a lot of turnover in EMS, especially with EMT jobs. Good luck!

Why this particular diagnosis? It could have been any type of vaso-vagal syncope. Actually my first thought it was postural syncope. I don't understand why your doctor is making that particular diagnosis. Or did he just suggest it as a possible cause?

"Your patient may not have read the same textbook as you." What's wrong with your patient may not be as obvious as when you practiced scenarios in class. Look out for subtle clues. Also, your patient won't always immediately present as being obviously Big Sick. Be especially cautious with patients that are "slightly off" as that may be due to hypoxia or hypotension. That said, it's hard to be perceptive when we run so many BS calls. Somewhat related...

In regards to keeping the ETCO2 within a certain range when you see clincial signs of brain herniation, it's my understanding that although in healthy patients the ETCO2 will match the actual PaC02, it won't match in sick patients. Am I correct in what I'm stating here--that you can't really use the ETCO2 as a guide for ventilation? I vaguely remember that there was a thread on this back in the day when VentMedic was active on this site. Sorry for my lack of references, but it's been a long day and I'm in a lazy mood, and I'm about to pour myself a nice glass of whiskey or two.

I think you should pursue your interest in EMS. L.A. County is actually not a bad place to work as a new EMT as long as you can get a job with an ambulance that responds to 911 calls. You should not expect to immediatley get a job for such a company since lots of people graduate from EMT schools and everyone wants to do the 911 stuff. So, take the class, but have something else in mind that you can do until you get hired by a company that does 911. By the way, there are no EMT ambulance jobs for fire departments in L.A. County. I worked on an ambulance in L.A. for a year a while back and I still have great memories of that job. Good luck to you! Funny, but I didn't fall into EMS like other people here are saying. I already knew I wanted to be a paramedic, and I'd taken anatomy, physiology, and a medical terminology class before even taking the EMT class. Since you are likely taking those classes as pre-req's for your radiology tech school, you will have a better understanding of the things you'll learn in the EMT class.

Thank you!

Can anyone direct me to online articles concerning CPAP? I couldn't find anything of much substance in any of my books, and a Google search just brought up a whole bunch of stuff regarding sleep apnea. Thanks!

Thanks for all the replies. Why do you guys think that magnesium is not effective for COPD exacerbation, while it appears to be of benefit for a severe asthma attack?

By "medic" I mean X-treme swat/tactical/Emergency Medical Services provider.

http://sports.yahoo.com/soccer/blog/dirty-tackle/post/Even-the-medics-in-Brazil-put-on-a-show?urn=sow-326382

@Firemedi65: Ha ha! Yeah, I was thinking the same thing. They could've pulled the guy forward right away and made their lives a lot easier. The bystander was doing some weird @$@!$# up CPR, but the EMT's did badly was well. They stopped compressions many times.

(Excuse me if this has already been posted somewhere.) Interesting video of a cardiac arrest save in the U.K. Don't want to be a hater, but I have to say that the quality of the CPR is really poor.

That sounds like a pretty cool EMS job! I'll have to tell some friends about it. Thanks for sharing this.

http://www.latimes.c...0,2932838.story Reporting from Sacramento — One more good reason to drive safely in California: If you cause an accident, you may be on the hook to pay the police and firefighters who show up to help.

Is anyone familiar with using mag for severe COPD exacerbation? (I'm familiar with its use in asthma.)

I had this patient on my last shift. No, not this same patient, but my patient's flail chest looked exactly like that. Very dramatic and hard to miss! In 8 years on an ambulance, this was the first time I've seen one. He was wearing his seat belt, and you could see a bruise from the belt running up along his chest. He did not get intubated in the ER, and he avoided a chest tube as well, at least while he was in the ER. The CT showed a pulmonary contusion and a bit of a hemothorax.

I actually came very close to doing an IO on drug OD some time ago. The call came in as a cardiac arrest, and when I got there, the patient was apneic with a pulse. The first-in medic had already given Narcan IM and of course they were bagging her. We did not see a vein anywhere, with both of us looking. She did not respond to the IM Narcan after quite some time into the call, so we gave it IN as well. I was expecting a quick response as from my past experience with IN's, but she did not respond at all and was still a 1/1/1 and apneic. I was about to do an IO when she finally began to respond. If I had not had this call, I would also have said that it seems overkill for a medic to do an IO on a drug OD, but there are situations where it is appropriate.

http://www.stocktongov.com/news/pr2010-8-31fireparamedicsorderedstopals.cfm

Okay, I think I figured all this out. Here is the baby's daddy.... http://www.ultimatecoupons.com/blog/wp-content/uploads/2010/05/rodney-dangerfield.jpg

I see how you're thinking, but no, I don't believe that could be the cause. With an opthalmoscope you would see papilledema, but that's all.