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Any of you guys use racemic epi for severe asthma? How well does it work? In my system, we give epi sub Q. I've never had any patients who've been bad enough to need it. Does anyone have experience using sub Q epi? How well did it work and how long did it take to work?

Does anyone know the typical noise level (decibels) in the crew cab of an ambulance (van type) when the sirens are on? I'm wondering because it seems awfully loud. What are the OSHA standards? I work for a private and we are not issued any noise protection.

I was just interested in hearing the details of the calls where you did needle decompression on peds.

Sorry, I should've been more clear. I meant a needle thoracostomy to relieve a tension pneumothorax.

Has anyone ever done a needle T on a young child? I've never done one and I'm just curious to hear from others who have.

Although it looks like you were wrong in disagreeing with the doc's treatment, it's nice that you followed up on your patient and cared about their pain managment.

If she's "hot" to the touch, then I would rapidly cool her. My first thought is that she's suffering from heat stroke. BLS before ALS. The other obvious reasons why she's ALOC could be fever, hypo/hyperglycemia, ammonia levels, AEIOUTIPS...

In our service we carry verapamil and have protocols to give it to someone in stable SVT who does not respond to adenosine. I've never given this drug nor known anyone who's given in recently. A few of the old timers here used it before adenosine was around. I did have a patient a few months ago who was in uncontrolled AF (I think the rate was 180 or so). I didn't need to give verapamil as we were just a few minutes from the ER and the patient was perfectly stable with a history of similar episodes. I wondering though if I can get some feedback from people who've used this drug. Is verapamil always contraindicated in someone who's got a history of CHF? How effective is it in controlling the rate of uncontrolled AF? Has anyone had bad experiences or unusual reactions when using it?

No, I haven't see it myself, just heard somebody say they did. He said that a patient of his, in whom he'd placed in NPA sometime earlier, started bradying down after they arrived at the ER. He pulled the NPA and immediately the patient's HR came back up. (I had never heard of this before and I seriously doubt that the bradycardia was due to the NPA.)

We don't carry fentanyl. We have Versed and morphine, but we're only allowed to give Versed when we pace.

I'm a new medic and have never had to pace anyone yet. So I have a question for you guys. If the patient is hypotensive, say with a BP at or below 80 systolic, Versed is contraindicated, right? So you give Versed only once the BP has come up after you've started pacing the patient, right? How much of an effect does Versed actually have on lowering the BP? I have seen someone getting paced w/o sedation, and they were not happy.

Has anyone ever seen a patient get a vagal response when an NPA was placed?

Do you guys think the bradycardia is due to the heart decompensating? Or is it a protective response to the MI? Or is it due to the ischemia knocking out the SA node (hence the junctional rhythm)? I don't know the answer to this, but I'd like to hear other opinions. I think the answer would greatly effect one's treatment of the patient.

I agree that a strike would be unethical. However, before you guys start blaming the employees for being greedy, consider my situation. I work in Riverside County, California, for AMR. The starting salary for a new medic here is $27K. I only make $31K and I've been with AMR for 4 years. So, if AMR was going to give me a 15% raise over 2 years, I would still be ridiculously underpaid. Consider that the MEDIAN price of a home in Riverside county is well over $400K, and that the MEDIAN price of a home in LA county is over half a million. I don't believe that paramedics should be paid the $80 or $90K base salaries that fire medics in LA and the Bay Area make, but to be making thirty-something thousand in California is a joke. Sadly, good medics simply can't afford to be medics anymore if they work for AMR. Right now 75% of our medics have less than a year's experience. Everyone leaves as soon as they can get a fire job, or they go to nursing school. And AMR doesn't care. For them it's all about to bottom line.