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I don't get it..why was a patient with sinus bradycardia given amiodarone?

Camulous wrote, "I certainly hope none of your ECG leads are inadvertantly dislodged without you noticing. I personally prefer to treat pt's rather than monitors" What kind of monitor are you using? It must be something ancient. LIfepak 12's won't show asystole if a lead is off. The crappy old Zoll that I'm using now will show asystole if a lead is off, but it will also say "defib pad short."

"Well at least that's one less illigal immagrant taking up all the government help that they truly don't have a right to." Wow, you are really a major [REMOVED]. I feel sorry for the patients that come under your "care."

Idiot.

Anthony, there's no point in doing pulse checks (after your intial assessment) until you see an organized rhythm on the monitor. Why check for pulses when you see asystole? You do however want to briefly stop CPR at regular intervals (and esp. before you push drugs) to be able to read what's on the monitor. On the first full arrest I ever ran, I wasn't expecting the guy to get a rhythm back because he had an unknown downtime, was asystole, and I had only given 1 round of drugs down the tube. Drugs down the tube aren't supposed to work, right? I had just established an IV and was about to push epi, but just before I did my EMT partner, who was looking at the monitor, said, "Wow, it looks like he's got something back." Our patient had just gotten a rhythm back with pulses. If I had pushed the epi, I might've sent him back into cardiac arrest.

What's up Anthony?! Sounds like when you go through ACLS in a few weeks you'll be way ahead of all the other students. To answer your question...during my many years as a paramedic I have seen countless patients in torsades. :wink: Okay, I'v never seen torsades, nor have do I know any medic who has. If you can't synch, then yes, defibrillate, but only if they are unstable. If they are stable, hold off on shocking them or giving lidocaine, and instead give mag. I've researched this in the past and my understanding is that mag is the best treatment if they are stable because if you shock them they will just convert back into VT. Has anyone out there actually treated a patient in torsades before? Hey, you ought to think about doing your internship in Riverside. I'll hook you up with a great preceptor (30+ years experience!) who was my old partner when I was an EMT.

Sounds to me like you did the right thing.

LOL! Love the squeaky sound effects!

Ok, I'm just gonna give it away. It was the same guy who said: "Our enemies are innovative and resourceful, and so are we. They never stop thinking about new ways to harm our country and our people, and neither do we."

Here's a clue: it was the same person who said, "Rarely is the question asked: Is our children learning?" "You teach a child to read, and he or her will be able to pass a literacy test." "One of the great things about books is sometimes there are some fantastic pictures."

"Too many good docs are getting out of the business. Too many OB/GYNs aren't able to practice their love with women all across the country." Who do you think said this?

Everyone's, rich and poor, is worse off than they were 8 years ago. I don't even check my mutul fund portfolio anymore. Yeah, it's a little silly how much people are in love with Obama. But you know, every new president has a honeymoon. I do like the fact that a lot of people who didn't vote for him say they are willing to give him and chance and really do want him to succeed. I like that he said we need smarter government. A lot of people are afraid of big government, but looking back at the past 8 years, the problem with government wasn't that it was too big but that it was poorly run. People were appointed to positions that they weren't qualified for.

It's that old? Geez, I'm always the last to hear about stuff!

http://paramedictv.ems1.com/Clip.aspx?key=2EA4C5103B680DE0

I did my field time with LA City Fire a few years ago. On my very first morning (I showed up like 2 hours early), there was an old man sitting at the kitchen table drinking coffee and reading a paper. He was wearing civilian clothes and I thought, How cool, this old guy must've been a firefighter a long time ago and now he probably volunteers at the station. Fortunately I didn't ask him how he liked being volunteer because I found out later that this guy was the battalion chief. He had first become a firefighter in 1948 and had just never retired. When I was an EMT, one of my long-time partners was a guy who's worked longer as a medic in the field than anyone else I know. He was a combat medic in Vietnam, and he'd graduated from the second class of Daniel Freeman, which is tied with PTI as the oldest paramedic school.

I haven't worked with too many spinners. What I do see more of are people who yell at others. A few years back when I was doing my clinicals, I observed an ER doc running a code. He got angry with the nurses and techs if something wasn't done fast enough. I noticed how tense everyone seemed to be. They were afraid of getting yelled at. I thought it was so odd that this doc, who was older and must've run thousands of codes, was getting so worked up. I think he liked being dramatic. It probably made him feel like he was a doc on the TV show "ER." I never want to be that guy. I do often get impatient when I'm on a serious call and I feel things are being done too slowly. I try to not let me impatience show. By the way, that attitude, "It's not my emergency," I have to call bullshit on that. It's our patient that we've been entrusted with, so of course it's our emergency.

I work in the same county where this incident happened--Kern County. This is pretty bad. I heard a different version of the story, however. Supposedly the medics stopped on scene, but before they got off the ambulance, the cop said something to the effect of, "This is a non-injury. He's drunk and he's going to jail with us." The news article contradicts this, so I'm not sure what to believe.

JaxSage, I got it. Thanks for taking the time to do that.

EMTDumbass wrote, "Any one who thinks this should be put out there for everyone to see should be shot in my opinion. " Well, it's certainly not pleasant to see these kids in distress. However, we very rarely see kids this sick out in the field, so it's an important part of our education to be familiar with how they may present.

Here are some videos from You Tube showing pediatric respiratory distress.... http://www.youtube.com/watch?v=I6WvSY_pqi8...feature=related

Spenac wrote, "Just wanting the questions answered so bumping." I second that. Too many unanswered questions here.

JaxSage, I can understand your concern for privacy. So, rather than providing a link to your protocols, which might reveal where you work, why not just cut and paste the protocol and post it? You started this discussion on transport refusals, and since nearly everyone on this forum works in systems where that is not allowed, we are all curious to see how your protocol is written.

Jaxsage...as others have asked, I would also really like to see your protocol on refusing transport. The thing I don't get is, where do you draw the line? Ok, let's say you have someone telling you that they want to go to the ER to get their Vicodin prescription refilled and don't want to spend $25 for a taxi. I can see how you might refuse that person since they don't have a medical complaint. But what about, say, a diabetic with a wound infection of his foot. He needs medical attention, but he doesn't need transport by a paramedic ambulance. So do you refuse to transport him? Where do you draw the line? In this country, most people transported by ambulance don't really require ambulance transport, so do you refuse all patients except those with ALOC, unstable vitals, CP, SOB, trauma criteria, etc? Can you give us a link to your county protocols? By the way, the example you give of refusing transport to the jail inmate is just scary. This is the stuff that 11 o'clock news stories are made of.

I was wondering who took the BP. A firefighter? Your newbie partner? Often the firefighter taking the BP is a boot or volunteer, and if they can't find a BP, they're afraid that they'll look incompetent in front of their crew. They don't exactly make up a number, but they'll got with whatever they kinda-sorta-maybe hear. To be honest, when I was an EMT in training, I did this once myself. I think a lot of firefighters and EMT's don't realize how critical a proper set of vitals is for us medics when we're treating patients like this. This is why I always get my own vitals before the ambulance starts moving. I've had quite a few patient with flash pulmonary edema and no prior history of CHF or MI. They all responded quite well to treatment, actually, but they were not in cardiogenic shock, which I suspect was the deal with your patient. Like you already know, patients with cardiogenic shock and rales usually have bad outcomes. I'm still relatively new myself (about 3 years as a medic now), so I know how you feel. Seems like you did a fine job though, so don't beat yourself up.

Yeah, everyone wants to be a SWAT medic. Why? I guess they watch too much TV.