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Nope, never happened before. No recent trauma.

Here's a call I ran a while back... You respond to a "generalized weakness." Your patient is a 20 y/o male who says, "I felt fine last night, but when I woke up this morning, my legs were paralyzed." He has has no loss of function to his upper body, but his legs are too weak for him to stand up. He was unable to get out of bed, and his parents called 911. All his vital signs are within normal limits. He says he does not have any medical conditions and doesn't take any medications.

I'm coming late to this, but about the "blue from the nipple line up" thing....I have also heard this anecdotaly. Some time ago when I did a lot of internet research on PE's, I never saw this mentioned in any of the literature. Anyway, it doesn't really make any sense when you think about it.

Hey Firedoc, I hope your wife is feeling better. Standby for a PM. I think you posted just as I submitted my last post. My reason for giving the fluid challenge was that he was hypotensive and I suspected an inferior MI with right-ventricular involvement. I wasn't too worried about his BP (90 systolic) at that point, but started two large IV's in case he bottomed out. (Also, in my county the ER's will do two IV's on any STEMI.) I was also worried that he might develop a heart block or get significantly brady, and AZEP's made a good point about attaching pacer pads just in case.

I thought this call was interesting for a couple of reasons. Our patients don't always read the same textbook that we do, but this one seems to have! It doesn't often happen that you get something that is such a textbook presentation. Crushing chest pain radiating to his left arm, skins signs, etc.. It's been a while since I've had a patient who was so obviously having an MI. Not only was it a textbook presentation of an MI, but he also had the classic signs of an MI with right-ventricular involvement: hypotension with clear lungs sounds, borderline bradycardia, and a new onset of AF. The other interesting thing about this call was that he did not have ST elevation an hourinto the event. I was expecting to see elevation in the inferior leads. It's possible that only the right ventricle was involved and not the inferior wall, but from what I understand that would be very unusual. I know that often MI's won't show up with ST elevation, but I really expected to see it in this case. A few days later I had a chance to talk to the nurse who had taken care of the patient. He said that his labs had come back with elevated cardiac enzymes, and he was taken to the cath lab where he was found to have "a big MI." Unfortunately the nurse did not know any other details, such as the location of the infarct.

His BP had come up a bit when we brought him into the ER, but I forgot what it was. We continued to run the IV's TKO. I'm surprised that some posters say that starting two large-bore IV's was unjustified. I don't know why we waited so long for a bed. The staff at this hospital is wonderful and I have great respect for them. I made sure they were fully aware of what was going on with this patient. I have never worked in an ER, so I can't say whether they were negligent. I was certainly disappointed that we had to wait so long after we made every effort to limit our on-scene time and went code 3.

Sorry if I gave the impression that I dumped a ton of fluid into him. I ran the two IV's wide open, but only gave him about 500 cc of fluid on the short ride to the ER; then TKO'd them. Doesn't happen often, but this patient read the textbook.

Firedoc, I'm gonna have to disagree with you on the use of atropine. Why would you want to use atropine rather than fluids?

I'll be at work until Friday night, so I won't be able to answer any more questions about this scenario until then.

Yes, it was 100 degress outside. I can't judge if he was physically fit, but he's 70, so... No inversion on the monitor, but again, it's only a 3-lead.

Here's a call I ran the other week. Nothing too crazy, but interesting in a some ways... We were called priority 3 (lowest ALS priority; w/o lights and sirens) to someone having "muscle cramps." We arrive to find our patient, a 70-something male, lying flat on his back in the livingroom. C/C: chest pain, described as pressure, midsternal, radiating to L arm. 10/10 (he looked like he really was in a lot of distress). Started suddenly when he was washing his car. skins: pale, cool, diaphoretic breath sounds: rate of 20. clear. PO 98%. pulse: 60, peripheral pulses present, irregular BP: 90 systolic (don't remember the bottom #) ECG: sorry, but I don't have the strip. He was in A Fib, apparently a new onset. The service I now work for does not yet have 12-leads (embarrassing, I know, but we're getting them soon.) History/meds: HTN, nothing else I gave ASA and O2, and I started two IV's and ran them wide open on the short drive to the ER. We spent less than 10 minutes on scene and went code to the nearest cardiac care hospital. I told them everything that was going on, but still we waited a half hour to get a bed, and another 10 minutes after that before anyone came around to do a 12 lead. The hospitals 12-lead showed no ST elevation (so this was about an hour into the event), and labs had not come back yet. Any thoughts?

Good job on a very scary call. I'm gonna disagree with some of the others about not taking parents along. I nearly always take family members if they want to go, and usually let them go in the back with me.

I think it's odd that you got so worked up about this call. Do you think that you will never find yourself in a position where you've made a mistake and feel like an ass? I'm sure the doctor felt pretty stupid afterwards. Why do you feel the need to punish her?

When I was an EMT I drove off from a gas station with the gas nozzle still in the tank. I ended up paying damages to the gas station out of my own pocket ($100) because I was new at the company and didn't want to report it to my boss.

I'll have to keep this in mind...sounds like fun.

Is her abd distended? Since we don't know when she last voided and she's been drinking a lot, I would consider acute urinary retention. She needs a Foley when she gets to the ER. There are many other things that couuld be going on here, an AAA being the most serious thing to consider. But really, without a CT how could you diagnose what's going on, and what could you really do for her even if you did?

If she has abd pain and is jaundiced but no Hx of liver problems, then I would consider that she may have gallstones. The most dangerous issues are AAA or acute MI. What does the 12 lead show? Is she a DNR?

IN administration of certain drugs works great if you're using an atomizer. I gave Versed IN at my old service. Unfortunately, the place I work now doesn't have IN drug admin in its protocols. I recently had a 90 y/o in status seizure and could not get an IV on him. I brought him into the ER still seizing. Not good. If I could have given Versed IN, it would have stopped his seizure almost as quickly as IVP (and much faster than IM).

Interesting article on drug deaths... http://www.slate.com/id/2194716/

Ventmedic wrote: "Elderly trauma patients. Just knowing that whatever years they have left will be shortened and full of painful procedures breaks my heart. " I'll second that. The elderly lady who injured her hip; who's been living alone in her own home and who has been independent, and who you know will likely end up in a nursing home.

1) neonates 2) kids with multiple and major health issues

Yeah, that might be him! I forget his name...maybe Tim. He's about 40 y/o but looks younger; looks like a surfer. Besides being the valedictorian, he was also the nicest guy in class.

Why do you want a medic alert bracelet in the first place? Having had an MI years ago would not be a reason to carry one. I don't think Plavix would be a big concern to anyone anyway, even if you were involved in an accident. Perhaps you should talk to your doctor about all this. He may be better able to advise you than we can.

Just reread your post...so, is she really altered, or is her friend just saying that she's "not acting right"?

Ok, I'll bite.... Obviously your main concern is that she may have injured her aorta and developed an aneurysm as a result. It's an unlikely possibility, but since that could kill her, it's your main concern. Cardiac tamponade is possible too, but very unlikely with blunt trauma. So, was she wearing her seatbelt? Hit the steering wheel with her chest? You'd want her to carefully describe the MOI. There are many other things to consider, and not just trauma but medical too. Taking her to a trauma center...they may be better equipped to deal with her there, but don't count on it. If she does have an aneurysm, it won't be the trauma surgeon who'll operate on her. Again, there are many other things to consider, but why don't you tell us what you're getting at? Was this another call you ran with those medics who didn't know how to use their Zoll?!!!