p3medic

I've always made the assumption that no recall of event = presumed LOC until proven otherwise.

The vast majority of my experience using mag has been with severe refractory asthma, state protocol calls for 1-2 Gms IVP over 5 minutes, which sounds completely wrong to me and most others (MD's included). In my typical adult patient I routinely place 2 Gms in 100 ml of NS or D5 w/a 10gtt set and infuse it over 10 minutes, which is still about twice as fast as recommended by most sources I've read.

My system has similar survival to discharge rates as Croaker, and interestingly enough, we work patients where we find them, on a hard, non moving surface. Transport before ROSC is almost always a bad idea.

We had an officer collapse a few years ago at the yearly Marathon, immediately defibed by one of our Bike Medics w/AED, no weapon discharge and immediate ROSC

I'd like to trade my partner for a helper-monkey.

Slightly off topic, a call I had over the summer. Police officer and suspect draw down on each other, suspect gets off one round through officers calf, no bony or significant neurovascular involvement, cop gets off 3, center mass. We arrive, suspect is supine, not restrained, but not fighting either, officer is ambulatory. My partner gets the suspect, I get the officer, 2nd ambulance on scene, BLS report my partners pt is "sick". I leave the cop for the BLS and assist my partner. Long story short, we transport the suspect w/PD, he's cut down naked, rolled and injuries noted, tx in route to hospital. ED notified in route, we go directly to OR w/pt, no BP, altered, 3 ABD wounds. Cops are not allowed into the OR, we move pt over to their bed and whoops, out from the back pocket of suspects pants falls a loaded 2 shot dillinger style handgun. FAIL on both our and PD's part, OR staff not thrilled, picked it up w/gloved hand and put it on our stretcher and brought it back down stairs for the cops.

Ruptured AAA would be my first guess.

AAA happens in the abdomen, upper extremity BP should be essentially the same, you may find differences or absence in femorals or lower extremity pulses. The difference in upper extremity BP is in relation to Thoracic Aortic dissection, a different animal entirely. It is not an aneurysm but a dissection between the intima and adventitia layers of the aorta. A case I had a few years ago involved a 37 yo F w/hx of HTN and cocaine abuse, sudden onset of 10/10 chest pain, couldn't sit still, visibly uncomfortable. BLS on scene administered 324 mg ASA and extricated to our ambulance. While giving their report and hooking up our 12 ld the EMT giving report stated a blood pressure of 108/50 (or something thereabouts). When asked what arm he took it in he stated her right. My partner repeated it and got the same, and then took the left which was dramatically higher, lets say 180/100. 12 ld unremarkable, hospital notified of our concern of a likely vascular catastrophe v.s. and ichemic one, immediate CXR on arrival unremarkable, CT revealed a dissection from the base of the aorta to the renal arteries. She went direct to surgery and believe it or not had a good outcome. I realize this is a single anecdotal case, however I tend to get bilateral BP's on pts w/significant chest pain FWIW.

You can absolutely move the leads of a 3 ld and get a reasonable result. Back before we had 12 lds we would use the LP 10 and use modified chest leads, MCL 1-6 and label them as such. You would end up with 6 feet of paper, but it worked in a pinch. Now, if you have no idea how to read a 12 ld or use MCL's, then I guess you are out of luck. We rarely did it with the LP 5, but that was a long time ago.

I had a lady from the show "Paramedics" ride with me a few times, she was good about being out of the way and the camera was very small, not your usual news camera. I'm sure I was aware of her presence but don't recall changing my behaviour or patient care to any great extent.

Its the trend everywhere, less fires and tighter budgets, IAFF tell their members its EMS or die. Its too bad, I spent a few year out at Schofield and recall the City and County EMS guys and gals were top notch, I almost stayed to go to P school in Honolulu, but ended up back east. Good luck

I don't know, without my union I doubt I'd be living the lifestyle I currenly have. No one cared about unions when the private sector was making money hand over fist, but now that the economy has turned, its all the unions fault. I don't remember which unions caused the economic collapse or how much they recieved in a government bailout, when you find out, please let us know.

Most likely a Todd's paralysis. Obviously a full P/E needs to be done, but post-seizure paralysis is relatively common, and usually benign.

Crotchity sounds mad because the white girl wouldn't sleep with him, that is awesome!! Guilt her into it, otherwise she's racist! Funniest thread ever.

Our first in bag has IV, bandaging, airway equipment, TQ's, etc...Our O2 bag has a D cylinder, assorted o2 delivery devices and BVM, our drug box is a pelican box, all the meds and syrninges, needles and glucometer, and the LP 12. 4 seperate pieces of equipment.

NYC, tough nut to crack. You have FDNY, the death of NYC*EMS, multiple vollies, a medical directory who probably doesn't know any of you by name, a huge range of clinical abilities which makes most MD's write protocols directed to the lowest common denominator. First, break away from FDNY back into a 3rd service model and let vollies take care of contracted facilities, leave 911 to a single agency with a group of associate medical directors (doctors) that are actively involved in the education and review of the city medics. Next, pay a living wage. Finally, admit the Yankees suck and join RED SOX NATION. That is all.

The fact that he may not "need" an expensive stethoscope is not relevant. He's asking if anyone else owns one and their opinion of it. I don't "need" a lot of things I own, but I still want them, so I don't mind paying for it. I own two Master Cardiology scopes, so when one is out being refurbished, I still have the other. Probably a bit extreme, but I don't care, its my money and I have found the quality to be second to none. I drive a Toyota Yaris, I suppose I could buy an adult car, but I care more about other things....

We deal with a lot of heroin around here, 99% get IM or IN narcan and they walk to the truck. If there are other findings that suggest a more complicated case that I feel I need vascular access, and peripheral IV isn't available, than I'm more than happy for the IO. I would not place an IO simply as a route to administer narcan.

We still love you Richard, even though the Yankees SUCK! Anywho, 18 members of the BFD were found to have falcified training documents, and one is under indictment. No one from BEMS is involved.

Was there ever a consideration of adrenal insufficiency? Monday morning quarterbacking, maybe a stress dose of steroids would be in order.

Never heard of it, care to elaborate?

I am a believer in pre-hospital pain management, however not everyone with a complaint of pain needs two paramedics and a bolus of morphine. Most people with a simple fx would get a ride to the hospital and sit in the waiting room, and would eventually be triaged and recieve medication. I think BLS level care, i.e. splinting, ice and elevation do a good job to reduce pain. In a city like New York, tying up an ALS unit to provide MS to an isolated extremity fx would likely mean someone else would go without. In a perfect world people would call for EMS only when needed and not for every ass ache, bug bite and fever. Urban areas are overwhelmed by minor illness/injury patients looking for a ride, and as a result resources are stretched thin. It would be great if everyone who called got a doctor, but it isn't going to happen, too much $$$. The folks who believe in an all ALS service need to realize how difficult it would be to maintain good clinical oversight and ensure skill retention, i.e. intubation. I don't have the answer.

Junctional ectopic tachycardia. How would volume expansion slow or stop pre-term labor?

My point is that if two docs on either end of this transfer feel it is unlikely that a need for additional resources would be needed, then the medic, who I know nothing about, might feel comfortable with the transfer. The fact that things went poorly is why they are in the legal situation they are in. I honestly can't fault the medic for not refusing the transfer assuming the doctors on either end realized the level of care doing the transfer and they felt no other resources were needed. For every case like this there are probably 1,000 that are uneventful. I do agree that in hindsight going to trial was a bad idea. Just curious, given the information we know about the patient, prior to transfer, what do you think the proper crew configuration and mode of transport should have been? Honest question.