p3medic

There are a lot of details of this case missing. Making some assumptions, it would seem that the sending and recieving docs felt the patient would make the transfer without delivering, or they would have planned for that eventuality. The EMS crew that arrived likely were assured of that as well. The sending doc must have felt this or would never have sent the woman with a crew of 2, a driver and a medic. With one medic in the back with 2 patients, I have a hard time faulting him/her for not intubating the kid. Securing an ETT in a 25 weeker in a moving truck is difficult at best, not to mention other resus that may need to take place. Even the most skilled neonatologist would be very stressed managing this kid solo in a moving ambulance. I have a hard time faulting the ambulance company for the outcome, I believe it is the sending/recieving docs who decide what level of transfer is appropriate.

No, you would use the 4th or 5th ICS, same for cx tube placement.

I would say insufficient catheter guage and length are the two biggest issues. I would suggest a catheter of no less than 3" and no smaller than 14g in the adult. Also, using a lateral approach seems to provide better access (less tissue) than the anterior approach.

Earnings: $112,376.43 Job Title: Paramedic Experience: 14 years as a medic, 16 years with company, 20 years in EMS Type: Third service municipal State: MA Avg OT: 8

Are you a member of the IAFF? If so, you pay dues to an organization that wants to do just that, save fire jobs at any cost, including taking over EMS functions wherever they can. If you don't agree, stand up to your Union and say NO or STFU!

I'd be doubtfuly of an immune response as the BP drop seems to have been transient. Whatever occured seems to have been self limiting. I didn't see a heart rate in the OP's post, a vagal episode is quite possible, although we have some other more serious diff's to consider.

I may be the exception, but I thought that was funny! Is it PC? Hell no, but I'll admit it gave me a chuckle.

Refractory asystole I can call too, however putting the electrodes on and identifying asystole doesn't make it "refractory" unless I attempt to tx it. Putting the EKG on just to "make sure" makes it look like I'm not. If I'm not sure, I should be treating it.

Hopefully in the near future there will be great improvements in hemoglobin based solutions, the crystalloid v.s. colloid debate has been around forever, perhaps time for a change.

We have a protocol for treating asystole, for this reason, we don't run a strip on any arrest we decide not to work. If we opt not to attempt resus, we use other criteria, apnea, pulselessness in the setting of trauma, rigor, lividity, etc...

I think its terrible that the man died, but a great precedent to set. How many in EMS have succumbed to a job aquired illness, yet no LODD benefit? All municipal EMS agencies should pay attention to this case, it could be used to help with the financial needs of EMS families who's loved ones have died due to job related illness.

No idea? It's your senario, feel free to fill in the blanks. You indicate an intercept with a ground ambulance, I have to assume they have the patient. The time required to land, tranfer care, transport, land, and hand off the patient in your senario v.s. transport 30 minutes via ground is pretty much the same. The flight crew has nothing more to offer this patient other than speed. I do a fair amount of mixed gas diving, never been 400 but been close to 300, in very cold, dark north atlantic water. I appreciate the urgency, but disagree air transport has a significant advantage over ground in the senario as stated.

I respect your opinion however disagree that the time difference is worth it. You have a ground assett ready to transport, why go through the trouble of setting up an LZ and wait for a helicopter? I could see if the boat was still at sea and you could arrange the transport from the dock, I agree that a helicopter "could" be a safe mode of transport, I just think it isn't warranted here.

Sounds like he should have gone by ground.

You still think the IAFF is serving your interests?

He was an EMT, not a paramedic, so much for the newspapers "facts". As far as a source, I have no intention of naming names, however I will tell you that his gun was in his cars glove box. When he left the party he walked to a donut shop and bought a cup of cofee and returned to his car, a block away from the house. He stayed in his car to avoid driving under the influence, and when he was attacked he was sitting in his car, no way to retreat and outnumbered he grabbed his legally owned weapon and defended himself. No where in the article does it state he "went home" and retrieved a weapon, returned and opened fire. He never made it further than the dunkin donuts where he purchased a cofee.

You're right because the newspaper reported that he was asked to leave and then returned? Are you a bit slow? That was reported by the friend of the "victims", you know the ones with the long history of alcohol abuse and violence? He left the party and went to a coffee shop to get a cup, and then back to his car to sober up when 3 of them came from the home and attacked him in his car, caving in his windshield. Go find the pictures of his car on line, you will see what I'm talking about. I know the paper knows everything, you must feel so high and mighty in your glass house.

wrong. He was at a party that took place after a fund raiser for his deceased partners kid, a party he drove one of the shooting victims to. He was a block away from the house when he was attacked by 3 individuals with bats who caved in his windshield when he defended himself with his legally owned handgun. He then rendered aid after the threat was eliminated. The "victims" are well known to police, one served time for vehiciular homicide, the other was arrested for assaulting EMT's and police while drunk earlier this year. Obviously the events were too much for him to handle, and he left a fiance and unborn child behind.

I use it on all acute respiratory patients, its a great tool.

Which drugs are we talking about?

Anyone want to discuss STEMI mimics? What else could it be?

What Chbare said. Sux will increase serum potassium, and given the EKG and history it is most likely hyperkalemia that killed this pt. Calcium Chloride, NaHCO3 and albuterol would be helpful, perhaps insulin/glucose for those who carry it.