p3medic

Talking to med control as a BLS provider would be a good idea in that senario, epi sounds appropriate, and if you painted the picture of a hypoxic asthmatic that has accepted and airway, and your actively bagging the patient most docs I'm guessing would ok the order. Another thing you might consider adding to your truck is some corregated tubing that you can run a neb on while ventilating the pt with an ambu.....one end of the tubing attaches to the t-piece of the chamber, the other side attached to the ambu, the tubing then attaches to the mask via and adapter......just my opinion.

what was his temp, blood glucose and Na+ out of curiousity?

I'm not too worried about intubating this patient yet. How about her GCS, neuro exam, 12ld, spo2 and etco2, what meds is she on? Any recent illness/injury? When was the patient last seen or spoken to? Thats all for now.....

Playing monday morning quarterback, if I were to have come to the determination that the BLS airway is not going to be logistically feasible I may have chosen straight etomidate, with or without lido as your current protocols dictate. I can render patient unconsious, not alter much hemodynamically and not render patient apneic; direct laryngoscopy and either intubate, confirm landmarks and feel overwhelmingly confident of success with addition of a paralytic, or place an LMA, or supraglottic airway of choice. But thats just me, and its Monday.

Well, you have improved his spo2 from the 80's to mid 90's with BLS airway maneuvers, and with all the highlights above, going down the path of RSI may be the wrong path. You have difficulty masking the patient due to trauma to the anatomy, facial hair and body habitus. Whatever muscle tone this patient has may be contributing to the patency of his airway, and removing that tone with the use of a NMB may result in its complete loss. Failed RSI may very well put us in a "can't intubate, can't ventilate" situation, in a patient with anatomy that not only makes oral intubation difficult, but surgical access as well. As it is now, we have a patent, albiet unstable airway, time to put pt on his side, and continue doing what your doing. If the airway becomes unmanageable enroute, I believe the needle/surgical option may be the best. If its going in the helicopter, BLS airway may not be a valid option, in which case the neck should be prepped prior to induction....IMHO.

I would not have RSI'd this patient. With that being said, and the senario now at the point of a sedated and paralyzed pt with a single failed intubation attempt and reasonable sp02, I'd say give it another shot while prepping a rescue airway device of your choice while prepping his neck as well......

Yes, "dibs" not "dips"....i'll fix that

Hospice nurses look like neurosurgeons when compared to nursing home nurses.

dispatchers should be docked pay everytime they send someone on a late call.

ER docs seem to think they've got "dips" on all the hot nurses...

I can't imagine what kind of a patient you were, sound like a candidate for the SPIT protoco'l 1.Sedate 2. Paralyze 3.Intubate 4.Transport Problem solved Just Joking :wink: Sounds like you have an axe to grind with the EMT's. You can argue protocol v.s. ethics all day long, without actually being there, you could argue both sides of this story successfully. Maybe you can prove the ortho staff at the hospital screwed you up, you might try to own them.

Medic students are the lowest of the low. They see every patient now as needing some sort of ALS care, have forgot all thier BLS skills and act like paragods(thats reserved for us medics) The only thing worse than a medic student is a fresh July EM resident, its just around the corner folks, the one time of year I can get on my high horse and crap on a doc, make him look stupid, thus making me feel important

medics suck.

We stransport all STEMI's (based on medic interpretation, not machines) to cath capable facilities, and more often than not go direct to cath lab

First off, YANKEES SUCK! The Red Sox are the classiest team in baseball, bar none. The Celtics have more championships than anyone, The Patriots are a dynasty, the Bruins? Well there still fun to watch. Also, no self respecting man puts tomatoes in a clam chowder, the best clam chowder comes from Mass. What other states governor drives around in a pimped out Cadillac Deville? We have the Cape, good fishing, decent hunting, some pretty good schools, not to mention the non accreditted paramedic ones (For Dust ) Hell, I'm a Masshole and proud of it! Nicks suck, Yankees suck, Rangers suck, Giants suck, Coney Is is a dump, on, and on and on.....

We run out of fixed stations, most of the BLS trucks run out of thier own stations or share a station with an ALS truck. We also have two larger stations that house mostly spare trucks, both ALS and BLS, but are not someplace someone is generally assigned. My station is just my truck, I think we are the only ALS truck without a BLS truck assigned to the station. Stations vary in size and quality, ours houses our truck, has locker space for the 9 of us assigned there, larger lockers/shelves for spare equip, bathroom with shower, living area with 3 couches, table with 4 chairs, stove, sink, cable tv and internet. A/C, heat etc...None of our units share space with FD, however several share space with PD stations. (A2/P2, A3, A6, A11, A13,) others are on hospital properties, but not hospital based (A5/P5, A16/P16, P3) one at the airport (A7), and the rest at their own facilities. We can drive around our districts as we like, or sit in quarters. When things get busy, we can end up anywhere. I could be at a hospital on the opposite side of the city, clear up and then get a call around the corner...not my district, but the closest unit. Somedays the only time I see the station is shift change, others I spend most of my time there, depends.

The idea that EMS should dispatch an ambulance to a hospital ER that is a recieving facility of said EMS system is rediculous. The patient is already at the hospital! The job of EMS is to deliver the patient to the emergency department, and the patient is already there, mission accomplished. The ER staff should probably have been contacted by the dispatcher as a point of courtesy, but I think EMS should be off the hook on this one, although I'm not a scumbag attorney.

NYC isn't the only place that celebrates a Puerto Rican Parade/festival. Its essentially a huge street festival, think MCI. No one goes anyplace except the closest appropriate hospital, don't go off in to a crowd without your partner, or better yet, let them bring the patient to you. If you aren't assigned to the event, you would be called in as a transportation asset only, so don't get too excited about it. Stay alert, stay alive.

my pleasure, good luck in Ct.

Virginia is for lovers, so how bad could it be???

If your in the boston metro area, you might want to consider boston ems. Third service, 911 provider for the city of boston, hire BLS and promote medics from within. You need to work a minimum of 1 year bls from date of hire, but when you factor in a 16 week training academy and field internship, its more like 6 months of bls. In that time you will learn the system, all the hospitals, geography, protocols, etc....the bls job pays well, and the medic job pays better. To be promoted to medic requires a competitive exam, practical and oral interview, and then hospital clinical rotations and a field internship as well, at the end of that another oral exam, and if you did well, you'll be a probie medic for the next 6 months. Something to think about. As for your initial questions regarding Hartford, I'll answer the same re:Boston. 1. BLS start around 18/hr 2. municipal 3. n/a 4. NR not required 5. over 100,000 calls per year, 15 BLS units, 5 ALS 6. pros: you already live in the area, great protocols for BLS and ALS, active training dept, QA/QI, paid overtime for con-ed, refreshers, etc. Lots of OT available, private details, special events, i.e marathon, good equipment, vehicles, 500$/yr uniform allotment, all PPE supplied i.e helmets, turn outs, pro mask, body armor, etc...good union, 15 paid holidays, 15d sick time a year, 2-6 weeks paid vacation depending on time in service. Cons: city residency requirement within 6 months of hire, mandatory overtime, although it happens rarely, for example its been over 3 years since I was mandated, high call volume (good for some, others would rather be slow), may not work the shift you want until you have some seniority, all assignments are by seniority, however once you "bid" a spot, its yours until you give it up, so someone with 30 yrs on the job can't bump you out. Living in the city can be expensive.

Pretty lazy I'd say, I mean the building has an elevator, your bringing the bed, might as well throw your stuff on the cot and take it up.

In the given senario she has clear breath sounds and an etco2 of 45mmHg, and a good waveform, this is not bronchospasm, this is dypnea secondary to exteme tachycardia. Clearly she hasn't been dx with WPW until now. Her 12ld is diagnostic, and theres no room to really argue that point, IMHO.

I wouldn't get too hung up on the respiratory aspect of this call, her respiratory distress is secondary to her tachycardia, not the other way around, fix her rate, you fix her breathing. The "asthma" hx is something to note, but this is not her problem today.