p3medic

SOA=Short of air? Damn, there are some strange abreviations out there.

I hate them, don't go unless its family and I can't get out of it....its kind of wierd, I do this for a living, but the grief thing has never been something I've got comfortable with....which is probably a good thing....I don't plan on attending my own if I can help it.

How about I told you so?

The 12ld post conversion shows clear delta waves, this is WPW. I am sticking by the SVT with aberrancy theory. If I were to give an antiarrythmic, amio would be my choice, because its my only resonable option.

yeah, life sucks...next time you get to ride in back...

carry them in my pocket, they are attached to an o2 wrench, and the keys for the truck too....never lost them, but ive gone home with them more times than i care to remember....

while the 5 differentials for this rythm is 1. VT, 2. VT, 3.VT, 4.VT 5. SVT with abberancy, the girls is young, no pmh, rate is very fast, faster than "most" VT's, has a LBBB looking pattern, and in my opinion in this internet senario is MOST likely svt....quite possible wpw that has yet been dx. I don't believe its a TCA OD, and tx the VT option is certainly the safest approach, as I stated when i made my intial impression that the origin of the arrythmia was semantics, the tx (electricity) is the same...I might, given an actual patient in front of me with ekg in hand, make the working dx of svt, and tx with a single 6mg dose of adenosine, it would be acceptable for were I work, however may be going way out on a limb for others....just my opinion. when in doubt, VT is your best choice.

had a guy with multiple gsw's, hypotensive, air hungry, left cx sounded clear, right was completely silent....dropped a needle in his r cx, no change, turns out i had a small tear in the tubing of my stethoscope where the bell attaches, when i listen over the left, the tear was closed, to reach over to his right caused it to open, resulting in no sound transmission through the diaphram...didn't change his long term outcome (dead) but was a misdiagnosis i was a bit embarrassed about....

Been lurking, i'm off my meds, so i'll be around for a bit

This is not a STEMI, its acute pericardititis in my humble opinion. As for tx for hyperkalemia, there is nothing about this 12ld or the pts hx or complaint that would lead me to believe this is hyperkalemia, so the short answer is "no".

sedate with versed, synchronized cardioversion.....repeat prn I'm calling it an svt with LBBB, but its semantics, tx doesn't change. she's unstable, i'm not waiting to infuse amio, she's not getting a ccb, I might consider 6 of adensosine just prior to my versed.....nurse is in for a treat!

a heart rate of 200-250 is not likely a result of her "asthma" fix her heart rate and i bet her breathing gets a whole lot better...and her anxiety too 8)

I had a kid with dandy walker a few years ago, apneic, unresponsive at home, complained of a headache to his mother, she went to get some tylenol, came back and found him down....for us he was a gcs 3, pupils fixed and dilated, thought his outcome was not going to be good. Turns out he did very well, had a blocked vp shunt, was extubated on day 5 and went home pretty much like he was before....interesting case.

good old fashioned index cards work just fine...

There are no voluntary fire depts doing calls in NYC, so why should there be voluntary EMS? Mutual aid is one thing, multiple agencies with different pay scales, training, oversite etc seems like a recipe for disaster, IMHO.....

epiglottitis is almost always caused by bacterial infection, croup is viral.....

It is NOT in the scope of any paramedics practice to transport any of the following without a nurse... Balloon pumps, VAD, BiVads. (quote by firefighter523) perhaps in PA....now run along little boy, i think i smell a dumpster fire.....at least that is well within your skill level

With the info provided i would agree this is most likely a symptom rather than a cause, i.e hyperglycemic diabetic on the dry side, with an appropriate sympathetic response to same. I'd give a fluid challenge and see were that gets me. As for cch v.s beta blocker, I tend to use the same class of drug they are taking, assuming they are on one or the other, otherwise look at the pts hx and make the appropriate choice....both drugs have there place.

damn, thats less than half of what i made last year....yikes....i work 8 hrs, 4 on 2 off, ot sometimes too....

I don't blame anyone for not wanting to go back and work BLS, it is just the way it is here, if you want to work ALS for the city, thats the process...You can get hired by a fire dept or private with just a medic cert, no experience necessary....

The pay at the BLS rate is as high if not higher than the ALS pay at most other systems in the state, so financially its not a hit....1 year isn't that long when you really break it down, you have 6 months of it gone by the time you are finished with the academy and field internship....6 months of working, learning the way the system works, geography, etc....it goes by fast....I can certainly understand why someone with an ALS cert wouldn't want to come here and have to work BLS, but to me it was worth it. The city has everything your looking for, third service, good pay, good protocols, all our con-ed is either overtime or reassignment, good equip etc....The fact you hold an ALS level cert is no guarantee you'll ever use it here, the promotional process to medic is very competitive, usually 4-8 position per posting, with 50 or so taking the written, practical and oral interview for those spots....and even if you become one of the 4-8, there is still a possibility that you won't get promoted depending on your performance in clinical rotations or field internship.....even with all that, the job is great, IMHO.

Consider Boston, great city for young people, lots of colleges and clubs, plenty of urban medicine to go around....requires city residency within 6 months of hire, although not strictly enforced, must work at least 1 year BLS. It is required regardless of your current level of education. ALS positions are promoted from within, very competitive.

www.crossfit.com

Speaking from the Army point of view only, the term "medic" is used for a specific MOS, used to be 91A then 91B, now something else....they can serve in a clinic, er, in the field with the infantry etc...skillset will depend on the type of unit they are assigned to, and its primary mission. A medic in an ER will be doing a lot more CNA/LPN type skills than a medic with a front line infantry unit. As for SF, different set of skills all together, different MOS, but still a "medic"....All the other medical MOS jobs are not "medics", i.e dental tech, xray tech, behavioral science, etc....At least thats how it was over a decade ago....

A save to me is a patient who leaves the hospital under their own power, neurologically intact, or with only slight deficit....I don't know how many i have had in my career, but I do know of 4 last year for sure.....