p3medic

I don't know, you have seven pts, you find this one not breathing, you open the airway, still not breathing = deceased. Now, once you have more resources he probably needed to get tx, but playing devil's advocate here I can see how initially he could be called. Now, if they just looked in at the pt and called him, different story.

Exactly. Look at v1 and v6, very unlike RBBB.

Disagree, but curious as to your explanation.

I like the answer as part of the post as well. Nice strip, I think if one uses the "rules" they should be able to flesh this one out.

LOL! That was quick!

Big vehicle, sun in drivers eyes....Who knows? Accidents happen, at least no one was hurt.

Do you transport all your medical arrests too? The survival to discharge rate for out of hospital blunt traumatic arrest is pretty damn close to 0%. You would have much better results working and transporting all your medical asystolic arrests. Unless you can identify and treat, or you are across the street from the hospital, a patient without signs of life after T-boning a car on his motorcycle at 70 mph is dead. You can come up with all the "what if's" you like, but without identifying and correcting an ISOLATED injury, this is a futile effort. About 10 years ago this was discussed on Trauma.org, the consensus among the surgeons and other physicians was pretty much the same. Other than thoracotomy with correction of an isolated thoracic injury at the time of loss of vitals these are non viable patients. So, ventilate, r/o tension and tamponade, if no improvement call it. At least thats how I see it, for what its worth.

I believe I'm more or less in the same thought process of Croaker. If its PEA, rule out correctable causes, i.e. tension PTX, tamponade, perhaps fluid challenge. This patient went from 70 to 0 in very short order, T-boned a car at that speed on a motorcycle. I know that where I work, the only question that the surgeon wants to know is if there was signs of life on EMS arrival. If the answer is "no", and we haven't found a readily correctible injury, the patient gets called. There is no indication for thoracotomy or the use of large amount of blood products in trying to resucitate a blunt trauma arrest, at least in these parts.

There is only one question to be asked upon arrival at one of the area trauma centers if this patient is transported, "any signs of life on scene?" If the answer is no, it gets called. The teaching hospitals used to do thoracotomies on all these patients, but in the last several years the feeling has been the risks involve were not justified by the abysmal survival rates of pts arriving w/o vital signs. This case has about a 50/50 chance of being worked in my system, the location, crew involved, crowd etc...being taken into account however our standing order is traumatic arrest of ANY etiology w/o signs of life at the scene, and with a greater than 5 min transport time in the case of isolated penetrating chest trauma is to call it on scene. I'm sure you could line up 10 ED docs or trauma surgeons and come up with 10 different answers. Best advice is to stay within your SOP's, and if in doubt, work it.

Unless you find a fixable problem like a tension ptx, he's dead. This is massive blunt force trauma given the OP stated mechanism.

Don't leave your boards at home, believe it or not, there is surf here on occasion, only problem is its either rare hurricane swell or middle of winter cold as a witches t$t Nor'easter surf....but if you can stand a little cold, buy a 6/5/4 suit you will survive. Mass isn't too bad, there are some great colleges in the area, night life is good, great sports teams, and you are close to oceans, mountains, rivers etc...Most ALS protocols are standing order, we don't call for much, however some systems are more restrictive than others when it comes to that. Oh, and Spanish is the Puerto Rican version, much faster and harder to follow if you are used to slower Mexican Spanish.

I believe the view on angiography isn't the same as the diagram you posted. I could also be wrong, I'm a paramedic, not a cardiologist, however I believe the posted angio is a right anterior oblique view, the vessel seen on the far left making a near vertical decent is the circumflex. Or, I could be completely turned around.

OK, I'll bite. It appears to be a proximal LAD lesion resulting in TIMI 0 flow resulting in no perfusion of septal branches of LAD. I see no occlusion of the circumflex. I would call this an anteroseptal infarct, but I'm no cardiologist. Nice job posting the angio w/EKG.

"Huge" is a relative term. Millions of people have died from influenza, I don't think West Nile even comes close. Just saying. We have it here too, along with EEE, mosquito's suck, but DEET works. Influenza is a far bigger public health threat.

West Nile isn't spread person to person, so despite it being "bad", it is much less likely to effect many people, or spread around the globe.

The test was about firefighting, not fine dining. All the candidates are firefighters, that recieved the same training and had the same ability to study the information on the exam. The position they are testing for is one that requires the requisite knowledge and leadership ability. They will be required to make decisions that could cost someone their life, and if they don't possess the knowledge to make a sound decision they shouldn't be in that position, regardless of their shade of gray. Does the British gov't owe me a handout because my potato growing family was starved into emigrating to another country? How about the Native Americans, do they get their land back? The injustices of the past shouldn't result in reverse injustices in the present.

So the Cleveland EMS medics took the exam, no cheating. The Cleveland FF's took the exam, cheated and most likely get a hefty pay raise with the medic stipend. They should all be sentenced to work the ambulance for Cleveland EMS. No, that would be an insult to Cleveland EMS.

I'd look at individual services you are considering. I know in my state alone there is close to a 20$/hr range from the lowest to the highest paid. You also need to look at things like health insurance, retirement, other bennies, SSM v.s. housed, urban v.s. suburban v.s. rural etc... I wouldn't pick a state based on that article. It's a place to start, but do some homework. Good luck!

We have them, motorola something or other. It has all the call info that the CAD has in dispatch, allows for access to PD and FD call info, intra agency comm's, CAMEO hazmat data base, etc....Love it.

I called your last patient black. Given your resources and number of patients, this patient is dead. A heart rate of 20 = CPR. We don't do CPR at MCI's unless it was a lightning strike or something along those lines. There would be no harm in making her red, but I wouldn't commit a lot of time to her.

Strong work!

Massachusetts has a provision in appendix U of the statewide tx protocols for tactical EMS, although does not recognize the title. It is an expanded scope of practice as dictated by the organizations medical director (MD). So, in theory, one can attend numerous tactical EMS courses and have no additional scope of practice based on where they work, or could have quite liberal protocols without any "tactical" training based on directives set forth by their medical director.

What was their rationale for giving this patient Narcan? He's awake, protecting his airway and combative. Regardless of having narcotics on board or not, their is no indication for Narcan in this patient.

I check pulses if there is a sudden spike in etCO2.

She's 85, on and off cx pain, took a ntg w/o relief and has a resting tachycardia in the 140-150 range. Unfortunately we only have one lead to look at, however given this patients age and hx, it seems very, very, unlikely for her to be generating that heart rate at rest w/o it being ectopic in nature. With that said, I'd be very much interested in controlling her rate, but not before a 12ld....and an IV.