p3medic

Or in V-tach at 180 but you can only detect about half of those at the wrist.... :roll:

Unfortunately the time to fix the underlying pathology takes much longer than the procedure.

Are you slow? V4 looks at the anterior wall of the left ventrical, not the inferior wall, not the right ventrical. The fact is, v4R, as in Right side, looks at the right ventrical. You will NOT see st elevation in V4 w/RVI, only V4R. Inferior MI presents with st elevation in II, III, avF, not v4. For someone who seems to be so sure of themselves you seem to know little about what you are trying to talk about. Perhaps you should sit back and watch a while junior... :evil:

Bradycardia, except in the pending arrest patient is unlikely. The most common EKG finding with PE? Sinus Tachycardia.

It would seem unlikely to have isolated st elevation in V4 associated w/II, III and F. I can't say I have seen it. I have on the other hand seen plenty of elevation in V4R associated w/IMI, which is diagnostic of RV infarct, in fact, I saw one three days ago. V4 looks at the anterior wall of the Left ventrical, V4R looks at the Right ventrical. You might want to ask him just for clarification, I think you may have misunderstood perhaps.

He's refering to V4 Right, as in the V4 electrode on the R side of the chest, in same position as it would be on the Left.

Nice try clown. You mentioned you'd get about 5 heart beats worth of relief, suggesting you are talking about BLOOD, not all fluids. Nice try at a cover up, but you FAIL. Want to try again?

Dude. you have GOT to be kidding. we have a story of a crew nasally intubating a drunk and throwing a NRB on their face and you want to let some of these guys dart a heart in the back of a truck? OK. so you assess the patient. Gee, muffled heart tones, a BP in the toilet, narrowing pulse pressures...Lets dart him! You stick him (without putting another hole in his heart)and siphon some blood out of his sac, how long until that sac fills up again? 5 heartbeats? This patient needs a diesel drip, not a medicmill grad sticking a needle in his heart. this is hard enough to diagnose in a controlled ER let alone bangin down the road in a bambulance. Maybe we'll all get echo's next christmas.

Massachusetts.

We see a lot of coining here, very common. My most unusual was some weird voodoo Haitan queen dancing around and passing out, something with chicken bones. Maybe some of our members from the Big Easy can comment on that.

Mobitz 1...If she isn't symptomatic, I'd leave it be. At that rate, it is likely well tolerated. I'd certainly keep an eye on things, pacer pads at the ready but for now, quite happy.

Thats HOBgoblin! :evil:

My concern is that giving flumazenil to a polysubstance OD may do more harm than good. This is a patient with a history of depression that the family reports took a benzo and opiate. We have no idea what else the patient may have taken, or how chronic his benzo use is. Controlling his airway would seem to be the priority after narcan failed, IMHO.

Am I the only one concerned about giving Romazicon to this patient?

ETT in the anus???? No thanks, If I choose to give in PR (and I likely won't) ET tube would not be the way. Interesting thought though.

You didn't consider the old NYC*EMS a "third service"?

Yeah, but that is healthy adults. I still think its impressive, but when you consider the patients we as prehospital providers are dealing with, I would think 1 minute is pushing it. I wouldn't go take a phone call during it (although if it were for overtime, I'd have to consider it )

Ok so answer me this!! So if doing cpr while transporting is so ineffective then how come there are so many times and so many stories of people getting pulses back during transport. That right there sounds to me like effective Cpr. If it wasn't effective I don't think they would of got pulses back

This could be doable...

Its not our place to make assumptions based on past experienc, i.e. shes probably been dead a lot longer then 10 minutes. We need to listen to the report as given, and leave out our own preconcieved opinions. Being 89 or 109 isn't a contraindication for CPR. I haven't seen any literature describing poor outcomes secondary to thoracic trauma caused by CPR. If the pt gets ROSC, then they are "better" than they were. ( I know, she probably is better off dead, but again, not our decision to make.) Cardiac arrest is a good indicator of poor outcome. Asystole even more so. If you are not required to start resus on an asytolic patient this call is a no-brainer. If asystole in and of itself is not an independant finding of a non-viable patient then we should attempt the resus as the assumption is the family/patient would want "everything done". I know we try to approach medicine as a science, but we can find ourselves in trouble by playing the odds game. Just my humble opinion.

The opposite of the jugular artery. :oops:

It is damn near impossible to provide effective chest compressions in a moving ambulance, no matter how many fire fighters you take with you. The way to resucitate someone is to do it at the scene. The patient shouldn't be moved until you have ROSC. If you are under protocol that you MUST transport, then spend 30 minutes on scene. If you don't have ROSC in that time, you never will, and you can move the patient to the ambulance and drive safely to the hospital with as poor CPR as you like because it won't make a difference, but dragging a corpse to the truck and beating feet, trying to run a code in a moving ambulance is ineffective at best.

Well according to your protocols you would work her. The OP senario said she was alive 10 minutes ago, and other than asystole, there are no other signs pointing to a prolonged down time. Believe me, I have no interest in working the patient as described, but unless I can prove otherwise, I would have to give the patient the benefit of the doubt. I could contact MC, and could very likely convince the MD on the other end to call it, but I'd likely work it for three rounds and call it, or as is also likely given her apparent state of health, get immediate ROSC and end up transporting.

Unfortunately the tank is HUGE! It would be nice if you could carry it in a D tank.

Sounds like someone else we know....