p3medic

No, you shouldn't have started driving in the first place. Its one thing if they arrest in transit, but if they are dead on scene, work them till there not dead or call it. I realize local protocal will vary.

If the patient has no advanced directives I would have to make the assumption that she would want the full court press. It is not my place to decide what constitutes quality of life. These facilities are well versed in DNR/DNI and most likely had this conversation with the family and patient at time of admission.

Worked an arrest two days ago, fire was thanked and dismissed. We worked the code with the 2 EMT's that were also there, got ROSC, and began therapeutic hypothermia and transported. No need for fire. I won't send them packing if we are by ourselves, rotating CPR amongst the 4 FF's are better than me doing it, but we don't NEED them.

Look at their vital signs too, if they have a good blood pressure they most likely don't have tension. Asthmatics like this, especially ones who are intubated and overzealously bagged can and do develop ptx. It may become necessary, but correcting the underlying bronchospasm is you primary concern. Allow for a prolonged expiratory time, ventilation rates will need to be decreased as well as volume. I'm sure vent will come along and post a link or offer her $.99

A witnessed signature refusing transport against medical advice, in a patient documented to be competent to refuse care, and a well documented chart is more than enough. In the U.S. people are allowed to make stupid decisions regarding their health, and if informed of the potential of not allowing treatment and transport they assume all liability. No need for a supervisor, doctor, nurse, etc....

I wasn't going to mention it, but since Fiznat brought it up, I too wonder as to why Solu-medrol was given to a suspected CHF patient. It seems unlikely to be part of a CHF protocol, and if CHF were in my differential, I probably wouldn't give it. Just curious.

Not even close to a combitube. Think extra long stylet, but more supple. The end has a small (1") portion with a slight angle to it. As it is inserted into the trachea the angled tip bounces off the tracheal rings, feels much different than the smooth esophagus. Also, the bougie will stop advancing at the carina, in the esophagus it generally doesn't stop. You can either insert the bougie into the trachea and pass a tube over it, or you can load a tube with it, leaving the last several inches beyond the end of the ETT. It is usefull for grade 3 or 4 airways were you cannot visualize the glottis. It can also be inserted blindly, or digitally, again feeling for the "clicks" as it moves into the trachea.

It seems as if you are going to make the incision to pass a bougie you might as well just do the cric and canulate the trachea, no? I can see it working, and its definately bigger than the guidewire, but at least you can pass the wire through a needle, you know what I mean?

I want to live in a small isolated place someday....preferably without bars and with a view.

Well I would just skirt the issue altogether and call it a "stylet" which it is. We carry them, don't have a particular protocol for their use. I use them frequently and for about $7.00 they are worth every penny.

I wouldn't know a combine if I tripped over it.

How far is the hospital? Any chance to get a Doc and blood to the scene? I've done this in the past, once for an amputation that ended up not needing to happen as we were able to lift the train enough to free him.

In addition to the Doctors question, does she have any difficulty with speech, mouth opening, or eye movement?

Ahhh, I see. We don't transport them if thats what you mean. If its a crime scene we leave them like we found them, perhaps a plastic sheet if PD requests. If we work someone in a home and call it we often will place the patient back in bed, or on a couch, or at least make them presentable for the family. ETT's, IV/IO lines all stay in place.

Same as the Doc, with the addition of a phone call to the ME, reporting pt info, race, weight, signs of trauma, drugs, etoh, pmh, next of kin, time of death (when I declared them dead), name of primary care physician if known, and contact number for officer on scene.

I feel for you kiddo...I don't know your personal situation, but I tend to agree with those that are telling you to run away. One thing I will add, not having been there, is I never push a med if I don't get the vial with it. I have a partner that I have been working with for 13 years and I won't push a drug he draws, and vise versa if it doesn't come with the vial. Always confirm what the drug is, especially at 4 am when the synapses aren't firing like they should. Good luck.

I actually treated a guy yesterday from Naples, Fl, even had the opportunity to educated him about the whole fire/ems battle taking place. Don't know if it matters, but one person at a time....

http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight= Here it is...

Yup, I remember that case, JP posted it....I'll see if I can find it.

A normal D-Dimer doesn't rule out PE, nor does an elevated D-Dimer rule it in.

Well if they didn't chart it they are in a world of hurt. I couldn't imagine not writing something, but then again, I don't work for a fire department or in DC for that matter.

It's the dead guys mother's story, so take it with a grain of salt. I think DC needs an overhaul for sure, however I find it hard to believe that the medics told the patient is was reflux, don't worry about it. I hope they charted well, and have a signature. A distraught mother will say lots of things. How come she didn't insist he go? If she was so concerned after all she could have pushed the issue.

I wonder what Eileen Bernsteins parents would have thought if her Social Studies teacher decided to shave her head, staple a yellow Star of David to her shirt and stuff her in a broom closet to simulate being stuffed in a cattle car and shipped to Auchzwitz? I'm betting the lesson would have been lost on her too. I'm no touchy feely liberal, but I think this was extremely poor judgement on the teachers part, regardless of her intent.

The problem with lowering the blood pressure with ntg alone is a potential for rebound tachycardia, increasing stress on the arterial wall. Beta blockade would be a better choice, either with ntg or without.

We work 8's with 16 hours max allowed in a 24hr period.