scubanurse

I like this idea

Wheezes are making me want some albuterol or humidified O2 blowing in with the mech ventilation... Still really not happy about BP... I'm thinking the Beta Blocker is working against the dopamine and therefore not helping to get that BP up. This may be completely off the wall but hey...I'm still learning How about a beta agonist like dobutamine? Probably not a drug you have but it's worth a shot? Start an albuterol neb through the tube maybe? We need something to get her pressure up.

weird warm weathered people...

Bagging anyways... I don't want to deal with the vomit from hours of using a BVM.

I also find it odd to see EMS providers wearing shorts on a scene like this...

I'm thinking like 2mg morphine with 25mg of benedryl or 6.25 of phenergan IV might be enough to settle her down long enough to pre-oxygenate before considering RSI. If we get good compliance with BVM...maintain the morphine combo until advanced help arrives...

I like the idea of a flight for this lady It's an interesting idea to sedate then use an adjunct... what would you sedate with?

Grr

Is he willing to return to your base camp with you? A little O2 bottle therapy to the cranium?

holy cow... any hx of drug abuse or possibility he is on drugs at the moment? I would probably find out whether he would allow IV access, and probably settle in for the long haul with him. If you leave him as is, that's abandonment. Can his employer order him to go? Are you in the position you can sit with him until his wife comes? You could pull a TV show medic drama and start a line and tell him you're flushing it but load him to 10 of valium and take him once he goes to sleep...

Can we sedate her some to prevent the combative behavior? She really needs some O2 therapy. Does she have a cath in? She could have sepsis from pneumonia but also a kidney infection that is compromising her kidney function. Any possibility to fly this lady out? The agitation and confusion can be secondary to the hypoxia... probably not a possibility but RSI? Just eliminate her need to breathe on her own all together?

Same... Our teacher last semester walked in and said yay everyone did well! Class average was 82% on an exam....

Funny enough someone tried that in my program... we were allowed to use calculators for med math but they tried using a phone app to calculate drip rates. We're not talking complicated drips either... simple math that anyone with a 5th grade math understanding should be able to do!

That's great Richard

Holy cow... That whole measure before inserting thing really didn't take for that provider did they...

Hahaha that's awesome

How is this a constructive response to the original post? OP: Stick with it. Maybe look at ER's for tech positions? Probably easier on the back anyways Good luck!

You have to prove a minimum level of capabilities, and I hardly think a 2.0 is unfair. Most nursing programs set a C at 80% and to get in you need above a 3.5... And please don't get offended and run off but a 2.0 seems like a great standard, as your spelling and grammar are leaving much to be desired right now. As an EMT you write legal documents for every call, this requires an ability to spell and use proper grammar.

How are lung sounds now after 2L of fluid?

well welcome back

http://www.allheart.com/3m-littmann-stethoscope/p/littmannlwt/ I've always had this one and I absolutely LOVE it... great sounds, it slides under a BP cuff nicely and works great even on my ped's patients... Also, Kiwi is right... no reason to auscultate through clothes

Maybe talking with a professional wouldn't be a bad idea?

I thought about this, but I feel like her pain would be sharper on inhalation when the diaphragm contracts... just like a torn calf muscle gets sharp pains when you try to use it... That would also cause acute epigastric pain and tenderness I believe? There's something we're not thinking of :/

I guess more of what I was getting at was that do you know what to feel for when palpating a liver? I would expect you to know which quadrant the patient is having pain in and what you've done for that pain...It's unrealistic in my opinion to ask an EMT or Medic to know how to palpate the abdomen to a doctors standards. It will also have minimal impact on your treatment in the field. With regards to the AAA, a light touch midline will reveal a pulsating mass or not, no need to do much more palpation that that. On the super skinny elderly, you should be able to palpate a pulse from the AAA and should correlate with their Apical pulse. I apologize if I seemed harsh with my comments, I'm just against causing more pain unless it's necessary, and in most cases in the field it won't change your management or transport criteria... Maybe one of the more experienced medics around here can help. I am absolutely for a thorough exam and learning as much as possible. What more is the hospital looking for other than LRQ pain, patient hx of general abd pain, n/v, possible appy... all of that can be done without causing further distress to the patient in the ambulance and increase their anxiety/pain level before the doc gets to see them. Edit to fix my tired spelling/grammar...

The BP is nagging at me now that I know the baseline... any orthostatic changes? Skin turgor? The BP just isn't sitting right. How is her mental status? The pain only on deep inspiration is changing my thinking of the atelectasis but I'm having a hard time thinking what else it could be. I'm really wanting new labs and a CXR but I know you don't have them. Ugh why couldn't the facility have just done a repeat CXR???