Shock Position - Research Help Request for Protocols

[Scaramedic]

...75 year old patient to the hospital whose lungs were wet bilaterally and a BP of 7030.

...Being a Basic/Basic crew...

...Pulse Oximeter said 42%.

...after 40mg of Lasix...

[captainstandup]

I'm confused, can a basic there admin lasix? Whats his heart rate and rhythm? If this isnt the problem he needs dopamine or dobutrex now! Depending on the degree of chf he may be able to o He is screaming for CPAP and perhaps intubation soon. I hope he already has a NRB on at about a million liters per min.

[AnthonyM83]

The problem is by not understanding HOW trendelenburg works, the partner doesn't understand why the two positions are mutually exclusive. Hence cookbook teaching [see x, do A because A couteracts X, but we won't tell you why].

I'm not sure if he truly didn't understand. IN THEORY, IF TRENELENBURG WORKS, basically, the blood is shifted in the direction of the lower extremities, of gravity. Having patient seated all the way up was in effect a reverse shock position. He tried to counteract the blood "pooling" in the legs (we're talking theory, here) by elevating the legs. In theory, that at least partially undo the damage of the "reverse shock position" the patient was in from the high Fowler's position.

Obviously, you can get carried away with the theory and end up looking silly when you wheel your patient in, but as far as understanding what each position was for, I don't see how we can assume he didn't understand from the story you gave....

PS could we create a new thread for this new discussion Admin? I really want to keep my original post uncluttered...I'm having trouble getting replies...

[EchoDBravo]

The call was dispatched as "7x year old female circling the drain per caller nothing further". we get on scene, home health nurse who was friend of the family was there, decided before our arrival to give 40mg lasix. She was normally on Nasal Cannula at 2LPM Liquid O2. Nurse put a NRB on the patient. And kept it at 2LPM because she 'didn't have orders for anything more'. Put her on pulse ox, 42%. Rhythm A-Fib at 110. Don't know how long patient was being suffocated by No-Flow 02 via NRB. We transport Signal 9 to Hospital. Sp02 still in the 40's with good waveform on hospital Oximeter. Respiratory went :-k :-k :-k . CPAP followed shortly thereafter.

No, BasicBasic crews cannot give lasix. I just didnt tell the whole story.

Basic's can use King Airway, ASA, NTG, Albuterol. All ambulances, whether BLS or ALS have a lifepak 12 with Sp02 and NIBP. New things coming: option to take a class on EKG monitoring and interpretation of basic rhythms, with exhibition of competency to medical director for clearance to use the EKG.

[Dustdevil]

[Ridryder 911]

Basic's can use King Airway, ASA, NTG, Albuterol. All ambulances, whether BLS or ALS have a lifepak 12 with Sp02 and NIBP. New things coming: option to take a class on EKG monitoring and interpretation of basic rhythms, with exhibition of competency to medical director for clearance to use the EKG.

To just to think EMS could not get any worse? For every one step we go forward, we take ten giant leaps backward.

R/r 911

[tniuqs]

I transported a 75 year old patient to the hospital whose lungs were wet bilaterally and a BP of 7030. Being a Basic/Basic crew, and transport time of about 4 minutes, ALS intercept would be out of the question. It was my partner's turn to give patient care. He first sat her all the way up, which helped her breathing. All the way to the hospital the Pulse Oximeter said 42%. Even on a NRB @ 15 LPM and after 40mg of Lasix, SpO2 readout did not change.

Ok well I have to jump in here, sorry but your pulse ox is telling you diddly, 48% ???

Best look on the ODC to figure out where your PO2's are at.....maybe around 28 to 32 mmhg, so if your patient is still awake this is telling you more than the machine.

Point being your Pulse ox is useless when patients are in Hypotensive states, and look for correlation of pulse ox to pulse.

At a BP of 70/30 doubtful that the kidneys are perfused as well so lasix is a waste of time too, one has to support BP with tropes in this situation, position (even the sleeping bat position) will not help you/ your patient.

cheers

[ERDoc]

In a feeble attempt to get us back on track:

http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus

http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus

[Ridryder 911]

Okay another myth that just won't die .. Why do we in EMS prefer to ignore studies after studies, because this was something that was performed over decades without any proof?

We have discussed this and many others, that we have attempted to end. Bledsoe has written multiple articles, describing the scientific and anecdotal reports on how it is not effective and possibly even harmful... yet, some continue. Maybe stretcher makers should be required to totally remove the ability to have the trendelenburg position, then possibly we could remove the "myth"...

[AnthonyM83]

Partially, I think it's because there are so many studies that have wishy washy conclusions are or it does work for half the patients...at least that's what I got out of the previous shock thread and the lack of posts in this one (right up to ERDoc one's...that has some stuff I haven't seen).