A very short scenario...

[firefighter523]

Dwayne, you gave a piss pore history, but if the person is lying on the floor starving for air, and STILL BREATHING, but very tight, you need to SIT HIM UP, give in albuterol, so he starts to move some air, if it is CHF, then you should lower his BP with nitrates, and place him on CPAP. If he is unconcious, barely breathing, you should intubate him, (watch out for the pink frothy sputum that might spout out the tube like old faithful and breath for him, and give him some lasix. If it is not a respiratory issue, you NEEEEEEEEDDDD to get a BGL and treat that if need be, and then if that is not the issue you need to take a look and any meds that he or she is taking, posible OD, and then look for any electrolyte showings on a 12 lead and treat them. This is why you need to have another medic with you, sometimes you can't but it would be nice. I just had this type of call today, and all those things got accomplished , but it turned out to be just plain old respiratory arrest from a long hx of COPD.

[Kaisu]

Dwayne, you gave a piss pore history,.

Did you read the original premise of the scenario? Did you read any of the responses? You missed the whole game bud.....

[EMT City Administrator]

Back on track please. No name calling. Not sure how to post? Read the rules.

http://www.emtcity.com/phpBB2/siterules.php

Thanks

Admin

[Dustdevil]

I didn't say that anybody's treatment was right or wrong. That was all determined before I ever even saw this thread, so it's a moot point. It's very convenient for you to come along after somebody else has made the proper diagnosis and claim that you knew it all along, while calling everybody else names that they do not deserve. But we're all still waiting for you to dazzle us with some real demonstration of knowledge or competence here before we start giving you any professional labels. So far, you fail.

You did not make any effort whatsoever to address your nonsense to anyone specifically. And by mentioning only Dwayne's name, you came across as laying all that crap on him personally, which was either very poor manners, or poor communications. Either way, you would do well to put more effort into that. Until then, your reputation stands the same as it did from your very first posts here; nothing but that of an immature and bitter instigator, with poor social and communicative skills, and nothing of medical, professional, or intellectual value to contribute to any discussion, seeking only to create drama for your own self-aggrandising amusement. Congratulations; you succeed.

[Just Plain Ruff]

oh my gosh, not this again.

[DwayneEMTP]

Dwayne, you gave a piss pore history, but if the person is lying on the floor starving for air, and STILL BREATHING, but very tight, you need to SIT HIM UP, give in albuterol, so he starts to move some air,

I'm thinking that with lung sounds absent, and obvious cyanosis he's not moving much air, which I was taught was useful if you wanted decent returns on your albuterol investment.

Also, I guess I missed the part in class where they explained pneumothorax as an indication for albuterol. I'll try and stay awake my next time through medic school.

By the way, he's still dead.

if it is CHF, then you should lower his BP with nitrates, and place him on CPAP. If he is unconcious, barely breathing, you should intubate him, (watch out for the pink frothy sputum that might spout out the tube like old faithful and breath for him, and give him some lasix.

Dead.

If it is not a respiratory issue, you NEEEEEEEEDDDD to get a BGL and treat that if need be, and then if that is not the issue you need to take a look and any meds that he or she is taking, posible OD, and then look for any electrolyte showings on a 12 lead and treat them.

Dead.

This is why you need to have another medic with you, sometimes you can't but it would be nice. I just had this type of call today, and all those things got accomplished , but it turned out to be just plain old respiratory arrest from a long hx of COPD.

I'm glad you got all those things done. But you failed to mention decompression here....dead.

I do like the way you think, and appreciate you pointing out the many possibilities for this patient. But for the sake of this scenario, it sounds like you guys were very efficient on your patient...but if your patient had been THIS patient...he would now be dead and unable to appreciate your impressive list of differentials and treatments.

It doesn't really matter if you are completely correct on a lot of things if you're just a little bit wrong on this one thing....I'm just sayin'.

Dwayne

[spenac]

Dwayne thanks for a very professional response to a very un-professional attack. May we all learn from this and treat each other with more respect.

[firefighter523]

Dwayne, you've indicated that his BP was not known. First... That was the crucial vital sign that you missed and before all else, if you suspected that it was a tension, you should have obtained ATLEAST that, as well as a good spo2 reading ON high flow 02. The only way to differentiate a pulmonary contusion, and tension pneumo is a chest x ray, as well as ( A hypotensive pt with an altered mental status, with a history of chest trauma , and absent lung sounds with a pulse ox of less than 90%) Not to say that if it is a pulmonary contusion, it will most likly turn into a simple pnuemo, but by the time that happens , they should be in the ED!!) LET ME SAY THIS TO YOU AGAIN, AND THIS IS WHERE THE POOR HISTORY COMES IN, you have indicated that this pt has a STRONG and FULL pulse, I would guess that STRONG and FULL probably means that he is NOT hypotensive. So until, you can give a better hx of a pt, expect some answers that you don't like in return!! Treat people like they deserve to be treated, you DO NOT decompress a person whose sats and BP are above 90!!!!!! PERIOD!!!!

[spenac]

you DO NOT decompress a person whose sats and BP are above 90!!!!!! PERIOD!!!!

I completely disagree. If you wait till they are in worse condition before decompression you are playing catch up. As soon as you recognize the threat to the respiratory system you should decompress. Failing to treat aggressively could cost your patients life.

[p3medic]

:shock: I'm almost speachless, almost. The only way to differentiate a pulmonary contusion from tension ptx is cxr? You don't have a clue kid. Pulse oximetry isn't a diagnostic test that proves or disproves tension. Do you even know how a pulse oximiter works? Do you wait until the sat is 89 and the bp is 89 before decompression? What happens to the physiology at 89 that doesn't at 90? You really ought to seek out some education and professional help before jumping down someones throat. Have a nice day, I think you should stick to fighting dumpster fires and rescuing cats from trees.