Kiwiology Posted November 23, 2009 Posted November 23, 2009 I tend to simplify it, is it stable or unstable? Stable use drugs, unstable- cook em, or cardiovert. You're an idiot. Such a broad statement is quite inappropriate and reflects poorly upon you as a provider. If the patient is stable and tolerating the rhythm quite well then why give drugs (atropine/adrenaline or adenosine/amiodarone) at all? Why do ambos have to think because they have a lot of kit in thier bag they have to use it? However acting without considering the big picture or causes that can be corrected or treated is myopic and potentially harmful IMHO. If this were a post resus renal failure patient who missed dialysis for a week, would your treatment modalities be different? Treating patients with blanket statements in a vacuum should be avoided if at all possible. This is why I continue to question patient history. A simple cardiovert/no cardiovert scenario is meaningless without history and additional considerations. I agree with you there mate; best plan of action is to treat the underlying problem vs the symptom of a dysrhythmia. In this case a little nebulised salbutamol and a quick trip to the hospital is in order! 1
chbare Posted November 23, 2009 Posted November 23, 2009 You're an idiot. Such a broad statement is quite inappropriate and reflects poorly upon you as a provider. I am not sure I would call somebody an idiot without definitive supporting evidence. Unfortunately, I find many paramedics are taught the exact phrase quoted. Stable = drugs and unstable = electricity. While it is partially true, many providers are not educated to look at the big picture and try to connect dots. Take care, chbare.
tniuqs Posted November 23, 2009 Posted November 23, 2009 I am not sure I would call somebody an idiot without definitive supporting evidence. chbare. EMS rule #5 = Assume all are idiots till proven otherwise .... The point being is anyone can parrot the ACLS paint by numbers cook book (this is a silly what if scenario in the first place IMHO) I am an true idiot to post it appears "WHAT IF SCENARIO" it took an entire page before that came to light. I have personally converted SVT or Narrow Complex Tachycardias refractory to Antiarrhythmic rx x 2 flavours, just with Fentanyl the patient was in an simply an adrenergic response because she had been cardioverted without sedation by a resident idiot prior. On one occasion converted SVT with a 400 mls of N/S ... one HAS to have a history of some sort before asking the wide open question what would you do, its a trap with no escape. ie as I tried to suggest in a previous post .... maybe I should go back to that Mail Older Bride again. cheers
CBEMT Posted November 25, 2009 Posted November 25, 2009 I tend to simplify it, is it stable or unstable? Stable use drugs, unstable- cook em, or cardiovert. You're an idiot. Such a broad statement is quite inappropriate and reflects poorly upon you as a provider. I've seen our ER bolus Amiodarone into an elderly male with sudden onset of VT (sudden as in, he was NSR in the truck, VT in the room) and a BP of 60. By my protocols, that defines him as unstable and requires cardioversion. Where I'm going with this is, we may not all have a choice in the matter. I would think that tends to breed the kind of either-or thinking that medic82942003 seems to have. (Ps- would have I have cardioverted the patient I mentioned? No, because he was wide awake and would have obviously required sedation- medications for which we did not carry at that service. So we were up a creek either way.)
medic82942003 Posted December 6, 2009 Posted December 6, 2009 (edited) Well So you called me a idiot- so what. I have been called worse. The Stable or unstable is just a protocol. I tend to oversimplfy my protocols. Every pt is different. You have to take in account History, Meds, allergies ect ect. Asking opinions on a scenario is training. Just to call someone a idiot because you dont agree is a bit much. But everyone is entitled to their opinion. When I am working and I hear other medics talking trash about a call that they heard about. I ask them, were you there? no then shut up. Well So you called me a idiot- so what. I have been called worse. The Stable or unstable is just a protocol. I tend to oversimplfy my protocols. Every pt is different. You have to take in account History, Meds, allergies ect ect. Asking opinions on a scenario is training. Just to call someone a idiot because you dont agree is a bit much. But everyone is entitled to their opinion. When I am working and I hear other medics talking trash about a call that they heard about. I ask them, were you there? no then shut up. Also I can handle being called a idiot, but call me a poo-poo head or something serious then we'd have a problem. Now if someone called me a poo-poo head or a farty face- then thems fighting words. Then I would get mad. But idiot. that has a nice ring to it. Edited December 6, 2009 by medic82942003
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