Strange days are upon us...

[Eydawn]

I would never have thought of that effect with regard to lung inflation. Whoa! That had to be trippy.

Excellent thread, Chbare!

Wendy

CO EMT-B

[Kiwiology]

Thanks mate, you do post such interesting scenarios

[speedygodzilla]

Thanks chbare for making us think. It really make sense after your explanation and art work.

Have a great EMS Week

[chbare]

Thanks, I am glad you guys enjoyed this one.

Take care,

chbare.

[armymedic571]

CH,

Most excellent art work. Great scenario.....

J

[Niftymedi911]

Since we are on this topic. Does anyone else use Etomidate?

Not only does it have a rapid onset (1-2 minutes), but it has a shortn half life (3-5 minutes) for those fearing Trismus.

I understand correctly. Can't Etomidate inadvertently reduce ICP??? I am not 100% as to it's mechanism of action.

We have a CAM/DAI (Crash Airway Managment/ Drug Assisted Intubation) Protocol here. It entails the use of Etomidate and Succs in cocktail fasion. We also have a Fentanyl, Ativan, Versed cocktail for sedation in post-DAI intubations. The etomidate has been shown to reverse the ICP caused by direct largynscopy. It is an awesome tool when used properly and followed through flawlessly. We used to have Diprivan for post-intubation sedation, but too many people were finger flicking the doseages instead of using an IV pump, causing Diprivan dumps..... a no, no.

Here's a copy of our Medical Guidelines:

http://internet.lee-ems.com/intranet/EMS/pub/doc/2010/1/20100111103119_publication.pdf

[Mateo_1387]

Aw sweet does this mean Ima finally be on COPS

Damn dudes lets have a chillax and see what we are working with eh? Sounds like a plan to me!

Log roll and collar, scoop, move to the ambulance.

Basic vitals (BP/HR/RR/SPO2/GCS/ECG) and exam, expose, good look at pelvis and abdo.

Oxygen NRB @ 10 LPM

IV access

Traction splint broken leg

I realize you write splinting at the bottom of the list, but our newer members should be told that the bilateral femur fractures are not the main concerns of this patient, although they are probably contributing to the hypotension. This patient needs aggressive airway control, aggressive control of circulatory status, and transport to a trauma center. As described by chbare, this patient is a critical patient. Although the femurs will need attention, they will take a low priority in our facet of care. I am not harping on you Kiwi, just trying to point something out to remind others. It is something we all must learn/have learned that we have to respond to the call and emergencies presented to us, not react to the scene, family, or injuries presented to us.

Chbare, thanks for the scenario, I found it quite interesting.