Diaphoresis

[uglyEMT]

Yes mobey as a B I am allowed Epi Pen auto injector. In it is Epinephrine at 0.3mg for adults and 0.15mg for children. It is used to counter the effects of a severe allergic reaction. In my protocols I can only administer if the patient is going into respiratory arrest or the tongue or throat is swelling and will occluded the airway. Before that its oxygen therapy and monitoring of vitals while transporting to nearest facility or to ALS (in my case with the closest hospital over 25 minutes away its always to ALS unless none are available.

After administration I would expect to see an increase in BP and heart rate, opening of the airway, reduced wheezing during occultation, and diaphoretic skin. I would also expect dilation of the pupils upon examination. If there was a skin reaction (hives) I would expect to see a decrease in the symptoms. The time until the effects of the Epi Pen wear off is around 15 minutes depending on severity of reaction. Upon contact with medical control we are, if advised, allowed to do a second injection. The second dose is rare. I haven't had MC allow it yet. Usually we have ALS onboard by that time and they do there thing with IVs and such or we are close enough to the ED that MC feels the second dose is unnecessary. The only caveat to the last statement is when we arrive and the person has already self administered their personal Epi Pen and the symptoms have remained or have returned, then if 15 minutes has passed we are allowed to issue our pen as if it is the original dose (ie offline MC) but document for ALS or ED that it is the second dose.

As far as the sympathetic and parasympathetic systems go all day today I have been reading up on them. Besides the usual fight or flight, feed and breed responses I am now learning more in depth about them. So far I have been looking at the sympathetic, I am getting my facts straight and trying to connect the dots between the system as a whole and what individual system responses are.

[fiznat]

next time someone tells you that you shouldn't be fucking around in areas 'over your head', because you don't belong there, or you won't need it, tell them to go piss up a rope.

I think this is a bit of a mis characterization of my post. What I said is that he is missing the forest for the trees. That is an accurate point, and I stand by the need to say it. The original post is a collection of copy and pasted Wikipedia article entries, which focus much more on esoteric detail than the greater picture. The OP can dive right into neurotransmitters if he wants, but I don't believe that starting at the microscopic level is really the most effective way to learn this lesson.

Keep in mind the original question was about a clinical symptom, not a biological process. The gap between those two perspectives can be extremely broad, and I think it was prudent to establish some groundwork before delving into a neurology lesson on an internet forum.

[Richard B the EMT]

Per the textbooks I used in training/refresher classes, and witnessed personally, sweating can be a diagnostic sign.

On the other side of the coin ,LACK of sweating, on warm or hot days, when accompanied by the patient having skin that is excessively warm to the touch, altered mental status, and possibly looking a bit red in the face (other than sunburn), is another diagnostic sign, in this instance, heat stroke.

[DwayneEMTP]

I think this is a bit of a mis characterization of my post. What I said is that he is missing the forest for the trees. That is an accurate point, and I stand by the need to say it. The original post is a collection of copy and pasted Wikipedia article entries, which focus much more on esoteric detail than the greater picture. The OP can dive right into neurotransmitters if he wants, but I don't believe that starting at the microscopic level is really the most effective way to learn this lesson.

Keep in mind the original question was about a clinical symptom, not a biological process. The gap between those two perspectives can be extremely broad, and I think it was prudent to establish some groundwork before delving into a neurology lesson on an internet forum.

Yeah man, fair enough. I'm afraid that I breezed over the posts, ran head on into his reply and then reread the posts in the context of him feeling put upon. This has been a weird week for me. I am lead medic on a project on "The Oil Spill" so have medics bounce in and out of here on a regular basis. It's been disheartening to find that the number one question that I answer from these medics is, "Do I get to put remote medic on my resume now??"

I actually had a kid tell a group of women that were all aflutter about the delivery of ones's child in the next few days, "You know, amniotic fluid is really just baby piss! So when you're water breaks, it's really like you pissing on yourself. No, really, it's the exact same thing!" So, not only was I really unhappy that he would say such a stupid thing to a woman about to deliver her first child, but I pulled him aside and said, "You don't really believe that, right? Tell me you don't believe that!" He said, "Don't you? It's the truth!"

I've been seriously considering if I really want to be associated with a profession that would allow such people to participate. It's disheartening sometimes to see that trying to be intelligent in EMS is a lot like washing your hands after you pee. As no one else does, it doesn't really matter. The first thing you touch is going to recontaminate you with all of their germs.

It's frustrating to know that no matter how hard I study, try to learn, try to mentor, no matter what example I try to set for the people that assign our contracts, it's all for nothing as the very next medic they speak to is going to show it all to be a lie. So I'm afraid that I got on the "Knowledge is power! How is anything going to change if we don't support the noobs!!" bandwagon and got all self righteous and colored you and Mobey's post in any context that I found necessary to attack something and jump up on my soab box. As two of about a dozen of my favorite posters here, I'm really sorry that I did that.

Rereading your posts, you are obviously correct. Taking the path that he had started down was certain to lead to confusion and frustration. My apologies for the undeserved generalization and criticism, as well as to all for ranting and raving in the middle of Ugly's thread without really thinking first.

Have a great day all!!

[Richard B the EMT]

Edited out, duped previouxs entry.

Edited January 21, 2011 by Richard B the EMT

[fiznat]

My apologies

Dude no problem at all, dont apologize! Lol I'd rather we fight about it than end up hugging and holding hands haha. Its more interesting that way.

I think there are a lot of good people on here with lots of different opinions and backgrounds. Threads like this get a good mixture of responses which I think usually cover everything that needs to be said. The OP got everything he needed, which was "DUDE WTF" (from me), "and we're here to help, start here" (from you). I think he needed to hear both!

Edited January 21, 2011 by fiznat

[NYCEMS9115]

Its like saying the severity of chest pains is proportionally related to the size of the infarct.

[DwayneEMTP]

Its like saying the severity of chest pains is proportionally related to the size of the infarct.

Yeah, that's a great analogy! This is a great subject/thread. I haven't had many spare minutes in the past few days, but I'm really looking forward to seeing, and hopefully participating in it moving forward!

Agree with the arguing/hand holding Fiz... :-) Threads where we agree are almost universally a waste of time.

I love that Mobey came back with an outstanding primer for what Ugly is looking for, and a great place to begin to build a more complex picture. I couldn't have done what he did, and that's embarrassing, as he's right, It's basic medicine and we should all know it off the tip of our tongue.

One of the many things that I love here, being reminded of what I don't know, or have forgotten, which allows me to remedy those things.

Dwayne

[NYCEMS9115]

Humility is enlightenment. I've learned that the hard way; in my whipper-snapper days......