Just Plain Ruff Posted February 27, 2007 Posted February 27, 2007 Firefighter523 I'm calling you out. I do not believe you are a medic. I think you are reading your treatments out of a textbook Nothing in your posts have proven that you are a medic. I think you are overstating your level of competency Prove that you are a medic. Several people including myself have asked how long you have been a medic and you have refused to answer but you continue to quote textbook responses. time to put up or shut up.
scratrat Posted February 27, 2007 Posted February 27, 2007 Scrat..... Um lets see, if you don't see p waves, (you didn't specify) and this person was 70 years or older, and was wheezing, yes I would give adenosine. Only, if you can answer (correctly) this rational, please reply, if not, don't waste my time!!!) Ok, my bad. That was an EXAMPLE. Judging from your replies, you infer that if someone has a tachydysrthymia, no matter what, you would correct the rhythm first. But you are still not answering the correct modality. If he's wheezing, why give adenosine assuming there are in fact discernable P waves? Wouldn't want to start with B before C? You know, breathing? Anyway, I'm done with you because obviously you can't have a conversation without getting all pissed off and derogatory. Here's a website you should check out. www.hpso.com They sell reasonably cheap malpractice insurance for EMT's and paramedics, I think it'd be a good investment for you.
Thunderchild145 Posted February 27, 2007 Posted February 27, 2007 Beleive the OP said it was irregular and the patient has a history of A-Fib. The "textbook" response is not going to be adenosine. It's going to be diltiazem and clenching your asscheeks and hoping they dont throw a clot. But once again, I'd be a fan of improving the hypoxemia first.
scratrat Posted February 27, 2007 Posted February 27, 2007 Beleive the OP said it was irregular and the patient has a history of A-Fib. The "textbook" response is not going to be adenosine. It's going to be diltiazem and clenching your asscheeks and hoping they dont throw a clot. But once again, I'd be a fan of improving the hypoxemia first. Thunder, sorry for the confusion. I wasn't referring to this post, I was using another example just for poops and giggles. I didn't mean the one originally in this post. I just threw a quick one out there to get to the point I was trying to make.
ERDoc Posted February 27, 2007 Posted February 27, 2007 Let's face it, in medicine there is no one correct way to handle things. This case probably has at least 3 different ways to treat (though some only recognize one). Cardioversion is one possibility and for those that worship ACLS religiously is probably the right answer. Cardizem is another option that would probably work. I would probably push some CaCl with it. Obviously, treating the lungs works also. Certain people need to realize that our pts are not multiple choice tests with one correct answer. I think that is one of biggest problems people are having with Fire is the fact that he is not willing to accept that there may be a different, but not necessarily better, answer. Personally, I had a problem with him forcing his will on his pts against their wishes. There is an old saying that says if you put 10 doctors in a room and ask for how to best treat a pt you will get 15 answers. I think this is a prime example of how true that it.
scratrat Posted February 27, 2007 Posted February 27, 2007 Let's face it, in medicine there is no one correct way to handle things. This case probably has at least 3 different ways to treat (though some only recognize one). Cardioversion is one possibility and for those that worship ACLS religiously is probably the right answer. Cardizem is another option that would probably work. I would probably push some CaCl with it. Obviously, treating the lungs works also. Certain people need to realize that our pts are not multiple choice tests with one correct answer. I think that is one of biggest problems people are having with Fire is the fact that he is not willing to accept that there may be a different, but not necessarily better, answer. Personally, I had a problem with him forcing his will on his pts against their wishes. There is an old saying that says if you put 10 doctors in a room and ask for how to best treat a pt you will get 15 answers. I think this is a prime example of how true that it. I think that's where the tread went to crap Doc. The forcefull part was the biggest issue I think everyone shared.
Ridryder 911 Posted February 27, 2007 Posted February 27, 2007 Here I'll sum it up.. wannabe! Period. As ERdoc discussed, those with clinical knowledge realizes there was more tan one correct way to treat this scenario all dependent on the patient clinical findings at the time. Those that have any experience and know more than the typical watered down ACLS realizes this. This is why the more experience providers avoided this thread. R/r 911
firefighter523 Posted February 27, 2007 Posted February 27, 2007 Thunder, if you can't discern if it is reg or not, and the pt is stable, you need to give adenosine first to slow it down to see if it is reg (SVT) or irreg fib or flutter. If you call medical control, they will tell you that also. If you give CCB to a reg SVT it could have disasterous effects. I definately agree with the profilactic CaCl before the CCB. Ruff, I thought I said don't respond to me unless you have the right anwer for my question. Not only have you perfected your mistakes for 15 years, but you can't follow directions either!! Stop crying that I offended you!! It is almost as bad as Rid's gloating!!! Bye, bye sweet pea!!
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