Dispatched to 16 y/o F Unknown

[Niftymedi911]

Well, You can't always tell from the outside looking in, you would have to be there in that particular moment to understand, but that's why EMS is never the same twice. Unless you get that 3 am stubbed toe everyone seems to get.

Dust, sorry to jump and take offense to what you had said, but with me being new, I get the same thing from around here, I feel that most of the medics in the South either take advantage of me or mock me becuase of how young and "green" I am. I really am soo used to snapping back to show that I am not the tpye to push around or talk about behind my back. I don't tolerate it, I will let you know.

It's all Gavvvvvy Dust

I can also understand your side of the relm Dust. I could of very well did the transport. I knew it after I posted what I read. Sucks how you get so narrow minded sometimes. But hey, either way I was doing what was BEST for the pt I didn't kill her and that's what matters most right? Not how many letters you can fit after your name.

Being as young and new to being the Medic in charge as I am I felt what I did was in her best interest. With more experience and balls I would of probably handled the call in a much different way.

Either way I would still stand firm on my decision to fly her out, but I would never rule out transporting on my own.

[AnthonyM83]

I think the point is that if all you can think to give a patient in regards to oxygen is either 6 liters per minute or fifteen, you may want to pack a lunch while waiting for other providers to have confidence in you.

Did that ever end up getting explained to us?

[brentoli]

I think he skirted the actual question with some sort of rebuttal. No the actual rational behind that specific comment.

The only think I can think he meant would have been 6lpm via NC or 15lpm via NRB.

But still, anything more then whats needed to keep the bag inflated is wasting O2.

[Coop]

Well, this has been interesting reading. If this were me on the scene, I'd be calling a medic--I'm about 3 weeks away from finishing off my EMT-B course, but for purposes of this scenario, I'm assuming I pass. I've been running as an observer and driver for about 18 months. So there's my (in)experience caveat.

That said, a helo sounds excessive in this instance. At least in my area--we've got 3 hospitals within 15 mins. Actually, the only times I can think of a helo being suitable here (disclaimer about inexperience being noted) is if we had to send someone to a burn center or some other specialized facility (up to Hershey Med Center, down to Shock Trauma, whatever) where drive time would be putting the patient at undue risk.

If, in some unimaginable reality, the medic deigned to ask my input (other than "ya know where to hook these up?" for his leads), I'd tell him that the slamming heart rate doesn't look kosher (yeah, that's me: understatement of the obvious), and considering she's in high school, I'd be thinking she's on something. I mean, Hell... that's why they call it high school, ain't it?

Later!

--Coop

[scope2776]

The nurse is taken away in handcuffs by the police officer.

You elect to synchronize cardiovert anywhere between 50 to 100 j (your preference). A 12 Lead immediately after the cardioversion shows:

During transport you do another 12 lead, this is what you see:

Vitals: P: 100 and regular, R:20 and a little more relaxed, BP: 108/70.

Soon after you take the second 12 lead she complains of palpitations and you look over at the monitor and see this identical rhythm:

Vitals remain unchanged, RR increases slightly. No other complaints/changes. You are 5 min away from the ED. What next?

Would you have done anything differently looking back?

[Coop]

NB: I'd be calling the medic because they can push some drugs --and it's pretty clear she needs more than 02. Don't want to be accused of passing off my inexperience (although it exists) to them. Unless I'm reading WAY too into it (and I don't think I am) this is a bit more than a BLS call. If a medic was unavailable, I'd package her up and get to the closest ED while giving her 02 via NRB--and hope she doesn't fish out on me.

Then, I'd find out if my kids would be going to that high school and make sure the nurse was out of there by the time they came of age to attend. Paper bag. "Teach her a lesson." Egad. Come to think of it, I'd ask if the cop could taze the nurse.

And the principal: "Why aren't you listening to her (his nurse?)" I have an answer right here, on the tip of my tongue, but I'm fairly certain that giving it voice (while satisfying) would get me in a bit of trouble.

Later!

--Coop

[medic001918]

The nurse is taken away in handcuffs by the police officer.

You elect to synchronize cardiovert anywhere between 50 to 100 j (your preference). A 12 Lead immediately after the cardioversion shows:

During transport you do another 12 lead, this is what you see:

Vitals: P: 100 and regular, R:20 and a little more relaxed, BP: 108/70.

Soon after you take the second 12 lead she complains of palpitations and you look over at the monitor and see this identical rhythm:

Vitals remain unchanged, RR increases slightly. No other complaints/changes. You are 5 min away from the ED. What next?

Would you have done anything differently looking back?

If we're going to call this V-tach or even if we're still not sure of weather it's an SVT or V-tach it would have been appropriate to push a loading dose and initiate a drip for this patient of an antidisrythmic medication. Since it doesn't appear that we can conclude V-tach vs. SVT, amiodarone would be a good choice as it works on both atrial and ventricular pacemakers. After conversion, a loading dose of 150mg IVP over 10 minutes would be more than appropriate. If you're set that it's V-tach, then lidocaine would be appropriate. The second 12-lead posted looks to definatly be V-tach to me. So in that case either would work. A loading dose of 1 to 1.5 mg/kg IV followed by the appropriate maintainence infusion at 2-4 mg/min would work well.

Shane

NREMT-P

[p3medic]

The 12ld post conversion shows clear delta waves, this is WPW. I am sticking by the SVT with aberrancy theory. If I were to give an antiarrythmic, amio would be my choice, because its my only resonable option.

[AZCEP]

The additional ECG's confirm that this is NOT ventricular tachycardia. As P3medic related, this is WPW.

Amiodarone is the best option for emergent management, but with a five minute ETA if the patient can remain vitally stable we can justify close monitoring only.

[ERDoc]

Assuming I am finally in the right thread, this is WPW. Those are some nice looking delta waves on the 12 lead. I think she could use a little more electricity since she has gone back into SVT, but I would also be getting a drip ready since she seems to like to go into this rhythm and she is only going to let us electrocute her so many times (though it has been fun in a sick sort of way). We could always call for the helicopter so they can perform a field ablation on her accessory pathway.