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Fuckwits ... absolute fuckwits. I disclaim little knowledge of tracheostomy care or maintenance but even me, who is dumb as a box of rocks, knows better not to tape the thing.
I wonder why they taped it to begin with and what they were trying to achieve?
I can understand if they were administering positive pressure ventilation for example then occluding the trach would be beneficial to create a closed ventilation circuit but in the absence of this .... WHAT THE HELL MAN?
Looks like this might be a legit win of the lawsuit lottery.
Put him on 100% oxygen and see if that fixes his SpO2.
If not and he won't take an OPA then call for an RSI capable Officer provided they can locate significantly faster than we can take him on to hospital; unless backup is very close (a few minutes away) I'd take him to the hospital.
The VT could be hypoxia related; see if some oxygen fixes it to start with.
There is good evidence that clinical people administer adrenaline for anaphylaxis poorly; i.e. not giving it at all, giving too much or too little, not giving it frequently enough, giving it too frequently or giving it by a suboptimal route e.g. SQ.
There is also good evidence that adverse effects of adrenaline is isolated to supratherapeutic IV dosing.
Early and appropriate administration of adrenaline is the cornerstone of treatment for anaphylaxis. All the other stuff like steroids and antihistamines are not well supported by the literature.
Give patients > 50kg 0.3 mg of IM adrenaline early and give another 0.3 mg in 5-10 minutes if the patient has not significantly improved.
There seems to be a bit of irrational fear about giving people adrenaline, particularly if they are older or they have cardiac disease. Well, there is nothing to fear, the balance of risk is always going to be in favour of administering adrenaline.
I wish I'd known how much sleeping at night was taken for granted.
... and that when ERDoc said he'd take me out for dinner and a movie he really meant Dennys on Plainfield and back to his rent-by-the-hour motel on 28th St to watch something from the $1/day bin at Snuff Bunker; the adult subsidiary of Blockbuster.
Could have been worse, could have been at Billy Bob's place out on County Road 309 down past the Glumpkin residence. That would have meant at least 3 volunteer "First Responders" showed up in their cars/pickup trucks each with 100 lb jump bags, the local volunteer Fire Department would have also come plus an ambulance or two, and because "it looked real bad" somebody would have responded a helicopter ... and all of this is not including the bevy of neighbours who would have come to help out, one of whom would have been a nursing aid and wanted to do an immediate cricothyrotomy.
Now if you'll excuse me, I have to go ensure that County Road 309 has been closed, I hear the helicopter getting close and they are always so fussy about having a suitable area to land.
Overall they offer a level of care that is no higher than your average American jurisdiction with a Medical Director who is not a muppet.
They utilise the local fire department for rapid automated defibrillation - nothing different than is already done with, for example the New Zealand Fire Service or the Metropolitan Fire Brigade and County Fire Authority in VIctoria.
They go on about survival to discharge for witnessed VF (and I think VT) only - well big shit, that's very selective reporting of the best possible data.
Forty years ago Dr Leonard Cobb and Gordon Vickery set up what was, at the time, a great system for the best possible chances of surviving a cardiac arrest.
It's now forty years later and survival from cardiac arrest pales compared to all the other things which have become important yet it's all they seem to focus on.
If as much effort was put into the 99% of patients who are not in cardiac arrest as to the 1% who are then who knows where things would be, and Medic One probably wouldn't be able to keep up their hot air filled reputation.
And yes, when I visit Seattle if somebody has a cardiac arrest infront of me I'll probably call Medic One ... maybe, if the Lifepak 10 in my rental car don't fix 'em up :D
Hi mate, you would have to go down the International route with HCPC which shouldn't be too hard plus you have an EU passport so no visa worries, but, do you really want to work in the UK? It rains a lot and they are a tad limited (although small moves are being made to address that) ... I would rather stay on the continent and work in one of the Doctor/Paramedic systems.