MedicEllis

We have had Lopressor for a while now. It replaced cardizem for Tx of AF w/ RVR. Cardizem in the powder form is not being produced any more and the mixed vial form can only be out of refrig for 30 days. I myself HATED to see such a good calcium channel blocker replaced by a beta blocker. Cardizem is the Tx choice for 90% of the AF pt with RVR and now we don't have it :? BUT now with STEMIs and reducing myocardial oxygen it is great, but as has been mentioned I think, there is no change in M/M. with that said, controlling hypertension in a AMI and decreasing myocardial oxygen demand can't be wrong....... One of the HUGH down sides to a beta blockers and specifically Lopressor is that it is a negative inoptrope along with being a negative chronotrope. AND in your AFIB pt that have CHF as a result of the ineffect cardiac output d/t the AFIB, Lopressor is counter-indicated!!! and thus why cardizem is superior. Also one of the hugh side effects to beta-blockers is it B2 effects in causing broncho-spams and must be carefully watched in your asthmatic and COPD pt. Peace

Yikes! q5 for a symptomatic bradycardia (that is 15 min at 1mg dosing and 30 min for .5mg dosing) that doesn't seem right and not anywhere what ACLS teaches. If you have a symptomatic pt, atropine should be/can be tried while TCP is readied. But I know of not a single protocol where should you wait 15 mins let alone 30 before you start TCP.

Yikes, not trying to be harsh here, but I know of no where in the US were SOB/DIB is considered BLS. EVEN if you suspect pneumonia. Granted 50%+ of the pneumonia pt I do transport (prob average 200+ a year) Get only a saline lock, and transport with standard ALS. That doesn't mean that these pt don't at least get a ALS assessment, with further Tx consideration (ie, albuterol/atrovent neb Tx, fluid bolus, IV Solu-medrol...ect) 100% of these pneumonia pt if they walked in (to the ER) get monitor and IV, chest xray, blood work along with supportive antibiotics (depending on there age PO or IV) and a good majority are admitted at least for a obs bed. With that said, why wouldn't you work these pt up (meaning full ALS)?

can I say AMEN!!!!! hypoxemia kills and hypercapnea does not I have always lived by this and always will. As for the call, from all the information you have given (and mind you I didn't assess the pt) you did fine and CPAP was not needed. With diff. breathers if you are having a hard Tx choice between CHF/Rales and COPD/Wheezing, pt Spo2/EtCo2 is fine and not showing respiratory failure, let the ER do there job with a chest x-ray and Tx decision based on that. If pt is stable and not decompensating CPAP would not be my 1st choice on this call. I may have choose to give the pt a neb Tx or two based on physcial exam, PMHx and Hx of current illness (ie, not sudden onset, fever/chills, sputum production, Hx of pneumonia in the past).

I will throw my two cents out the window here. I think we tend to over think situations in EMS. As Medics and EMTs we are recipients of alot of information that we are to use in any numerous situations, and as recipients of this wonderful information we want to use it on ever single call, when there is usually a simple answer bitting us in our well intentioned buttocks. As the provider in charge why would you let uninvolved bystanders get involved and start debating anything? That is insane to think anyone (EMT or Medic) to allow this to happen. 1st and foremost you have to control the scene you are on, if you cant then you need to call someone who can, which ends up being law enforcement 95% of the time, to help with control. There is a simple answer here, you split resources and deal with the situation at hand. One person (with which I assume have trained FF on scene assisting) package/backboard the pt that was struck by the vehicle and send your partner over to assess/Tx the pediatric patient. Very simple, most probably the pediatric doesn't need to be transport and needs some wound/bleeding control and some PFA to the parents. Once that is accomplished if the parents still want transport then, it is very simple to have the parents sit in the jump seat, ped pt on the bench seat and pedestrian on the cot, with full immobilization. We don't live in a controlled environment and certainly need to make decisions on what is best for the pt/pt's. If you life by this golden rule you will never loss any sleep and most important you will be able to defend yourself against boss's galore as well as those lawyers who want to complain about malpractice. peace