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Quakefire

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About Quakefire

  • Birthday 07/13/1987

Previous Fields

  • Occupation Advanced Care Paramedic

Contact Methods

  • ICQ 0

Profile Information

  • Gender Male
  • Location Saskatchewan

Quakefire's Activity

  1. Quakefire added a post in a topic Fall Not Acting Appropriately   

    This is only the second patient I have encountered with an acute inferior MI, last one was declining very rapidly so I was being cautious with anything that might cause hemodynamic compromise, this in addition to the fact that when asked the patient stated she has never had morphine before. As a side note, I never placed defib pads on this patient. I explained to her what was happening and what might have to happen, but she was quite anxious and I had very quick access to our monitor so I felt that any decrease in her anxiety was also a good thing. I doubt that I would have had to pace her at any point, as she is far more likely to progress into a vfib.
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  2. Quakefire added a post in a topic Fall Not Acting Appropriately   

    Our treatment was pretty simple. I cheated a little bit with the ECG's, the first 3-lead and the first 12 lead are 10 minutes apart, the second 3 lead was 7 minutes after that and the final 12 lead was 30 minutes after the initial 12 lead.

    ASA, O2 with nasal cannula at 4lpm, 18g IV with NS TKO. I gave two 2mg doses of Morphine about 15 minutes apart being mindful of her BP which didn't change for us. This only dropped her pain to a 5/10

    I really don't see this patient as a symptomatic bradycardia as the lethargy was consistent with her normal use of the sleep aid (Zopiclone). The main issue I have with using dopamine is the inotropic and chronotropic effects on the heart. I dont want to make a damaged heart work harder (plus dopamine isnt in our protocol for that) Nitro is contraindicated in this patient as per our protocols.

    Pt maintained her GCS, BP and vitals throughout the transport to the recieving hospital and into the cath lab 10 minutes later. Pt had a 100% occlusion of the RCA, once cleared and stented the 3rd degree AV block resolved and the patient left the CCU into a cardiac ward within 3 days.

    Thanks for playing!
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  3. Quakefire added a post in a topic Fall Not Acting Appropriately   

    Follow up 12 lead and 3 lead after ASA, Morphine, O2

    Edit for Vitals: No change in vitals, pulse remains 45, BP 124/68 RR 18, SpO2 98% Pain 5/10 after 4mg Morphine IVP

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  4. Quakefire added a post in a topic Fall Not Acting Appropriately   

    I did see that, just looking for a diagnosis from that.

    Any further treatment?
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  5. Quakefire added a post in a topic Fall Not Acting Appropriately   

    Ok, to consolidate everyones treatment

    We are now enroute to the Cardiac Center, about 40 minutes transport, we have O2, a NS line, 3-lead and 12 lead, and quick combos in place. STEMI alert has been called.

    Haven't seen a interpretation of the 3-lead, and no one has has actually said what kind of MI the 12 lead shows

    And just you in the back, in the event that she goes into arrest, you have access to a Zoll Autopulse.
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  6. Quakefire added a post in a topic Fall Not Acting Appropriately   

    The fall as described to dispatch was when the patient dropped herself onto the bed, no syncope. No prehospital fibrolytics yet supposed to be in the pipeline. Also no pressors except for severe sepsis


    Home hospital is 20 minutes away, Lab, X-Ray, ECG

    "Big City Hospital" is 40 minutes away, Cardiac specialty, Cath lab, Cardiac Sx and CCU. This hospital has a STEMI alert protocol

    Of course two hospitals are in opposite directions so transfer time is 60min. Rotary wing is not available at this time
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  7. Quakefire added a post in a topic Fall Not Acting Appropriately   



    Oh and here is the requested 3-lead and 12-lead


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  8. Quakefire added a post in a topic Canadian ACP programs   

    I went to SIAST as a Sask trained and registered PCP for my Advanced care Paramedic. I had two PCP's from BC in my class who had issues with the JI because of the strike. Both passed one is employed with BCAS the other stayed in Saskatchewan. As the courses and their content is always changing I can't comment specifically to the course now except that it is still a CMA accredited program.

    As HellsBells stated SIAST is a full time program M-F 9-4:30 in either Regina or Saskatoon with class sizes of about 30, Practicum placements throughout the province. minimum requirements are listed in the course info. Passing requires passing the course as well as your practicum which is up to your preceptors and practicum coordinator. As for a lack of a strict selection process, students tend to get weeded out by exams and through practicum, no one is guaranteed a pass
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  9. Quakefire added a post in a topic Fall Not Acting Appropriately   

    No allergies known, Zopiclone is a PRN medication but no excessive amount of medication is missing from the bottle (not empty and refilled two days ago kinda thing) Dose taken is normal and listed on bottle.

    Fall described as "plop" on the bed

    BGL 6.8 mmol/L (122.4 mg/dL)
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  10. Quakefire added a post in a topic Peds pads and Zoll defib   

    It sounds like only the newer style AEDs and possibly the R-Series are capable of determining what pads are attached to the monitor
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  11. Quakefire added a post in a topic Fall Not Acting Appropriately   

    Daughter stated that the somnolence and CNS presentation is normal for patient when on this medication. I will post a 3 and a 12 lead in the morning probably because I don't have them with me at the moment Sent from my iPhone using Tapatalk
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  12. Quakefire added a post in a topic Fall Not Acting Appropriately   

    When you arrive the patients husband leads you in, the patient is sitting on the couch, appears quite lethargic, able to answer questions, but sometimes requires question to be asked several times, answers are short and slow. States dizzy when standing and walking, had to crawl up stairs to bedroom to wake husband, states plopped onto bed. No memory problems or dysphagia.

    Pt. states took 1 and a half 7.5mg Zopiclone tablets at approximately 21:30 and fell asleep on the couch. Pt, was woken up by 6/10 substernal chest pain, with both arms painful and numb. This was around 0100, family took about an hour to decide to call for an ambulance. No syncopal episodes prior to EMS arrival

    PMHx: HTN (Irbesartan), Hypothyroid (synthroid), hasnt taken meds since Saturday morning. Smokes approximately 1/2 pack a day

    Vitals: Pulse 48, BP 126/62, Resp Rate 18, SpO2 98% Pupils ERL

    Onset 0100
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  13. Quakefire added a post in a topic Canadian ACP programs   

    Just wondering what your looking for, with a bit more information about your goals we can provide you with much better information


    Dan
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  14. Quakefire added a topic in Scenarios   

    Fall Not Acting Appropriately
    Dispatched for 53 y/o Female pt. Fall not acting appropriately
    Time of Call 02:00 am Monday Morning

    You work for a rural ambulance service home hospital has basic emergency room with X-ray and labwork, time to scene approximately 20 minutes

    Dispatch info updated 15 minutes into response, Pt now has CP

    This scenario starts from arriving on scene
    • 27 replies
    • 1,991 views
  15. Quakefire added a post in a topic First Mobile Stroke Unit in the United States!   

    Video on the manufacturer website (frazerbilt) says MD, CT Tech, RN and Paramedic on the car. Seeks like a waste of a Paramedic just to sit there and drive. CT and tPA in the driveway prior to transport to stroke center. Give it a few years to find out if they increase survivabilty rates or how close they come to "ideal" outcomes before we can see how effective this is. I was under the understanding that tPA is not the safest drug in the first place, so I wonder how well a "standard" ambulance with a CT scanner in the back can handle those complications.
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