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About 1EMT-P

  • Birthday 07/30/1971

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    Mid Atlantic
  • Interests
    Biking, Critical Care, Fishing, Outdoor Emergencies & Wilderness Medicine. Expanded Scope of Practice!

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  1. CHF & Low BP

    I seriously considered CPAP and also a trial of Dopamine, but after talking with the ED Physician I learned that they had tried CPAP and Dopamine in the past with this patient and that CPAP significantly increased his hypotension and that the Dopamine caused him to develop serious tachycardia.
  2. CHF & Low BP

    I was curious as to how the ED was going to manage this patient so I stayed to see what they did. The first thing they did was address his code status, then the Dr. ordered stat labs, a portable chest X-ray and a 12 Lead EKG which showed a SR with a 1st Degree AV Block. The Dr. ordered BiPAP in addition he also ordered Duo Neb treatments to be given to the patient. Plus he ordered 0.625 MG of Vasotec IV and he ordered an Echocardiogram at bedside.
  3. CHF & Low BP

    This patient proved to be a challenge, because of the fact that he had CHF and Pulmonary Edema. Normally we would have used CPAP along with Nitroglycerin, but given his low blood pressure those weren't viable options so I consulted with a Physician. The Physician ordered a 250 ML fluid bolus of 0.9% Sodium Chloride, following the fluid bolus then BP was 80/60, the Physician then ordered an additional 250 ML fluid bolus which brought the BP to 92/64 followed by 40 MG's of Lasix IV given slowly.
  4. CHF & Low BP

    So here is a case that I would like you to comment on. I was recently called for a 78 year old male complaining of shortness of breath & generalized weakness times three days. The patient was allergic to Penicillin & IVP Dye. Medications included ASA, Plavix, Zocor, Metformin, Lasix, Metoprolol, Digoxin, Proscar, Flow Max, Albuterol, Lantus & Magnesium. Past Medical History included AMI, CAD, CHF, COPD, Hypertension, Diabetes, Arthritis, Parkinson's VTach and ICD. Vitals were as follows BP 72/52, RR 24, Pulse Ox 88, SR with PVC's, Glucose 120. Assessment: Patient was alert & oriented to person, place & time, skin was pale, cool & dry, pupils were equal & reactive, + JVD, trachea was midline, lung sounds revealed crackles in the bases with some wheezing noted, abdomen was firm, CMS was intact & there was trace amounts of pedal edema. The patient denies any pain only increased shortness of breath and weakness. What is wrong? What should we do?
  5. Afib RVR

    I would have been reluctant to give ASA & Nitro to this patient. I would have been more inclined to administer either Amiodarone, Cardizem or Lopressor.
  6. Books Every Paramedic Student Should Read

    I would recommend Dr. Nancy Caroline, Bob Page, Dale Dublin, Dr. Bledsoe just to name a few.
  7. Spinal Restriction

    We still use backboards, but on a very limited basis. We primarily use them for auto extrication, cardiac arrests and severe trauma.
  8. Capnography

    When I first started in EMS we didn't have ETCO2 or Pulse Ox. I use both regularly in the field because they give me additional information. Micro stream technology is a wonderful tool!
  9. Capnography

    Off Label can you please explain why you feel that nasal ETCO2 is not a diagnostic tool in the non intubated patient, but that it is in the intubated patient.
  10. Capnography

    I can think of several types of patients who can appear fine, but when you assess their ETCO2 you could find problems including Asthma, COPD, CHF, Heroin Overdose, Sedation & Seizures just to name a few.
  11. I have seen Versed assisted intubation used in the past. They would apply both a nasal cannula & face mask connected to oxygen. Then they would place some Lidocaine in a small volume nebulizer to help blunt the cough & gag reflex. Then proceed with Versed usually 5mg IV (0.05mg/kg) titrated slowly every 5 minutes up to a maximum 0.1mg/kg. Then they would give Morphine usually 2mg IV every 5 minutes up to a maximum of 10mgs.
  12. Must Have IV & Monitor "Because Management Said So"

    If I were you, I would do a good assessment on every single patient & document your findings & your treatment. I also would ask for a copy of the policy & I would refuse to do any procedure which was not medically necessary. If the company is indeed billing for services at a higher level of care than is medically necessary, they could face an audit, fines & fraud charges.
  13. Capnography

    Spock, I totally agree with you on the nasal cap ETC02. I have seen the nasal capnography used on patients that looked totally fine, but when the nasal capnography was applied it revealed a serious issue. Thanks for sharing your case study. All the best,
  14. Video laryngoscopes

    I have tried most of the video based laryngoscopy devices, but to be honest with you none of the EMS agencies in my area currently carry the devices due. I have noticed that many of the Paramedics are using King Airways.
  15. Bougie Intubations

    When faced with a difficult airway there are a number of devices that can be used to improve your odds of securing the airway. If you are interested in learning some good airway techniques I would encourage everyone to check out the procedures section of http://emcrit.org/.