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About 1EMT-P

  • Birthday 07/30/1971

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

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  1. 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.
  2. 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.
  3. 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?
  4. 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.
  5. I would recommend Dr. Nancy Caroline, Bob Page, Dale Dublin, Dr. Bledsoe just to name a few.
  6. We still use backboards, but on a very limited basis. We primarily use them for auto extrication, cardiac arrests and severe trauma.
  7. The facilities that I have worked at all had fluid warmers that were set to 100 F.
  8. Hey how you? It's been a while... I hope you are doing alright... Have a Merry Christmas & a Happy New Year! Peace!

  9. I understand ACEP's concerns, but there is simply no way that the emergency medicine residencies in the US can produce enough emergency medicine physicians. I have worked with some very skilled & talented physicians who were not board certified or residency trained in emergency medicine. If memory serves me correctly Canada has some FP residencies with additional training in EM!
  10. Life is short, take time to play!