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Just to recap the information provided: From the door Patient mentation: Altered/Unresponsive. Cyanotic around lips/peripherals Eyes open. RR - Shallow, labored, 35/min Pulse - Fast, weak. Obese Hx COPD/CHF "Okay" yesterday (HAHA, what does that even mean? Talking, conversing, aware? Or in the same exact unresponsive state sans SOB - I'm going to assume the former) Diagnostics EKG: Narrow Complex Tachycardia - 210 BPM; No P-Waves BP: 84/58 SPO2: 85% LS: Rales in all fields I think that's it? I'm coming late to the party but from what I've gathered, we're on the brink of cardioversion. And chbare brings up an excellent point. You don't have a lot of time. Interventions (~2-4 min with 2 ALS crew members?) O2 via NRB -> BVM IV - with blood glucose from the stylet; NS flowing @ < WO. Monitor - 4 Lead Cardioversion Prep Physical Assessment: Eyes PEARL? Smell of urine/feces? Sores on her body? Edema? Abdomen palpation - soft/hard? Assessment Questions (during interventions) What is she in rehab for? What is this patient's baseline mentation? Why is she not on oxygen? What has this patient's trends been in rehab? Improvement or deterioration? Increasing complaints of SOB during her stay or sudden onset in the last 6 hours? Any other complaints? Bed-ridden or active? Paperwork history: Recent infection, surgery? Pertinent meds - Antibiotics, Anti-Coagulants, Antiarrhythmics? Ddx Infection (sepsis), Stroke, Hypoglycemia, Hypovolemia (internal bleeding), Overdose, PE, CHF/COPD. While it's easy for me to say I'm shying away from immediate cardioversion, I'm sitting at my kitchen table nursing a caffeine headache in shorts and a t-shirt. On-scene would probably be a different story. I feel like an immediate cardioversion may convert her rhythm to NSR only to revert back to its narrow complex tachycardia (which I'm going to assume is SVT). So with my assessment questions in hand, I can cross off quite a bit of my differentials as I package. Assuming none of these questions are answered: TX Cardiovert; -> No response, package. (If there is a response, stop here). I feel like cardioversion is an appropriate, valid response. But I don't believe it will solve the problem (with the information available). Grab a nurse or a third responding crew member En route: BVM (followed by RSI), 12-LEAD. On-scene time: 10-15 minutes; Transport time: 10 minutes; Total elapsed time: 20-25 minutes. I'm a new, green medic. If this is inappropriate or VERY inappropriate, please tell me. I'm still in the midst of being trained. I'm working on my prioritizing my assessments so any feedback would be appreciated. And whoever thought of the auto-saving feature on this forum, you're awesome.

Another consideration is the fact that we have a patient experiencing significant tachycardia and significant instability. When faced with this situation, how much time are we going to take to ask and answer incredibly detailed questions?

I had to take it for nursing school. What I got out of it was a better understanding of journal reports and how reliable they might be. The common term around here for anecdotal experience is using the n=1 model. Having a foundation in statistics helps you to understand the reliability of studies and how they were conducted. Understanding what standard deviation is and how they get to that number. With just 3 weeks go go, suck it up. Go in for tutoring, buddy up with another student to work through the homework. It's worth having a solid foundation, even if you think you'll never need it. Good Luck!

Actually, I work for a volly squad with a very small stipend lol. So no, you don't want to work here if you want to support a family, that is for sure. Those EMTs who think having a high end stethoscope is cool won't think it is cool when they lose it or break it. I have to constantly check for it when I have it because I can't afford to just replace it. I was using the one from our second ambulance on test nights, but once sdwe went to breathsounds, I ccouldn't take it 2 to 3 evenings a week. I replaced it with mine which was OK but not that frequently. Stethoscopes can run hundreds and hundreds of dollars. So a $50 one would be considered low end for some. Not for most EMTs though. I bout a $75 littmann at first after using the tinker toy quality ones in class thinking a better one would help. I knew I had hearing issues since teen years and after a few tries at a bp, an instructor found his with a cuff on, pit it in my ears and said "Hear that loud thump? That's what you're looking for" I gritted my teeth, jammed the ear pieces as hard in my ears as I could and couldn't even make out a sound . He asked me if I ever had my hearing tested and I said I had and it wasn't the best, but I didn't feel it qualified for hearing aids since it didn't disrupt my day to day life. I for a fewminutes felt my EMT days would never happen The lead instructor came over and knew I was having a hard time, he then inflated the cuff until the pulse was strong, put his stethoscope in my ears and asked if I could hear it. I did. I had thought I wasn't putting it on the right spot, or just wasn't getting it. Well he told me he was also hard of hearing and had a master cardiology stethoscope. I took several after that and was able to obtain a bp each time. I looked around for a few days online and was let down. I couldn't pay for a stethoscope like that for a volly position. Within days one came in the mail, from Santa Sorry for the typos, on my phone and trying to correct them is causing a scroll issue

I'm sorry...there is no place in EMS for Lefties.... :-)