Shelbmedic

Not sure how the accidental wasting of Valium would be handle in USA vs Canada. But the Province I work out off. Once you have been notified as the manager about this mishap (1) would be get more valium for restocking (2) account for the expired morphine and the new Morphine. (3) The provincal Medical Director would have to be made aware. (4) The Local PD might even become involved. (4) The Medic would be Questioned about this as well as the witness at separate times plus both their actions would have to in a written report. (5) Ask how it is possible that 2 people both took the time to look at the medication name on the box and vials could have accidental still wasted the wrong DRUG..... (6) After the investigation a memo would be sent around to all bases about making sure you have the right drug. (7) Then change the type of box by marking it with a different color tape Bright Yellow to show the difference in the boxes and might even hold staff meetings to drive home the importance of BEING sure about what Drug you are wasting

I have never seen this done. I was taught if your IV was patent (large bore IV and AC) then push the D50 with the line wide open. However I did witness an ER Doc push D50 through a 22g IV. It was really scary to watch. I left before the vein blew up.

Well young man let me start of by saying that you make me sick. You have no respect for yourself and the rest of us professionals in the field. Well here I go on my long winded speech again I tried to post earlier but the system was down and I couldn't save the post. SO I'll say I'm sorry now if my post shows up twice. I'll try to keep this short and to the point. Young man first of all your under age to buy Alcohol. If you get caught this will be a black mark on your record and any employer who might hire you will see this. The employer might say will son I like to hire you but I have issues with people who at one time was caught using his uniform to by alcohol and was under age. It shows the employer that you have no pride in your profession or your self.It also sets you up for showing that you can not be trusted. If you are willing to due this what to say that you won't start stealing from the stores by grapping something and running out saying you have a call and that you'll be back later to pay for the Meal, Item. (This has been done before) The medics that did this were caught and it put areally big black mark on the rest of us who went to this restraunt. 2. Young man you think that you are so smart because you put your uniform on and walk into the store and buy alcohol for yourself and maybe your under age friends. Well my friend one of these days it will bite you in the ass because the Cheif of the Vollie dept. you are on is going to see you or some other member will see this and they will fry your ass like it should be. 3. Or you will be there buying your alcohol thinking your so cool and you'll walk out with your head held high and thinking those ass holes didn't even check me for ID and its because of my uniform. Thats when you'll come around the corner meet face to face with one of the local PD who knows your true age and will haul your ass in. 4. You go to the store and buy alcohol for your friend and you you each have a couple of drinks your friend says he going to his girlfriends and says thanks man for the bottle of rum and I'll see you later. Three hours later you are dispatched to a 2 car MVC with 6 pts involved when you roll up in your Vollie unit you jump out and run to the car that you think you reconize. Thats when your worst nightmare hits you your drinking buddy and his girlfriend and one other friend have been injured. The second car is the wife and his kids of the store owner who sold you the alcohol and he reconizes you and the friend and thats when he over hears the ages of your friends and he knows you bought the alcohol. I bet right now he wondering if you had been drinking also and now your here going to take care of these people that are injured. LET ME SPELL IT OUT FOR YOU..... YOUR NOW GOING TO COURT FOR SUPPLYING ALCOHOL TO MINORS AND THEN YOU WILL BE SUED FOR THE CAUSE OF THE ACCIDENT BECAUSE YOU AND YOUR BUDDY WHO WILL TELL THE COURTS ABOUT HOW YOU USE THE UNIFORM TO BUY ALCOHOL ALL THE TIME AND HOW YOU BOTH HAD BEEN DRINKING EARLIER. NOW THERE WILL BE A TRIAL WONDERING IF YOU WERE UNDER THE INFLUENCE WHY WORKING. THE SERVICE THAT YOU VOLLIE FOR WILL BE SUED THEN YOU WILL BE SUED BY ANY PT THAT YOU HAD CONTACT IN THE LAST 6 MONTHS WHEN THIS HITS THE NEWS.SHOWING UP TO THE SCENE UNDER THE INFLUENCE. BUT WHAT THE HELL YOUR COOL RIGHT BECAUSE YOU CAN USE THE UNIFORM FOR YOU TO BUY ALCOHOL. ONCE AGAIN ITS BECAUSE OF PEOPLE LIKE YOU! US TRUE PROFESSIONALS WILL HAVE A VERY BIG BLACK MARK ON OUR SHOULDERS AK I feel sorry that this young man has put you into this position. I know you being a true professional and do the right thing. Thanks to you all. Sorry for being long winded

Broke8026 I asked about vitals in my first post

are the blisters on his feet as well? What started first the blisters in his mouth or on his hands? I might also want to know what kind of work this guy does and what kind of chemicals he has been using at the job site.

Ok you have a 48y/o M. post sz who is on the floor CAO x 4. S/S of any trauma? A- any allergies? M- what medications does he take? P- past medical history? any sz history? is he a diabetic? any heart problems? any B/P problems high or low? any respiratory problems? asthma, COPD. emphysema, any recent surgeries? any recent trauma in the last 72hrs? L- last meal? last time to the doctor? and what for? E O/E what do you see? any trauma ? any s/s of sz activity? How long did the pt. sz for. Any s/s of street drugs being used? What are his vitals, Blood sugar? pupils are the e/r and what size? hand grips are they strong and equal? whats the monitor showing in lead II / ?12 lead if lead II shows anything? whats the pt/ LOC?

Sorry ASA and O2 both were given to this pt. My standing order for extreme CHF Pt give o2 Nitro, Salbutamol if wheezes present, Morphine 2.5mg, then lasix only if on diuretic if SBP>100mmHG. So I called on line Dr. explained the story. He said give a 100cc bouls keep an eye on spo2 and lung sounds if B/P >100 give lasix as per standing order. Cabbage was 4 years ago. According to family.

Sorry about the spelling mistake Mike. Yes Dwayne that is her pulse rate would be from 88b/min to 132b/min

Here we go again! Called for 90 y/o/f syncope. on scene found 90 y/o lying supine on the floor next to her bed with a pillow and a blanket on her.Family states that mom was found semi sitting on the floor next to her bed and she doesn't know how long she has been sitting there Mom says she can't get up off the floor. 90y/yo f. lying on the floor and no obvious s/s of trauma noted pt seems S.O.B. very pale and sweaty looking as you enter her bedroom you and your partner not that she is in content of urine and the obvious smell of fecal is in the air :pukeleft: A- Codeine M- ASA,81mg , Nitro spray, Altace, Diuril, dulcolax, Glburide, HCTZ, Lasix 20mg, Leukeran, Lipitor, Norvassc, Motoprol, Ranitine P- lymphoma, Cabbage x4yrs, diet cintrol diabetic, MIx 4yrs, HTN, angina, CHF, Acid Reflux L - last meal pan fried fish potatoes, / last Dr. visit last week to the ER by ambulance for syncope. Nothing was found during the investigastion at the ER. E- O/E Pt. CAOx4, (A) maintained by pt. ( - Rapid/Shallow @ 32b/min © P-88-123 irreg/strong/ equal at both radial,B/P 130/92. HEENT - clear, no s/s of trauma noted. Pupils E/R @ 4mm, Neck no trauma noted no deformity, no JVD/TD, Chest Obvious s/s of cabbage surgery, Rt breast removed 5yrs due to CA. Pt. Denies any CP, SPO2 @ 83% R/A, lungs A/E crackles @Rt & Lt basesminor wheezes at Rt&LT upper lobes. ABD soft NT/ slightly distended pt states she needs to pee. Pelvis stable. Note pt in content of urine and fecal. Ex pitting edema noted bot Rt and Lt ankles to knees. no s/s of trauma noted, Back normal back pain no s/s of trauma noted. Skin pale/cool very sweaty. Treatment by us was Vitals P-88-132 irreg strong A-fib in lead II, B/132/92, RR-32b/min blood sugar @ 11.3mmol. IV Lt wrist # 18 TKVO, c-spine cleared on scene. 12 lead obtained A-fib with RBBB, slowly sat pt up. and Re checked pt vitals. Then it happened Pt became very aggitated yelled at her son for her Nitro spray becasue now She feels very S.O.B and discomfort in her chest. (" I have a heavy Pressure in my chest") recheck of vitals Now are : B/P of 120/p resp- 42 shallow use of ex muscels / ddecreased LOC,JVD1-2cmm now. HR 130-160-afib pt has audiable wheezes and her chest sounds are very little next to none for air movement in the lower lobes and what I could hear in the upper was crackles/ wheezes. on the monitor as I stand up to ask my partner hit her with the nitro as I get ready to hit her with Morpine 2.5mg I see a run of PVCS 10 in a line I say to Mike it a run of V-Tach. His face said it all. pt converts back to a-fib/flutter on lead II. Pt was given Nitro x2 sprays, B/P remain @ 110/64 then 2.5mg of MS B/P 90/62 fluid bolus of 100cc brought pressure back to 102/66 Lung sounds improving spo2 up to 90% pt LOC improving . Pt transported 10 min drive Lasix given in route. CP decreased to 1/10 Pt left ER then went to ICU is still there that was 3 days ago

In our FD the MFR's have a run report which is filled out each time they are called to a scene. This is then give to the medics on scene and then the hospital gets a copy with our run report. Means large paper trail but its a CYA thing these day.

Well here we go this is one of those calls. We were dispatched to one of the local nursing homes about 25min away from the Hospital. The staff called in saying the 65y/o male pt was having a diabetic problem. Dispatch says pt is unresponsive staff sates that their meter reads low. We arrived on scene to find the pt sitting in a chair and the on duty RN pouring OJ into his mouth,down his shirt and lap. The pt looked DOA as can be. Right out of the blue I say that poor bastard is dead and she is still trying to feed him. So the pt was DOA, Pupils fixed Dilated, rigor in the jaw but he was well hydrated!!

We advised the pt. that he had been unresponsive and that we thought that he might have a head injury especially with his PMH of DIC and that if not treated at the trauma center there could be a fatal out come of death. Pt stated I don't care I'm not going and Family and friends were of no help so I called ONLMC and he agreed it sounds like a subdural bleed and wants the pt taken to hospital. while the pt was being explained that he should go and the on line Dr. said for him to go pt had a big time decreased of LOC became very combative and vomiting big time I was still on line when this was going on and requested life flight to meet us at the local hospital to transport to the trauma center 2hrs away by ground. Pt vitals Pupil lt wide no reactive B/P 220/120 H/R130 load and go and did the following pt still had gag reflex was given and resp 10 GCS 5 . c-spined ,IV 14 Rt AC TKV at present. Pt then given 1.5 mg/kg lido cain IVP as per protocol and then Lido sprayed the cords pt intubated #8.5 22at lips pt started posturing as life flight was putting him in the bird. He died 2hrs later in ICU

This call happened a few years back. I thought you might find it interesting. Unit 136 respond Code2 (non- emergency mode) for a 68 y/o M. post fall. Caller states husband got up slipped and fell approx. 2hrs ago. Denies any decreased LOC Post fall Assessment code 2 will be fine. Dispatch out! Just as you are pulling into the drive way Dispatch calls back for ETA and an up date and to advise you that the Pt know has a Decreased LOC. Arrived on scene @ 05:00 hrs scene is safe, Your met at the door by his wife and a family friend. They both state that Joe got up at 03:00 hrs when he tripped over his feet falling to the hard wood floor striking the right side of his head on the base board in the hall. As you and your partner are walking to the master bedroom you noticed a large blood stain on the side of the wall next to where the pt had fallen earlier. You ask his wife was he knocked out she states no but he is C/O of a H/A then she says he has been up to the bathroom several times to Vomit. Just before you guys got here Joe tried to get out of bed but he couldn't and he threw up all over himsef and had a massive BM that the wife had tried to clean up before you go there. You ask for Joe's medical history wife and friend both stae that Joe has DIC (Disseminated Intravascular Coagulation Dissorder And has weekly Blood transfusions at the local Hospital. and he is is not allowed to take ASA. You walk in to the master Bedroom you findyour pt. lying supine in bed covered in vomit and is haveing a seizure. You also notice the pressure bandage that is Blood soaked on the right side of his head. Pt stops the seizure. You Find 68 male Not alert . A- Pt has gag reflex post seizure when you try opa B - 12 times shallow C- 180/90 p[ulse 120 strong Chemstrip 8.0mmol Spo2 94 R/A S/S of trauma is the Rt side of his head 1-2" Lac with Pressure bandage on it Lungs clear egula bilat Abd soft NT/ND pelvis stable / no other s/s of trauma noted 12 lead showed Sinu Tach Pupils ER left was sluggish PMH DIC / Blood transfussion weekly / is not allowed to have ASA one last bit of information as we were back boarding this pt he comes too and is CAOx4 does not want to go to hospital what do you do???

This reminds me of what happened to me back in 2000. I was working for an Ambulance Service in a small minded town which was based out of the Hospital. We were called to Pt who was known to have aids and had came home to die. We were asked to go and pick this person up at home to bring them to the hospital. We said no problem so we asked the supervisor for face mask and gowns because we knew the pt was at home N/V/D x 3/7 and we wanted to protect ourselves. Well the supervisor was pissed and told us that we were not to wear any PPE well I told the supervisor I would not go and transport and that I had every right to protect myself. She told us that the person we were picking up was a friend of her family and then said how would you two feel if you had Aids and people showed up with gloves and mask and gowns on to pick you up. I said I would know that the medics were professional enough to protect themselves and if they didn't have any PPE on I would make sure that were wearing it and would not want them to take a chance that I might accidently infect them. Needles to say We ended up calling her supervisor and we won.

sounds like a good call

The Pt is 75kgs. I was ordered to give nothing in the field other than to support abc and be ready for Seizure and to intubate. Pt was becoming dizzy and had extreme thirst. 5 min out from the hospital pt became very hypotensive on me 80/0 weak radial pulse. opened IV wide open. For the medic that wondered about the time was 23:45hrs that evening that she took the od. The pt was intubated and rushed to ICU she spent 3 weeks in ICU and was released she is now on dialysis. But has since thanked myself and my partner. The IV's in same arm is a Protocol because the local hospital has a fit for lab work. The MCP is the head Dr. for the hospital. The Dr. on call couldn't belive that this lady was even alive after the first night in ICU. He said another hr at home she would have been DOA.

My first post So here we go. Called for a 55y/o F. Intentional OD on ASA. Being told by dispatch that scene is safe no need to stage, but we sent PD due to location is 45 min from the main town. Arrived on scene @ 11:45 hrs to find a 55 y/o female inital scene safe PD on scene Pt took 100tabs of ASA ES 500mg/tab ingested at 19:00hrs. Pt is CAO x 4 vitals P-120 reg strong B/P 130/90, Resp-24 shallow reg, Spo2 94 on R/A C/S of 8.1mmol,Skin Pale cool sweaty. Only other C/O of abd pain going across abd left to right 8/10. No abd distension noted no pulsating masses,Lungs clear equal bilat. no JVS no TD no CP, No N/V/D. pupils E/R @ 5mm hand and feet strong. 12 lead shows sinus tach no ectopy noted. We were on scene with the pt 10min then transported code 1 to local hospital which is 45 min away. While in route pt states she needs to pee as she put it. The pt goes to the voids out 350cc of bright foul smelling urine and now c/o of a H/A 9/10 across her forehead. Vitals now are Hr-126 reg/strong ,Resp 24 shallow reg. B/P 188/96, Spo2 100% on 15L/min. Pt is very restless and needs to pee every 10 min pupils are E/R 5mm. Pt was still CAOx4 we treated this pt. with Vitals o2, via nrb@15L/min, 12lead x2, 2 large bore IV 14RT AC and 16 Rt arm Heplock, Rapid transport as well we called for life flight but it was on a mission. How would you treat?

if the fluid bouls of 250 worked and gave us a B/P of 78 I give another bolus of 250cc if lungs remained clear. Then reassess pt vitals,GCS, 12lead again for changes. If no changes and the HR came up just transport and monitor vitals. But if his B/P remained low or none as before then give atropine0.5mg up to 1mg if needed. Then reassess and go from here.

The service I work for carries the Cardboard splints in various colors and sizes plus we carry the sam splints which are my favorite to work with for the fact you can mold them into any position needed.

well 12 lead is good pupils er and hand grips are fine after I gave him his inital bouls of 250cc I would move him to the stretcher place him in the trendenlenburg position move him to the unit . Then do vitals again if no change I would bolus 250 again and if that didn't work I would do another 12 lead and if that doesn't show any changes I think about atropine 0.5mg repeat till 1mg if needed then try dopamine drip. Just one last thought how long has he had parkins? Is at the end stage ?? Has he been taken his meds the way is supposed to?

Well I think I would want know few more details what are his respriations like? Depth/Volume? A/E is it equal and bilat? what do you hear?Any chest discomfort? Hand grips/ Pupils are the E/R if so what size? any JVD?? any edema noted. Treatmeant including what you have done so far would be o2 via nrb@ 10l/min, Iv x 2 large bore. a fluid chalenge of 250cc if his lungs are clear and a 12lead?

Tniugs, I just looked at the web site for the cricothyroidotomy kits these are the same kits we have on our units I work on.

Great Job Guys I would have called for life flight also. Lucky for you life flight was given the go ahead for you unlike what happend to me a few years back.

Thanks, Capmedic-EMWFD I accept your apology.

Well I live in a small Town in Canada where The local Hospital Dr.'s are still like Gods to the local people. I have been doing this job 18 +++ years. I have seen plenty of things happen in this small hospital that have been written up by me but goes now where since the family of the Pt had told the Dr. of the children Hospital that they couldn't understand how the medics were so concerned about our child when the Dr. and nurse blew his neck being stuck off to a " Sprained Neck" as indicated in the OPD Dr. report. Trust me this one went to court down the road the Dr. was only caught on this case because the Dr. at the childerns hospital made the family aware that there was no way that the pt neck should not been x-rayed. Final out come the kid made a recovery and is doing fine his family has moved but they still keep in contact with me. This was not the first time this particular Dr. to SCREW UP! and not x-ray people. But in this town when you bring it to the people attention they say "no way he's a Dr. he can't be wrong" I don't care if you if you think it's bull shit. Unless you have lived in that town you'll never understand. In Canada alot people don't think Dr. can be wrong especially in the rural areas.