HellsBells

What do you mean by CPR fraction times? LIke the percentage of time CPR is performed during a code?

Since this is where the thread starts, lets look at the situation created by this decision. An ambulance crew has taken an individual who is most likely scared and hurt from a car accident, then stripped her of her clothes, and dignity in a public place, where persumably numerous bystanders are looking on, some with cameras. Then, instead of concentrating on pt care the attendant becomes fixated on some member of the public at large with a camera, gets into a protracted standoff/battle with said individual. I think we have an ethical duty to our pt not to create this type of situation in the first place. In my opinion, if a yahoo is standing by, filming the scene, we should simply do our level best to package the pt and get them into the ambulance, and out of the public eye quickly. To me, stripping a pt in public is farther beyond the pale, then a callow citizen filming an accident scene. The fact of the matter is, we live in a linked in world, where nearly everyone carries a camera/camcorder on their person, and all can in effect be amatuer journalists, uploading pictures to their web blogs. In fact, its possible that some of these amatuer journalists could have already uploaded their pics to a twitter account, or their facebook page before youve smacked the phone out of their hand or ground it under your heel. Agreed, The police should have nothing to fear if they are conducting their duties lawfully in a public place.

Sounds like complete incompetence on the part of this so called Fire Dept.

Gosh Mikey, what a flawless argument.

...and likewise, my stating that this is sensationalist bullshit would be a bit of an understatement.

Thinking of Haloperidol off the top of my head

I agree that its futile to work a code over the 20-30min mark. Full stop. However, its a shit excuse to say that folks at nursing homes have zero quality of life, as not every individual who resides at one has the brain activity of a cucumber. In fact, by kiwi reasoning maybe we should just stop responding to any medical situation at the nursing homes, I mean their just an albatross on our necks anyway. As for calcium and Bicarb in a code, I think they have their place, in particular with the hyperkalemic cardiac arrests.

Don't know what much else we could do here, its a wide complex rhythm, non-perfusing you say? We could also try 1g of calcium chloride IV. This there any evidence of renal problems, i.e. a fistula?

Evidence of drug or ETOH abuse? Whats the surrounding temp like? Im assuming hes a big faker, so ill just yell at him to get up... should work.

Our instructor played this for us in Medic school, its a good one!

Ive had stitches to the fingers twice, the first time it required about 3 stitches, my most vivid memory is the sting of the lidocaine, the second time I required just a single stitch, the doc gave me the option of going with or without lido, I declined it, and it hurt a little when the stitch went through, but it was much preferable to the lido injection.

Funny you should mention that, that was kind of my thought process at first, I asked his co-workers about any drugs, they said no, and mentioned he seemed way too straight edge for anything drug related, at that point my mind wondered away from the drug angle for awhile. Another possibility is that if the drug did contain PMA/PMMA, it can apparently be up to 48hrs (i havent verified this yet) until it takes full effect. This call occured on a Monday, so its possible he was partying over the weekend and it took that long to come at him in full effect... a long shot, but possible. Thanks for the Kudos Mobey, I'll try to post more here, its kind of fun.

Patients get a shot of the anesthetic Lidocaine to numb the skin before the IV needle is inserted Really? Wow. Otherwise, if people want to pay for this service, and he can provide it safely at a profit, why not?

Ok so... I think asysIn2leads more or less had the answer here, his Dx at hospital was an ecstasy O/D, I'm unsure at this time if PMA or PMMA was present as well. Like mobey's initial thoughts, I first tried to control his rate, as the pt was afebrile on first contact. I tried unsuccessfully to use adenosine 12mg, then cardioversion at 200, 300, 360. After that I started to suspect it was something other then rate causing his unresponsiveness. My first thought was possible a CVA or possibly a seizure. As we got close to the hospital and I noticed his temp rising, I began to suspect a possible stimulant OD. After the 1L fluid bolus, I did give 5mg of versed for possible seizure activity to little effect, his pulse did drop from 200 to about 188. I considered intubation, but we were less than ten mins away from hospital and he seemed to be maintaining a patent airway. At hospital he was immediately intubated, the ER docs were at first unsure of his Dx, they tried a second adenosine dose at 12 mg, again to no effect. After some discussion it was suspected he may have been a cocaine OD, he was then given a total of 30mg versed IVP, then put on a versed drip, 2 amps of sodium bicarbonate was given, then about 2 liters of cooled saline, as well as aggressive external cooling, as within minutes of our arrival his temp has pushing 40*C. I'm not sure exactly what the tox screen revealed, but when I was back at the hosp later, the doc said it was in fact ecstasy, pt was in ICU, but prognosis was poor. I'll post back here when I learn more about this pts outcome. It was a good learning call for me, and I think what threw me off was it wasn't a traditional setting for drug ingestion, but in hindsight makes perfect sense.

Ok done, lets say we use ketamine 1.5mg/kg and Succ 1.5mg/kg to RSI this fellow, use a size 8 tube, and with intubation his 02 SAts increase to 99% and all other vitals remain consistant with the above posting. Any other Tx option or ideas for this pt before I wrap this up?

Ok mobey lets cardiovert at 200, 300, 360... no effect, lets even try adenosine @ 12mg... no effect Since asys mentioned it, lets try versed- 5mg... some small reduction in moaning BP rises to 100/70 following 1000ml fluid repeat vitals hr- 188 bp 100/70 resp 24 shallow temp 39*C- A/C on, ice packs applied gcs 3 02 sat 94% on oxygen

He went to Mcdonalds for lunch, ate with his co-workers in the restaurant.

I have no intention of translating the BGL to the weird system of mg/dl used in the USA, but rest assured 6.4mmol/L is a normal BGL. Sp02 is 93% on room air, 100% after Mobeys NRB is applied The ECG shows a Sinus Tach/ SVT (depends who you ask) of 200bpm, no ectopy or visible st changes. The pt appears to have a regular body type, neither thin nor obese, no scars, or needle marks, appears healthy- with the exception of his current condition. Never applied capnography prehospitally ( although in hindsight may have been good tool) 16G IV is started on R A/C- NaCl 0.9%- wide open, Defib pads applied to chest.

Co-worker calls father- reports no current meds or significant Hx Bp- 78/40 Pupils- 4mm PERL BGL- 6.4mmol/L Has been maintaining proper hydration Skin- Diaphoretic, warm to touch Temp- initially 37.4*C Mucous membranes- moist Skin Turgor normal oh and heart rate is 200BPM- sinus tach

Ok, had a good one today... 21 y/o male pt, working as a roofer. Its his first day on the job, started his shift @ 0830hrs, at about 1300hrs tells co-workers he feels ill and walks downstairs into the partially finshed house their working on, the temp is approx 30*C Ten mins later a co-worker finds the pt lying on the floor supine, unconscious, no response to external stimuli, shallow irregular breathing, moaning between breaths, no signs of trauma/deformity noted...go

Yeah I like Rajs platform on healthcare, but not much else about the Liberals. The Wildrose is a little scary on the prospect of healthcare. How much will it cost to dismantle AHS at this point? I'm thinking quite a lot. I think the best outcome would actually be a PC minority at this point.

So fellow albertans, What's your take on the election platforms? Which party do you like/hate? Is Wildrose gonna win it?

Personally, I've been doing about 5-10mins of good streching following my workouts, it makes a huge difference in the amount of stiffness/soreness I feel the next couple days.

Initally, I was thinking perhaps malignant hyperthermia may have been the case, although it generally occurs within minutes or hours of sedation.

I'm not sure about this. However, Tim was the head of Augustana's Paramedic/EMT program for years, before they moved to Lakeland college. He is a very big proponent for "proper" Paramedic education. Most importantly, he has been an outspoken critic of ACP's more obdious blunders, including the CISM. Hopefully, he is able to effect some positive change from the inside and can refrain from drinking the kool-aid, so to speak. As for 68 members showing up to the AGM, well, we only have ourselves to blame for that one. Personally, I'm not really sure what to do about the widespread apathy practitoners have in general for our governing body. If there was some way we could get members to participate in greater numbers on a regular basis ACP would be forced to be more transparent to their membership. In closing, does anyone know of any juicy gossip on why Tammy Leach has left so abruptly?