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emt322632

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Posts posted by emt322632

  1. Ugh I hate this topic...

    I had a discussion similiar to this with a probie once, wanting to know why we didn't respond priority to every call because after all "Dispatch could be wrong..."

    After I stared blankly at him for a few seconds I responded that it all boils down to safety. The safety of me, my crew, and all other drivers on the road, for it's not just our safety that we have to worry about, but the safety of all other drivers. We must respond with due regard, and if involved in an accident with an emergency vehicle, it would most likely be the responding ambulance/fire apparatus that was held liable for the incident.

    I can tell you for a fact that the vast majority of calls in New York State are BLS calls, : http://www.health.state.ny.us/nysdoh/ems/stat.htm

    I can't attest for all other states, but I'm betting the statistics are similar. Why put yourself at risk for a basic call?

    So...in short...if someone has a hangnail, I'm not responding priority...I refuse to. I refuse to put the lives of myself, my crew, and the other motorists in jeopardy because someone can't afford a bottle of Motrin or use their digits unaffected by a hangnail to call a taxi.

  2. Moats is a better man than I am; I can GUARANTEE I will NEVER be caught speeding to the aid of my mother-in-law. Loitering, maybe. Speeding, never.

    Wow I guess I have it pretty good...I actually like my mother in law...my father in law on the other hand...what a putz...

    Seriously though, the officer definitely should have realized something was up when 2 hospital employees told him that there really was an emergency...

    Common sense....

  3. I would have said CO poisoning but with your reading on the monitor I'm leaning away from that...

    Check out the BP and pulse, elevated BP and low pulse could indicate neurologic involvement (bleed) any s/sx of stroke? Patient favoring one arm over another which which to swing at you? :-)

    Do we have any other medical history besides his psych history?

    I could see the rationale for narcan here, while right now he's only altered with a patent airway, he could go even further under and lose the ability to maintain it on his own. Stop the drug (if there is one) from working and prevent him from possibly going further downhill.

  4. If asked about a year ago what I felt about abortion, I would have said, "It's the woman's decision..."

    Now however, after having to deal with the issue and its potential outcomes, I'm much more on the pro-life side (save for the aforementioned instances of threat to mother and baby)

    Last year when my wife and I found out we were pregnant, we were so scared. The thought of abortion did cross our minds at first, until the very first ultrasound. Even though my daughter was the size of a peanut, I still had that special connection that only parents have with their children. We decided not to do it.

    15 weeks later, we visited our doctor who told us our daughter had ventriculomegaly, which could mean a potentially serious complication or that she could simply need a shunt to drain CSF from her brain. We went to a specialist, and he laid out on the table that it could be 3 or 4 different things:

    1) She would need a shunt, in which case there may be no inherent long term problems.

    2) She could have a fatal genetic disorder.

    3) She could have Down Syndrome.

    4) The ventricles could return to normal and she could be fine...

    After saying all this, he also said we had a week to decide if we wanted to terminate the pregnancy.

    It all seemed unreal, here we were again at this decision. And still we couldn't do it...seeing her in the ultrasounds, she was her own person, and she was developing a personality!! Much of what I saw her do in the ultrasound, I see her do everyday now.

    We decided to keep her, even in the face of the unknown.

    Now, Olivia Marie is 5 months old, and even though she does have Down Syndrome, I wouldn't have it any other way. She has absolutely no physical health problems, and is just so damn cute and funny. She recently started smiling and laughing, and that is something that I will keep with me always, and can always brighten up my day.

    Looking back on all we went through, it seems like it was ages ago, and that I was a totally different person. I guess I was.

    As far as the thread (didn't mean to hijack I just started typing what was on my mind) this was a very sad case, and a heinous act. If they noticed the baby was breathing, they should have attempted all measures to save her. Period.

  5. If the patient denied drug use, you have nothing else to go on unless you can run a tox screen in the back of the rig.

    All you had to go on was the patient's report that he had not used illegal drugs. If you found paraphenalia (crack pipe, burnt tin foil, the drug itself) that would be a different story.

    I think you did an excellent job of managing the patient as best you could.

    For them to say it was a reaction to the illegal drugs...well...yeah...I guess tachycardia could be considered a reaction, but to have the non-chalant attitude that "This is just a cocaine induced MI", is just worrisome in my opinion.

  6. If you say so.

    I will base my findings on something a little more substantial. Like BP, HR and pt. presentation.

    I agree skin tempature is a vital sign, however its a poor indicator in this example.

    Im not arguing the point of exposure of the affected area. Just stating there are more reliable indicators then skin tempature.

    If you're waiting for changes in BP, HR and presentation, you're waiting too long...

    Back to the forum...

    Prior to going to nursing school I was very guilty of auscultating through clothes and not wanting patients to disrobe for an assessment. Now though, it's second nature, and really has to do with more confidence on my part. If I come across as a calm, cool and collected professional, I can gain the patient's trust and things will go alot smoother.

    My nursing instructor made a very good point, though it was in regard to bathing patients, never ask. I had problems with my patients saying they didn't want a bath, and she asked me how I presented it to them. I said "I ask them..." and she simply said don't ask, don't give them the option of not bathing. So now it's "When do you want to wash up?"

    So, instead of "Is it alright with you if I check your stomach and chest for injuries?" It's..." I need to check your stomach and chest for injuries..."

    I haven't had any problems since...

  7. I want to know some oppinions on what this rhythm is.

    CC: Resp. Diff. - 86 y/o F.

    EKG.jpg

    It looks to be sinus tach with ST depression and T wave inversion, possibly indicative of ischemia. See a few PVCs in their too, but too much of a wandering baseline and can't really tell from the photo if it's regular or not, could you scan it instead of photographing it?

  8. Hmmm,

    Do we see any odd signs with the baby? Bruises that shouldn't be there? Odd marks? What are the parents reactions to the situation? Do they seem appropriately concerned? Overly apologetic? Apathetic?

    I'm thinking these guys from history may have had this baby and are feeling just a little overwhelmed and that may have resulted in some shaken baby here ! A head bleed could certainly account for the unequal pupils and bulging fontanelle. As far as treatment, I'm gonna go aggressive with this kid. I want definite IV access (if I can't get it, you better believe I'd go IO), and with isolated head injury possibly consider mannitol (even though I know it's getting pulled off more and more trucks). If kid seizes again, consider some benzos and I'm gonna be prepared to take care of the airway if needed, but I'll only tube if I have to (bag 'em if you have to, tube them only if you must). I'm not thinking febrile seizure here - wouldn't account for some things. Tell me more of what I want to know and I'll tell you what else you might get.

    As far as letting mom and dad stay with the kid, I'd be hesitant, especially if I can separate them calmly. In general they probably aren't good candidates to have around with a kid going down the tubes and I prefer to keep things as calm as I can. Oh, BTW, at the hospital, if findings confirm my suspicions, I'll be having a chat with the ER doc 'cause I'm seriously believing one of the parents got overwhelmed with a new crying baby and just couldn' t make it stop, snapped, and didnt realize the damage they did until now. I've seen more than one case like this and this is reminding me too much of a run I made not long ago which fit the criteria. I could be way off here, but it's sounding mighty close.

    Oh and BTW - can I add a transfer to an appropriate facility either via bird if available to fly or I'll take ground either way this baby needs a pedi neuro and it's not looking like we're gonna get it here !

    I'm keeping that in the back of my head as well...The child definitely needs to be evaluated by a specialist, so if we don't have one at this hospital, let's get them to the nearest one.

    Meanwhile we can do a CT of the head, CBC, Chem Panel, Toxicology (just in case) U/A, and also double check for any signs of trauma while we're at it, expose the child if they aren't already and just take a peek to look for any bruises.

  9. As a student I was shocked that so many fail to realize that even though supposedly stable at the time that if left in this condition will rapidly become unstable. Because of beig stable you have the option of using Cardizem rather then adenisone or shocking to reset. Stay ahead of you patients and avoid having to work so hard. Much easier to treat while "stable" than after they go south.

    Completely agree...I'd rather be in front of the 8 ball than behind it...

  10. The parents state the patient has had a 24-48 hour history of lethargy and "not eating well." Patient was born at home and had no medical care, mother had no prenatal care as well. Parents state there were no problems with the delivery.

    The patient is very lethargic and responds with a weak cry to tactile stimuli. Blood sugar is WNL for age. No other history is noted. Sidestream ETCo2 is 17-20. You note sinus tachycardia at 130-140 on the monitor regular rhythm. Left pupil is dilated and non reactive at 5 mm, right pupil is 3 mm and reactive. No specific findings of trauma are noted; however, the anterior fontanelle is firm and bulging slightly.

    Take care,

    chbare.

    Alright this little fella/lady could potentially be in serious trouble. Bulging fontanelle = increased ICP, and since mom had no prenatal care and baby has had no medical care, opens up a list of possibilities for complications (hydrocephaly, ventriculomegaly are tops right now...)

    IV access, if we can get a BP good let's do it...supplemental O2, may actually consider intubation to protect the airway if we want to get really agressive here...

  11. What did the seizure look like? Full tonic-clonic activity or something else?

    Has the baby been sick at all, any underlying medical conditions that we need to know about? Any signs of trauma?

    Any other children to these parents with any health conditions? Was the birth uneventful (thinking if vac was used to assist delivery maybe just maybe something happened, it's a stretch but hey...)

    As others have said, vitals, blood sugar...how is the baby responding right now? Awake? Is he/she acting normally per the parents?

  12. You are contacted to respond to a "seizure" call.

    Take it from here.

    Take care,

    chbare.

    Well, let's get in the ambulance first ;) When we get to the scene, how old is the patient, what exactly happened, did anyone witness the seizure, is there a history of them and how long did it last?

  13. You have a pt, mid to late 70's. I cant remember her exact age. Called to a nursing home for trouble breathing, upon entering the room find the pt, sitting up in bed coughing up green / yellow sputum, AOCx4, answering questions appropriately, full sentences with intermittent coughing up the nasty stuff, also has a low grade fever past few days. Staff states her pulse Ox fluctuating between 85-90% they have her of course on the normal 1.5 Lpm NC. Hx of A-Fib / HTN / recurrent pneumonia.

    only complaint from pt is mild dyspnea. no other complaints. (-) CP, nausea / vomiting / diarrhea, no recent falls or trauma. took normal meds today. Staff is concerned that she might have pneumonia. Lung sounds diminished Right lower lobe, (-) wheezing / rhonchi / crackles. Pulse Ox is 92% on monitor, Monitor Rapid A-fib rate of 170-210 at times. still no other complaints. On 4 lpm NC pt's O2 sat up to 97 - 98%. Pt denies any complaints of SOB now and that it is easier to breath.

    My question is... we need to call command for orders of Cardizem. ETA to hospital was about 10min / 15 at most. Pt was stable. BP was within normal limits. My preceptor, kept asking me if there was anything i wanted to do.. i assumed he ment treating her with the Cardizem. Which i did not do, number one because of the history of a-fib and her being hemodynamically stable.

    Later we talked a little bit, he was thinking along the lines of it didnt really matter about hx when the rate is that high, and that if we didnt do cardizem then we shoudl have considered treating her with maybe a fluid bolus - i agreed with that, however by the time we would have done that we were at the hospital, i did jack a lock into her, but didnt hang fluids. and then he said something about possibly a neb (albuterol) tx, which i again disagreed with because of the tachycardia already.

    My question on here is,, would you have pushed or considered the Cardizem?

    thanks

    I would opt to give the cardizem, rate control while attempting to treat the underlying condition (poss. dehydration secondary to infection, hypoxia r/t infection etc. etc.) Her rate is very concerning. She may be stable now, but there is only so much that a heart that old can take, and I'm assuming she has other comorbidities as well which weren't listed.

    Hypoxia and infection increase the heart rate, putting more strain on the heart in an attempt to get more oxygen to tissues deprived of it. However with a rate this high the heart isn't doing itself any good, the ventricles can't fill completely and sooner or later she will decompensate. I would have consulted with med control on this but I'm going to lean toward administering the drug, while attempting rehydration.

    Found a very good article on treatment of rapid a-fib:

    http://www2.nursingspectrum.com/articles/a...le.cfm?aid=5861

    In the article it says that treatment is, "...aimed at controlling and slowing the ventricular rate, treating the underlying cause, preventing embolic stroke, and restoring normal sinus rhythm..."

    It doesn't say "Well we'll assume this is a respiratory problem and treat as such without worrying about the cardiovascular side effects..."

    Treat the rate, while treating the underlying cause...

  14. I have been thinking about this call since it happened and now it's really starting to bug me, so I would like input from the rest of you as to how you would have handled this call...

    Called to the scene of a MVA, dispatch says that an off duty officer believes that a possible heart attack is the reason for the accident. We got on scene to find in vehicle 1 an elderly man who is extremely aggitated, complains of no injuries, and confirms that he remembers the accident. Vehicle 1 has airbag deployment. Vehicle 2 has two passangers who are out walking around and are refusing all treatments and transportation. SO back to vehicle 1.... The patient tells the fire department that he remembers the accident but shortly after tells the police that he does not. When questioned by EMS about remembering the accident, he says that he doesn not remember. After the fire department does their evaluation and checks the pts glucose level, they get a reading of 49. The patient decides to go to the hospital, I told my partner, who then passed on to fire, that the patient needed to be c spined due to mechanism and airbag deployment. The paramedic from the fire department then told us the they were not going to c spine the patient because the patient was not complaining of any neck or back pain. She then questioned the fire medic about not c spining even though there was airbag deployment. The fire medic replies with "Airbag deployment doesn't mean anything because they go off at 20 mph as well as higher speeds. It's not important."

    So again, my question to you, Would you have done c spine on this patient or not and why? I feel that it should have been done but even in my own department I'm getting different opinions.

    I'd immobilize based on the information I have, level of consciousness being the big thing here. I'd like more information though, there isn't really alot there to go by....

  15. The type of attitude seen on that forum seem to run rampant in NY. I ran into some problems very similar to that on a local web board. I've kind of given up on it as they banned the IP address of a friend of mine and honestly...it's not worth my time.

  16. Where I run, (the frozen tundra that is Northern NY), we don't have the type of response the OP was mentioning, where an ALS ambulance would call a BLS ambulance to transport a patient. I've never heard of such a thing and it souds kind of ridiculous.

    I would have transported the patient without ALS interventions in place, I would not have handed him over to a lower level of care for transport, just because the chance DID exist for him to develop a pneumo.

    Just a misunderstanding I guess.

  17. Seems to me like the diagnostic tests support the diagnosis of commotio cordis. This was an otherwise normally healthy individual (I think, did we get an accurate history from the family? If not we should!) Who sustained a direct insult to the chest which resulted in v-fib.

    The emedicine article that was posted earlier, http://www.emedicine.com/ped/TOPIC3019.HTM seems to support the diagnosis here.

    This kid was just unlucky enough to get hit in the chest in that 15-30 millisecond window.

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