emt322632

I've actually used the "plane crash" remark. It was on a drunk call. I don't think the lady appreciated it very much, but she didn't ask me any more stupid questions.

Ok maybe I should clarify my post...why should a person who has no signs or symptoms of respiratory distress (no cyanosis, no accessory muscle use, clear lung sounds, A&0x3) receive oxygen at 15Lpm? I'm not talking only chest pain here...anybody... As I said the head of the CQI committee will look at a PCR, see 98% SpO2 and ask why they weren't on a nrb...

Getting cancelled because the BLS bus decided to take the 5 minute trip to the hospital instead of waiting 10-15 minutes for me to get there doesn't hurt my feelings any. You did right by this patient. I know of too many basic providers that will wait for ALS to show up, just because they panic. One group actually waited on scene with a woman in resp. distress (accessory muscle use, audible wheezes, SpO2 92% on 15lpm) had her all loaded up in the back of the truck, waited 10 minutes for me to get there...but they had the neb all set up for me

I've been slapped on the wrist multiple times for not following NYS BLS protocol when delivering O2 to my patients. The head of the CQI Committee in my organization believes if a pt gets O2 then they deserve a NRB at 15Lpm. If they can't tolerate it, they get a NC at 6Lpm... They haven't really offered me any rationale other than "it's protocol..." I'll give them that...it is protocol... But why should someone who is satting at 98% get O2? Why should someone satting at 94% get 15Lpm? I really enjoyed that article by the way, felt like posting it at my squad for everyone's review :-)

I live in NY, used to run for a private service where we did lots of NH runs. A story I never tire of telling (mostly to EMT-B students who I threaten with bodily harm if they EVER do anything like this) occurred when we got dispatched to a 70 y.o. male unconcious/unresponsive We get there, hx of diabetes...they said they checked his sugar and it was 40, so they gave him some sugar... oral glucose...3 tubes...on a patient who was UNCONSCIOUS!!! Let me tell you, that stuff is hard to suction... Another story involved a call to the same home for a pt with low Spo2...we get there, pt is in no obvious distress, just lying in bed, wondering what the heck is going on...his SpO2 was around 93%...he was on 2lpm...we upped it to 4lpm, and what do you know, his SpO2 increased to about 96%... Took him to the hospital...then about 30 minutes later took him back to the home...another 30 minutes later we got called back to the home again for the same man, low SpO2...again, we did the same thing...The ER doc said she was convinced they didn't know what they were doing...so was I... There are some good nurses in nursing homes, but unfortunately it's the bad ones that stick out...

while the old

No recent illness, the yellow sputum was new. No hx of pneumonia to my knowledge. Agreed with the too far gone issue, just like 2nd opinions:-)

Been a while since I posted here:-) Just want to get some opinions on a recent call I had... 66 y.o. female c/o severe difficulty breathing. She has a hx of COPD for which she is not being treated, pt. states she had been smoking a cigarette about an hour before onset of symptoms. Cyanosis noted around lips, bilateral upper wheezes, no a/e in bases. Pt. SpO2 on 15 lpm nrb is 92%... Only other med hx is HTN, she takes lopressor for that.... Vitals are: Resps: 28 labored, pulse is 110 regular, BP is 140/100. She is extremely anxious, coach her breathing down slightly with the NRB on while preparing to travel the COPD route with her... Give duo-neb of atrovent and albuterol, pt states some relief, however cyanosis is still noted and her effort in breathing really hasn't decreased at all. Establish an IV, cardiac monitor showing sinus tach at 110. Begin to hear some rhonchi and pt begins coughing up yellow sputum...start her on 2nd neb, just albuterol this time, give 125mg solumedrol as well.. We don't have CPAP, though I would have killed for it... Get to the hospital and they ask me if I gave her lasix...I sat there and wonder why would I do that, this is straight forward COPD, but I don't say it... Before we leave they have her on BiPAP... So my question...did I miss anything, and would anyone have done something different given the presentation?

What happened prior to his paralysis? Was he actually drinking, or is this just a case of wrong place wrong time? (Could have been picking a buddy up but doubtful lol) Any history of trauma? Any medical history? Meds (legal or illegal)? related syncope? incontinence? history of sickness? Let's get some vitals and get some O2 on this guy, considering him a priority transport is probably not a bad idea, IV and monitor as well... Oh also...any family history of stroke, seizure or any other good stuff? (Diabetes, heart problems, any other neuro disorders?)

Here we have to have a systolic BP >100 to push lasix and nitro both. Anything under that is considered a no no.

SOB, Cx pain, and of course with 2 colleges in the area lots of ETOH involvement.... Course today at work...been seein a whole lotta nothin.... :roll:

Sounds to me like you did all you could, and did it well within the extent of your protocol. Would I have done the same thing? I honestly don't know... Definitely would have tried the airway first, but from what it sounds like, that wasn't happening. I think you guys did the best you could with what you had, which wasn't much... Good job.

Firefighter, how many years of experience do you have? I really and truly doubt that Rid, Ruff, and others here are gloating when they're telling you how many years of experience they have behind them. They're trying to get it through your thick skull that they've been around, they've seen things. I've been doing this for 3 years, and I know not to upset the big dogs, something you have yet to learn. But maybe you will when your card gets pulled for assault and battery eh?

I had a Littmann Master Classic until it grew legs and walked away at work... :shock: Now I'm looking into either a Master Cardiology black, or maybe just another Master Classic...we shall see...

Doesn't play well with others Horn broken watch for finger PETA People Eating Tasty Animals If God didn't want us to eat animals he wouldn't have made them out of meat Work Harder: Millions on welfare depend on you!! Gun Control Means Using Both Hands Can't Feed 'Em? Don't Breed 'Em! Guns don't kill people, drivers with cellphones do For a small town this one sure has alot of a&@holes and my favorite... Bush/Cheney '04 :shock:

I would have worked them up for ACS as well...you said he had no history, therefore I would assume that the ST changes aren't from old ischemia or an old infarct. Were there cardiac enzymes drawn? No pain, dyspnea, or n&v at all? I had a woman a few weeks ago who presented with N&V, ST elevation in lead 2, no 12 lead done (shame on me). She didn't have ACS though, just a viral infection...ST elevation was totally unrelated. So maybe it's nothing, but I would think your doc would have at least done a workup just to make sure.

I hate pulling up on scene when there are 4 "Good Samaritans" who have already diagnosed the patient with a broken arm, concussion, severe asthma, and a broken pinky. It's happened on more than one occasion. People's hearts are in the right place, sometimes they just need to breathe. Keep in mind though, I was speaking about people who have no medical knowledge and simply stop because they stayed at a Holiday Inn Express the night before.

I would have gone down the CHF route as well with the presentation. Gradual 2 day onset, positional dyspnea, pitting edema...with that pressure though I would avoid the lasix and nitro and instead opt for CPAP. He's in a bad way, no doubt about it, in protocols here we can't shock unstable A-Fib. If the above treatment didn't work, maybe some cardizem or adenocard to attempt to slow the rhythm. Definitely consult med control.

New York doesn't currently, but alot of the Paramedic programs are switching to 2 year degrees, and downplaying the availability of certificate only programs. Also, NYS is currently in the process of researching licensure for Paramedics....or so I've heard....

Hey Ruff, thanks for the input. I'll definitely take you up on your offer and send you my resume. Thanks alot

This is a question for employers. I'm moving to a new area in about 3 months when I finish school. I've contacted 4 or 5 companies in regards to applying with them when I move there. Several have replied back stating they may have openings when I arrive... My question is, should I submit an application and a resume now, 3 months before I arrive, or wait until a month before I leave...my thoughts are if I apply now, my application is on file, and I can contact them when I arrive or potentially get an interivew now... Any thoughts from employers?

You didn't eat the entire smore?

Very nice! Something to cure the boredom

Kumbayah? Look...I brought smores!!! :wink:

ACtually yes the one that was conscious was hospitalized 2x previously for alcohol poisoning. Found out today that the unconscious one removed his own tube today...hopefully he learned a lesson, albeit the hard way...