als2170

All the stories you hear about EMT/Paramedics pronouncing when the patient is still alive is probably one of the reasons we don't field pronounce too often. As far as I'm concerned I'm glad it's not on my shoulders (and the buck continues . . )

we are only allowed to pronounce in the field when there is obvious signs of death/ injuries incompatible with life/ prolonged down time. We don't work those. Witnessed arrests or any reason to believe short down time we have to work. Once we work it, we transport. If the question was why are we specifically carrying as opposed to another department (FD) we don't always have that luxury

being that most of our transports are less than 10 minutes, we don't usually call a code we worked. I understand your reasoning, now that you mention it you're probably right. I'm going to speak to med control to clarify, but what we do is monitor/shock, iv/meds, tube, few rounds of meds (cpr, of course) and then start moving. Like I said, 2 people doing cpr better start moving. Optimally, an extra set of hands during transport is good too

how else do you get them down If it's a hard carry we can call for FD, but the truth is most of the staircases can't fit more then 2 maybe 3 people carrying the pt. Either way my point was vaso is easier than stopping for a round of epi. most of the time i have to disconnect the monitor to do the carry . . .

I agree with what you're saying. The question is how long ago did she take her insulin, how long has she been on this insulin, or is she on a new one? Although, I would think she would have to take a lot of insulin to burn through 2 amps of D50 like that? Any chance she took too much insulin?

We carry both, and protocols say either one for first 2 rounds. Personally working a code with just my EMT-B partner, it's a lot quicker and simpler to push the epi (hand me the mustard yellow box). The only times I have used it was on long carry downs. The winding 4 story narrow staircases around here don't allow for stopping and resting, let alone pushing a round of epi.

I've been 'cut loose' for about a year and a half, and finally now my heart doesn't pound as much when responding to a call. I agree with everyone about keeping on your toes, not being the 'paragod', but now that I'm a little more experienced , I try to pay more attention to the things I can continue to learn on the job. I run in a medic/EMT system, so I rarely get someone to bounce ideas off of which is frustrating sometimes, especially on intercepts with 5 volunteers waiting for me to 'do something'. Dwayne- even the most experienced medics, nurses and docs have 'off' days. Sometimes I can't get a line to save my life. I think the trick to being a good medic is to be able to roll with, take what the call throws at you. Keeping that in mind helps me be calmer and more in control on calls.

I hate to analyze or answer about other medic's calls because i wasn't there and don't know everything that was happening. Sounds like you guys kept level heads and did the best you could. The object of this game is to deliver the patient to the ED in not worse condition than when you met them, which you did, so kudos to you. As to the cardioversion, generally, the thinking is the heart is hypoxic, probably due to blood lose and a poor airway. That's why we generally 'consider' just one shock on a traumatic arrest (in my area anyway) instead focusing on quick transport and fluid replacement if possible. Just my two cents, but like I said it's important to remember, there's always a lot of distractions going on at a scene, that don't distract the 'Monday morning quarterbacks', so nobody can say anything but the people that were there.

never used any of the automated devices, just the plain old fashioned IOs. Just wondering is the flush from the gun any more painful than the regular IO?

could be something real simple, like maybe he has hx of lung cancer etc, and thats why he shot himself.

sounds to me like it is used more in "end-of-life" situations than out on the street. i wonder how long it would take to absorb in a real acute pulmonary enedma, and if it would pay. Also, I think the problem with most inhaled meds is that it is very hard to get a consistent dosage. Every person inhales differently, and would therefore make accurate dosing pretty complicated on the street.