Kaisu

thanks for all who answered. As I mentioned, this was not my patient, but it was interesting enough for me to follow up on as I had not encountered narcotic induced pulmonary edema before. For those of you incensed at what you perceive to be a lack of care you can rest easy. The woman was in very good hands. I just wanted input into the mechanism involved in the phenomena. The very first reply gave me what I was looking for. Thanks again.

The only issues I have with this type of deployment of epi-pens are 1 - are they stored properly ?and 2 - are expired meds disposed of and replaced ? Its pretty useless to have them if they don't work.

This one was a new one for me. I was on my clinicals at the ED. All h*** was breaking loose so none of the nurses were at the desk. A respiratory tech comes out of room 2 and is near panic - says the patient is in big trouble. I go into the room and there is a 40ish woman in the bed with a non-rebreather on. I can hear wet lungs without my stethescope BUT.. the patient is exhibiting a wierd breathing pattern - sort of a hiccup - no accessory muscle use, skin pink and warm, vitals normal, O2 sat at 100% - She says she's having difficulty breathing and I tell her we may need Bipap. ABSOLUTELY NOT she says - she claims claustrophobia and PTSD. Now its even wierder because any pulmonary edema I have ever seen is so happy to get help breathing that once they've had CPAP they are reaching for the mask. Her husband is standing beside her, rolls his eyes at me and says "Would you like to try and work through it hon"? I try and coach her breathing to get rid of the aforementioned wierd pattern but she is not cooperating. I leave the room and go check her history. She has the usual drug seeker mile long list of previous visits and extensive bronchoscopy less than a month before. At the hospital she was treated primarily for pain management and her tolerance was so high that they extrapolated this huge dose that was likely her daily intake of narcotics - dilaudid being her drug of choice. My question - definately drug seeking, definately nothing wrong with her lungs BUT what causes the fluid? How is she doing that? I'm thinking some narcotic induced parasympathetic sludge thing happening but I am puzzled. What do you think?

Its one thing to Its another to kick the farts out of it.....

[quote="triemal04 Not to be rude or anything but...1mg/hour for 6 hours is only 6mg. .5mg/hour for the next 18 is only 9. I'm guessing what you meant was 1mg/min, but hey, I've always hated math so maybe I'm wrong. Not to mention that even with my longest transport I won't be seeing a patient for 6 hours. I'm sure there are places like that out there, but generally speaking...there aren't many, and a lot don't seem to be ALS. Point being there is nothing wrong with mixing 150mg of Amiodarone into 50cc of D5W (or 100cc) and running it in at 1mg/min. Gives you 2.5 hours to get them to a hospital. Any problems with that?

In Vfib/pulseless Vtach, bolus dose of 300mg IVP. Other arrythmias (patient has a pulse) bolus dose of 150mg IV over 8 - 10 minutes. In Vfib/pulseless Vtach, post resuscitation care the drip is 900mg in 500ml, 1 mg/hour for the first 6 hours, 0.5 mg /hour the next 18 - that's what the hell for

I can't get the link to work either... can you copy and paste the text?

I don't see a right bundle branch or even a wide QRS. I do see a septal STEMI. I agree with amiodarone 150mg over 8 - 10 minutes, but the drip can wait till the hospital. How many ambulances carry 900mg of amiodarone to make up the drip and with the half life of oral amiodarone at 280 days, there is no hurry to get the drip going. I wouldn't tube the guy if ventilations are adequate and there is no distended belly. If I have any doubt about ventilations, he would get the ET tube - At the hospital, the guy will get heparin and possibly fibrionolytics but it's cath lab HO! The rest of the ischemia protocol (MONA) has been superceded by the VF and the arrest. It's time for the cardology experts to take over.

Yeah... but how often have you done that with a patient in the back ? That's the point here.. they had a patient in the back, a child no less, that they subjected to the uncertainties present at any scene. I like the discussion this has generated, but I can't imagine a mentality, a work place or a system that says what the medics in the original posting did was in anyway acceptable, let alone "heroic".

Speaking of EMTs, I was riding with two paramedics to a middle school where an 11 y/o had injured his ankle. BLS was there before us and had the patient all splinted up and ready to go. It was a matter of picking him up, putting him on the cot and going to the hospital. I was at the end of the cot and was being very careful to make sure I had a good grip (11 y/o and about 160 lbs). An EMT literally pushed me out of the way and raised the cot. When he was done I turned to him and said "Thanks" (he did help). He said " and who are you?" I replied "My names Kaisu, and I am a paramedic student doing my ride time here." He responded with "oh great - another paragod in the making". I sincerly thought he was kidding and I smiled and said "Goddess". He said "Step on my feet and you will find out you're human pretty quick". I bit my tongue and walked away.

Re: EMTs - if you plant cabbages you can't grow roses

I not an expert yet by any means, but the T wave inversion in V1-V4 tells me possible septal-anterior ischemia. With this lady's history (MI x 5) I would call this unstable angina - (mabe prinzemetals) obstruction somewhere in the LADD - Not sure - don't care - My treatment - MONA and beat feet to a cath lab.

Men who like paramedics - patch punchers?

I would LOVE to meet you folks - however - I am in paramedic school till middle of May - There is NO way I could do it until after then... please please do it .. but do it after the middle of May... otherwise I will really sulk.....

Johnny Carson was a funny man... One night he had Dianne Cannon on and she had a cat on her lap. Cannon (who was one hot number back in the day) asked him if he wanted to pet her pussy. Carson looked her straight in the eye and said - Well sure, if you'ld just move that damned cat.

Tenant of the Jehova Witnesses and discredited by almost all reputable scholars and theologians of all faiths

That is correct Spenac - she voided it as she is his POA - so now that he couldn't tell anyone what to do, she took over. She wanted the other kids to have time to get there so that they could say goodbye... He was dying at an inconvenient time... so regardless of the fact that he had talked about his options and come to a decision.. he got tubed, paralyzed and sedated...

Lymphoedema ? just a wild hair guess.. cause if it was torsion after a month it would be black. Guy didn't visit any foreign countries did he? not a case of elephantitis? PS - how come he didn't just drive to his doctor's office?

so who's gonna sue ? the guy's wife ? as executor of his estate ? She's the one that insisted on the tube. I have no standing - all I am is someone who cared for the man. It's frustrating as hell.

and what does the nut in question look like? as compared to the other nut?

Thank you Jake.. consider me mollified .. *** goes off to peruse pictures in peace ****

We get called out for "respiratory distress" at a local nursing home. It's me (paramedic student) and two paramedic preceptors. (wonderful people too). They're griping that there is a MVA in an area we run intercept for and now we'll miss that because we've got this BS nursing home call . (I'm too green to think any call is BS - I'm happy to be on the road and moving toward something). The first clue should have been the nursing home attendant (torn herself away from the crosswords) to meet us at the door and escort us to the patient room. I can hear the guy gasping out in the hallway - peek in the door and see a man on his way out of this world - eyes rolled up in the back of his head and too obtunded for CPAP. He'd been that way for 45 minutes. They had a nasal canula on him! This man had 7 different mestasteses and should have had a DNR bracelet. Typical F*******G nursing home he's not wearing it. This is the ONLY legal form of DNR in Wisconsin. It's in the file they tell us - so off to the file they go and guess what? can't find the bracelet. The man's wife is in the room and she is insisting he goes on a ventilator because she wants the family to all have a chance to say goodbye. We load and go and of course, intubate on order of Medic control. WTF??????? Does the wife think that after everyone has had their weep and goodby at the door that we just pull the tube out and let the guy die? What gets me (among a million other things) is this guy was diagnosed last fall and he knew what he wanted.. and he didnt get it.. now he's going to be on the vent for days? weeks? months? - cranking up god knows how much in bills and costs that are never going to be even close to being recovered... and more importantly, this is my patient and he didn't get want he wanted. Thanks for listening

OK boys so is there a male equivilant for those of the female persuasion? or do they all run screaming for the safety of mom home and apple pie? :wink:

This is pretty neat if you have a PDA (and many do) http://medicine.ucsf.edu/housestaff/ecg/index.html

Dorks RULE!