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TicTok

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About TicTok

  • Birthday 12/25/1980

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  • Occupation
    Paramedic

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  • Gender
    Male
  • Location
    Cape Town. South Africa

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  1. On the topic ECG, I automatically decided it was VTACH as only one lead was presented and it is very broad. It would have been interisting to know if any canon wave were present during the episode. Regardless though, it does not really matter wheather it was was non sustained VTACH or a PSVT with aberancy, it was a warning sign and not the pathological cause. External juguler vein canulation is still classed most times as a peripheral line as it is superficial so to say. Yes I do agree that the neck is involved and if it bleeds there may be complications if not closely monitored and tamponaded if extravasation occurs. In South Africa we seem to use it more often than I.O. canulation in adults, probably due to the extreme price of the equipment needed for I.O. here. I have a fair amount of experiance with EJ canulation and am comfortable with the skill. This patient needed iv access and the risks (also taking chronic meds into account) dont outway the benifit of a large bore line (14G my needle of choice in almost all EJ canulations) with an often increased patency over time. I do however suspect that this is anecdotal and teaching in our system. I also find it less distresing to the patient when explaining what is coming........ We have an awesome MandM group here who take responsibilaty for or actions with out arguments and being guarded. You Sir Bieber have achieved this in the most unpredictable place. Well done too you. It was well presented. I think I will visit farrrrr more often if this becomes a trend. Thanks to all. It was an awesome read.
  2. Hi all. I am from South Africa so this senario would have gone a little different for me. For one thing in our country, well DNRs donot really exist and nore do living wills. So no fighting for me. It is the patients decition and not the daughters and well we now have implied consent. Who is to say that she does not want the trust fund. This patient can be treated. I have had this pateint more than once (really is an old age thing). The problem is patients donot read text books and make our lives easy. Vital signs often over lap between lung cardiac/ respiratory pathology. So is this a bronchospasm with air trapping or cardiac asthma?. mmmmm. I was always taught that which ever one you pick must be hit hard. I am moving toward LUNG pathology. What is the ambiant temperature there, also what season is it. Being male he is more likely too have a rapid progresion of a life threatening brochospasm. I also agree that pneumonia must always be concidered. I would not have tubed this patient. I agree that a Sulbutmal neb is good but i say it should be combined with Ipatropium Bromide for the first dose (COAD/ COPD patients often responed better to the anticholernergic for relaxation of the bronchial smooh muscle). We donot use CPAP on the road here as other than intubated patients so I am not going to comment. On the iv access side of things. The patient has large Juguler veins. Why not try there. I find awake patient tolerate it well and you have large bore access if needed. It is quick. Mag sulph is a good Idea. I would maybe hold of on the solumedral though. I like fluid in any brochospasm who is dehydrated - small boluses. I probably woud not have waited on scene to long with this patient. Neb, monitors, load high semifowlers. IV access if posible and get going while waiting for the first neb is being finnished. Pull out the adreniline, intubation equipment and iv salbutamal and put them next to you - my good luck charm.This is only my 2cents worth. What monitor were you using there. Stay safe all
  3. We start with 0.5mg and repeat 0.5-1mg to a max of 3mg(0.04mg/kg) post ruling out precautions ie, certain AV blocks. Repeating the dose is to put the pt into therapeutic range. Neither atropine or pacing should be used for the "conscious alert people who are only mildly symptomatic". Remember once it is in, it is in and a SVT is as bad as brady dysrhythmia. But these are our protocols. You keep well.
  4. Goodday all I agree with the statement "how much insulin". I have seen a few insulin over doses - intentional overdoses (often very well masked by "it must have been a mistake". All Pt's know the danger of this hormone as they are well warned. This pt sounded as if she had serious health problems and all combined must be absolute torture. Though infection, cortisol, etc will increase metabolism and possibly be the cause, how could you really know - you don't carry a lab around with you. Being ill is not always only physical. Sorry to be the pessimist, i just want to ad the possibility. You did well and i would have done the same.
  5. Ha Ha Ha Ha ha, Or ten :wink:
  6. Ha Ha I worked at a place where every friday security guards at to do fitness evaluations. Problem was every week there were new people. Thanks to them we got +++ practice at 14g IVI canulation and chronicly ran out of rehydrate. I suppose at the end of the day it your choice. Think of all those refuse treatment waivers. I dont however agree with the complete use of resourses. :roll:
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