Novisen

Thanks for your answear VentMedic! What CPAP or PEEP valve are your using? 7.5cmH2O is standard and 5cmH2O for the ones who doesn´t accept 7,5. http://caradyne.respironics.com/valves.htm For the intubated patients we have Oxylog 3000 for planned transportation. Every ambulance have one AMBU Matic Ventilator with demand valve 0-20cmH2O. http://www.med-worldwide.com/product4202.html http://www.med-worldwide.com/peepvalve.html Are you running all your patients at approximately an FiO2 of 0.30? Yes! FiO2 is always 0.30. The liter flow Per/minutes is 120-150 liters/minutes. Novisen//

You could have been helped with 50mg of KETAMINE and 1-2mg Midozolam i.v!

Hello! We have used the Wisperflow with a fixed flow output for the last 15 years. Often you don´t have to use 15 liters/min to get enough flow to the patient. I use 12 liters whenever I can. If every O2 cylinder in the ambulance is full we have atleast 300 minutes to get to the hospital when using 15 liters/min. http://whisperflow.respironics.com/Features.asp I´dont see any benefits with having a CPAP with variable flow. Alveolar ventilation is improved in a matter of minutes and saturation is always about 95-98% in five minutes even when the patient have an saturation at 60%. High PaO2 can reduce coronary flow and reduce Cardiac output. And then I hope someone can explain M-tank, D.cylinder, PSI etc.? Thanks! In Sweden we have cylinders with 2.5 liters and 5 liters in ambulances. They are filled with a pressure of 210bar=3000PSI. Thats 525 liters and 1050liters. http://en.wikipedia.org/wiki/Bar_%28unit%29

Hypovolemic and older patients can get severe hemodynamic effects. With some Versed and some Fentanyl you can often reduce the dosing of Propofol down to 5 ug/kg/min in these patients. Maybe Ketalar and Versed is an better combination? The hemodynamic effects from Propofol is easy to adjust. When the patient starts to chew on the ET tube you just start the drip again :wink: .

Nitro is the first choice of drug when you have AHF with CPAP and Morfin. CHF is treated with Nitro and Lasix. The best study I have seen is on this site: http://www.escardio.org/knowledge/guidelin...t.htm?hit=quick

The patient must have breathing on their own to be breeding...... Actually I RSI an subarac bleeding yesterday with Propofol and Succ. The intubation failed and I used an LMA airway. In the ER they also failed to intubate and have to use a Fast Track LMA.

When I intubate a patient with RLS 8 or GCS 3, I don´t use any medication. Give me an example of a patient that needs RSI that has own breeding.

I have done about 5000 calls and I still haven´t met a patient that had need for an RSI. Have intubate some of my patients after trauma on vital signs with no medication. If the patient have problem with A or B, RSI is the last thing we try if all others methods have failed.

You can always search job in the Netherlands or in Sweden.

We have Propofol, Versed, Ketamin and Celocurin. I don´t see Morfin and Diazepam as anhestetic agents. I always carrie Fentanyl and Alfentanil with me in case of. Entomidate is´nt an registered drug in Sweden.

Nausea and womiting "hick" :?

Sorry! Vomiting!

10mg p.o is like 1-5mg i.v (3mg).

Serotonin, 5HT3, Muscarin, Dopamin. You never know witch receptor to block. Metoklopramid doesn´t work. Zofran is expensive and only goes on 5HT3 receptors. The best antiemeticum in my opinion is Dixyrazine, Droperidol or Promethazine. If the treatment has no succsess you can add Zofran and Glycopyrrolate (or Betametazon or Dexametazon). http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum Ketobemidon is an better alternative than Morphin when it comes to nausua and womiting after administration (in my opinion).

I prefer to work with another nurse :wink:

Uniforms european style! http://www.newshunter.se/filmer.htm

Bad preload gives a Bezold-jarisch reflex with bradycardyia, hypotension, slow breathing. Seen this one time. Gave atropin and fluid and the patient went back to normal HR, bloodpressure and breathing. The problem is that I can´t find anything about BJR and atrial fibrillation on the net. The underlaying problem can be a stunned myocard like the 12:lead showed. (Inferior)

http://www.kelticclothing.co.uk/KLT-MedicalWear.htm http://www.spservices.co.uk/index.php/cPat...3e17af7bffc0f1d

Between 7-36 hours. 45 hours a week.

In Europe more and more services have yellow and green clothes! http://www.taiga.se/ http://www.wenaas112.com/

Hello chbare! As I wrote earlier RSI on vital signs is needed now and then. I´m not waiting until patient become unconscious. Stunning myocard with hypotoni (chock) is more often seen in inferior and diafragmal MI. Dobutrex, Dopamin or Adrenalin (and Simdax) + volume + intubation can give you some time before the patient dies. Early diagnosis and treatment with PCI or trombolytic agents. We carry Rapilysin in our cars but the patient needs his/her bloodpressure for the treatment to be succesfull. One problem with RSI is the high grade of failure in prehospital settings. To performe a succesive RSI with minimal deacrease or increase of bloodpreasure is hard. You never know how your patient going to respond on the anhestetic agents. Remember that all clinical resersch is done on healthy male volonters.

Easy!

Hello chbare! Anterior lateral MI + fulminating pulmonary edema = left forward fail. You are absolutely right. Induction with Ketamine shouldn´t be attemt. Entomidate or Versed is an better option. But do you have to RSI these patients? We have used CPAP prehospital for 15 years now and I have never get to the position that I have to RSI an patient with AHF or an CHF. CPAP to reduce preload and Nitro to reduse preload and afterload in the first place. Morfin and Lasix can be added related to patients permission later on. CPAP, not RSI is the answer :wink: . Interesting reading about Ketamin to THI patients. http://meetings.acep.org/NR/rdonlyres/AE1F...uryCarcillo.pdf Suggested sedatives for selected clinical situations Clinical Scenario Options Normotensive/euvolemic Thiopental, Versed, Propofol Mild BP and head injury Thiopental, Versed, Etomidate Mild BP, no head injury Ketamine, Versed, Etomidate Severe BP Ketamine, ½ dose Versed, Etomidate Status Asthmaticus Ketamine, Versed, Propofol Status Epilepticus Thiopental, Versed, Propofol Isolated head injury Thiopental, Propofol, Etomidate Combative patient Thiopental, Versed, Propofol Entomidate is not for sale in Sweden so I shouldn´t comment a drug I don´t have personal knowledge about. We carry Versed, Propofol and Ketamine there I work.

http://www.fda.gov/cdrh/safety/dehp.html Amidarone can realese DEHP from bags. Nothing going to happen if you exposed to DEHP once or twice i your life in the prehospital setting.

We administer Amidarone in a singel bolus shot on VT and VF that don´t respond on defibrillation (300mg). If the patients is awake we give it mixed with 250ml D5W over 20 minutes.