mattlott

pearl of wisdom "you can not give lasix the patient is incontinent she will wet herself" --LPN not to be name facility not be named. As you hear the frothing pulmonary edma from across the room.

In light of the NFL play who suffered a severe spinal cord injury this weekend mild hypothermia might be comming to an ambulance near you. How would we do this on a practical day to day basis? see article below: (Buffalo, NY, September 11, 2007) - - We have some breaking news about the condition of bills tight end Kevin Everett. Doctor Peter Ostrow reports with some hopeful news. I spoke with Dr. Andy Cappuccino, one of his surgeons, Tuesday, and he was much more optimistic than yesterday. He said Kevin Everett is able to move his arms and legs, a great advance since yesterday. All of us who saw the injury during the football game and heard the early reports feared the worst, but many things went right for Kevin Everett. The Bills' training staff practices for situations just like this and they were ready. Dr. John Marzo led the drill, and trainer Bud Carpenter immobilized Kevin's head. As soon as they put him inthe ambulance, treatment began. He was given steroids as the ambulance went through the tunnell, and two IV's were inserted so he could be given a treatment that would lower his body temperature. Within an hour of the time thay reached Millard Fillmore Gates, he had a CT Scan and an MRI Scan, and within an hour and a half, Dr. Cappuccino and Dr. Kevin Gibbons began surgery and it went very well. Dr. Andrew Cappuccino, Othopedic Surgeon, "The spinal cord was completely decompressed, and the spine was fixated from the back with four screws and two small rods. At that point in time, an intraoperative ultrasound or doppler study was performed to evaluate the cord, the covering of the cord and the cord itself were completely intact, and actually looked good." The doctors were reluctant to give an optimistic prognosis, but there were some early hopeful signs. Dr. Andrew Cappuccino, Othopedic Surgeon, "This examination, about 6 hours after surgery did show voluntary movement of his legs in his adductors, the muscles that ppull his legs together, and his plantarflexors the muscles that push his feet down." And Kevin himself, in a message to his mother, gave the most optimistic prediction. Dr. Andrew Cappuccino, Othopedic Surgeon, "He told her that he was going to get better and he didn't want her to worry." And Tuesday, Dr Cappuccino says, "We may be wittnessing a minor miracle." He said that because, today, Kevin Everett was able to voluntarily move his arms and legs, a marked improvement over yesterday. He also noted that the MRI scan taken after the surgery showed only a small amount of swelling in the cord. Those are both good signs. [Q] You said they lowered his body temperature. What did that do? [A] Its one of the things that prevents the cord from swelling, along with the steroids. The treatment protocol was designed by Dr. Barth Green in Miami, who happens to be a personal friend of Ralph Wilson. _________________ International Herald Tribune NFL: Optimism on Kevin Everett spinal cord injury By Matt Higgins Wednesday, September 12, 2007 <A HREF="http://ad.doubleclick.net/click%3Bh=v8/35cc/3/0/%2a/f%3B34953186%3B1-0%3B0%3B4944035%3B933-120/600%3B16756730/16774625/1%3B%3B%7Esscs%3D%3fhttp%3A%2F%2Fwww.iht.com/pages/properties/index.php" TARGET="_blank"><IMG SRC="http://m1.2mdn.net/518758/2183_Prop_Com_SKY_Final.gif" WIDTH="120" HEIGHT="600" ALT="Click here..." BORDER="0"></a> BUFFALO, New York: Two days after he was paralyzed during a game, and one day after doctors described his condition as potentially life-threatening, Buffalo Bills tight end Kevin Everett was moving his arms and legs. The doctor who performed surgery on Everett, Andrew Cappuccino, said Everett's condition had "improved." Another doctor, who has consulted with Cappuccino, said Tuesday that Everett could eventually walk out of the hospital. "Kevin Everett is moving his arms and legs, his legs stronger than his arms," said the consulting neurosurgeon, Dr. Barth Green. "He's moving them both to a point, to a degree that he will end up walking. He will walk out of the hospital." On Monday afternoon, Cappuccino, an orthopedic spinal surgeon, described Everett's chances of a complete recovery as "unlikely" and in the range of 5 to 10 percent. The next day, however, Green said he had spoken to Cappuccino and described him as "elated." "I think he's walking on clouds right now," Green said. "Any physician would be. "What he told you yesterday is the case 99 percent of the time. That is that people who are paralyzed stay paralyzed." On Monday, team doctors said Everett, a 25-year-old backup tight end, was paralyzed from the shoulders down and in life-threatening condition after a collision Sunday during a 15-14 loss to the Denver Broncos. Everett was injured on the second-half kickoff while attempting what appeared to be a routine tackle of Domenik Hixon. But after striking his helmet on Hixon's shoulder pads, Everett immediately collapsed. He lay motionless for about 15 minutes. The Bills' team physician, Dr. John Marzo, described Everett as conscious and alert on the field but unable to move his extremities. Everett was immobilized using a back board and taken by ambulance to the hospital. During the ride, Cappuccino began lowering Everett's body temperature to protect his brain, spinal cord and other organs. At the hospital, Cappuccino operated for four hours Sunday night to repair damage to Everett's third and fourth cervical vertebrae and spinal cord. Cappuccino said that Everett had suffered direct compression of his spinal cord between the C-3 and C-4 vertebrae, but that the spinal cord was not snapped. Reached by phone Tuesday night, Cappuccino said he was not permitted by the Bills to comment further. Green is chairman of neurosurgery at the University of Miami. He is also president of The Miami Project to Cure Paralysis, a foundation he started with the NFL Hall of Fame linebacker Nick Buoniconti, after Buoniconti's son Marc had a spinal cord injury in 1985 while playing football for The Citadel, a college in South Carolina. Green is also friends with the Bills' owner, Ralph Wilson, who has helped support The Miami Project. Green said the fact that Cappuccino lowered Everett's temperature to 92 degrees Fahrenheit (33.3 Celsius) immediately after the injury made a difference in his recovery. The procedure is called moderate hypothermia. "It's like a bruising of an arm, an ice pack will help," Green said. "The vascular system was the ice pack for Everett's spinal cord." Dr. Joseph Torg, professor of orthopedics at Temple University in Philadelphia, said Tuesday that it was difficult to make generalizations with spinal cord injuries. "You want to see improvement in the first 24 to 72 hours if the individual will have a normal recovery," Torg said. "Every case is unique. You can't close any doors any way this early. "The fact he has some spinal cord function is extremely optimistic." Players for the Bills were unavailable for comment. "It's a dangerous game, and yesterday we saw that and it came right to us," Coach Dick Jauron of the Bills said Monday. "It was right in front of us. It was one of our teammates down on the field."

please review the fda warning on Phenergan and pediatrics. Many deaths. Came out last year.

first off sit the patient up, try the nasal canula at 3-4. But my pet peeve is they are COPD I am going to knock out their hypoxic drive. NEVER WITH HOLD O2 if the patient needs it. If the hypoxic drive goes out bag them. This does not mean you go straight to the NRB. It means you work up. You might even try a brochodialator treatment first. hell if they are that clamped down assist ventilations get the patient air. Hypoxic drive is never an excuse to watch a patient suffocate.

Does that imply IRS

as i read this one I grimaced, verge of tears, and yes like a seasoned medic held back a laugh. Now how would you call in the report on this call with a straight face. ______________ article setting up call below http://www.nbc5i.com/sports/13968715/detai...better_headline

had it really been bearing down on us none of us would have had much time to play. so things need to be simple. I was in the Dome and can tell you people can be very resourceful. My main concern was the people who came with the misconception that this would be comfortable. Granted shows and food could have been better at the shelter, but lets be honest had the storm hit sleep, showers, and food would have been hard to find. Also we need to understand this it the type of work that people can get killed at easily, it is very serious business. I know many people went through 911. However hurricanes are different based on massive loss of infrastructure and geographical area covered. The saving grace of 911 was the confined area of the attack allowing workers go to safe shelter and get warm food. Katrina made no concessions and truly made you know how fragile your life was due to civil unrest. my crew has a joke about me bringing a small inflatable raft. Yet having swam through a flood I wouldnt have trade it for anything.

should we do this again this year we need to organize shelter entertainment on our own. crews should mingle and get to know each other. This cannot be done by shelter or drill managers. What i noticed was creativity and forts being built every where. That alone was very funny. Maybe talent show off to the side. Maybe some skills competitions or education. This can be done during the down time at the strike level to pass time.

yep we got stuck doing the warehouse and breaking down supplies for units. I was at the dome during katrina, and was proud of how well this went. We had more than we needed we just need to organize better and other supplies were on the way. Unfortunately had this disaster turned bad like katrina the reality would be any patient that needed a full ACLs code would probably have to be triaged out. Even with the crews we had a major hurricane would have limited our ability to maintain a code past first round drugs, a round of defib, and basic airway maintence as we would not have been able to do one on one care. Now if the disaster had limited patients then you can move foreward with aggressive als. Yes I saw your very unique sign our operation was to the left of you on the back wall. I was the Matt running around trying to get supplies organized at the warehouse and trying to organized. For a first drill i am well pleased. We can do better and will do better but we all learned very important information for planning and implementing disaster response. IT WAS NOT A WASTE. Would love to exchange notes.

Well we all went and proved we could mobilize. Our group out of AMR Monroe some how got the job of stocking trucks with the help of various medics from around the country. Would like to thank Christy from California she was a great help and resource on Monday. As you guys left it was our crew directing traffic and collecting "pink slips". Things will be better next time. As people learn what worked and what did not. Looking for photographs for our local office. Did not have time to take pictures. At the end of the demobilization our group from Monroe, LA and several individuals from gulf port AMR and texas AMR felt we drove just about everyone of your trucks five feet at a time. Thank you all for comming =D>