canuckEMT

Hahahah gotta love em saggy boobies, just like an old lady and an old man are talking dirty in a rest home, he says show me your boobs, she lifts up the bottom of her skirt.

Ok I'll stick to work not comedy

Scotty

Just remember.....Cupping is not a BLS skill!!!!! :shock:

Most of the time I will do a 12 lead on resp calls. I will usually wait until I am enroute to the hosp first as I like to get these pt's into the unit asap and do most of my interventions while trnasporting.

I'll take a wild guess and say maybe ....... Rid?

Congrat's Brock, hope to join you in those ranks somewhere around August 15th after final ambulance practicum.

Based on the presenting 12 lead I would also opt for a 15 by adding V4R and posterior V8 &V9.

I would start an IV and start ASA, trial of nitro 0.4mg SL while I wait for a reply on the Cocaine hx.

Is this pt a diabetic? What was his BGL?

I would not jump to thrombolytics just yet on this pt, one, because we don't have that option in my area and 2, I don't believe they are warranted just yet until we get the rest of the Hx of prior events leasing up to the pain (ie: cocaine)

It sounds to me like the underlying problem is the rate, but I would not rule out a PE either at this point.

Keep her on high flow O2, also try to gain hx of same episode previous? Even though she has no prior medical hx, she could have had prior episodes that spontaneously resolved.

I would also want a 12lead, but in the unit to remove her from the stress of the ( so understanding school nurse and principal) and question again about rec drugs or stimulants lately. Then enroute, vagal maneuvers, IV 18 ga in the left AC while trying to coach breathing. I would also get the EMT to hook up the nasal ETC02 under the NRB to see the waveform.

Other tx's will wait to see what the ECG looks like.

They use 7 seperate ones, most of them are actually thier own books. Not a good school to go to, Do not get on the bad side of Kim, she will make you cry, as she did with a few people in our class. Best to sit in the back and not put your input in at all.

Is there a story behind this? I know lot's of people who have taken this course and gave rave reviews for both the EMT and EMT-P programs.

I have administered Narcs for abd pain during my last practicum after discussing it with my preceptor. Although I did use a lower dose than I would use for other forms of pain ( fentanyl 1mcg/kg VS 2 - 3 mcg/kg).

Damn, how come I can never get those kind of transfers?

Same training here. Try to align into anatomical position to regain distal pulses then splint.

And BE, the only fracture I would use a Sager for would be mid-shaft femur ( non-compound)...... :wink:

The service I am hoping to work for has fairly liberal protocols for pain control. We have access to Moprh, Fentanyl and Entonox. It also has just been adopted that we can also add midazolam (only benzo they carry) with the analgesic.

Morphine: 2.5-5 mg q 15-30 min prn to max 20mg

Fentanyl : 1-3 mcg/kg to max per dose 200mcg q 5 to 15 min prn

Midazolam: 1-2.5 mg titrated to response in combination with analgesic

I haven't given any analgesics IM in the field. I guess I have been lucky and all my patients so far have opted for IV analgesia. I do employ the use of Entonox quite frequently if the pt is stable while preparing IV and meds prior to moving the pt or splinting any fx's.

EMT-P 18, 000 plus gas, practium logbooks (200.00), textbooks (1300.00) so in the end we will be looking around 21, 000.

Speaking only from my practicum experiance, IV AND 12 lead can happen simultaneously. Personally, if I am suspecting AMI, I like the 12 lead to be done before the IV. I delegate the ECG after I have done my chest assessment. By the time I am done my assessment, my preceptor would have the 12 and IV done. Then enroute after initial admin of ASA and Nitro, if there was a change in pain level I could do another 12 lead enroute to compare.

Again, that is personal preference and also the way my preceptors wanted things done. It seemed to me like a good use of resources and flow of interventions.

Very good video to watch the night before my OR rotation starts. I am beginning 40 hours in there tomorrow and have to attatin 15 successful tubes.

We have both Ipratropium and Salbutamol in single nebs as well as Combivent. We have choice to use either. If the pt is on home Salbutamol, I will go straight to combivent.

The BLS service I work for is considered " on-call". We can stay at home but we have to be within 5 min of the station.

Whew!!!

Just got my marks back for second semester. I am going onto Second ambulance, ER and OR practicums starting in January. Really looking forward to putting this new found ALS knowledge I have to work and seeing if everything comes together.

I will aspirate during D50 admin after half the amp, then push the rest. While continually monitoring the site for patency and infiltration. But 3 times seems a little much for me.

Oh and as well, pinching the line upstream from the med port then flushing with approx 20 mL after administration.

The airbag had deployed, and there as a starburst crack on the windshield. The drivers side door was messed up, so it would not open. The Patient had a laceration on her forehead from striking the windshield. There was a passerby (a vol. emt from a diffrent town) was in the vehichle maintaing manual c-spine stabilization. The patient was alert and responsive, she remebered getting into the car and driving, but she did not remember the exact details of the accident. The only thing she was complaining about was head pain.

So the drivers door could not be opened (without extrication equipment), but all the other doors could. Also between the drivers side, and the passengers, there was a non removable center console, about four inches higher then the drivers seat.

Responding to the call you currently have one BLS unit on scene, one BLS and Rescue unit responding (about 5 - 8 minutes away), and one ALS unit responding (Unknown distance).

If she is alert and maintaining her own airway, I would keep the EMT doing manual c-spine and apply a NC, do a rapid trauma assessment, apply a c-collar.

Depending on the pain and vitals, I might consider some pain control. When rescue arrives, get them to do a roof flap and extricate via KED ( as she is stable and no indication of rapid extrication required). Still the possiblility of a TBI so reassess LOC often during the extrication. Hand off to ALS to transport and ready the unit for another call.

Maybe just because I am a student now, first thing I would do would be to take the 4 vials of morphine into the station and have them accounted for. Also if we were doing unit checks they way we were supposed to before every shift, these would have been noticed a long time ago.

To have a viable narcotic tracking system, the rules have to be followed to a T every day. If Medics get complacent, that is when you have the oppertunity for missing narcs and possible abuse.

Just my " goody 2 shoes" answer being a new medic student.

Guess I should have read it a little better.........

Has she been compliant with her atenolol? When did she start the prescription? Has she had any follow up with her MD since the prescription was started?

Amiodarone

Class III antiarrhythmic

Some of the adverse effects of this drug are: Hypotesion, bradycardia, malaise, tremors and of course N/V

May cause digitalis toxicity if given with digitalis preperations; potentiate the effects of some anticoagulants

contraindications: Hypersensativity to drug or Iodine, Sinus node dysfunction, bradycardia

It is given IVP 300mg then if Vtach recurrs a second dose of 150mg. If it converts, an amiodarone drip of 0.5mg/min to maintain

Please fill in the blanks if I have missed anything.

This Pt in my book is still on the stable side even though he is mildly hypotensive. No SOB, CP, ALOC yet.

I would have my partner start an IV in an AC as I would like to try Adenosine first. While getting the IV Iwould be applying the pads to prepare for cardioversion if the first trial of Adenosine was unsucessful. If at any time his condition worsened, I would go straight to cardioversion and transport.

Maybe I see things a little different in this scenario and if anyone disagrees please let me know what I might be missing. We ahve been going over these scenarios for the past week in class so I thought I would try my hand at posting a little and see if I am on the right track or not.

I'm just saying that we don't know a thing yet. Presentation of "headache" (and my husband just left for work) could be anything from a subarachnoid bleed to bacterial meningitis to a hangover to she's lonely and wants to seduce us. We just don't know. Before I do anything, I want to be sure that it is an appropriate intervention. With just a little more info that can be garnered on scene pretty quickly, we can begin to get a little focus.

We don't even know our intial impression of the patient yet. But just for pretend, lets say she's conscious, alert, oriented, good skin color/temp (don't even need pulse/ox - grab a finger & do a cap. refill) I just wouldn't feel a pressing need to begin O2 without delay. I would want some more info. But you're right, O2 wouldn't hurt. I'm just thinking its not an immediate priority, it may not even be necessary. Or maybe a NRB will be more appropriate. We just need to see more and hear more.

I agree totally. If she is Ax0x4/4, speaking normally, no signs of cyanosis, good cap refill with strong reg radial pulse, why would O2 be a priority in this Pt so far? Of course with a HA you cannot rule out ischemic stroke, but need more information.