ERDoc

Keep it in mind the next time you have a partner that you don't like that falls asleep. Ice water works best. :wink:

It is a way to test brainstem reflexes (aka the oculocephalic reflex). You take a comatosed pt and turn their head to either side. A normal response in an awake person will cause their eyes to turn with their head. In a comatosed pt, the eyes will stay looking up as the head is turned. The exception to this is if their is a lesion in the pathway involving the reflex. As Ruff said, obviously don't do this in a pt whose cspine is not cleared. In this case you can do cold calorics where you instill cold water into one ear canal. In a comatosed pt the eyes should look towards the ear you put the water in. This is used as part of a braindeath protocol. No response indicates braindeath. DO NOT do this on a conscious person. They will become very dizzy and violently sick (projectile vomiting).

We can assume where it came from, but there is no way to prove it. As others have said, this kid might have enough to worry about. I would turn it over to a supervisor to CYA and document it (not necessarily on his chart).

It could be. Droperidol can cause QT prolongation (though how clinically significant it is is up for debate) and it received (an unwarranted) FDA black box warning. I will admit that I didn't do a very detailed search, so there may be more literature out there on fentanyl.

If I see an ambulance on scene I generally don't stop. If there is no one on scene, I'll stop but once the ambulance gets there it is all theirs. The least I can do is place a call to 911 and let them know what they might need (multiple ambulances, helicopter, FD for a washdown, etc). When I was in the field it was always nice to have an extra set of hands if they were needed, as long as they knew who was running the scene.

"It's classified. I could tell you, but then I would have to kill you." --Maverick in Top Gun How many great lines came from that movie. Also from the same scene (I don't know if I have it exact)... "We were keeping up international relations. You know flipping him the bird." Makes for a better visual when you can actually see Goose give the finger and then apologize... "Sorry, I hate it when it does that."

I'm not sure why this is making news now. It was published in June of 2005. Below is a link to the abstract with a link to the full article. You will have to register to read the full article, but registration is free. CRUSADE is one of the largest databases on ACS in the world. Most of what we know and what we use to determine care comes from what is in this database. It is very similar to the trauama registry. It's a great source for data collection and analysis. Nothing shoddy about it. Morphine was shown to be associated with an increased risk in a subgroups, controlling for many factors. Sound EBM at work here. http://www.ahjonline.com/article/PIIS00028...001493/abstract A study was published in 2000 that showed pts with fentanyl also had increased mortality compared to morphine (pubmed.com is your friend). http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum

I think this case is actually a little more complex than what I originally thought. After reading a few people's post I was left wondering what they were thinking and where they got their information from. I went back and reread the OP. I must have misread it or something, because the second time around I was left wondering what was really going on. Complex for sure. I don't think there is any simple answer in this case and there may be more than one right answer, it's a personal prefernce type situation. I think this is one of those scenarios where actually being able to see and examine the pt might change your mind about your treatment. 1EMT-P, my comment about beta blockers was made under the assumption that this was pure COPD, a fact that I admit is probably not true. However, when you make an agruement that several studies have shown such and such, you need to reference those articles so that others may argue for or against them. Interesting case. I'd be curious to see what the workup shows.

My paycheck went a lot further under a Democratic White House and Congress than it does now.

If you are going to chemically control the rate, I wouldn't worry about it. You are almost maxing out heart rate as it is in this case. I don't think any more sympathetic or any other form of input is going to drive the rate up. The heart is at the point where it is depolarizing as soon as it is out of the refractory period. You've got to treat the lung problem also. I don't think this case can be sliced nicely with Occams Razor.

You want to give beta blockers to someone with bad COPD???

I would treat what sounds like a COPD exacerbation as such. I don't think you can ignore the rate though. As someone else said, this isn't a little STach. This guys heart is working harder than a prosititue at a sex addict convention. It is going to need some help or else it is not going to keep ticking. If this guy was on coumadin, I'd hit him with some etomidate and shock him. If he was not I would use IV cardizem to get the rate down. I would also push some calcium gluconate to help maintain the BP. He'll be better off if we don't give him a stroke.

I alledge you might be right.

Nope, actually published in the British Medical Journal. Also recently reprinted in on of the sports medicine journal, but which one escapes me right now.

Interesting article published in the BMJ a few years back. Feel free to discuss. http://www.bmj.com/cgi/content/full/327/7429/1459

I do not know what the delay was. It was a commercial service that has a contract with the county. I do not know what the specifics of the contract are, so I don't know if there are any response time provisions. Obviously, being a commercial service they also do the hospital d/cs and interfacility transports so it is possible they were caught on one of these, but like I said, I cannot say for sure.

Since this seems to be going down the volley vs. paid route again, I just fingured I'd add my 2 cents. There was a case recently in my area where a guy went into cardiac arrest. The volley FD was able to get 3 members to the scene in less than 6 minutes. The FD does not have an ambulance because they are in a paid system. They waited on the scene for over 20 minutes doing CPR and shocking with an AED. The paid ALS crew finally showed up and took the pt to the hospital where he was pronounced in the ER. No way to say what the outcome would have been, but if they volleys had their own ambulance they could have had the pt off the scene and at the hospital much earlier.

Yeah, I tried the ice bath once. The pt expressed how much he loved it with several rounds of four letter words. Had him bear down too. That was a good laugh for his family. Nothing like seeing an overweight, 50 something year old guy on his back, knees drawn up trying to push out a baby. I'm glad this guy had a good sense of humor otherwise it would have been much worse. Even ended up doing a carotid massage with no change. Had to do it chemically (though I admit I did not try the rectal method).

Personally I like Droperidal and Zofran (though IV Zofran can be pretty expensive). For migraines I give my antiemetic of the day with benadryl and toradol. Works like a charm and keeps the drug seekers away.

We'll let it slip this time, but don't ever think about making a funny thread educational again.

We'll let it slip this time, but don't ever think about making a funny thread educational again.

Sorry about that post. I guess it is a little to "local" to be of any use here. My appologies.

Asys, maybe you should head out to Suffolk County and show some of these numbers to the tax payers. The volley system out there is so overburdened that they could use a little help, but the volleys are too proud to open their eyes (despite the fact that most of them are already paying people). There are companies that run 3-4 calls/day and still have budgets over $1,000,000. You also have coompanies that have a huge membership, lots of ambulances and still are being overburdened by the call volume (CI-Happaugue, Brentwood to name a few). If the county went to a paid or even a paid/volley system, but consolidated everything they could probably save so much money and help ease the property tax burden that has caused so many people to leave.

-5 for taking a thread that has gone down the wrong path and trying to make it more educational. :wink:

Makes it easier to find when you have to get it out.