MrSpykes

Thanks guys this cleared a lot up for me.

If a patient has allergies to Sulfa then what drugs in the "paramedic arsenal" would we want to avoid giving if any? I looked it up on-line but it didn't seem clear cut. Would I want to avoid Morphine Sulfate, Atropine Sulfate, and Albuterol Sulfate. Or are those okay. The search i did said something about antimicrobials. I am just a little confused and we are on a break from class right now and I don't want to forget to ask. Thanks everyone.

When I started my clinicals in the ER my first two 8hr shifts I probably got 15 glasses of ice chips, 100 glasses of water, 50 turkey sandwiches, fetched 30 wheelchairs, and cleaned more rooms than I can count. I did it all with a smile on my face. From there on out the nurses knew that i was willing to be a team player and help out. Then they started letting me start IV's, push meds give injections, start breathing treatments, and all out just perform my skills. I still clean rooms and do whatever is asked of me with out bitching and when ever a nurse has a good case or something neat is going to be done to a patient i am called in to watch or help. Moral of the story bust your ass and help out and prove to the nurses that you are willing to go the extra mile even if " its not your job" and you will do anything for them and they will throw you a bone and help you get experience.

I definitely agree with all of you and I do get a mindset and feel for a call based on dispatch info. But I try not to read to far into what info is given and wait and see what we have on scene. Especially in today's day and age of people calling and saying that its a chest pain or a difficulty breathing just to get us on scene quicker. Then it turns out to be someone who burnt there finger five hours ago and it still hurts. Sometimes its like we are driving a "Cabulance". I whole heartedly agree with plan for the worst and hope for the best. You can never truly know what is going to beyond your ambulance doors.

I think " ambulance thoughts" can be a double edged sword. Yes, it is good to think about and prepare for a call based on dispatch information. At the same time this can contribute to tunnel vision. Not to mention if the patient is completely different from the dispatch info it can throw you off guard and make you seem unprepared. Two calls come to mind. 1. I was told i was going to a psych facility for a ground level fall. Patient was reported to still be on the ground. So we went en route lights and siren. Dispatch told me the patients airway was patent. I thought that was a strange piece of info for a ground level fall unless there was a loss of consciousness and we were told there was not. U/A at the facility I get out a LSB, C-Collar, straps, towel rolls and tape. We get up to the floor and we find out the call is for a female whom swallowed her toothbrush after lubing it up with tooth paste. She also swallowed her razor in the past. 2. I heard it dispatched as a male with an injury to the wrist. Once the patient climbs in the back i look at his wrists and don't see any swelling, deformity or bruising to either. So I asked, "What seems to be the problem to day?" He responded with a story about how last night he and some friends were wrestling and he hit his chest. I was completely caught off guard because i was expecting an injury to the wrist.

Hey Ace what did you eat at lunch? It seems as the graph shows that at lunchtime you became smarter. I need some of that i could use all the help i can get.

We trade ours out at the hospital. I believe from that point on hospital soaks and then autoclaves. Yes, if i wasn't breathing and needed a tube to save my life I would let someone put the blades in my mouth.

I would definitely RSI, her resps are snoring, she is combative, her GCS is low, she may have a stroke or other bleed in her head, maybe she through a clot from surgery. We really cant find the problem and we need to take control of her airway at this point. I almost want to say try and give 12.5 of D50 but if it is a head bleed then we don't want it necrosing the brain. I don't think the Narcan will do much because opiates would sedate her and not make her posture and be combative. I would probably just RSI and get to rolling hot to the hospital. Continue monitoring pt and ventilating about 15/min.

Lets get his shirt off inspect the chest and abdomen. Any bruising or paradoxical movement? Palpate the chest and abdomen. Any crepitus in the chest or any tenderness. Is he ABD soft and non-tender? Are there any pulsating masses or unusual findings. Check lung sounds, heart tones, and bowel sounds. Has he had a bowel movement recently? Any diarrhea? Was there any Hx of trauma on these training exercises. Any tick bites or other insect or other poisonous creature bites. Matter of fact lets expose completely and check back and extremities and scalp for that matter. Also is there any other associated symptoms, ie. headache. Also can we get a BP in each arm. And check pulse in all four extremities and compare quality and strength.

Put him on the monitor, get an abuterol updraft started to take care of those wheezes and see if that clears up the chest tightness. Get an IV- saline lock started on him. Check his pupils, mouth, and throat. Check his cap refill. I am thinking maybe lung CA.

I would like to know what kind of surgery the patient had on their liver, was it for CA, or a transplant, or infection. Try to verbally calm her down. Get a SAMPLE history from a family member or caretaker. I would like to assess the area of the liver surgery looking for any redness, heat, discharge. Also note any evisceration of ABD organs. Find out when exactly the pt had surgery, PN rating on a scale of 1-10. Definitely put them on high flow O2. What is the general appearance of the skin.

GA, As far as HBO's Real Sex goes i don't feel that is the same as a rated R movie. It is labeled adult everywhere I have seen and as i have already stated i do not feel this appropriate for the station, it is porn. But at the same time if my 16 yo daughter did feel uncomfortable I would expect her to leave or i would go pick her up and take her home if that's what she wanted and i would expect her to go and speak to a superior about the crew mentioned watching something of a pornographic nature. If they cant follow the rules in the station then why would i want my daughter learning from them in an ambulance anyway. But I wold not have any problems with her watching Rescue Me, American Pie, Saved, Saving Private Ryan or any other R rated movie with a crew of young males or for that matter males of any age. If she is my daughter i am sure she has heard a gamut of curse words at one point or another. If she wants to get into this field then I am sure The gore won't bother her. And considering she is female she see's her own boobs every day, I don't think someone else's will make her feel that uncomfortable. She will probably have seen and R rated movie before if she is sixteen and I am in EMS so you know she is going to public school so she has probably heard and seen a lot worse already than what in an R rated movie.

Actually, My girlfriend is in EMS and I nor She has ever had a problem with me or her watching an R-rated movie. As far as the daughter question goes it truly depends on the age there. I wouldn't have a problem with my 15 yo daughter watching an R rated movie with me at station but i would probably not let my 10 yo daughter watch it at station, or home so it has nothing to do with the it being inappropriate for EMS stations. It has to do with it being age appropriate. I also work with many female EMTs and Medics and none of them care about watching an R rated movie. Most of them curse just as bad as the movie or the men do and they have seen boobs before, and have seen worse gore than the movie. As far as shutting of the movie when a member of the general public walk in, its not because it is wrong its because it conveys that we care enough about that person to stop what we are doing and take care of them. Whether its as menial as just a BP check or if they bring there child in who was just hit by a car outside the station. By shutting off the TV it says that the patient is the most important person in that room. It says that taking care of there needs is priority numero uno. And that after all is our job, treating patients. You do what you feel you need to do at your station and we will keep ours just the way we like it.

I agree with the porn thing. It doesn't need to be at the station. As far as R rated movies go its perfectly acceptable. Our station is our home its not a store people don't come shopping at the station for a TV, some deodorant, or show up looking to buy fruit. If they are coming into the station for a BP check or for medical attention and an R rated movie is on what are the odds that they will walk in when there is nudity or when someone curses. When they come in we will probably shut the TV or DVD off so we can hear them better and find out why they need us. Also if its a medical emergency then they probably won't care what is on the TV as long as we help them. As far as the Chief, Chaplain, County Commissioner, or my hypothetical daughter are concerned I am sure all have seen an R Rated film on occasion. These people are not completely shielded. This field is rough and gruff, we can cut the clothes of of a female trauma victim and expose for injuries but we cant see an R rated movie with some nudity. And also i believe you are sexist because you said daughter and not children do you believe its okay to let your son watch an R rated movie but your daughter cant. That's a double standard. There are bigger issues in the world than should we be able to watch an R rated movie at the station.

He is in decompensated shock, he is hypotensive or close to it, he is tachy, and has an altered mental status. Lets recheck vitals and do another trauma assessment. Its not heroine that would constrict his pupils and its not alcohol. Maybe cocaine. Could also be a head injury. Are the pupils PERRL. Restrain him and head lights and siren to the trauma center. monitor his ABC's, hang a bag TKO, constantly assess him on way in. Let the hospital know what you are bringing in.

Also how long does she run and has that been constant lately. What are here vitals now and what is her max pulse when running if she knows. Is she photophobic with these headaches. Does she run by any chemical plants, gas storage facility, or any place where she could come into contact with any chemicals. Is the area she jogs in polluted.

I would give a 250ml bolus and see what it does to the pressure and if our effect is if patient responds positively but pressure still below 100 keep giving fluid until the pressure gets up high enough. But you can throw nitro out the window the inferior MI is reducing the preload and NTG is only going to enhance that. I would be looking more at the Morphine because it wont decrease prelaod as quickly as NTG. I would probably also check frequently on the lung sounds and keep dumping in fluid. Hopefully the fluid will increase preload and that will decrease the ischemia and the heart rate will pick up on its own. If it doesn't the the tissue is already infarcted.

But look at the patient in the scenario. They converted to a beautiful NSR. There was no ectopy at all. We cant determine if the patient is experiencing any pain or funny feelings because they are tubed. I would want to actually see the patient for myself before i make an exact decision but from the info thus far I would just monitor the patient search for the reason of the arrest and provide supportive measures. I would continue to control the airway and if the monitor shows some ectopy then i would bolus some Lido and hang a maintenance drip. I don't believe from what has been presented here that this patient would truly benefit from receiving a bolus of Lidocaine prophylacticly.

I think that since you had no ALS supplies and can not perform ALS interventions while off duty, that in effect you were acting as a EMT-B. The only thing you could actually do was an assessment which it sounds like you did and then you gave a brief report to the personnel that arrived on scene. You then left the scene after transferring care to on duty personnel, whom had medical equipment and could perform interventions. Also I would like to commend you for stopping. If that was my family member that had an MVC and someone was able to get to them right away and if do nothing more than let them no that they are going to be okay i think that helps a lot. Its our job to help people on or off duty, and we can still at least stop make sure everyone is allright and comfort them until help arrives.

I would leave it alone and monitor and supportive measures into the ED. There has been some studies that question the efficacy of Lidocaine prophylacticly. If PVC's come about all the sudden and they are malignant then i would use the Lido but otherwise I would hold off and monitor.

The best way i have found to splint either a dislocated or fractured hip is to take a sheet and fold it lengthwise and lay it across a backboard, scoop stretcher, or just the cot. Then move the patient over onto it so that it is under the point of injury then wrap it around the patients hips and tie it. This will apply some pressure to keep the injury in place and relieves a lot of pain. Also the patient will probably want to be rolled on the injured side because that extra pressure helps the pain too. A lot of times when you find these patients the will have already rolled onto the injured side. Also make sure to give pain meds probably before attempting to move them.

O2, Monitor, IV, check vitals, 12-lead, lung sounds, hang a bag give 250cc bolus NS then tko , ask if she took her meds today, get her on the cot sitting up. move her out to the truck. Start making our way in nice and easy.

Our Medical Director here in St. Joe County did a presentation on past, present and future trauma trends and he briefly talked about Polyheme and Hemopure. He did this presentation at our state EMS conference last September. Also i was lucky enough to see it again when he came and spoke about trauma in my medic class. As was already stated the difference is the source of the fluids. Polyheme is made from outdated blood from humans and Hemopure is from cows. One of the things that was holding the Hemopure back was the thought of could this carry the mad cow disease or is it safe to use on humans. But both of these drugs sound very promising.

Could we also put him on capnography to see his ETCO2 wave form and value? Is he easy to bag? What about his cap refill? I agree with Doc pull back on the tube and see if that fixes the lung sounds and if they remain the same lets decompress the left chest.

What was the patients build like. Was the pt. tall and skinny. I am thinking maybe a spontaneous pnuemo. Ha he had any bad coughing spells. What were his lung sounds like. Just a thought....