Jump to content

MSDeltaFlt

Members
  • Posts

    104
  • Joined

  • Last visited

Everything posted by MSDeltaFlt

  1. So long as their VS can handle it.
  2. As far as therapeutic levels go, you'll know you're getting therapeutic when VS, breath sounds, and overall pt status improve. When you hear more air exchanging, respirations are less labored, and pt states they're breathing better, you're getting there. When lungs are clear, and there's no SOB, then you're therapeutic. Odds are you might not make it THAT far by the time you get to the hospital. Just get them on the road to recovery is all you can do most of the time.
  3. It's redundant because of its length of duration. It will still be working at its peak 4hrs after you give it. That's why. So just give it once with albuterol and then you don't need to give it again until 4hrs later at the earliest; sometimes 6hrs later. However you CAN keep giving albuterol only back to back and even continuously for an hour or two to get the effect you need; so long as pt's VS will tolerate it (Heart Rate, BP, cardiac O2 demand, etc).
  4. Atrovent any more frequent than Q4-6hrs is redundant. Give it once with albuterol and then keep giving albuterol continuously.
  5. Chronic asthma and chronic pain in which he has acquired a tolerance of all kinds of things and is allergic to what you carry. In 40 mins you're not going to fix this guys pain. I doubt you'll even be able to take the edge off. Also pain is not mentioned in the primary survey. You are stuck on "B", my friend. Stick with the nebs. You'll be fine. So will the patient.
  6. Late in the game here. I apologize. I like the way CH thinks. He brings up some good points. Regardless of which meds you have at your disposal, there is something that needs to be made intimately aware of. There is a difference between "giving sedatives" and "sedating your patient". There is also a difference between "giving pain meds" and "treating pain". I, myself, was once on a Fentanyl drip in the ICU with an unstable C2 Fx and extubated myself. Thought I was dreaming. Apparently not. Know the difference. Just my thoughts.
  7. So far this year I'm 100% for ETI, however there were 2 pts where it took 2 attempts to get the tube.
  8. Generally speaking all of the electrode wires are color coded. They are also labeled. RA means Right Arm. LA means Left Arm and so on. Place them in the proper places and you'll get an accurate ECG. http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson1/lead_dia.html V1: right 4th intercostal space V2: left 4th intercostal space V3: halfway between V2 and V4 V4: left 5th intercostal space, mid-clavicular line V5: horizontal to V4, anterior axillary line V6: horizontal to V5, mid-axillary line Generally start placing V1 & V2, then V4, then V6. Then you place V3 between V2 and V4 and V5 between V4 and V6.
  9. It depends on the amount of chest pain and the kind of chest pain the pt complains of. Some pts' complaints of chest pain just as you described will get the full workup. Then again, some pts' complaints of chest pain just as you described will get absolutely nothing at all except maybe a trip to ED. It depends on what the assessment shows.
  10. Get a manikin and practice it that way, and imagine the way it'd look like on a real patient in a real scenario. that way you'll have a little better understanding of just how difficult it can be. Some right handed people may try to tube with the blade in the right hand because they say they have more power and control with the blade in the right hand. If that's the case then they're doing it wrong. ETI is all technique; not power.
  11. No NIBP will ever claim to be accurate. They are only good for one thing: trending. Get a baseline first by getting a manual.
  12. To be honest with you, Vent. I absolutely do not understand that. In order to provide pt care on a helicopter, you have to go through so much training. But on a service with one medical crew member, that is not necessarily so. Some things just don't make sense to me.
  13. Following MONA is indicated, as you well know, but street drug use can cause SVT. Granted they always deny, but the HR is high enough technically. What was the BP? What were the other S/S's? Now we weren't there. Did your pt, according to your assessment, warrant Adenosine? Could it have been an option?
  14. Personally I would make the drip a 1:1 concentration. Pull out 100cc from the bag to make it a 1:1. The size of the drip chamber is mute because Amio should be given by pump. I won't give it my gravity.
  15. After reading the blog, I'd have to say that standard exposure protocols would probably not work. You'd have to take those protocols over the top and keep going. One would have to be very aggressive and very generous. Especially with pain management. 16,000,000 Scollville units, I believe, would more than likely hold the world's record. Anything you have to handle with tweezers and latex gloves should be considered a hazardous material.
  16. Mostly I agree with what Arizona said. The Med Control was treating the symptoms moreso than the numbers. Plus you gotta think. Is a liter of fluid really that much fluid on an adult? He lost a liter and a half of blood in the truck. Blood is three times thicker than isotonic fluid. Running one bag in, MAYBE 2, is not unlike spitting in the ocean. It won't hurt him. Were there any adverse effects of only 200cc in? More than likely not. While writing this post I've been thinking. You ever wonder why MD's stand by the wall of the ER room when a pt is rolled in as they are giving orders? One reason is keep out of the way of us subordinates doing our work following their orders. The other is maybe they are taking in the "Big Picture" of what's going on. Big picture here? Treat the symptoms. Run the bag in. Humbly written
  17. That's just the thing. It helps. It's not all inclusive or exact, but it's still something you definitely need to learn.
  18. Medic30, Vent and I see eye to eye on a lot things. This is no different. I can understand why they nasally intubated. When you don't have RSI/DAI capabilities, you have to go nasal in order to better secure the airway sometimes. However, "Airway" and "Breathing" are not the same. In the same way "Oxygenation" (measured by SpO2%), "Respiration" (respiratory rate), and "Ventilation" (measured by EtCO2) are three completely different entities. You can be breathing normally and oxygenating like a champ, but if you're not ventilating worth a damn, you're still gonna die. You've seen this happen. We've all seen this happen. If the CO2 gets too high, the pH will drop too low. Nothing will work in an acidic medium; up to and including pulses. Did any adverse conditions actually happen? Probably not. But here's the thing. Luck counts, but don't count on luck. Bag 'em. If they're still breathing, bag with them, but still bag 'em.
  19. Advanced Practice Paramedics, I believe, should be able to bring critical care to EMS. RSI, surgical crics, chest tubes, vents, yadda, yadda, yadda should all be made available.
  20. Celticare, It depends on what you want to do with your ECG. Do you want to monitor or assess? If you just want to monitor, then the torso works fine. RA is close enough when on Right Upper Torso. You won't be able to assess as accurately, but you won't be assessing. If you want to assess, then you will have to place the leads on the limbs. On assessment, lead placement is paramount. Limb lead placdement on the torso can result in false positive ST elevation. RA means Right Arm. Hope this helps.
×
×
  • Create New...