Kiwiology

Well darn it I didn't read down far enough---- HOWEVER-- I have had my flight crews meet and go by ground over long distance trips helping provide a higher level of care for the long ride-- still an option worth a call.

LOL. Thats my thinking too - I don't want this guy go go into PEA or total resp arrset on us out here in the boon docks. He needs an advanced airway, now, if worse comes to worse then here's my plan of attack.

1. Continue allbuterol and look at breath sounds and a 12 lead

2. Both are good, I would try 0.5mg IM adrenaline q20 max x 2, although he is not having bronchospasam or constriction I want to try it unless there is a contraindication. I am worried about this guy getting tired and stressed out from having resp diff and I don't want him to arrest, so this should help with that.

3. Load this guy into your guvna'd rig and start towards the hospital, the longer we sit here the longer before this guy gets to def care

Now, if the breath sounds aren't good it could possibly be a slowly manifesting edema maybe caused by ischemic problem?? Keep the frusemide handy.

I am going with it some sort of hypoxia be it ischemic or environmental.

I want this guy in the bus and on the way to the hospital, and keep the whirly bird handy, our local Westpac HEMS chopper is bright red and yellow so it wont run into anything out there in the snow. Maybe Santa does HEMS?

I'm not too into an advanced airway because thats not going to help up the SO2 if he has a patent airway but if this guy gets really tired and stressed out from having resp diff then I dont want him to arrest on us. I'd looking towards RSI or a surgical cricothyroid puncture to keep him from having to work so hard to breathe - needle is no good, that only lasts about 45 minutes and our guvna'd rig wont go fast enuf to get him to def care in time!

Don't think it will come to that, but it might.

Did anybody mention getting a sample of that yellow gunk or getting in contact with the ENT doc yet?

Shirt, this is an interesting one.

Breath sounds? Good bilateral? Wheezy? Crackly? I am either thinking some sort of airway obstruction (maybe do a laryngascopy) and check for swelling or some sort of hypoxia. As my clinical guidelines say, oxygenation and ventilation are two different things. If the O2 is only 85% then something is preventing oxygenation despite good ventillation.

If this kid can breate w/o difficulty it rules out some sort of airway obstruct but I'd still like to take a peek down the throat with a laryngascope just to rule out anything (never say never) stuck down there.

Whats his EKG/BP looking like? My concern is that if this kid is stressing out trying to breate and he keeps on doing it, getting tired in the process he might PEA out (had a severe asthmatic do that) so I want to prevent that.

I would be looking at the lungs, seeing if they sound clear and good equal breath sounds because I'de be looking at worst, maybe a pulmonary edema which would fix with the hypoxia. Unlikely I know but still.

If thats not it then I would be thinking maybe something cardiogenic or edema wise hence the breath sounds.

I want to get this guy on a 12 lead and take a good look at the breath sounds, maybe take some bloods for sampling and keep high flow O2 with the allbuterol and try some IM adrenaline if his O2 is still ~85% if the bronchodialators don't work.

I would also want to get in a cannula in case he codes out or goes into PEA.

Interesting topic.

First off, good on these kids for getting out there and into the EMS system. New Zealand essentially has a similar system (heavily reliant on volly EMTs in many small areas - Darien, CT pop is ~20,000). So I commend them very highly for doing so. Be them EMT-B or EMT-P I am generally not for high school kids staffing emergency ambulances.

I say "generally" because somebody who is 16 can be very mature and a practical thinker and make the perfect gurney jockey. Then there are obviously those who are not suited to being the next EMT Pimples.

This problem is really not about "can they save me when I code on the floor" because be they 17 or 70 an EMT-B is an EMT-B and an EMT-HP an EMT-P, they carry the same gear and scope of practice (SoP) regardless of age.

I am not keen on a teenager turning up in the bus to the next car wreck I happen to be turned out to. Simply because is a teenager really mature and grounded enough to undertake the sights, sounds and responsibilities of an EMS worker? I say no.

Then you must consider the other aspect which us Kiwis are having to deal with more and more - say you get some aggressive family member who doesn't want you working on his mother, father, husband, wife etc and starts to nut out. Got to think safety too, I can imagine the situation. Its hard enough for two well trained, physically fit adults to deal with, let alone a couple of teenagers. We have a good tool for that, its called our Maglite with D Cell batteries . I did note that EMT Charlie in the CBS piece seemed to be wearing a stab resistant vest, we need to get those!

Problem is a high school student probably lacks not only the general life experience but also the critical thinking skills and driving experience to become an EMT.

Here in Kiwi land, you won't get touched to become an EMT until you have at least 3 years behind the wheel on a full license (so around 4 1/2 years in total) and pass a bunch of tests and reference checks showing you can think and act in critical situations.

So good on them, if I am in cardiac arrest I'd rather they turn up than waiting for either the fire department or an ALS ambulance from further afield but ..... I'm still not very keen on the idea.