mshow00

The point is not to make you feel small, its so the rest of us can learn from the veterns in reguards to mistakes we make. I said we because all of us at some point have said something stupid and it has been pointed out. Now, I was told that if you enter the IV upside down, then you sheer the skin and vein, opening the pt up to any number of complications. Or more pointedly increasing the risk. Is this not true?

SAMPLE, OLDCARTE, family hx, social hx of last couple of days, moniter, IV, blood drawls (if hospital will accept them), PMS check... large bolus of deseil.... First thought: Meningitis. Differ Dx: unknown at this time

What about one or both lungs having a "bow out" in the lower lobes from impact on the cinder block? I agree with Itks post of what is going on, taking it a step further though, when was the last time he ate? did he rupture his stomach and is spilling out all of his digestive enzymes? What about his descending aorta, did that get damaged in anyway(check for pedal pulses and injury site below perfussion)?

If is abd is getting bigger just drop a OG/NG tube(depending on if he is able to tolerate either) that should help with the air in the stomache, as for any "free air" in the abd couldn't you just put a "loose" compression bandage on it? What about trying to transport with the head of the bb slightly elevated(gravity working for you)? other than hauling butt and or calling for a helo maybe i dont know what else to do for this pt.

Looking for other obvious injuries... any other life threats... looking for signs that he either fell from the tree to land on the cinder block or slipped off the cinder block taking it to the chest... do RTA... when I get to the chest pay close attention to TIC... any signs of a tension hemo-pneumothorax? if so pop chest (if required)... load and go...full trauma package... ET if deemed needed... transport to trauma center with 2 large bore IVs, one NS one LR, with trauma treatment, and ACLS protocols as required...

My understanding to CCR is that is designed to take the delay out of lay-people and bystanders starting chest compressions. Apparent some(a lot) of people were withholding CPR so they would not have to give the two breaths on a stranger (who can really blame them) when no barrier device was available. The theory behind this is that when a person has sudden cardiac arrest they have enough O2 in their bodies to last for several minutes, until the first responders and or EMS can arrive. According to my medical control Dr. it was never meant to replace CPR for health care providers(EMTs, Paramedics, First Responders).

Technically anyone can make an arrest, but it sounds like this guy couldn't cut it as a cop and has the "big d*ck complex".

I was told sterile was not such a big concern anymore when I preping for ITLS. The pt just needs dry "clean" sheets. Was I told wrong, or is this acceptable seeing as how I have two level 1 trauma centers (Barnes Jewish and SLU) about 15 mins from everywhere? The rational behind why we were told that was one of the first things the Drs. are going to do is put on a thick layer of anti-biotic cream and dry dress everything. We also have critical care support by air (Arch, Airevac) and by ground (a CC transport truck). I am just trying to figure out what is truely proper?

My questions here is simple, can one push all "IV meds" through an IO? More pointedly would you be able to push D50? I ask because we had a call out here last weekend where a morbidly obese diabetic went in to severe hypoglycemia. When the original unit arrived on scene, they immediately checked her sugar: 24, and called for an assist truck (my partner and I) Our supervisior also met us out there. All 5 of us (three medics and two basics) were looking for a vein to do an IV, but could not find sh*t. My partner found an EJ, but when he started to push the D50 it blew. We do not have IO's of any kind here (unless its a peds code) The first crew had already given Glucagon IM recheck of the BGL:19. My partner was finally (last second attempt) to obtain an IV in the left breast of the woman, and was given two Amps of D50 and transported. With her BGL being so low (and her unresponsive) and the Glucagon not helping we had no choice. The ED Doc told us to never ever do that again (IV to the breast) but good job as well. Would an IO option have made things easier? disclaimer: we did not delay transport to obtain said iv, after ej blew the other basic and i cleared a path through the house to we could carry this woman out to our str.

From one student to another, I have found that going into a clinical to work brings me great respect. I go to work, I clean rooms, get vitals/place them on a monitor, interview the pt, obtain blood/ urine (hand them the cup), and possibly start an IV. I run the collected to labs the lab, take pts to the floor when needed, I get food/water, take the pts to x-ray/CT. I do all of this because I want to earn their respect. I ask questions respectfully, take advise and offer my "limited experience" (even though one of my preceptors is younger and greener than I) to understand and find what works best (& what they will ultimately allow me to do). I have never missed anything "cool", I have had the medical control Dr. of one of my sites take me aside and personally instruct me on various things. I go in humble (or try my best too) and usually have great experiences with everyone (yes even those nurses that "hate" paramedics/paramedic students).

The movie you are thinking of is actually "The Sum of All Fears" not "A Clear And Present Danger". It has the same main character in it, Jack Ryan, played by both Harrison Ford "A Clear And Present Danger" and " Patriot Games" and then Ben Affleck in "The Sum of All Fears".

LR/RL is lactated ringers... I'm not sure if my region and/or my company mandate we carry both NS and LR, but we do, several bags of both on all ALS ambulances. LR= gets converted to sodium bicarb in the liver when metabolized. As far as changing the pH balance the pt is already acidotic, the body(my guess) has already reverted to anaerobic metabolism releasing more lactic acid, and the the resp rate is so low that the baby is not "blowing off" the increased acid in the body, so would you not want to try to balance that (at least in theory) with the bicarb? I understand the not wanting to add more sodium to the already dehydrated body, but is not getting the pH balance more equal the higher priority at this time? What about a second IV, one running NS and the other LR (as in the ITLS cocktail)? Having not gotten into peds yet, I am at a loss, but is my thought process off on this?

Can you be a little more descriptive please. brand new baby medic student here.

What about LR or even sodium bicarb, the pt is in resp and metabolic acids( - normal limits)? I mean before the mvc

DRD= dead right der FUBAR= F***ed up beyond all repair (classic) DILLIGAF= Do I Look Like I Give A F*** (nother classic)

In regards to the heart sounds it can assist you in your field diagnosis if it has extra sounds: normally it is a "lub" followed by a "dub" sound. I don't know what the 'extra" sounds translate out too, but that is the gist of that. It is done with both the flat and bell part of your ears. You can hear murmurs, mitral valve prolapse (supposedly) and things of that nature. As far as percussion it is a lost art that when trained properly one can map out organs of the body etc. It can also tell you whether your pt has a hemo vs pneumothorax. Dull sounds mean a mass (blood, organ etc) It is a lost art according to my medical control doctor. At least that is what my minimal training has told/showed me. Hope this helps a little.

I am thinking it is hypoxemia-lack of adequate O2 in/for the brain, or even a rare case of "dry drowning". (or at least "dry near drowning" seeing as how he is a live at the hospital)

Thanks for the help... I passed with flying colors today.

From a current student to a new student congrats, good luck and pre read your book before class starts(I did and it really helped me out quite a bit)

Now I am confused... as I understood it HIPPA was to protect specific pt information(like the demographics: name, address, SSN, telephone number etc). Am I wrong here, or do many people take HIPPA way way to far, like one of the EDS we go to that will not give EMS crews a "face sheet"?

thanks that does help

I have and am... I was hoping someone could point me in direction of what kind of scenarios are used, how much pharm is involved, if "special" equipment (ie chest decompression, KED, traction splint) is used, and the such

I am taking ITLS the beginning of next week and I am looking for some advice/tips on what I should study. Been studying basic trauma/treatment and started to look at trauma codes. Can anyone point me a little better direction for study? Thanks in advance.

On a side note to the argument made by the article, my medical control doctor has received a grant to explore the little researched affects of high-flow to ICP. Some possible changes in the years to come.

Umm wow!!!