celticcare

I'd continue transport but question what methods, there is no sign of trauma? Cut marks, isertion of objects below or mutilation?

Ingestion of pills?

With a few new defibs being released and being a while since this thread was orginally posted, do we as providers feel any changes have been made? The idea of Bluetooth device recognition is something I still havent seen on any units yet and I agree with dust, the cables and wires are just horrific to work around, especially when tranporting out of the ambulance to the emergency department and postitioning the monitor where it can be out of the way, still usable and reachable in the event you need to.

Has she passed a motion? Is her GCS altered? Monitor still showing sinus tach?

Ye Gods why does everything about women have to be about bleeding all the time :S :o :o :o :o

Masses or lumps on examination? Family history of Gall bladder issues? Murpheys Sign? Rebound Tenderness? Change in bowel habits or urinary issues? But yes dont fix her, lol

Station checks - 0700, start the trucks and leave them to warm up in the cool winter morning, fleet consisted of ALS, ILS and BLS trucks and PTS truck also. Everything fine, defib works, truck works, oxygen full, all the drugs present, suction works and so on and so forth.... lets go have cofee..... Tones drop 0730. Priority one for Respiratory Arrest. Go to the truck, open the doors, turn the key whiiiiiir whiiiiiiir, what? Whiiiiiiir whiiiiiiir. Engine would not turn over. ILS unit was out, BLS unit was out, only truck left was the patient transfer service *PTS* unit. So swap the gear fast, start up the unit and bzzzzzzzzzzzzzzzz to the scene. Had other things like stollenwerger stretcher collapse once and crunch on my foot. Thank god for steel caps but when you got big ol bubba on one of them, it aint fun. Had the pin holding the scoop give way during class once and boy that guy wasnt impressed landing on the ground. Had a Stiffneck snap once, bodox seal on a cylinder disapear and no seal on the cylinder *luckily there was spare seals and regs* but thankfully, for me personally, nothing that has been hugely detremental to individuals.

If we are transfering a patient, we take our own pumps. There is a standard pump used in all the hospitals in my area now and its lightweight and easier to carry. Ambulance themselves dont carry pumps, as the meds given are on a titrate effect and gauge with the dropper. Interhospital transfer etc, the nurse is to take a pump so problem solved.

I am surprised though, that Zoll hasn't made a decision to make a bulky big battery either, thought they'd like to make some money lol

Just got an e-mail from medtronic that the Lifepak 15 has approval for shipping now from the FDA. Perfect timing in a recession eh Ben, I have told you countless times, the lifepak 10 can do twelve leads and no our ambulance region never bought them as it was not standard for Paramedics to do 12 lead acquisition let alone interpret them. WFA used the ten to acquire the V leads in MCL mode monitoring in lead 1 and printing a strip each lead. 12 leads weren't routinly acquired in our ambulance region until about 3 years ago.

Why is it, I now see Phil, sucking in his gut, puffing out his chest and yanking that door open and throwing it up in the presence of a patients hot 24 year old granddaughter? :lol:

If the sats improved, overall airway maintance was achieved and you had no other options, then hell better than letting her further injury due to secondary hypoxia. Its a tough one to weigh up, NPA or nothing really, EMS is full of judgement calls, and you made one. If I started feeling anything that would deviate during the insertion I would stop, we all know the shape of the nose and airway basically is like a sideways J so if i felt it start to veer off the wrong way, I'd withdraw. No other options, I would have probably gone the same path as you. Scotty

That would be definatly time for the trousers to turn brown. Was chatting to the cardiologist at work yesterday, and is doing more reading into them and looking at seriously importing them, they would be on a rotational use basis as in patients on a holding period for their ICD would get them until the surgery then they get cleaned, stored and then another person gets it. Should be interesting. Luckily we dont have the whole unibomber thing or terrorist belts to worry about here and would probably be easier to teach people about it here. Being a smaller population I mean lol

Hey thats awesome, its something that I've been thinking about just curious really, I'll talk to one of the docs at work when I'm next back on shift.

The shifty ninja strikes again

Isn't that the same sort of time as the international market started a big drive to dump the monophasic gear *which you can pick up cheap on ebay* and buy only biaphasic? Been talking to a combination of medics and nurses and there seems to be a consensus that biaphasic is more successful in cardioversion of atrial arrythmias and vts however they found monophasic more successful for defibrillation. Will see if I can find anything to back it up but sometimes just human experience is good too.

Ok, just been thinking lately, and how there is the main placement of paddles for defibrillation of sternum and apex for your general defibrillation and cardioversion etc, what do you do if you have a patient with Dextrocardia (Heart facing the right hand side)? Do we still go for the paddles in their usual spots.... and hope we get a shock through.... or do we modify the placement of the paddles. I have been talking to my cardiac nurse educator and she was saying it is something that medic alert makes a bracelet for so if we came across it, do we need to modify paddle placement, hand position for CPR or go with what we know and hope it works? I know it is rare and probably has never been encountered, but am just curious what would you do if you were presented with a cardiac arrest on a patient who'se medic alert tag said they had Dextrocardia. Thanks and here is an xray image of Dextrocardia to reinforce the topic... Scotty

Is this going to result in the purchase of more autopulses then? I mean not going to use that oxygen to ventilate them, lets pump it into this machine to go humpity pumpity on a chest while we decide where to have lunch. Compressions only CPR has been in the pipelines for years, I am pleased we dont have the ability to be sued if a patient remains dead during a resus *unless we do something so stupidly wrong* be it lay person or professional. Scotty

Hahaha you're always going to get them Doc, and as you say, no snot of your nose. OP - Compressions and FBAO, its been said in the posts above me and so I wont repeat it on the reasoning of Compressions. Here in New Zealand we do chest compressions for that mere fact of increased interthoracic pressure to give a chance of POP *it coming out, not a lung lol*. Intermediates here can do direct laryngascopy and mcgills forceps to remove the object if seen. The side issue raised on C-Spine management, the statement about "they'll never come off the ventilator", couldn't agree more, nursed a guy in ICU with that exact same issue, people pulled him out and started CPR, yeap he lived but with the rough movement *as reviewed by the doctors* an already injured spinal cord snapped at c5. Bye bye phrenic nerve and that patient never left the ventilator. No Oxygen = no brain = bye bye blue sky No Breathing ability = no oxygen = no brain = bye bye blue sky. C-spine care is important as airway care.

Fentynal is used prehospitally and in hospitally here in the RSI kits. I've not seen an RSI being done yet to be honest in the heat of the moment (only induction in theatre and cardiac arrest intubation). Had a chat to an advanced paramedic friend of mine, and he is of the mindset also, that analgesia is important, as a relaxant agent and for pain relief *and yes I know the other agents are used to sedate and relax, but narcotics have that calming effect too, so hey I'd rather be calm and mellow if your sticking something down my throat........ and no wise ass comments either guys*. When I get my first one, I'll be sure to post here lol, watch this space.

Happy to help from a New Zealand perspective also, can reach me on scottymedic@xtra.co.nz

Again as said above, check your monitors settings and check that they are calibrated to the wrists or the torso. That will make a difference. Its down to an eye to see as well and being aware of transient acute coronary syndrome symptoms *such as apical ballooning and coronary artery spasm*. It's not all about the STEMI either, its all about your systematic review of the 12 lead and following a sequence to interpret it. Scotty

We have been looking into them here *in my role as a CCU nurse not in EMS* however a pretty price tag involved is the main stopping factor. One of the cardiologists I work with is keen to gain a stock pile of them as we have a queue of people waiting to get ICD's at the moment and so these could be quite helpfule. I can just see it now though, some paramedics rocking up to an arrest, see a person twitching on the ground and thinking its a seizure not a lifevest and go to pull out the midazalam lol. I think its a bit of ... watch this space.

Talk to your telecommunications provider, alot of private companies offer good paging deals and who knows, your comms room might just have the feature built into their system already, just sitting there unused

Ak, cyanosis is caused by lack of oxygenated blood circulating, when a person has hyperventilation, they have too much O2 in their system do they not? there fore would not have Cyanosis. I am going for the majority vote on this one, it is more than likely A as that is my first instinct response.