StrchrFetchr

Uhm, doing some EMT-B instruction in NH leads me to believe that for the Cardiac Arrest management station, CPR is performed by bystanders when you enter the room. Scene Safe/ BSI Verify that it is actually a Pulseless victim [Open Airway, 2 breaths, check pulse] Resume CPR, turn on AED, Attatch Electrodes, clear patient and analyze. Reclear patient, and Shock. First Shock must be within 90 seconds [Or - Critical Failure, and pay another $20-$50 for the station next week] Resume CPR immediately. 5 cycles of good CPR, interrupted for less than 10 seconds for any reason [excluding analysis]. During this time, it's your choice. You can do compressions [30/2], OR, you can manage the airway. My advise to you is to manage the airway. It's easier, and requires less thought. Whenever the compression stop, breath twice... Don't forget to 'tie up your loose ends' of the station. Call for ALS, Attatch the BVM to 15 lpm O2, and insert a BLS Airway adjunct of your choice. Just make sure to verbalize exactly what you want your partner to do, because that's what they will do. If they do it wrong, you told them wrong, and you'll be back next week. [Next Advisory will be "No Shock Advised", as Pulse returns with pulse check but still apneic] Manage the airway with BLS Airway Adjunct for 30 seconds both as 1 person rescuer, and 2 person BVM. 10-12/ minute. Do all of that in under 10 minutes = Win.

Funny you mention all of this, R/r, because [for me] it's all true. I work FT in a relatively small suburban ER, with a grand total of about 18 beds. During the daytime, the Paramedic is banished to Triage for the day, where we have 2 expectations: Vital Signs on all triage patients, and IV access and blood draws for what the nurse orders. [Yes, what the Nurse orders...Ugh...].. And that's it. Occasionally, we'll meander inside to start IV access and assist in other CNA/ PCT duties, and transport patients. That's it. My ER Manager states consistently that EMT-P's are unable to actually perform the triage, because of JACHO. [Maybe she means EMTALA, or doesn't know herself, HA!] She also informs us that we're unable to 'care for' a patient, as in have an assignment, for the same reason. Above this, Paramedics are unable to administer medications to patients on the basis that due to State Nursing Regulations [Massachusetts], only Nurses are able to administer medications inside a hospital. [Which I am unable to find any documentation or verification of this for or against] What's somewhat laughable, is there's another sister hospital only 12 miles away where the Paramedics are allowed to practice at the state's EMS Protocols. And, something I don't think I'll ever understand, Paramedics are unable to transport a monitored patient without a nurse present. Not a tremendously huge deal...But if the nurse doesn't bring a code box with her to transport the patient, why do you need a nurse? Paramedics are allowed to transport monitored patients in the other hospital, with another staff member who is not required to be a nurse. So, we're quite limited at what we can do. That's it. It's weird, though...If there's an ICU or OR patient that Critical Care/ Anesthesia/ ER Doc can't intubate, we get the call to go do it... But only after the Nursing Supervisor Okays it. ((And sometimes, it's nursing [theory/ practice] that is the biggest hindrance to patient care...But that's another story)) Now, why? Are nurse's afraid? No. Intimidated? Some, yeah. I've had one nurse tell me she hates working with me because I intimidate her 'because you're so booksmart'. Legal Liability? Sure, in a hospital everyone deserves to have a state licensed RN to hold their hand. And knowledge? That's my guess. It's a small hospital that lives in the shadow merely minutes from, debatedly, some of the best hospitals in the world. Simply put: We don't get sick people. All sick people [e.g. Trauma, MI, Stroke, all pedi, etc etc] go to town. Our population is typically geriatric, and a good percentage nursing homes. We do sepsis better than many. It's what we do. But all this ER eveer sees EMT-P's do is Longboarding, splinting, and an occasional IV and/ or neb. In 7 months of FT employment, I can honestly say I've not seen nor heard of any ALS Ambulance transporting a patient to this ER and administering anything more than Oxygen, Albuterol, Atrovent, or a few cc's of Normal Saline. /shrug Sorry for the ranting. Maybe not so educational as it is cathartic, but it is something that exists somewhere... Hope you don't get to see it. ;-)

Jumping in late... If I hadn't just read the answer here, I was going to toss out the "Well, we did give a rather high amount of sodium" part, by giving Sodium Bicarb. Although I could only imagine [As I haven't experienced...yet] that Heart failure wouldn't be that rapid, it's still a possible sequelae down the road. Good scenario, ERDoc, thanks! ~Stretch

/Agree And not trying to hijack the thread, but somewhat on topic with Dwayne's comment: "Hell, this seems like the month to lose a lot of good people... " Jayme Thissel, ERMD, of Concord Hospital in Concord, NH died last week, also. [Motorcycle Accident]

^^ Not always so true. I spend a good deal of my time working as a Medic in a small, suburban ER. 8 Rooms, 5 Hall beds, and a 5 bed 'Fast Track". During the day, there's typically 6 nurses staffed. Sometimes 7. 1 for Charge, 1 for Triage, 1 for fast track, and that leaves 3-4 for a typical 8 patients at any given time. IMO, in this instance, it's too much staff and not enough output or/or flow. Just something else to help bump up those Press Ganey scores... [Anyone thinking of the commercial where they suggest throwing money at a problem to fix it?] [Not mentioned in staffing is the unit Secretary, 1 Aide in Fast Track, 1-2 in the ER, and a Medic] /shrug ~Stretch