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brock8024

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    Ron Schmidt, EMT-P, RN - Injured

    in General EMS Discussion

    Posted

    Ron Schmidt, EMT-P, RN (Mercy Medic 246) was critically injured in a motorcycle accident this evening in south OKC. Ron worked for EMSA before going to Mercy EMS and is currently working at Presby as a RN. He is in extremely critical condition at Presby with GCS of 3. Please keep him, his family and friends in your prayers.

    More information as it becomes available.

    This was reported by John Bridges NREMT-P, Yukon Fire

    Please say a few prayers

    burn sites and IV's

    in Patient Care

    Posted

    That IV will be removed very quickly if possible in the hospital as do most field sticks. However, whatever IV is available to start fluid rescusitation immediately will be used. The IV site will have to be capable of handling a large volume of fluids. If there is potential damage to the vessel itself, then it will be useless very quickly. The patient may be tubed, tubbed, bronched (if airway is an issue) and possibly taken to the OR all within the first two hours. In the OR they can place any type of line necessary for the long haul. Infection of course will be an issue, but they will probably have major antibiotic coverage.

    Of course 3rd degree burns and obviously blistering sites are not feasible. Sometimes the hand veins are too small to run alot of fluids through, but they are a start. The burn team will be more upset about multiple unsuccessful sticks than a good stick that they can use until a secure line placement is obtained. A good burn team is very aware of the difficulty of starting IVs on burn patients due to a fluid redistribution and loss.

    I work in a burn center and not many of our patients go to surgery in the first 2 hours. Depending on if there is cirulation compromise then the patient may need escharotomies. Sorry for spelling.

    In our burn center we have a central line placed in the ER for fluid replacement. Most pt's are behind on fluid anyways because of not having a IV or staff in other hospitals not giving the right amount. It seems that most are scared to give that much fluid. I have seen a few patients that get up to around 30 to 40 liters of fluid in a day or two.

    As far as infection they are at higher rate of infection but that does not mean they start getting antibiotics when they hit the do. I know most of the time we wait for something to grow out before just guessing what to give.

    This is the thing people can get an IV in a foot, leg , hand or arm. As far as the hand veins not working u will be surprised at home much fluid you can give in one. And at that point I think I am going to want a IV no matter how big , I mean life net.If you pt crashes while you are trying to get a big iv then you have no iv access. Something is better than nothing in some cases.

    3rd degree is past blistering. At that point you are now to down to muscle and nerves are gone. 2nd degree burns can be deep but not to third yet. Burns can even convert to a different degree. Like a 2nd degree can convert to a 3rd degree in a matter of days.

    burn sites and IV's

    in Patient Care

    Posted

    I would think that you could find a place to start an IV other than the burned area. I work in a burn center and yet seen a burn patient that did not have a site that you could not start a IV in. I mean lets look at this realistically. We as humans have two hands, arms, legs, feet, and a neck. All these areas have multiple areas that you can start an IV. Well the neck may only have one spot on each side. But if you think about it how many burns have you seen that had both feet, hands, arms to where you could not get a IV.

    Another thing is that most burns can convert from 1st to 2nd and from 2nd to 3rd. As far as the pain things is concerned if I am burned and you do not start an IV to controll my pain and or to induce intubation I am going to be a little pissed. I know we try not to hurt our patients but sometimes we have to to help them.

    I do not think that you will ever come across a Pt that has been burned so bad that you can not start an IV in a hand, arm , foot or leg.

    Would you stop?

    in General EMS Discussion

    Posted

    This is a intersting case. I have worked where we stopped at a roll over and had a noncritical patient. The car empty so that did not make a difference. I can see where this would be difficult to not stop. We are trained to provide medical care and it is what we love to do or we would not be in this profession.

    I know that my paramedic school made us take the EMS oath. I remember it said something about not inflicking harm. Did they inflick harm on the pt they already had? Nope but the outcome could have been worse. I mean if a stray bullet would have hit that baby or the family that was with them it would have been different story.

    People also said that if they did not stop that people would have been calling the news and the 911 center because the ambulance did not stop. If they stop and one of them would have gotten killed they would have been calling the 911 center and the news.

    THIS IS A CASE OF THE DAMN IF YOU DO, DAMN IF YOU DO NOT!!!!!

    I graduated last night!!!!!

    in Education and Training

    Posted

    Thank everyone.

    Rid that is so true. It is neat to see the older pics and know that others are still in ems. I took the computer test and passed it. All I have to do now is take the practical test and then I will be paramedic. It is amazing to know what I went through to get where I am now. Like you said the learning has started.

    EMT-Enhanced

    in NREMT - National Registry of EMT's

    Posted

    i see this where I work now. I work for a rural service and it is fun, but most do not like paramedics. most are intermediates with special protocols. I had one tell me that she would much rather one of those intermediates work on her family before a paramedic. I think alot has to do with some of the paragods out there who put others down. I told most of my partners that I do not care if they are a basic or what I will listen to them and see what they have to say.

    I will agree most of my co-workers have no intent on moving up to paramedic. It cost money and they have families and already get paid crap. I think we need to find a way to fix the problem but how will that happen when most of the higher ups could care less about us.

    Evidence-based use of nitro?

    in Patient Care

    Posted

    Nitro helps vasodilate coronary arteries, which in return, supples the heart muscle with oxygen which helps lessen damage to the heart muscle. I might be wrong but how could this not help the heart during a AMI. This is why we use MONA. We try at every angle to help the heart muscle til a stent or what ever needs to be done.

    Dispatched to 16 y/o F Unknown

    in Education and Training

    Posted

    Looks like VT to me too.

    Someone once told me ... "if it looks like VT it probably is" ... has held true in every case I've come accross.

    If it were me this chick is getting 100mg of lignocaine 2% iv. We don't cadiovert conscious pts.

    Why not cardiovert consious pts?? I was taught that you could give 5 mg of valium if needed. In this case her LOC is going down fast enough that she needs to be fixed now. I say forget the 5 mg of valium cardiovert here and then give it if needed. why wait til she codes on you or goes fully unconscious???

    I graduated last night!!!!!

    in Education and Training

    Posted

    Thanks for all the comments.

    Yeah I was looking at our wall of grads and the first class that had a picture taking was up there. I was looking and one of my instructors was telling us about that class and what they was doing now. And one guy was up there was tall and had red hair. And he then told me his nickname. He is floating around on this board can anyone guess who I am talking about. LOL

    Patient impaled ... decision time ...

    in Education and Training

    Posted

    I would call her as I found her. Like somone else said, she is dead and it took 10 mins to get there. I would call my ER doctor and get the ok to do so.

    I mean you could pull her off the poles and work her ,but if the poles are keeping something from bleeding and you pull her off what good are you doing anyway. If you wait for fire to get there to cut her how are you going to do good CPR while she is on the poles? I know you can start a line and push drugs and intubate her , but how are you going to get the drugs to circulate?

    Patient impaled ... decision time ...

    in Education and Training

    Posted

    I would call her as I found her. Like somone else said, she is dead and it took 10 mins to get there. I would call my ER doctor and get the ok to do so.

    I mean you could pull her off the poles and work her ,but if the poles are keeping something from bleeding and you pull her off what good are you doing anyway. If you wait for fire to get there to cut her how are you going to do good CPR while she is on the poles? I know you can start a line and push drugs and intubate her , but how are you going to get the drugs to circulate?

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