defib_wizard

As a rural provider this test along with my assessment could change or alter my transport decision. Bypass the local hospital and transport to the cath lab 60 miles away. Or if Im on the far end of my area call for air transport. I don't think this will replace 12 lead interpretation but will enhance our capabilities.

I agree spenac an NAG or OG tube to decompress the abd will improve tidal volume. I would also keep her ETCO2 between 35 & 40. And if you want the truth about where I work another option would be to call for the helicopter that is stationed at the airport. Because she will be flown either from the rural ed I transport to or from me. But PD does a great job of taking care of me so it would be a very rare day that they wouldn't be there. If this call was outside the city and it was raining then the other kids would be a problem. But you do what you have to do. Belt them in and take them with you.

epinephrine IM, Albuterol and atrovent svn ( in-line with bvm ) solu-medrol IV

Ok surgical cricothyrotomy time.

ok, now we got some info. ( thanks kiwi ) I think intubation is needed then a call to med control. Since this looks like a probable beta-blocker od. Im going to ask for IV glucagon and see what he thinks about a second iv and an epinephrine drip. This call already is not pretty and is beginning to get uglier by the minute. Also hanging out with the other kids is not an option its time for a diesel bolus!

I would look for a string. ( AKA rip cord ) plus other signs. Blood tinged panties, bad odor. I have to agee with a lot that has been posted Secure the airway, assist ventilations, Start an IV ( large bore ) give a 20cc/kg bolus. Narcan 2mg check a bgl give D50 if <60mg/dcl You should also consider spinal immobilization. Get her to the hospital. let leo's take care of the other children.

Another thing to think about is toxic shock syndrome. She is old enough to be going through puberty. A full secondary exam is in order.

spenac said Or better yet just squirt some bactracin in the wound and tape it with duct tape. Tell the pt to watch it if it turns green or falls of in less than 5 days he can go to the urgent care. If it doesn't fall off within 8 days he needs to bathe more. :shock: What do you think ? If your gonna screw up go for it and REALLY do it right!

axevixen wrote; Did you even read the post. He gave his opinion and it wasn't sexist. I have worked with good and great medics, both male and female. That being said I have worked with medics that I wouldn't trust to work on stray dogs. Again both male and female. My opinion is this: I don't care what type of plumbing you carry in your pants indoor or outdoor. Do your job, be a paramedic, we go into places and deal with people in situations most people can't even imagine. This is reality if you can't put up don't try to step up. Go back to asking people if they want fries with their order! End of rant

A-fib @ 55-130

How can you be a paramedic without a drug box and monitor? That in itself should be more of a liability than level of care. I'll give you an example of what I have seen with the state where I work. An emt / medic crew were investigated by the state, both were held to their scope of practice. The medic had additional issues to answer for due to their higher level. In the end the complaint was found to be unwarranted. The lesson I learned from this was ( no it wasn't me ) everyone associated with the call will be held to their scope of practice and standard of care. If the medic feels a bls skill was not needed and the standard of care shows that it is, then the basic emt is just as liable. I was following orders doesn't work. If you are not the one that is doing the paperwork and there are potential issues. You need to review it and correct the problem. You will be asked what happened and if your story doesn't match the documentation then you have a problem.

I read your post to my wife, who has been in ems almost as long as you've been walking. She came up with this; Many years ago she was told that women were not welcome in ems and couldn't handle the physical requirements. Her response to that was " Bite Me! " Now there is about an equal amount of males / females in the places we have worked and now work. FD is still more males than females. A lot of things come to mind when you describe your situation. 1. Look in the mirror; what do you see (be objective as what a pt sees ) A. Do you look like a teenager ( we have a 25 yof that wears her hair so short that it has been asked how old is that young man that is driving the ambulance ). B. Do you assert yourself on scene. If you are the paramedic and it is your pt then you need to take control of the situation. If you don't someone else will, up to and including the pt. 2. Some of it may be sexism or it may be age based ( If your partner is older than you the pt may assume the older person is in charge) This occurs everywhere and the only recourse is to explain to the pt who you are. Hope this helps!

This is an interesting discussion. The service I work for is private for profit. We cover 40 miles of interstate plus a few hundred miles of two lane road outside the city limits. The local FD staffs one person on an engine. They page out paid on-call for all calls. If extrication is even hinted at we call for them because it will take time for them to get a crew and respond out to us. If they are needed they will bill the pts insurance for the time and equipment. But for the most part its a 2 person ambulance crew getting the job done. If you call that the pt is out they will cancel unless you request manpower.

Impressive description. You've painted a pretty good description of your assessment. But I do have some questions about her loc. How does she respond? you say slow but a&o is her speech slurred as in a cva or is she sedated from a possible accidental OD of morphine and lorazepam. Based on what you have said I would like to obtain a blood glucose. And would consider some iv narcan and reassess her loc. ( One of the worst OD's I ever had was a 75 yof that took 100 percocet we still had to intubate her after 4mg narcan ( she started breathing on her own but didn't wake up) It took 6 more to extubate her at the hospital and a narcan drip)

We don't draw blood anymore, mostly due to the fact of not being used by the lab. Nothing ticks me off more than stupid risks to me or my partner. I have had vaccutainers break during filling or during transport. Then to watch the lab person throw out the blood I drew. So we no longer do it. I did for a while when I was approached by an ed director, but with the stipulation that she furnish the tubes and they better be used. This agreement worked until she moved up and out of the er. Now I have no tubes so no draws are done.

For the most part I agree with what was done except the fluid amount. I have a good team of docs that are pretty aggressive for med control. ( med dir. is a former medic ) If the bleeding is internal we can max out at 2000cc isotonic crystalloid. The feeling is the same that anything more will contribute to platelet washout. The target BP is 100 systolic as most people can maintain at this bp and there is less of a chance of you (overfilling the pt) causing an excessive pressure that will cause whatever is bleeding to worsen. That being said If it is external trauma with the bleeding being controlled then wide open to support perfusion is appropriate. Case in point I had a 47 yof that cut her wrists with about 1.5 liters of blood loss + etoh. U/a she had a weak carotid pulse and gcs of 3 she received almost 4000cc of ns during transport and woke up before I could intubate her. She received 4 units of rbcs at ed then was flown to higher care fore surgery. We had the bleeding stopped with pressure bandages as we ran the fluids in. I also patched to clarify that the bleeding was stopped and was given orders to continue the fluid wide open. BP at ed was approx 90-100 systolic if I remember correctly.

High drama over stupidity. Thank god it wasn't a puppy or someone would of had to call 911 for sedation.

You could put it in little braids with bows. :shock:

I hope you start to get better. I am learning the other side of the hospital bed rail as well.I haven't felt good since mid sept. I have had multiple sinus infections, then was admitted with pneumonia. I lost a week of work over that then went to the er this sunday and am off for another week for another infection. Gotta love it ! GET WELL SOON BRO!

Here is my 2 cents; If I were to be able to start over i would become a nurse. ( I am looking into starting my prereq's for it now). The opportunities are endless. Including some prehospital work, most are as flight nurses on scene call. However some companies will hire RN's for critical care ground units. Another option is what has been said here, get your BSN then your medic. You can work at both levels, nurse full-time and medic part-time or vice versa. ( although I wouldn't like the pay difference LOL)

Only if you have sand in your eyes!

when adenosine was first introduced it was widely taught that you could use it to slow down rhythms long enough to intepret them if needed as in a-fib with rvr versus svt. There are better ways of doing this than giving your pt 6-20 second of asystole. (remember do no harm) sinus tach will change a little with O2 and IV fluid. It should also change with a vagal maneuver. A good hx will also help with this for differential dx. A-fib with rvr will be slightly irreg even at rates >200 svt is usually very regular in rate and the pt typically complains or palpitations. Another way to tell is increase the speed of your monitor tape to 50mm/sec if you have the option

This puts a new meaning to body substance isolation being worn.

AMESEMT wrote Okay I got the answers to questions 1-4 memorized. What else do you remember? LOL