Thunderchild145

Unconscious pt, therefore implied consent. Conscious patient, and even with AMS is probably still able to make decisions. EXPRESSED consent is required.

Yea. <21. My bad. It was a long day. ;-)

Right. It doesn't matter. Just most people prefer BP to be written in even numbers. Some places require it. You do your thing, and I'll keep doing mine. :wink:

My service will hire at 18, but you are much less likely to be hired if you are >21 than if you are 21 and over.

Rounding an automatic? No. Automatics have the ability to decern that kind of detail though. Me? I'm only human and I can't really tell if it's on the line or the space anyway. For simplicity, it's on the line. But yea, I'd say rounding is not 100% accurate but if your patient dies because of a 1mmHg varience in blood pressure, I would be astonished.

That's not a terribly good analogy, as most watches have marks for minutes as well. I'm sure in the booklet that comes with a watch, it would tell you that the minutes hand will take 60 minutes to go all the way around, and 5 minutes to move between the hour marks. We just dont have to read that because we know. As a counter-analogy, taking an even blood pressure with a manual cuff is like saying it's 12:19 and 30 seconds because the minute hand is between the 19 and the 20. It's just not accurate.

My opinion is that I haven't seen anybody harmed by administarion of supplemental O2, but I've seen plenty of people helped by it. If we want to talk logically, you can make an inductive arguement that says it's probable that most people in the future will not be harmed by supplemental oxygen, and some will actually be helped by it. Paramedics are perfusion specialists. Perfusion is all about getting oxygen rich blood to the cells and removing blood laden with wastes from the cells. More oxygen in my mind means better perfusion (assuming uncompromised circulation/artificial circulation).

The cuff is manufactured with the intended reading to be taken on or approximately on a black mark, not on a white space. If the sound stops on a white space then it stopped approximately on a black mark. If readings were ment to be taken on odd numbers, they would have a smaller black mark on them. Since the standard is to record manual blood pressures in even numbers only (and I personally think that this is mainly for making easy work of calculations related to blood pressure, like when calculating mean arterial pressure or intracranial pressure, that sort) then you are only allowed to record a reading on or near a black mark, not on a space. Personally I don't really care whether it stops on the mark or the space anyway, cause I'm going to write down the number by the mark. :wink:

We used to carry morphine and nubain, but now we carry morphine and fentanyl. I like this combo of drugs because fentanyl is a great analgesic drug for EMS, but we still use morphine for ACS.

Pain is temporary. Death is permanent. I think just about any person of sound mind is going to elect cardioversion over death, but for the sake of arguement, yes, I would allow them to decide until such point as they became unresponsive in the back of my abbulance and at that point, if I didn't have it in writing, I would be forced to decide for them.

If they absolutely need cardioversion, forget sedation. Just do it. Obviously give them a little heads up that this will hurt. A lot. And even that is an understatement.

Yea. Basics here can't even use the glucometers. Intermediates can though. IVs, D50, all that. Unfortunatly for an EMT-B I'd say go with the PR route glucose.

Could be something other than pnuemothorax too. I've had pneumonia patients so bad you couldn't hear anything. I'm not saying this is pnuemonia. That doesn't make any sense. Just saying to keep an open mind. =)

Isn't Albuterol contraindicated with a rate that fast?

I think the main idea in trying to treat the hypoxia first is that if you attempt to cardiovert without treating the hypoxia, then the heart won't respond or will respond poorly to the attempt. This article says that the heart needs oxygen to restart, so if you cardiovert and the myocardium is hypoxic, you may just send them into asystole. That's what I gather anyway.

Nothing says they're medically trained. I'd hope that they are though, so that they're not just sticking catheters in each other.

Normally, I would tend to agree with you, but I do understand where the article is coming from. For the same reason that we're now doing CPR prior to defibrillation/intubation/intravenous access in ACLS, it's saying that myocardial hypoxia needs to be corrected before cardioversion takes place. Also, there's always the risk when cardioverting A-fib patients who havn't been on blood thinners that they well throw a clot, so the cardioversion is something better left to a hospital anyway.

Re. Tard.

I don't know anything about volunteer squads, but the question that I've gotten -every- -single- -time- I've applied for a paid job is "Do you have any conditions which will prevent you from executing the functions of the job I just described to you?" Some can be accomodated (Most, like back problems or hearing loss really can't.) This may be what's set in his heart, but as many have said, if he can't lift, it's probably time to think about something else.

Liter bags of LR and NS. 250s of D5W.

If you're worried about aspiration, I was taught you can administer glucose paste PR (yea. per rectum.) [Disclaimer: When your patient wakes up with sticky butt cheeks, they -will- be pissed off.] [Disclaimer 2: I wasn't taught that by any EMT/Medic instructor. I've been a type 1 diabetic for 17 years and that's what the docs told my parents to do for me in lieu of glucagon.] But yea, totally serious about that. You can absorb it PR but it may not be the most practical way to administer it. (Due to the speed of absorbtion and the nature of a hypoglycemic emergency)

Eh. If I don't have pads already on the chest, what the hell? Why not? In my own (read: limited) personal experiance, I've never revived someone with a PCT, but it's worth a shot. =)

Wikipedia is your friend. http://en.wikipedia.org/wiki/Saved_%28TV_series%29

Kay. Point taken. I'm an asshole.

Granted. I made a mistake by making an always/never statement. I'm just going to go bury my head in the sand now. :wink: