Thunderchild145

Right on. Since the doc said she probably would have died had she gone by ground to an ER, I think that about sums it up. If I was the patient, I'd rather spend the money for a helicopter than die, and I'd rather have a 10 minute ride to a Level 1 than a 20 minute ride to a Level 2.

No. You're not wrong. It's definately weird.

Point being, paramedics have better assesment and treatment skills than EMT-Basics. Even -without- ALS supplies like IVs, cardiac monitors, etc. etc. etc. The paramedic using his knowledge of A&P is better prepared to assess the patient and give a handoff to the ER. And, as before mentioned, it's usually not acceptable for an ALS provider to turf a patient to BLS providers, at least here.

Yea. if the FF was also an EMT-P he probably should have gotten in and ridden with you to the ER, even if you didn't have any ALS supplies in the truck.

We just got done covering this. For the chest leads, they are contiguous. I.E. when looking for Q waves and ST elevation you look for it in pairs, right? Well if you see it in V2 and V3, that counts. V2, V3, and V4 would indicate anteroseptal STEMI/AMI, even if V1 shows nothing.

I was actually amused, because in an episode of Star Trek: The Next Generation they are using Scoop stretchers. Apparantly they have that futuristic look to them. Also in the remade version of Battlestar Galatica (the episode where the president is dieing from cancer) they have her on a Stryker ambulance cot.

Very simple really. You can figure out gtt/min is you are given mg/min, but you can't really figure out mg/min when given gtt/min, thenfore it's always best to describe in mg/min. Everything else is variable, but mg/min should always be constant.

Whoa whoa. 300mg IVP is for WCT -Arrest- patients. If the patient is not in cardiac arrest you infuse 150mg of the drug over either 10 minutes or 360mg over 6 hours depending on how high you want the serum concentration. Then again your protocols may be different. Anyway. We give 300mg IVP for VF/VT diluted in 20-30ml of Normal Saline with a repeat of 150mg IVP q 3-5 minutes. For Stable WCT, you mix 150mg of Amiodarone with 100ml NS or D5W and run at 10ml/min for a 10 minute infusion which you can repeat once if it fails to convert. The repeat is the same as the first. 150mg over 10 minutes. For a slow infusion you mix 1000mg in 500ml of solute and run at 30 ugtt/min (1mg/min). Finally for peds, it's 5mg/kg IV/IO. Contraindications are hypotension, cardiogenic shock, hypersensitivity, pulmonary congestion, and 2nd or 3rd degree AV blocks. The most common side effects I've seen when using it is headache and dizziness, but it can also cause hypotension, bradycardia, AV conduction problems, flushing, and excess salivation.

Yea, actually now that I look at Medtronic ERS's website it says "Available with Adaptiv biphasic technology." That leads me to believe that not all of them come with biphasic, even brand new ones. So I retract the previous statement. =)

Yea, this is not another Zoll vs Lifepak thread. This is just asking if all Lifepaks are biphasic. The answer is indeed no. Only the new Lifepak 12s are biphasic. If you bought it a few years ago, it might still be monophasic.

Yea. This is not really a situation I'd give electric medicine first. I'd try adenosine. Failing to see results after 6/12/12 of adenosine or if the patient destableized (drop of BP, CP, syncope) then yea I'd cardiovert but I've always had better results in converting SVT with drugs than countershcoks.

Hah. Actually I'm just about deaf so I make up for a lack of hearing with better equipment. It was a gift anyway so I didn't really complain. :wink:

That's our job? :shock: Hunh. I knew we had more to do than sit back there and chat. 8)

Yes. The email "Badtimes" is an insidious spreader of the "marriage virus". =)

Yea. They typically don't need years to start trying to control this thing. If you were hypertensive back in 1999, they should have told you then and there to start trying to control it through lifestyle changes. (mainly exercise and diet) and scheduling a followup. Not for years later, but months later. If you showed no improvement with exercise and diet they would probably try pharacological interventions. Speaking of, the typical drugs you get are dieuretics, angiotensin converting enzyme (ACE) inhibitors, and beta-blocking agents. You're probably on at least one of these three types of medications now. Good luck with this.

This is my Littman Master Cardiology (custom, obviously.) I love it.

Yea, due to the incontinance I'd almost certainly say stroke/TIA. Due to interventions we can rule out Beta blocker overdose and hypoglycemia. What did the neuro exam tell us? Quick check of pupils, "doll's eye" movement, break open an ammonia amp and wave it under the pt's nose, that type of stuff.

Something in the back of my head says overdose. What about those BP meds? Does he take Beta Blockers or ACE Inhibitors? I'd also like a CBG and a quick neuro exam.

A-Fib is always irregular. A-Flutter however can be regular. With this one, I think I'd go with what has already been said. V-Tach until I can prove it isn't V-Tach. ST with BBB? I don't see any P waves. They could be hidden in the T wave, but I just don't see them so I still think VT. A-fib with BBB? Again A-Fib has to be irregular. Ventricular Pacemaker? Well I guess it depends what type of monitor you have. I know on ours, it -will not- display pacer spikes. Instead it places a triangle on the strip whenever it detects one, but you'd have to have a printout of your 4 lead to find out. (It won't print the triangles on the 12 lead.) and that's with our Physiocontrol Lifepak 12. Still, I gotta call this V-tach. As before it's slow, but I still think V-tach.

I think maybe it alludes to the fact that BLS actually is critical. I.E. If an ambulance rolls up to a cardiac arrest, down time of 8 or so minutes and no BLS has been started, the patient is gone. It wont matter what drugs you have.

Started in August of this year. We've done dysrhythmia, parenteral medications, and A&P.

Eh. I don't keep track of what we have and havn't covered. I'm pretty sure we've covered it all.

I guess I was always told rate over 150 bpm.

Statistically I don't seem to treat peds as often as adults so something like the Broselow system is awesome for a quick reference to that kind of stuff.

My service uses the "partnered" system Dust was talking about with a Paramedic partnered with a Basic. I think it works well because most (note: most) of our basics are capable and know what needs to be done. They really help the paramedics. Here in Arkansas I'm pretty sure that the emergency ambulances all have to have a paramedic on them, but we also have many first responder squads in the area that are staffed by MFRs and EMT-Bs. Usually they get there before the paramedic. I can appreciate an extra hand when it's offered. The other thing about my area is that EMT-Bs are a dime a dozen, but paramedics are gold here because there aren't many of them.