Thunderchild145

Kinda slow for V-Tach. Don't get me wrong, I still think it is V-tach. Are there pulses? I'd go with amiodarone unless there is no pulse.

Is it possible he stimulated a vagus nerve? Could stop hiccups.

Yup. The 4 limb electrodes provide 6 leads (I, II, III, aVR, aVL, aVF) and each of the chest electrodes provides 1 lead (V1-6)

From what I hear, the autopulse and manual CPR have the same or very very close to the same results for return of spontaneous circulation, -BUT- the 30 day survival rate for patients on whom the autopulse was used is lower. I'll stick with CPR.

Funding. Right here, right now, it all boils down to the fact that my service is out of money. This leads to layoffs. Layoffs lead to fewer employees (obviously). Fewer employees means the ones who stay get payed less for doing more. Our equipment is falling apart and so are we. So yea. Funding.

Ours say 2.5-5mg Albuterol. So I'm going to say 2.5mg. If it doesn't work, we will give another 2.5.

hunh. I was going to "Makes Diagnosis (based on what others tell him/her)" ;-)

This one isn't so much for education, but it's awesome for practice. It doesn't seem to open well in Firefox but works well with IE for some reason. Dynamic Cardiac Rhythm Simulator And Dale Dubin's book Rapid Interpretation of EKGs 6th Edition rocks. Just an all around good book for that kind of thing in my opinion.

Eh. Verapamil kills people even when used as indicated. I don't like that drug.

Hah. Thankfully I never seen a 1:1000 preload. I know 1:10000 comes in a 10cc preload for a 1mg dose but I've really only seen 1:1000 in amps and vials.

Doesn't sound too bad. Dehydration/Heat exaustion/electrolyte imbalance (caused by dehydration). Get her inside, get her cooled down. Rehydrate. (Even Water PO would be fine for this. Dont even need an IV)

I'd be mre inclined to agree with fallout. Atropine is a parasympatholytic, and the vagus nerve (Cranial Nerve 10[Parasympathetic]) really only innervates the atria. I think you'd see an increased atrial rate, no real change in the EKG and really no change in the patient's status. However if you did manage to convert the patient back to a sinus rhythm, you'd definatly see a sinus tachycardia, PAT or other re-entry supraventricular tachycardia. But also thbarnes is right in that when associated with AMI, atropine increases myocardial oxygen demand and could worsen the infarct. In short, med errors happen. Can you kill someone? Damn right. Try not to. And in this case (an EMT grabbing the wrong syringe) that won't go on the EMT's license. It goes on the paramedic's license. Always double check your meds.

Epi wasn't my drug of choice, but I see no reason why it's contraindicated or not desired. The patient is hypotensive and bradycardic. Assuming it's a sinus brady and not a large degree block, Epi would probably be 3-4th on my list. So if you can tell me why Epi is not appropriate here..

As far as sedation you might consider Nalbuphine (Nubain). It's similar to morphine without the effect on BP. Or at least the effect isn't as bad. Like I said though I'd really try and manage that Hypotention/Bradycardia before bothering with sedation for TCP.

We're using Brady's Paramedic Care Second Edition. I havn't seen anything about it in there.

Noted for future use.

Eh. Right now I'm in the "Please God don't let me kill anyone" phase of my paramedic clinicals, so yea. I feel ya.

The pt seems to have decresed LOC already, also the BP is way, way too low. Skip the sedation.

I'm not saying that's the correct thing to do, but I do think that's how I, being a brand new medic student, would try and manage this patient. EDIT: Actually, seeing as how the temp is only 90 I'd probably skip the active rewarming and run it to the ER. But I'd go after the hypotension/bradycardia fairly aggressivly. I might even consider TCP.

As far as the hypothermia I'd probably just take hot packs and place them over carotid and femoral arteries. I'd consider a few drugs for the hypotension/bradycardia, mainly epinepherine 1mg IVP, Atropine 0.5mg IVP, or dopamine 2-10 mcg/kg/min IV infusion. I'd definately keep ventilating with BVM and ETT. I'd probably check lung sounds but even if she did have fluid on her lungs her pressure is too low for nitrates, diuretics or vasodilators. Oh yea, and the low amplitude EKG makes me think about electrolytes. I'd probably hand some Ringers and see if it helps any.

Yup. A good way to put it is if there is a threat to life or limb, then Code 3 (L&S) is justified. Your pts VS were within normal limits. Granted, I won't say he/she was stable, because they can crash at any time, but this patient just doesn't seem to have any life or limb threat going on. On the other hand, in the ALS world, the paramedic makes the call about emergent or non-emergent status. In a BLS truck though I truly would defer to the one taking responsibility for the patient. Then again I've never worked on a pure BLS truck so that doesn't fall within my area of expertise.

I want to say the diluting solution that comes with the glucagon is Hyporet, but don't quote me on that. It does have added acids to lower the pH.

haha. "Once you start down the path to the dark side, forever will it consume your destiny.." Love the diagram.

No kidding? Same cop?

Seconded.