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Quakefire

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Posts posted by Quakefire

    Pain with IO use

    in General EMS Discussion

    Posted

    Nerve Blocks and Sutures? That would probably decrease our number of transports a fair bit. 5 minutes is a very long time, but sometimes IO is the only way to go, never want to have an exj as my only option on a 400 pound patient. Unfortunately benzos are not a common option for pain control for us. Our protocol requires at least 2 doses of a narcotic pain killer with no relief (and usually right up to our max dose 250mcg of Fentanyl or 10mg Morphine) before we can request versed or ketamine for pain from our medical control.

    Pain with IO use

    in General EMS Discussion

    Posted

    One of my partners is getting ready to go back to school to become an Advanced Care Paramedic, and she has been doing an online A&P course ahead of time for a little extra study time during the course and she asked an interesting question. According to her text books the only place that has any nerve endings is in the periosteum, and yet we teach that the pain of insertion of an IO is much lower than the pain from the infusion. So she asked where the infusion pain comes from and I haven't the foggiest idea. I know there are people here much smarter than me so can anyone answer this question?

     

    Dan

    Fall Not Acting Appropriately

    in Education and Training

    Posted

    This is only the second patient I have encountered with an acute inferior MI, last one was declining very rapidly so I was being cautious with anything that might cause hemodynamic compromise, this in addition to the fact that when asked the patient stated she has never had morphine before. As a side note, I never placed defib pads on this patient. I explained to her what was happening and what might have to happen, but she was quite anxious and I had very quick access to our monitor so I felt that any decrease in her anxiety was also a good thing. I doubt that I would have had to pace her at any point, as she is far more likely to progress into a vfib.

    Fall Not Acting Appropriately

    in Education and Training

    Posted

    Our treatment was pretty simple. I cheated a little bit with the ECG's, the first 3-lead and the first 12 lead are 10 minutes apart, the second 3 lead was 7 minutes after that and the final 12 lead was 30 minutes after the initial 12 lead.

    ASA, O2 with nasal cannula at 4lpm, 18g IV with NS TKO. I gave two 2mg doses of Morphine about 15 minutes apart being mindful of her BP which didn't change for us. This only dropped her pain to a 5/10

    I really don't see this patient as a symptomatic bradycardia as the lethargy was consistent with her normal use of the sleep aid (Zopiclone). The main issue I have with using dopamine is the inotropic and chronotropic effects on the heart. I dont want to make a damaged heart work harder (plus dopamine isnt in our protocol for that) Nitro is contraindicated in this patient as per our protocols.

    Pt maintained her GCS, BP and vitals throughout the transport to the recieving hospital and into the cath lab 10 minutes later. Pt had a 100% occlusion of the RCA, once cleared and stented the 3rd degree AV block resolved and the patient left the CCU into a cardiac ward within 3 days.

    Thanks for playing!

    Fall Not Acting Appropriately

    in Education and Training

    Posted

    Ok, to consolidate everyones treatment

    We are now enroute to the Cardiac Center, about 40 minutes transport, we have O2, a NS line, 3-lead and 12 lead, and quick combos in place. STEMI alert has been called.

    Haven't seen a interpretation of the 3-lead, and no one has has actually said what kind of MI the 12 lead shows

    And just you in the back, in the event that she goes into arrest, you have access to a Zoll Autopulse.

    Fall Not Acting Appropriately

    in Education and Training

    Posted

    The fall as described to dispatch was when the patient dropped herself onto the bed, no syncope. No prehospital fibrolytics yet supposed to be in the pipeline. Also no pressors except for severe sepsis

    Home hospital is 20 minutes away, Lab, X-Ray, ECG

    "Big City Hospital" is 40 minutes away, Cardiac specialty, Cath lab, Cardiac Sx and CCU. This hospital has a STEMI alert protocol

    Of course two hospitals are in opposite directions so transfer time is 60min. Rotary wing is not available at this time

    Canadian ACP programs

    in General EMS Discussion

    Posted

    I went to SIAST as a Sask trained and registered PCP for my Advanced care Paramedic. I had two PCP's from BC in my class who had issues with the JI because of the strike. Both passed one is employed with BCAS the other stayed in Saskatchewan. As the courses and their content is always changing I can't comment specifically to the course now except that it is still a CMA accredited program.

    As HellsBells stated SIAST is a full time program M-F 9-4:30 in either Regina or Saskatoon with class sizes of about 30, Practicum placements throughout the province. minimum requirements are listed in the course info. Passing requires passing the course as well as your practicum which is up to your preceptors and practicum coordinator. As for a lack of a strict selection process, students tend to get weeded out by exams and through practicum, no one is guaranteed a pass

    Fall Not Acting Appropriately

    in Education and Training

    Posted

    When you arrive the patients husband leads you in, the patient is sitting on the couch, appears quite lethargic, able to answer questions, but sometimes requires question to be asked several times, answers are short and slow. States dizzy when standing and walking, had to crawl up stairs to bedroom to wake husband, states plopped onto bed. No memory problems or dysphagia.

    Pt. states took 1 and a half 7.5mg Zopiclone tablets at approximately 21:30 and fell asleep on the couch. Pt, was woken up by 6/10 substernal chest pain, with both arms painful and numb. This was around 0100, family took about an hour to decide to call for an ambulance. No syncopal episodes prior to EMS arrival

    PMHx: HTN (Irbesartan), Hypothyroid (synthroid), hasnt taken meds since Saturday morning. Smokes approximately 1/2 pack a day

    Vitals: Pulse 48, BP 126/62, Resp Rate 18, SpO2 98% Pupils ERL

    Onset 0100

    Fall Not Acting Appropriately

    in Education and Training

    Posted

    Dispatched for 53 y/o Female pt. Fall not acting appropriately

    Time of Call 02:00 am Monday Morning

    You work for a rural ambulance service home hospital has basic emergency room with X-ray and labwork, time to scene approximately 20 minutes

    Dispatch info updated 15 minutes into response, Pt now has CP

    This scenario starts from arriving on scene

    First Mobile Stroke Unit in the United States!

    in General EMS Discussion

    Posted

    Video on the manufacturer website (frazerbilt) says MD, CT Tech, RN and Paramedic on the car. Seeks like a waste of a Paramedic just to sit there and drive. CT and tPA in the driveway prior to transport to stroke center. Give it a few years to find out if they increase survivabilty rates or how close they come to "ideal" outcomes before we can see how effective this is. I was under the understanding that tPA is not the safest drug in the first place, so I wonder how well a "standard" ambulance with a CT scanner in the back can handle those complications.

    Peds pads and Zoll defib

    in Equiqment and Apparatus

    Posted

    Ran into an interesting problem. We use Zoll E-Series monitors for the most part, and I recently found out something interesting. If you use the normal or CPR sensor equipped Pedi-Padz with older Zoll monitor/defib like the e or m series, and use the built in AED, the monitor will deliver a full adult defib dose if a shock is indicated. They make a reduced energy pad with a large resistor pack on the cabling but it doesn't exactly cut the dose in half (120J becomes 56) with every defib. This prevents you from doing a accurate weight based defib dose.

    So we are left with carrying two different sets of pediatric pads in the event that a BLS crew is at a call without ALS backup. Or not allowing our BLS crews to use the AED with pediatric patients. Sounds like this has been changed with the newer R and X series

    Very hard to find any info on the reduced energy pads, so I'm interested to hear your thoughts

    Dan

    Saskatchewan "Old School" practitioners forced to upgrade or DIE!

    in General EMS Discussion

    Posted

    As far as I know there will be no more additions to the ACP scope of practice, all treatment protocols are now being handled by the Saskatchewan College of Paramedics, the big switch being the change to classification based medications instead of specific meds. So the protocols no longer read Ventolin, it says bronchodilator. It is now up to the individual service and medical director to provide research and evidence based medicine for that services drug choices and doses. This must be kept on file in the event the college audits a patients care.

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