medic112

The regulations should be the same as any person that is licensed to carry a conceiled weapon on there person. I know i carry a weapon on me about 75 percent of the time while OFF duty. You just need to have common sense.. I know this is a GREAT stretch for some people. Not trying to stur up a bunch of drama and stuff. this is just my opinion.

what type of impact was that video of? and it doesnt look like the litter straps were secured / tightened properly.

okay. still going with my origonal tx plan of neb n O2.

Im not thinking so much that this is a CHF pt, #1 no history of CHF, no crackles or rhonchi. correct? Possibly a PE. however like it was said before he's not having any CP, is he experiencing any calf tenderness? I would treat him like any other respiratory pt, presenting with SOB and wheezing. O2, Monitor, IV, Neb treatment. possibly NTG for the pressure. but would give the neb first and re-assess after that as far as breathing and maybe the use of NTG.

Dispatched class 1 for a fall victim. additional info provided by county, 89 y/o female, conscious / breathing, not alert, fell from standing. AOS to find FD and BLS treating an 89 y/o female, lying supine on the floor inside doorway, strong smell of urine. No acute respiratory distress, eyes are open, following people with eyes, incoherent when spoken to. Per family they found her laying on the floor when they came in the house, pt was lying prone when they found her. Pt stated that she fell yesterday (approx 24 hrs ago), family states she not acting normally. she lives in the residence alone. No complaints from pt other than being cold. (-) pain. pt does not know why she fell or exactly when,. PMH: TIA, A-fib, HTN, high cholesterol, dementia. Meds: Beta blocker (cant remember exact which one), no digoxin, ASA 81mg / day. NKDA VS: Pulse Rate 86, A-fib on monitor 110, Pulse Ox 95% RA, 97% on 4lpm NC, BP 150/60. BGL 174 from finger stick. PE: pt conscious / breathing normally without difficulty, originally able to answer some questions, slow to respond at times. following later pt was AAOx4, with no complaints. Patent natural airway, No JVD, trachea midline, ENT clear, PERRL. Oral mucosa dry. Skin: cool / dry. mild tenting. head / neck / back atraumatic. Chest unremarkable. lungs clear and equal bilaterally. abd SNT, (-) distension, no pulsating masses. pelvis stable with incontinence to urine. extremities: PMSx4, no pedal edema. Pt weights approx 50kg. question is how do you treat this pt? does anyone have protocols for adult rhabdomyolysis? Just wondering. Command did not agree with that treatment and only monitor / transport. wanted other opinions. Our protocol is 500mL fluid bolus. 1 amp Sodium bicarb in 250mL bag running at 100mL / Hr. thanks, and enjoy.

We have Morphine / Fentanyl. Versed Valium. Wish we had Nitrous Oxide. but oh well. its on the approved drug list for the state.

WOW, thanks for all the responses. Her "pulse" rate radial was 88 bpm, systolic bp was 130. i dont remember off the top of my head if she was currently taking any beta blockers. i think she was. And i did follow up with the doctor that i transferred care to at the hospital. pt was admitted with sepsis, secondary to pneumonia (again). Pt was given fluid bolus's in the ED and her rapid atrial rate did resolve, cardizem was not used and the doc said he would have been very hesistant giving me the orders to administer it, if i would have called command. Thank you everyone for posting, it helped.

scott 33. yes a typo on my part, thanks. II , III, avf. thanks

right, cardizem wont convert A-fib, however it is protocol (under command line) to use cardizem on rapid afib pts. however contraindicated again because of clots in pt's with a hx of afib and its not a new onset. I should have rephrased it better, it wont "convert" but it would control it because its a calcium channel blocker. As for the steriod therapy. what does your system use? we have solu-medrol in our system. just curious as to what you use. To answer jwraiders question, the pt's history was pretty much like i stated in the first post. And her nomal vitals were unknown. i asked and got the normal reply of "well i dont know how she's been the past few days, i just came back to work from being off awhile, and its not really my pt, her's the paperwork. Which wasnt to much help. She did have a temp for the past few days, however it wasnt documented in her chart about any recent VS's. And i did believe she was dehydrated, mild tenting was noted which i did not mention earlier. Dartmouthdave: yes i have seen CCB used in the field and also in the ED's. I have administered Cardizem once before, when i was a student to an elderly pt, new onset afib (or it wasnt documented) either way. rapid afib, no real complaints, i think Chest pressure with exertion and SOB. EKG rapid afib, called command and got orders for 10 of cardizem gave it slow and in incriments and was able to control her rate prior to arriving in the ED. (little bit longer transport time for her).

i have been taught that we should start doing right sided 12 leads (time allowing) if we see ST elevation in the inferior wall leads (I / II / avf). as we know that most inferior wall MI's have some right sided ventricular involvement. most us medics try and do that, again pending transport time and how the pt presents.

im not sure about the steroid treatment myself either, maybe he will be able to enlighten us later in this post. As for the question to me.. had the pt been unstable and longer transport time. i would have probably tried fluid bolus's first. she is dehyrdated due to the underlying infection.. most likely.. and had that not converted her, yes possibly tried the cardizem.. however i am really hessitant with using that medication on pt's that have a history of afib, simply because as much of us know she could have a clot forming in the atrium that once the rate is slowed down she could throw that and back stuff happens.

my thoughts exactly. The problem being i argued this up and down with my preceptor. I could have given a little fluid bolus. her temp was above 102, and my working diagnosis was sepsis, secondary to pneumonia. the rapid afib was due to her being septic. after she stated that she was feeling better, i didnt feel it nessicary to treat the afib, and the hospital ended up putting her in a non monitored hallway bed, atleast for some time. Unknown about the orthostatics, we didnt stand her up or anything. but semi-fowlers her bp was within normal limits. thanks for the input

You have a pt, mid to late 70's. I cant remember her exact age. Called to a nursing home for trouble breathing, upon entering the room find the pt, sitting up in bed coughing up green / yellow sputum, AOCx4, answering questions appropriately, full sentences with intermittent coughing up the nasty stuff, also has a low grade fever past few days. Staff states her pulse Ox fluctuating between 85-90% they have her of course on the normal 1.5 Lpm NC. Hx of A-Fib / HTN / recurrent pneumonia. only complaint from pt is mild dyspnea. no other complaints. (-) CP, nausea / vomiting / diarrhea, no recent falls or trauma. took normal meds today. Staff is concerned that she might have pneumonia. Lung sounds diminished Right lower lobe, (-) wheezing / rhonchi / crackles. Pulse Ox is 92% on monitor, Monitor Rapid A-fib rate of 170-210 at times. still no other complaints. On 4 lpm NC pt's O2 sat up to 97 - 98%. Pt denies any complaints of SOB now and that it is easier to breath. My question is... we need to call command for orders of Cardizem. ETA to hospital was about 10min / 15 at most. Pt was stable. BP was within normal limits. My preceptor, kept asking me if there was anything i wanted to do.. i assumed he ment treating her with the Cardizem. Which i did not do, number one because of the history of a-fib and her being hemodynamically stable. Later we talked a little bit, he was thinking along the lines of it didnt really matter about hx when the rate is that high, and that if we didnt do cardizem then we shoudl have considered treating her with maybe a fluid bolus - i agreed with that, however by the time we would have done that we were at the hospital, i did jack a lock into her, but didnt hang fluids. and then he said something about possibly a neb (albuterol) tx, which i again disagreed with because of the tachycardia already. My question on here is,, would you have pushed or considered the Cardizem? thanks

actually our local protocol for Wide Complex Tachycardia with a Pulse calls for either Lido 1.5mg/kg OR Amio 150mg infused over 10minutes. we do not carry pumps in the field. and No not a student, just a new Medic. trying to refresh on a lot of things that i have questions about.

150mg of Amio, 250ml Bag NSS, and a 20gtts/ml set. How do you do the calculation. I need refreshed. and you need to administer it over 10minutes. whats the formula??