AZCEP

Not to argue, but if they were both in the front of the vehicle wouldn't the passenger also be responsible for alerting the driver to the possibility of the accident? Do you suppose there is more than one at fault in this incident?

Ahhhh, that makes much better sense. Although I may be in the minority, enough higher math to understand that you are learning to follow patterns and rules is a good thing. Algebra, calculus, and statistics are all about being able to follow the rules that have been set, then discovering the pattern that is hidden in the calculation. If they were more directly applicable, they would not be as useful for the critical thinking aspect.

Dust, you've managed to confuse the "bleep" out of me. :? In one paragraphh you question the value of physics, then turn around and suggest that it should be mandated. Please clear this up for us simple country folk. If physics can be used as an application type course, it holds great value. Many times the difficulty with this path is the course becomes so diluted that it will hold no value. Even for a profession directed degree, once you hold it you should be able to discuss the subject matter with anyone else that has taken a similar course.

Nice try though. I'm willing to bet there are more than one way to spell rhabdomyolysis, and if you change it around a bit it will describe an entirely different problem.

I wish I did mean something else. :roll: The way the law is written, anyone can. Unless time is taken away from the resuscitation to verify the authority of the person, EMS is obligated to proceed with all measures. It has happened in my own experience to have someone walk past with no knowledge of what the patient wants, and make the statement to "do something" and we had to until medical control was contacted.

This would be a good indication to use the sodium bicarbonate as Wendy noted. Once ECG changes are witnessed, start treating the associated hyperkalemia that is probably the cause. However, without any progression toward this, I'd hold the bicarb/calcium for the time being.

Outside your comfort zone...? On a bus full of walking wounded? What's the problem? Treating 15-20 people out of a standard trauma bag is all kinds of interesting. This is a good time to learn just how useful duct tape can be.

Calcium gluconate can be considered if a gel form is available to place on the site. IV/IA use has fallen out of favor however. I'd consider using as much Benadryl as possible to see if we could calm her down. Adding in the BZD and maybe some fentanyl/morphine as well. Sodium bicarbonate is not going to be terribly helpful at this stage, although contacting poison control might be. Aside from the sinus tachycardia, is there any abnormalities noted on the ECG? P wave flattening, T wave hyperacuity, ST depression/elevation, QRS widening/voltage changes?

Send a supervisor type to the hospital to help them manage the mess they are going to be receiving. Send air resources to the hospital as well if they are able to get there. Not real sure on if the fog precludes this option. Continue to the cardiac arrest, and work toward an early termination if possible. All resources will be stretched thin with the MCI, but it might be worth trying to get law enforcement or victim's advocate to respond to the arrest. Just to shorten the turn around.

You handle the call that you were assigned first, then make your way to the glamour. Yes, I'd suggest that this patient could transport himself, but that is no different than if there wasn't another call happening. If the management of the MCI hinges on one transport unit there is a bigger problem here than which call to handle.

I wonder when they will have a cable so I can attach it to my smart phone. :wink: I wish they would just go ahead and get the tri-corder technology usable already.

In AZ anyone can rescind a prehospital DNR order. Only a physician, or a patient can allow for one. If there is a conflict of any kind with carrying out the order as written, call medical control.

Wrong-O my friend. Once the father has requested your help, you have to carry it through. They can tell you to start, not stop. In this case a call to medical control is necessary. Perform good basic resuscitation until you receive an order to terminate.

If it was a money maker the previous government entity would have kept it instead of letting it die on the vine.

If your system designates this mess as BLS, that indicates a serious problem with the ability of those that called for your help. [/quote=ibemt31]Upon our arrival, however, we found our patient to be semi conscious and incapable of coherent speech. the frazzled doctor and nurse, who commanded me to get the pt to the hospital "NOW!!", disregarding the escort required by protocol, and informed me that our pt, who had a hx of gastric ulcers, had developed severe abd pain, before "deteriorating".

Precordial thump is only to be used if there is not a defibrillator immediately available. Performing this dubious value action wastes time that would be better served by applying your defib pads and shocking directly. If you witness the arrest, go ahead and shock as soon as possible. If you have to send someone to get your defibrillator, start compressions.

With the presentation we were given, I'd choose not to perform RSI on this patient. Thus mitigating the hyperkalemic effects of succinylcholine.

Consider the spinal column to be similar to any other long bone with a joint at both ends. If you immobilize the center of the bone, but don't secure the two ends movement at either one will reduce the effectiveness in the center. The movement may not be much, but it doesn't take much to misalign the column.

What kind of work does he do? Does he take any medications? Allergies? Epiglottitis, tonsilitis, angioedema would be my coniderations. With the amount of edema, are you able to ventilate through it at all? Surgical airway is indicated, and quickly. Might consider some nebulized epinephrine to reduce the swelling if possible.

Cardiac arrest following succinylcholine tends to happen a bit quicker than it did in this case. I'm not willing to hang it up as the cause, but it just doesn't fit too well for the scenario. Hypoxia is definitely the most likely cause of the arrest. A trial of simple bag-mask ventilation might have given some information to suggest that RSI was a bad idea. I'd also wager that the providers did not consider the immobility of the patient as being a problem. 24 hours without moving allows muscle cells to begin atrophy. As they break down, they will leak potassium into the blood stream. A little sugar, maybe some sedation, perhaps even nasal intubation, and transport. I'd have probably left the paralytics out altogether.

The CPAP unit is well worth the expense. It is not quite as tunable as a wall mounted generator, but it does a good job with less oxygen spent. I'm not a fan of the tube tamer design though. The cam-lock style clamps tend to undo themselves when side loaded, and the latex strap will dry-rot to a state of worthlessness in short order.

The Howland lock and the Grandview are two alternatives to standard laryngoscopy. Neither are meant to replace the other. The Howland lock changes the angle of the blade at the handle to make it easier to direct visualization to the cords for some patients. The Grandview can't make this happen without over extending the neck. A Grandview is much better than any currently available fiber-optic set up. The light is brighter, the tip of the blade is easier to see, and the tongue is better managed. The H.I.D. bulb by itself is worth the MSRP. Since I bought mine, I've not had to use any other set up outside of nasal intubation.

I, for one, wish more departments would issue one of these to their employees. Maybe we could make it part of the uniform.

Right on firedoc5. Many times the patient with the history that would warrant having a home AED will get the ICD prior to discharge. Home AED's should be considered if there is a waiting period between discharge and having the ICD placed. They can also be used if the possibility of pulseless arrest is there, but the utility of an ICD would be questionable. They are not the answer that everyone wants them to be, but they might buy some more time when they are needed.

The irony of it all, Pinky. Years of trying to take over the world, and all I had to do was say "moo".