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AZCEP

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Everything posted by AZCEP

  1. Medical direction creates the protocols that EMS works under, and therefore creates the situation of requiring transport of patients that do not need it. Spenac may be on to something, but only a small part. EMS is not responsible for the situation, but does indirectly contribute to it only if you consider medical direction a part of the EMS system. If you don't consider medical direction part of the EMS system, then it would seem to be something larger.
  2. Cost and utility would be my major concerns with adding US to the prehospital arena. If the physicians aren't willing to take our word on ECGs, how likely are they to listen to our interpretation of an US? I suppose it could be useful to add to triage decisions, but there are many questions to be answered first.
  3. Yes jwraider, all you are really changing is the volume that the dextrose is contained in. How to get there depends largely on what you have available to you. Many ways to accomplish the same end result.
  4. The simple way I've found is to take the D50 syringe (25 grams), and add it to a 250 mL bag of NS. This gives you a ~7.5% concentration of dextrose without the withdrawing step. Another option is to add the 25 grams to a 250 mL bag of D5. This results in D12.5 and is diluted enough to not cause the phlebitis issue.
  5. Since the typical dosage of dextrose is in GRAMS, not milligrams, are you sure about this?
  6. I'm sure you mistyped, but you only use 6 milligrams of dextrose?
  7. The national scope of practice is a myth. It is the minimum that DOT curriculum adherent programs will educate to. Then the individual regulatory bodies will decide what is/is not acceptable locally. Chances are there won't be many changes to what is already in place anyway.
  8. Any time you suspect a nutrition imbalance Thiamine is a good idea. Urban outdoorsman with alcohol is probably the most common situation, but those in the wilderness/extreme rural setting also can benefit.
  9. This really becomes important when you are dealing with ventilators. Kudos for a great question once again Anthony 8) Typically, volumes are 4-6 mL/kg. When using a BVM the standard from AAP is to ventilate enough to get chest rise then allow for a full exhalation before giving another ventilation.
  10. Use them as trained bystanders. They will not be able to perform any treatments beyond what you have available anyway. If they take too much control of things, wait for the transporting agency to arrive, and watch the fireworks.
  11. "Whew that was close. We almost lost a $400 hand cart." Taggart Blazing Saddles
  12. Any time that "testicle" and "injury report" appear in such close proximity I tend to stay away from the story altogether.
  13. http://www.azfamily.com/video/3tvextra-ind...59507&shu=1 Video of the NTSB news conference. It is roughly 30 minutes long.
  14. "Springtime for Hitler und Germany"
  15. It is highly unusual for the ventricles to have a rate that high.
  16. When were we talking about glucagon? The issue at hand is related to post administration of D50, and has nothing to do with glucagon or the glycogen stores of the liver. The best answer that we could give you Anthony is that it depends. I've had it happen to myself personally, and it isn't terribly enjoyable. I'd suggest using your best clinical judgement instead of hearsay, and making your decision based on what presents.
  17. The hemodynamic status of the patient is immaterial. "Normal" cardiac physiology will tell you that the absolute maximum for atrial tissue during AF/Aflutter is 700 beats per minute. The conduction rate of the AV nodal tissue is 180/min in the "normal" healthy adult. The only way for the rate to exceed the AV node's ability to conduct is through the use of an accessory pathway.
  18. http://www.azcentral.com/news/articles/200...rcrash0701.html http://www.flightglobal.com/articles/2008/...-collision.html http://www.usatoday.com/news/nation/2008-06-30-Crashes_N.htm
  19. There is more going on here than a simple answer can give you, but kudos for asking the question. For a diabetic, the change in blood glucose level (BGL) will be related to the amount and time since their last dose of insulin. It will also depend on the presence of viral/bacterial infections that alter the sensitivity to the insulin and glucose. For someone that is simply hypoglycemic, it makes sense to manage the underlying cause of the problem. Dextrose solutions will manage the hypoglycemia, but do nothing for the reason for it.
  20. All devices are a bit different in how to set them up, but by and large the process if the same. Set your current. This should be the minimum amount needed to obtain capture, but don't take all day deciding how much energy you need to use. For your transient PEA patient, I'd suggest using the maximum and leaving it there. Set the rate. Because the idea is to accelerate the rate past the bradycardia it really makes no sense to start at 60/min. 80-90 beats per minute is the norm here. Continue monitoring for effect. While the TCP is working do not cave to the suggestion to turn it off until you arrive at the receiving facility. Should you do this there is a very good chance you will not be able to obtain capture again.
  21. I seem to have overstated things a bit. According to local news reports weather conditions were clear and calm, and should not have played a part in this incident.
  22. This is uncontrolled airspace. The Flagstaff airport does not have air traffic controllers, and this incident occurred less than 1 mile from the Flagstaff hospital. From what I understand of the situation, the visibility was near zero in the area due to several wild land fires. The dispatching centers for the two companies did not have information about conditions at the site to relay to the aircraft.
  23. From local news reports, there have been reports of six dead including one patient and one flight nurse critically injured. Two "emergency workers" were injured on the ground at the scene. It is still unclear whether they were both transporting patients at the time, or if one was picking a patient up for transport. The Flagstaff Medical Center helipad does not have the space for two aircraft so I can only guess that they were both trying to land at the same time, and did not see the other aircraft.
  24. Glucose paste is significantly cheaper and easier to prepare for oral consumption than D50 is. Your service should consider carrying both of them just to have another option if nothing else. If this medic wants to make a change this is a reasonable one to suggest, depending on his methods. Suggest he carry a jar of peanut butter with him until it happens. :wink:
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