wrmedic82

Im assuming ( i hope lightning doesnt strike me by saying this) this is a 3-lead strip. Since 12-lead is unavailable. I would say you can take the LA lead and place it where V1, V2 ect to look at individual leads. Takes more time and not as reliable..but its something to go by to give you an idea. Now as far as giving nitro to the patient w/o IV access. Thats a judgement call you would have to make based on how the patient presents to you. If they are a bit tachycardic and they have the systolic above 110, you can give probably 1 spray and might be able to get away with it. However you leave yourself vulnerable if it just so happen to work a little too well.Its also possible the only way the patient is compensating to sustain that pressure is because of the tachycardia. Trendelinberg could be an option to help raise BP, not that Im a big fan of trendelinberg as I have read in a study that it can cause more harm than good. (in a nutshell by placing patient in trendelinberg, fluid shifts to the torso, thus tricking the body to thinking it is ok, and stopping the release of catechlomines. so once patient returns in the ER to a semi fowlers postion, the body has a difficult time catching up) And for those spell checkers out there I will say this in advance.. Bite me lol Have a good night.

Just when you thought you have seen humanity at the lowest levels.....then you watched that...... Makes me appreciate all those psych calls I get 5 minutes til end of shift.

Im with EMT on that. regardless of cause of the increased ICP. The patient needs a neurosurgeon like a fish needs water. I know its a corny analogy but its early for me.

Its the governments solution to helping parents who dont know how to be parents...we all know the type...not saying its right..But who's going to start the initiative? we know who should, but lets face it there are alot out there that dont which screws others that act like parents. it sucks

I also meant to ask what do the pupils look like? Any signs of trauma?

Based on the presentation stated above I would assess ABC's (that how I start on every patient regardless of CC) manage airway if indicated. I would also put the patient on O2. Since we have the fancy shmancy monitors that digitally monitor ETCO2 with NC. I would put them on that and see what readings we get. ECG.d-stick.Attempt IV access so I can unload benzos if needed. Monitor and reassess. So now what I would like to know is this Rate and Rhythm ETCO2 Glucose mg/dL SpO2 No necessarily in that order. Also I had a brain fart is there any PHx?

how are you going to even know other than seeing peaked t-waves on ECG or w/o a lab spread sheet produced by dialysis center or NH?

The only thing I would think that you may need to give calcium chloride for is accidental calcium channel blocker overdose. Im sure that there are other condition that I will find as I research more. But that in the EMS setting is neither here nor there, we are not going to know that the patient is going to need it until lab work is done at the hospital. or in a whirlybird setting on a CC transfer.

here is a link to another forum and again the answers are not clear http://forums.firehouse.com/showthread.php?t=43590

I agree with you to a point. 9/10 call is BS anyway. However I do believe that w/o equipment to definitively rule out the worst case scenario which most ambulances do not carry. Its usually better in some cases to transport. Other times I feel that a recommendation to a Dr office it the most appropriate. It all depends on how blatant the CC is.

Good Morning from Texas!!!!!!!! I have been asking this question around alot and I seem to only get alot of speculation vs reason. With most medication when it comes to pediatrics, its been said that the pediatric dose should never exceed the adult dose. However in the case of calcium chloride in pediatrics the dose is 20mg/kg, however in adults its 2-4mg/kg. So what I am trying to figure out is why that is the case. Ive heard alot of confusing reasons so whats everyones take on it.

To answer your question, No. Based upon the situation that was described in the forum, yes I would. It all depends on the scene, the patient, and the CC. The CC of neck or back pain gets a 1 way trip to the hospital on a backboard regardless of how BS the scene is. Case and point, Ive been on scene of a relatively minor MVC, the patient I had was a 65/f CC neck pain. We packaged her up backboard, c-collar the whole nine yards. Didnt think much of it until we got to take a look at the xray. Which to say the least was a ass puckering event as the patient had a c-4 Fx. Its just a judgement call you have to make on your own. Would I transport a patient involved in a MVC with a CC of a stubbed toe who is ambulatory on scene....Probably not. However Im sure someone has a whacky story that may make me reconsider.

Good Point

We can practice medicine, but screwing around on scene delaying definitive care isnt doing the patient much good. We provide transport to the hospital as well as pre-hospital care while enroute. We can give breathing treatments all day long, as well a some steroids, but ultimately a physician has to evaluate and treat the patient according to findings we may not be able to determine in the field. Im all about practicing medicine, however sitting on scene so I can play with all my toys seems crazy. Everything can be done enroute to the hospital..Lets face it, hospitals have more resources to treat things better than we can in the field. We use medicine to attempt to get the ball rolling so definitive care than take over, and determine what further interventions may be needed. Last but not least lets be mature.

ACLS is a class indeterminate intervention. There is not a shread of proof that ACLS has any effect on cardiac arrest outcomes....try again. Blood transfusion are life sustaining, not life saving...you may also want to check into the associated complications of blood transfusions. Which is not applicable in the pre-hospital setting. Other routes are also used that may be delayed, but are effective. Yes IV is the fastest route and the preferred route. However the uses are more for sustaining life vs saving life. Along with any medication, it either works or it doesn't so it does not matter whether or not an IV is established or not. Its the medication doing the work, not the IV. We can argue this one all day or call it a day.. you decide

Just food for thought, sometimes alot of artifact is attributed to lead placement. Just something to check out. If your patient is having CP. I personally would treat the patient and not the monitor. I do not see the need to dick around on scene with a ECG monitor and delaying definitive care. Another ECG will be done at the hospital anyway. So trying to figure out whether your monitor is on the fritz or not on scene is delaying care. Lets say there is no ST elevation, depression or whatever, does this completely rule out acute myocardial infarction?? Absolutely Not!!!! Do what you can and get to the hospital.

Show me how an I.V. has ever saved a life?

Friends dont let friends work at AMR (american medical retards) lol Just know your stuff and be able to pass their physical and your good to go.

In my opinion its about reading the scene and doing whats best for the patient, as well as you and your partner. Lets face it there are tons of people out there that freak out over stubbed toes or other related bs. If you can start a treatment at the patient's side why the hell not? Another option is to start treatment while moving the patient to the ambulance if possible. Whatever it takes to get the patient taken care of safely and efficiently without delay. Remember that EMS is in the transportation business. The hospital can do more good for the patient that any ambulance service. That is one thing alot of people in EMS forget.

Lol something I will have to add to my zombie bag for the inevitable zombie invasion...self preservation is a great thing other than the weapons needed for defense. And yes everyone I am joking btw

EMS...You call, we haul, thats all. Unless they put law enforcement into my job description...not my problem. The only thing Im concerned with is getting that patient to the hospital and getting what can be done for the patient done. If all that can be done is a ECG, o2 and ASA. Im ok with that. An IV has never saved a life...but it does help out greatly. Definitive care is the ultimate goal. they have much better toys to play with.

Me personally I would have fully immobilized him for a couple reasons 1. He may be altered due to hypoglycemia 2. Adrinaline may mask injuries 3. Just because the patient is walking around does not R/O head, neck or back injuries. 4. Most importantly C.Y.A. Of course everything is a case-by-case basis. It wouldn't cause further harm to fully immobilize the patient. What alot of people get complacent about is the routine stuff. Lets face it almost everyday 911 EMS providers will encounter a MVC once or twice a shift. Its also complacency that brings cause for litigation (in the U.S.) Unless you have a X-ray machine on scene to R/O Fx to head, neck, or spine, C.Y.A. and immobilize the patient.

My bad I wasn't aware that there is politics involved when it comes to meal breaks, especially when it comes to EMS.. Next time granny or little Tommy decides to code during my meal break...they will just have to wait. Im sure the patient and the family will understand....

Im all about making the patient as comfortable as possible. On our trucks we carry Phenergan and Zofran. The one thing we started doing last year is moving towards Zofran ODT. We still carry the Zofran IV, but thats what we are pushing towards. My personal experience with Zofran ODT is that is works great if the patient has nausea, but not actively vomiting. It dissolves under the tongue in about 30-45 seconds and tastes like cotton candy. The only problem I have seen is with patients actively vomiting. Its kinda pointless at that point. Most medics in our system as well as myself prefer IV Zofran. Whats everyone elses take on it??

Hmmmmmmmmmmmmmmmmmm