armymedic571

No. I want to stop the seizure and control the airway. Unfortunetly, that is waht I have to work with. Also, If you give Etomidate to a person with a clenched jaw, and experience trimus ---> back up plan... re-oxygenate and nasal intubation, or NPA and BVM. So, wait, I guess yes, I would give the etomidate.....

AT , I couldn't help but note that you stated Wikipedia as a sourece of factual information...........Sorry dude. FAIL. I still disagree..... You sir are hilarious..... I would personally use our Medication Assisted Intubation (as we are not allowed to use Sux in our system). This is basically drowning our patient with etomidate. So, 0.3 mg/kg of etomidate please. Boujie tube if necessary. If the patient is still clencked, re-oxygenate and nasal intubation. When we get the tube in Fent and versed for continued sedation......

MB, I haven't been in the Springs since 2002, but from what I remember both services were professional and all about good patient care. I did rotations with AMR in both the Springs and Pueblo, and to be honest I found the ambulance crews in Pueblo to be more laid back, professional and calm on calls. However, call volume and call type was definetely better in the Springs. If I had to give to 2 cents I would suggest looking into CSFD. There medics are competent and professional (as I remember). Also, they are better paid and less worked. Not to mention the benfits that come with the job. Just my opinion as my info is out of date....... PS CSFD station 11......ROCKS...... J

This is completely anecdotal......but how does this differ from some one who is touching a person who is tazed? If I recall from less-leathal weapons training. Every person who was tazed, had two other people holding them to help them to the gound. Contact was never let go, and no one received any rougue shocks.....as I recall. But like I said......That is just anecdote..... .

I like your thought process wit hseizure, but disagree with Hypertension as hypotension is the side effect of choice with effexor. Funny..... Although, kiwi already clarified this....heart rate and pulse rate are not the same and can be different. One measures the electrical rate of the heart (HR), as the other measures its mechanical manifestation (PR). But that is a discussion for another thread. AT, I must disagree. Although intubating based off of the patients GCS score would be considered bad form where I am from, I agree with Ruff as airway control is key. An unresponsive patient cannot definitevely control his/her airway (especially as presenting for this scenario), therefore CPAP/BiPAP would be countra-indicated in this case. if RSI is not in your bag of tricks, nasal intubation might be the ticket. Phil, I dig your style, but why the glucose? If the patients Blood sugar is 90 mg/dl (~4mmol/l). I would not consider that hypoglycemic, and as we cannot determine whether a stroke type event is hemorrhagic vs embolus. I would be extremely cautious with this. However, if I have misunderstood, please clarifiy for me...please. Another reason to control this patients airway.

Bushy, Based off the information you have given. I would say that your interpratation is correct. -- Once again as Dave stated--> How did you know the patients INR was 6.5? -- Although I agree with you, I would think that a one time dose would not cause the patient any further harm, as this sounds like a chronic issue as opposed to an acute one. What ever damage has been caused to the kidney's, liver, etc, or whether clotting, acidosis, or sepsis is at play....that damage is done and most likely would not have been affected by your dose of aspirin. But like I said.....good play. J

Phil...not to change the subject, but you got a plus one for making me laugh....

YUP..... I started asking other providers in my area to include some PD guys I know if thiers worked. Answer...NOPE. I guess saving a few bucks in the software is worth the possibility of loss of life. This is definitely somthing I am going to look into further for my agency.

Now ^ that's funny. mcleod--really. THIS IS NOT A POPULARITY CONTEST!!!!!!!

To the OP. Great question. Don't be afraid to ask those questions. In the end, there is only one way your going to learn...ASK. As I believe JWade has already asnwered, I will let it rest. I would like to ask about your medical command physician. Does he/she update on new information when your service does? Often, in my area we have many that have "paradigmitis", or in other words, people who do not want to except that evidence based medical facts are changing the landscape and scope of our practice. The statment, "Because that is the way we've always done it" not longer is appropriate. If you can no longer perform adequate and effective CPR, there is no reason to attempt to continue. Best of luck to you and your partner. Continue to learn and improve. J Sorry, I had something to say on the LUCAS. Our service tested the pnuematic LUCAS device with Catostrophic effects. I believe one liver, one spleen and two pnuemothorax's. None of which could be contributed to misplacement of the device or user error. HOWEVER, a service to the north of us, is testing a newer electonic version of the device, and they seem (anectodally) to be getting very positive results. To go along with this, I have been told that in the next batch of AHA recommendations that they are going to push for even more compressions per minute, which could further effect provider fatigue in these circumstances.

Unfortunetly, not completely inaccurate.

Dust, At first I was going to disagree with you. However, the more I think about it the more I realize that you are right. My discontentment is in the fact that the realization of that fact SUCKS. It just goes to show that just because you do not like the message, does not make it wrong. Good thread.

I just can't stop laughing.......

Ohhh, my apologies.... I stand corrected, but I fail to believe without data. I have firsthand knowledge of integrity failure. But that is hear-say at best. OK, Dust you got me. I went back and researched it myself. You are correct. However, Level IIIa does not protect against 7.62 or 5.56. The Assault rifle rounds that will most likely be used in certain environments. But once again, I stand corrected.

Arrrghhhh..... This is conflicting. As I agree with FireMedic, I know that our "senses of humor" and practical jokes can be off color to the outside eye, (part of what makes our PROFESSION unique), I feel it is very necessary. The fact that it was done in public, is where I have scrupples. Franco-Glad to have you. Funny as it may have been. Sorry for ya. I guess that's is why it is nice to have a station to retreat to. On a seperate note. Our management has been known to google names and search facebook looking for comments about out service and hospital. It is what it is...

I think Dust has a valid point. A onetime class is a drop in the bucket. I have had the continual training, but know that I would be extremely cautious using any of the techniques. We have the option of calling LEO. But short of "Shots Fired", an actual response is slow at best. Not to mention. Actual training of this sort requires providers to be at some sort of fitness level. Perhaps we should tackle that first? But that is just my opinion.

That's funny... . The fact is that even newer helmets like the ACH or MICH helmets are not rated for "Direct Bullet Penetration Protecion", and are good for shrapnel at best. Now, I have no supporting documentation for this, but I know it is out there.....I prefer my baseball hat anyday.

As Dwayne said, this is a very interesting topic. I recall reading an article posted on this forum just recently, written by Bryan Bledsoe in which he discussed doing away with on-line medical control. Our brothers with the funny accents (or do we have the funny accents?), make a very astute and valid arguement, that any well trained provider should be abe to practice their profession without permission or distraction from Medical Command. The main difference here is education. Some of us, have been blessed with making the right decisions on which school to go to, to finish our degrees, and to work for progressive, professional orginizations. Not all of us have this, and that is where we find ourselves. I will agree with Fiz that online med control should be available, but can honestly say that the only reason I call for command is because I have to by our policy, and not because I cannot manage my patients. I would presume, that this is the same case in a majority of the people on this Forum. I think there is a large disparity from those of us on opposite sides of the globe, simply based on the way our educational and liceansing systems works. The fact that these systems are not only different in regards to requirements, and level. They can be further complicated by by region, state and even service. Because there is not one set standard, although a shame....we are all not craeated equally. The bottom line here is that it is the personal responsibility of the provider to continue to learn, be compitent, and be proficient. It is the managements and Medical Directors job to set boundries, but most importantly to trust their proviers to do their jobs. If this is not the case, why are we employeeing these people? Cheers everyone.

I need to agree. ACS would be my first choice of DD and any treatment of such would be more than appropriate. However, I am not 100% convinced that it really is ACS. I would continue to work through my other DD's as necessary. Dave, Upon exam, were there any findings to the neck or back with palpation? IE tenderness, radiation of pain, traumatic finding. Did the pt take his medications the day of the call? Specially seeing how the patient has a history of HTN, Anxiety and chronic back pain. Your "Bandlike" finding makes me wonder if this is more MSK and involving a dermatone and some type of nerve impingement, etc. The great part is that the treatment for ACS will help with the HTN and anxiety if MSK is found to be the underlying cause. My only concern would be what traumatic findings on exam you would find, if any? And whether they would necessitate any spinal precautions? Hope you follow up soon.

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