FVFD441

should RSi be standard care aross the country

You are called to a residence for a 60 year old male complaining of difficulty breathing. You arrive on scene and notice a two store apartment building, Pt's, apartment is on top floor with 20 steep steps up to the door. you make your way up the step and notice that the steps are in poor condition and doubt that you will be able to use your stair chair due to the condition of the steps. In the house you find you patient in the back bedroom, down a narrow hallway. you start your assessment on this patient. you find your patient has a decreased mental status, his color is gray, excessive sweating, you also find JVD, Peripheral and Pulmonary edema, lung sounds are wheezing and course crackles in all fields. You pt patient on the monitor you notice a wide complex tachycardia at a rate of 230/ min. his pulse is faint, pulse ox reading is 61% on 3 liters of o2. his family states he has refused to be treated in the past. his weight is approx 350 lbs., His vitals are B/P 90/50, Pulse of 230, respers of 60 what is you next step in care for this patient?

I have only been a paramedic for a fue months now, we were called out to a elderly male c/o the same complaint. He looked to be fine had no complaints other then what he states was minor S.O.B when he lays flat. I noted clear lung sounds through out. 12 lead shows A-fib with RVR. How ever the QRS was wide I was thinking that he was in V-Tach with a pulse, He refused all care other then transport to the hospital. We transported him. of course I had him on o2, re refused IV, and all other care. Got him to the hospital, he was cardioverted in the ER!

Should there be officer testing in volunteer fire/EMS Departments? Who do you feel about this?

VOTE FOR ME IN 2008

As a rule I try to limit the time for the seriously ill to 10 minutes in the house. I feel that 10 minutes gives me time to figure out whats going on and get on the road. I can always do more in the medic then in the house. But when working a code I do one round of ACLS, Get an airway, IV, and BUST them before going to the truck.