bizar.one

ever tried normasaline for pain control.... works wonders

simple answer...

get them calm

mark swelling with sharpie and notate time

get in the car

dial 911

and meet up with ambulance

they will call local hospital for anti-venom

we use crofab and boy let me tell you... to mix a vial it takes about 20 minutes a pop..

so use your traveling time wisely.

Most likely the ambulance does not carry the anti-venom... its about 3,000.00 a vial.

and yes different snake venoms work differently...

neurotoxic

anticoagulants.

where i work EMTs and Intermediates are up to date with their skills... Paramedics just sit back and relax... thats how close we all are that we trust each other with our own skills...

Sad to see i cant be said in other states.

Greetings from New Mexico

my initial thought in this matter... well it seems like you might be at risk of a DVT... although due to your history of traveling and discomfort in the calf area are all text book signs and symptoms of DVTs... minus the swelling and the warm or hot to the touch to the affected area... another thing...why are you taking that much ASA in a day... my concern would be for you to become acidotic and cause a change in your PH system. that can also relate to maybe the signs and symptoms of your cramps, which also may explain the bruise on the side of the calf. The whole "pop" that you felt with the relief of symptoms.. that would definately sound more muscular than all...

So in summary

i would say... watch how much ASA you are ingesting a day, u might develop an ulcer..

second of all... how is your dietary intake... u do mention keeping hydrated... being in a third world country an all.

check yourself for any DVT's

i definately agree with the whole RSI, ET tube placement... sometimes you do have to think about your basics first... what ever adjunct that is going to help you stablelize an airway... secondly the vagus nerve originates at the bottom of the brain so if you are worried about vagal stimualtion think again the increased ICP will take take of that for you... ICP and TBI is a great risk that alot of these trauma patients face.. most of it you can control on the rate of oxygenation (ventilation)...... RSI definately will help include narcotics as part of your sedation... Fentanyl works great premedication will help as to not have a spike on BP, HR and oxygen demand does not increase. therefore not elevating ICP.

definately hard to pick up on a 3-lead or 12 lead ECG with a rate that fast... i guess the only thing i can think of that would definately give it away would be the QRS complex to be a regular pattern... if this does not seem to be regular then you are maybe dealing with an accelerated a-fib rhythm therefore the pt. would be more likely in need of a calcium channel blocker.. in most cases especially if pt does have a history of A- fib i would have probably initiated care with maybe a 500 cc bolus followed by sedation and then sunchronized cardioversion just for this matter. Initially adenosine is a drug that is used to yes decelerate the heart but mostly to treat the underlying rhythm found. hope this helps....

I'm just a paramedic student about halfway through my field internship, but if you don't mind I'll share my opinion.

It sounds like the patient was able to maintain his own airway, and I'm assuming was also alert if intoxicated. You had good sats on the NC and he was maintaining his airway, and I'm assuming he wasn't in any respiratory distress so I think it was appropriate not to intubate him; it wasn't really indicated if he could manage his airway and wasn't in respiratory arrest.

As far as I know, anti-emetics are no longer the recommended therapy for poisons, the preferred method is activated charcoal or the antidote for the poison, so I think you were right not to administer anything to him--especially if the patient and family are denying an OD. And I don't really think the NG tube was indicated unless you were thinking about giving him some charcoal anyway just to be on the safe side.

Honestly, and this is just my humble student opinion, but I think your treatment was appropriate, and I don't think I would have done anything different. You kept the patient's airway patent, had him on the monitor and had IV access. Adderall's a stimulant so I think if he was having an OD you would have seen an elevated blood pressure, but you said it was fine. I think that hypertensive crisis and seizure would be the two biggest concerns with an OD of Adderall but you had IV access if he seized and his BP was stable.

I don't know about him being so pale, so he definitely needed further eval at the hospital, but otherwise, like I said, I wouldn't have done anything different. The only question I have is why did you give him the fluid bolus? Did he appear dehydrated or what exactly was it that made you give him all the fluid?

I think he is right. There was no reason to intubate this pt. due to the fact that he does not have a compromised airway.. although i would have to question giving him any activated charcoal... 45 minute rule is out of the question the alcohol and medications are already in the system and not in the GI system. Secondly i would probably go with the NG tube if you were concerned with him aspirating any of his emesis. other than that i think you did the right thing. IV O2 monitor. let him sleep it off.

Not only that depending on what anti-emetic you are using. I mean say for example phenergan, well that is going to also help his respiratory efforts due to all the alcohol already in the system and that phenergan having some calming neurogenic effects. But maybe zofran or ondasetron would have worked.