PCP

Breath sounds were? The description of this patient's chest pain was? Other past medical history? Depending on your location I would definitely be calling for ALS intercept as this is not a BLS patient presentation. What precipitated the patient's shortness of breath? You're right to be considering the B1 effects of the ventolin but failing to treat a patient's bronchospasm will harm them more than those effects in the long run. Airway, Breathing, Circulation in this instance. Realistically you can work on both. A nebulizer running at 8LPM of O2 is supplying a significant amount of oxygen already and allowing you to treat the bronchospasm. I've never viewed running a nebulizer as a contraindication for nitro.

Remember we're working under treatment guidlines now. If it's in your scope of practice, and you have good justification for your actions, do it. As a bit of a side note I would be placing at least an 18g IV prior to the nitro. It isn't protocol but without a monitor for PCP's it damn well should be.

The breath sounds are audible wheezes bilateral to the bases. The patient describes the chest pain as "Crushing", The pt just tells you that he had an MI two years ago and has been prescribed Nitro, but has never had to use it before. The patient tells you that his Asthma is brought on by dust and that he had been cleaning out his basement when he started to find it hard to breathe.

The town I am working in does not have ALS, so it is up to us PCPs to deal with this kind of situation. That is my thinking as well, is that the B1 effects from the Ventolin could be causing him to have chest pain, but on the other hand the chest pain could be causing his SOB.

So, you state that you have never viewed running a nebulizer as a contraindication for nitro. I did not think of that, so what you are saying is that I could continue running the Ventolin protocol, as well as treat the chest pain with Nitro?

Sorry people I should have posted this question in the forum for scenarios

Okay, going out on a limb here folks as I am new to the forum and still fairly new to the world of EMS. If you are treating a patient that is having SOB with the Ventolin protocol and while giving them the first dose of Ventoline they develop chest pain. What would one do? Now the pt. states they do have Asthma, but also have suffered two episodes of Angina within the last two years and are prescribed NItro.

Should one stop the treatment of Ventolin, apply high flow O2 and then start down the Chest Pain protocol or do you continue with the SOB protocol while questioning the the pt. about the chest pain they suddenly developed?

I guess my thinking is yes, they have a cardiac hx, but at the same time they have Asthma and said they have been exposed to lets say dust which brings on their Asthma and are having a hard time breathing and used their puffer that did not help. I feel I should continue with the Ventolin protocol and question my patient about the chest pain they are experiencing.

Any comments good or bad are welcome!

Sorry if my questions seems a little confusing. If you need any more clarification feel free to ask me.

Sorry I would have posted a picture, but computers and I do not get along

Has anybody used one before and if so, what are you thoughts good or bad?

My personal opinion I find them a little too time consuming to put together and possibly not as stable to use as the regular SAGER splint that comes in one piece. This is based on me, just playing around with it in the first aid office, and never having the chance to use it on a patient. After playing around with it, I would rather have someone go and get the regular SAGER from the ambulance.

As well, not sure if any of you use the pillow splint for a stable ankle fracture, but what are thoughts on using a pillow for a splint? I personally find that it works well, long as you get the trauma strap tight around the pillow.

Zippy, I've never had any issues with pt slipping around on a quartered blanket.

I agree with Dwayne on this one. I feel if the pt. is on a blanket which they should be for pt comfort and properly restrained there should not be much room to slip around.

The main benefit, other than feeling like a better person for making them more comfortable, is that it eliminates most of the voluntary movement in the majority of pts. They don't fight so hard if they aren't so uncomfortable. And more comfortable means better history, more compliance to interventions, more cooperation. At least that's been my experience.

Without a direct order from a physician, or some other unforseen, unavoidable complication, I will never again choose to board a pt without the blanket.

Dwayne

OOPS!! Sorry guys, still trying to figure out how to quote something from a another post.

Okay so this might be a stupid question but remember Im only a basic!! Okay so on Thanksgiving I ended up falling down (thanks 2 cusions) on my knuckles which are now swollen & bruised!! I can move my fingers but when I put slight pressure onto my pinky knuckle and move the finger you get a rice krispie (sp) feeling!! My uncle thinks that it is a boxer's break but others do not think so!! People are telling me that if it was broken I would not be able to move it!! So my question is do you think that it is broken?? I am going for an x ray later today but I thought that I would ask!! Thanks!!

Sorry to hear about your luck. Hope it all turns out okay.

It's a vinyl frame, full of round pellets. You suck the air out, and it fully conforms to the shape of the patient. A novel idea, we purchased a BoundTree "Vacuum Spine Board" w/ an extra scoop for Wilderness extrication. Used it in training, the only problem is it sticks to the patient if it's warm out. So placing a sheet over it is good practice. It's easier, we found, to scoop the patient onto the mattress, rather than trying to log roll them onto it.

That is AWESOME I have never seen or heard of one of these being used in Canada. Hmmm learn somethig new every day

Saakatchewan 31 Montreal 17

I am watching TSN with 5 hours to gametime, and Montreal is already whining about how SK got the better dressing room, that none of their fans are there, they have so many injuries, blah blah blah..... it appears they are already coming up with the excuses for losing...

GO RIDERS!

Yes, I watching TSN last night as well and they showed the interview with the two players that had been whinning about the locker room conditions and injuries. It is soooo brutal that they feel the need to complain. I guess they are trying to as you mentioned make excuses for losing already!

31 to 17 would be an awesome score lets hope that the score is that high or higher as I want to see Montreal get knocked off their high horse.

Besides for RSI, I used etomidate a lot for conscious sedation. If a pt needs a painful procedure such as fx/dislocation reduction or a kid needs stitches, I use it to provide moderate to deep sedation. I will generally start with half the intubation dose and titrate from there.

PCP-RSI is Rapid Sequence Intubation. Pts are sedated and paralyzed to allow for a proper intubation.

Thx for the information.

That is way beyond my scope of practice and knowledge. when I was doing my clinical at the hospital I was able to maintain the airway of a pt that was given a milky white substance through an IV that would sedate him/her so that they could cardiovert their sinus rythm from being Tachycardic and irregular to back to normal.

It was a great experience to have been able to help out and watch and learn from the ER Dr. and the attending nurse as to what was being done for this pt and why it was being done.

the long board is the wrong device for this scenario - vacuum mattress please TYVM...

What is a vacuum mattress?

In this scenario we would be using the clamshell for sure for the transport as stated it helps stabalize the pt and helps keeping the pt from turning their head and possibly becoming paralyized. If I was called to the pt. house and she was complaining of back pain along with the fall she would be getting the full package deal no doubt about it

I enjoy having my license and I inted on keeping it!

Today is Grey Cup Sunday Montreal against Saskatchewan anybody care to take a guess at what the score is going to be or who is going to win?

My guess is going to be Saskatchewan 24 to 17

Thanks for the information. It sounds like it is a little tricky when trying to understand the scope of practice for each level of care. I feel lucky that I can do as many procedures as I can working here in Canada as a Primary Care Paramedic. I would love to do a ride along one day somewhere down in the US just to see how things are done and to give me a better understanding of the level of care that can be done by each level.

Have a good day

we use the clamshell 99% of the time and a spine board the other 1% of the time for extracation of a pt from a vehicle. At the mine site where I work as a first aider I have the ability to use the clamshell or the spine board. In most cases when I am called underground I use the spine board, but when on surface I use the clamshell just because when underground when called for an emergency when I arrive the workers already have a spine board there for me, as well as I find it easier to use a spine board on uneven ground compared to when working on ambulance I am usually working on a flat surface where a clamshell is ideal

I am not sure what brands are the best, but I would have to say Ferno is probably the most popular brand out there.

Tough call for sure. For me it all comes down to if the patient has suffered any trauma. If there has been trauma to the area then yes we should expose, but remember we want to maintain patient dignity and the pateints wishes. So if they don't want us to take a look then we dont and document that on our report. If the patient said they have not suffered any trauma in that area then I would just ask more questions and try to find out why they may be experiencing some discomfort in that area.

As Happiness mentioned this is a tough one. I dont care that it was going to be my last call of the day and I just wanted to go home, all my patients get the same treatment. I am thinking again that for me it depends on the hx of complaint and how they answer my questions and if I feel I need to take a look to get a better picture then sure I am going to look or as stated above in a previous post have my female partner take over the call if the pt is a female.

For those that have RSI protocols and for those that have etomidate in your tool box:

Have you used this med for other than RSI. If so, what was the scenario?

sorry for asking but what does RSI stand for and what is etomidate?

Basic level providers typically have basic level education. While the actual "skill" of placing an IV is rather easy and really nothing more than a monkey skill, appreciating the physiological implications of administering IV therapy is not. Unfortunately, even developing a basic understanding of chemistry and physiology of an isotonic solution of sodium chloride takes time. Marry this fact with the argument that IV therapy may not impact pre-hospital care significantly in some areas, and you have a situation where not every entry level provider in the United States will be providing invasive modalities.

Take care,

chbare.

Yes, I do agree that appreciating the physiological implications of administering IV therepay is not easy and takes time to understand when you are giving an isotonic solution of sodium chloride or other medications through an IV. I RESPECT all ALS medics for their knowledge and understanding of the chemistry and physiology of these certain solutions that they administer to a patient, as well as their more indepth knowledge of anatomy and physiology of the human body. As I am only a PCP with just the basic understanding of anatomy and physiology and always striving to learn from the ALS medics or by reading text books, so that I can offer better pt. care due to having a better understanding of what that pt may be experiencing that day. I was just wondering about how come a BLS medic down in the United States do not learn how to initiate an IV and administer normal saline to a patient who is in need of fluid replacement due to hypovolemic shock, hyperglycemic pt., or to a pt experiencing some dehydration, just to name a few.

After reading the original post, I was trying to think of ways that a BLS unit could generate more calls, as well as not have the medical director or whom ever may be second guessing their ability to handle the call without having an ALS unit respond just to initiate an IV for a sick pt. who is a little dehydrated, or as mentioned for a pt. with trauma that needs a fluid challange to up their BP and then maintain at TKVO. I agree with you (chbare) starting an IV is a skill that a monkey can do and in most cases does NOT save lives!

Sorry for being so ignorant to the way the EMS system is ran down in the United States and what the BLS and ALS units are allowed to do under their scope of practice I have lots to learn about the EMS.

Brian

Sounds like ALS is dispatched for alot of calls down in the US. I know for the most part the ALS crews usually only get dispatched out for SOB, cardiac and seizure calls here in Canada. Of course not all communities have ALS so it is left up to the PCP or I guess you can call us the BLS crew to deal with what ever the call may be. A PCP in Canada can start IVs and admin. pain medication (Entonox only) and admin. D10W IV as well as 0.4mg of Narcan through the IV port. In my opinion a BLS crew should be able to be dispatched out to any call and be able to call for a ALS crew if needed and if available.

Is there a reason as to why the BLS crews are not able to learn how to start a line or give Entonox? I guess to me it just makes sense as alot of times the pt. needs a line or some pain medication.

Brian

Thanks Happiness, I forgot that not everybody down in the United States knows about Tim Hortons. Tim Hortons is coffee shop. It's like Star Bucks, but BETTER

Had a bizarre call the other day. We were dispatched out for a pt not feeling well. When we arrived and asked the patient what seemed to be wrong. He replied by stating that he was unable to sleep. when I asked how long he was unable to sleep for , he said just last night. He then also said he could not pee and that he had drank lots of water as well. I then carried on and asked how long he was unable to pee for? He said just last night. We took him to the hospital anyways I am thinking he just needed to talk with somebody.

Thank you all for your comments and helpful hints Our service does provide a stethoscope in some cars, but for the most part we all supply our own stethoscope. The way I look at is, I really don't want to be putting something inside of my ears that another person has been using and just so happen to have not cleaned the inside of their ears in the past six months.

when I was taking my PCP program, everybody in our class decided we wanted to order our own stethescope and I after some carful consideration and what my wallet would allow me to spend, I decided on the "Littmann Classic 2 SE" I figured it was in the middle of the road and was not too expensive, but expensive enough that I should be able to use it for a while without any problems.

Again thanks for all of your suggestions and comments. As a new person to this forum and not sure how one will be taken when posting questions or adding their comments I find it great to see that people actually take the time to try and answer a question or even add a few suggestions. I can see that there are some really seasoned medics on this site with some real great advice, along with some funny comments (DwayneEMTP) which I find very entertaining to read.

Looking forward to some more great discussions with all of you

PCP, seems to me, the guy had an allergy to stainless steel bracelets, hense his hesitation to getting out of the car, and if the LEO (Law Enforcement Officer) knew of the order of protectiion's existance.

Yes, I believe he did have an allergy to stainless steel ha,ha, ha, The cops did know about the restraining order but I am not sure why they did not handcuff and take him to jail. Could it be because the lady allowed him to get into her car and was taking him to the local Tim Hortons??? On my home that evening I stopped in for a coffee as I was heading off to work at another ambulance station that night, and low and hold guess who was there and asked for a ride to another town? Yep, the same guy who I was trying to talk out of the car. Funny people in the world I tell ya!

I rememberd what the guy said he had and why he was scared to get out of the car. He said he had a conditioned call " Transthoracic Syndrome"

Anybody ever heard or read about this condition before?

hey sorry about that my friend. guess I kinda went off on a different path. I would say yes they should be stopping compressions to give the two ventilations. Now that being said that is based on my training through the Heart and Stroke foundation. I am not sure where you are from and what your protocol is down there. I would talk to someone in your area and confirm what is expected in a CPR situation.

I find it very confussing at times, as I was shown one way on how to do CPR and it is alway 30 compressions to 2 ventilations and then I take my OFA training again and they are telling me to give a breath once every 5 seconds while your partner is still doing compressions. Another thing I just learned through the organization I work for is when the AED is charging to deliver a shock, we are to be doing chest compressions during the charging portion. But in school and through the Heart and Stroke Foundation we were told not to touch the pt. while the AED is charging..grrr why can't they make the same rules for everybody!

I was curious to know if the company you work for has put GPS units inside of the ambulance and if so how often do you use them? The BCAS has supplied every car in BC with a GPS unit. I use to work in a small town so we never had to use it to find a address, but I feel it will come in handy when I start at my new station as I don't know the roads and if I am driving sure would be nice to find the fastest way to the Big Green "H"

Do you think they are a waist of money and we should stick with using maps or do you think they are worth the money and the money should put towards training and new equipment?

Here's another poem.

I WANT TO TELL YOU LIES

© Kalvere, all rights reserved

I want to tell that little boy his Mom will be just fine

I want to tell that dad we got his daughter out in time

I want to tell that wife her husband will be home tonight

I don't want to tell it like it is, I want to tell them lies

You didn't put their seat belts on, you feel you killed your kids

I want to say you didn't ... but in a way, you did

You pound your fists into my chest, you're hurting so inside

I want to say you'll be OK, I want to tell you lies

You left chemicals within his reach and now it's in his eyes

I want to say your son will see, not tell you he'll be blind

You ask me if he'll be OK, with pleading in your eyes

I want to say that yes he will, I want to tell you lies

I can see you're crying as your life goes up in smoke

If you'd maintained that smoke alarm, your children may have woke

Don't grab my arm and ask me if your family is alive

Don't make me tell you they're all dead, I want to tell you lies

I want to say she'll be OK, you didn't take her life

I hear you say you love her and you'd never hurt your wife

You thought you didn't drink too much, you thought that you could drive

I don't want to say how wrong you were, I want to tell you lies

You only left her for a moment, it happens all the time

How could she have fell from there? You thought she couldn't climb

I want to say her neck's not broke, that she will be just fine

I don't want to say she's paralyzed, I want to tell you lies

I want to tell this teen his buddies didn't die in vain

Because he thought that it'd be cool to try to beat that train

I don't want to tell him this will haunt him all his life

I want to say that he'll forget, I want to tell him lies

You left the cabinet open and your daughter found the gun

Now you want me to undo the damage that's been done

You tell me she's your only child, you say she's only five

I don't want to say she wont see six, I want to tell you lies

He fell into the pool when you just went to grab the phone

It was only for a second that you left him there alone

If you let the damn phone ring perhaps your boy would be alive

But I don't want to tell you that, I want to tell you lies

The fact that you were speeding caused that car to overturn

And we couldn't get them out of there before the whole thing burned

Did they suffer? Yes, they suffered, as they slowly burned alive

But I don't want to say those words, I want to tell you lies

But I have to tell it like it is, until my shift is through

And then the real lies begin, when I come home to you,

You ask me how my day was, and I say it was just fine

I hope you understand, sometimes, I have to tell you lies

author: Kal the Rebel

WOW! That is an amazing poem and really hits home and it really made me think of my 1 year old twins at home and how I want to make sure they are safe every day. As well as not taking my work home with me after a bad day of sad calls.

The most bizarre call I have been on is my partner and I were dispatched out for low impact MVA. when we arrived everything was normal the police and fire on scene. What had happened was a car with two occupants had stopped in the middle of the road and the SUV behind them ran into the back of their car doing about 15km an hour. The driver of the SUV was not injured and the driver of the car said she was fine. Now comes the bizzare part.

The passanger of the car said he was scared to move and did not want to get out of the car. The lady driver was telling him to get out and let us take a look at him and transport port him to the hospital. He just kept saying he was scared to move and he just did not feel wright. So my partner kept asking if he had neck pain and the pt just kept saying he did not feel wright and he was scared to move, as well as he mentioned he had some sort of condition that we had never heard of which turned out to be false.

Any ways, after a while my partner asked to speak to the woman driver in private, and let me try and talk to the pt and find out what was going on. He told me he had neck pain and that his legs felt funny. Now remember it was a low impact MVA at 15km an hour, so I was thinking okay maybe he has neck pain, but there was no damage to either vehicle, but who knows. So I told I am going to have to put a hard collar on him and put him on the clamshell and take him to the hospital. Well now he is saying he is fine and he could maybe move now. So after about half an hour he eventually got out of the car and walked over to our ambulance.

While inside of the ambulance my partner was taking notes and I was taking a BP and then came a RCMP officer holding the guys backpack and a few other things and said to our patient that the lady left and asked him to give him his stuff. The freaked out and the cop had to ask him to relax or else he is going to jail. Turned out the lady had a restraining order against him and she was on her to drop him off at the Tim Hortons when they got into a fight in the car and she stopped in the middle of the road to kick him out.

Sorry the story was a little long but had to paint the picture.