EMS Guru

I was right, hooray. Converted Supraventricular tachycardia.

Called the code and went to lunch. :roll:

I like the paddles, but I refuse to use them on very obese people. They get the pads only. I'm not going to chance getting lit up leaning over someone unless they are of average build. Admittedly, pads do work better in a code situation than paddles. Also, if you have to cardiovert someone who is unstable but still conscious, I sure wouldnt be caught without pads.

I completely disagree with that interpretation. I would say looks like a fast sinus tach or perhaps SVT(I see P waves here and there) converting to a Junctional Rhythm with bigeminal PJCs.

This is why we need an autopulse.

Thats okay; no harm, no foul. I think we can all agree that the healthcare system in the US is flawed, at best. I still cant get used to the adjustments switching from 5000 calls to 500(maybe). I have been up all week studying for finals, so I may be a little jumpy myself as well. I think of EMS as just one giant learning experience. No matter how long we have all been in EMS, we havent seen everything, and there is always room for improvement.

Dont need informed consent, pt is clinically dead. Implied consent takes over when the pt is no longer A&O. For crying out loud, if doing a quick sweep is battery, I hate to think what I "must have committed" when I was pounding on his chest doing CPR and broke a couple ribs in the process. Sheesh.... :x

I dont recall if he had a watch or not, but no cell phone, as we did a quick pat down during initial assessment. Plus, if he DID have a cell phone, it probably would have gotten fried at 200 joules.

I guess the monitor wasnt turned off because nobody botherd to, I dunno. Either way, monitor was and had been turned away so only the Fire/EMS personnel could see it, and all the family was in the other room. Just an oversight I suppose. People were still picking stuff up, and I turned off the monitor, because it was starting to creep me out.

I have to add, after the pt was called deceased on scene, the monitor was still attached during the cleanup phase. When PT was pronounced monitor was showing an organized junctional rhythm, albeit PEA. After CPR was d/c'd, this pt appeared to have a rhythm FOREVER. 10 minutes later the monitor was still showing an idioventricular rhythm of about 28bpm. After everything was cleaned up (15min later, total), the monitor was still showing a rate of about 15. Has anyone ever seen this? My guess was this was the epi still working away.

We have pacing capabilities, but there is no provision in our ALS protocols for pacing in PEA. I never said a 10 min transport time is long, I simply stated that had we transported, it would have taken at least 10 minutes. 7 rounds of epi? We have and can give up to 10 rounds of epi as indicated per protocol. I dont understand why you say we need to "look at our protocols". What would have been done differently in the ambulance that couldnt be done in the home?? In fact, I would certainly argue that it would be better to say on scene since better quality CPR can be performed on a hard, flat, non-moving floor, as opposed to a shaking, bouncing, moving ambulance. :wink:

Yep, good ol' Morgantown. aka "Touchdown City". Nearest facility was either WVU Ruby Memorial or Monongalia General Hospital, which are up the street from each other. Going Code 3, I would estimate a 10 minute trip. CPR? Get the Fire stations to host free community CPR days where the public can come in and get certified, and either get someone to do it pro bono, or pay the instructor out of whatever slush fund the dept has. Fluid challenge? A weight based fluid bolus was administered per protocol. CPR was continued due to the fact the family was there, even though we all knew what the outcome was going to be. The wife advised us we could stop, as she realized that he has passed.

Well, I recently made the the switch from urban EMS to rural ems. I am used to running significant call volumes in the Central Virginia Area, and have recently moved to Northwest West Virginia to attend college. Well I have gone from an average call volume of 5,000 down to 500. I still cant get used to the long response times, though... Now I am working out of a fire department instead of a rescue squad, but I am first on scene much of the time, since we respond Code3 in POVs. Anyhow... I was coming back from doing some shopping, and as soon as I had parked back at the university, my station was toned out for a "possible cardiac arrest, 66yo/m"...oh, super. :shock: The dispatcher got the address, but for whatever reason was unable to give us a nearest cross street. All the while, the dispatcher was telling us to "hold-on" as she was trying to give the pt's wive CPR instructions over the phone. Well, this basically confirms that its an arrest, and not just bad chili. . I knew the road, (as it runs north-south from one end of the county to the other) but had no clue "where" on the road it was. The fire chief was as clueless as I was and he kept asking for a cross street or landmark or something, but once I saw them pass me, I did a 360 and followed everybody else. Anyway, we found the house. I felt it took so long to get there(even though it shouldn't have) because I had no idea what house it was... Well we pulled up on scene, and the pt was in the living room, and quite cyanotic. Slapped the defib pads on and got asystole on the monitor. Started CPR. The rest of fire, ems, and everybody and their brother showed up at this point. ALS was initiated, and pt was intubated, and an IV of NS established in the left AC, AND. After about 7 minutes of "good"(by my definition) CPR, 1 epi and 1 atropine later pt went into v-fib. Lit him up at 200J and got an agonal rhythm. well after I cant remember how long, 7 epis, maxed out on atropines, we ran in some bicarb, and pt went into PEA. rate ~ 80. Well this continued despite using every remaining epi in the box, and everything else that was clinically indicated. Eventually the pt was pronounced on scene, and tx'ed to the funeral home of the family's choice(this is SOP here). We must have gone through an entire roll of LP12 ECG paper. For what its worth, at some point during the code, pt's glucose was 62, but no D50 was administered, as we felt that this certainly was not a contributing factor of this pt's arrest. Anyway, I cant get used to how codes seem to go out here. I wasn't running things, but I would have tx'ed the pt after about 20 minutes in. Also the "unknown down time" and prolonged response times really get to me in these situations. For what it's worth, I think that this was the "cleanest" code I have ever worked on. ETT went in great, no foaming or anything. IV was established on the 1st attempt, nothing surprising there either, and good CPR was kept up throughout. I think that there needs to be a greater emphasis on teaching the community CPR at no cost, because when it can take 15 minutes to get on scene like in this case, it could make a difference.