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DartmouthDave last won the day on April 19 2014

DartmouthDave had the most liked content!

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  1. Hello, I liked the blood set for the Medsystem III. It is quite helpful when giving lots of blood. Sorry, I am not following you 100%. I think you are suggesting connecting a gravity blood set to the half-set (the one you connect the syringe to). If so, where I work we do that from time to time. No issues at all. Just not as tidy. All the best, David
  2. Hello, I have attached a YouTube link showing the challenges of a status patient in the field (starts around the 2:15 mark). Interesting stuff. All the best, David
  3. Hello, I agree Matt, outside the hospital, things are more worrisome with many unknown factors. In fact, in most cases, the etiology of the seizures is unknown and airway protection is a great idea. Especially, in the case of a TBI, SAH, and so forth. As opposed to a 'neurology' consult with a chart and background information. In fact, many difficult to manage seizure patients (if local) are know by the neurology service. I was referring to the approach outlined by the authors and not critiquing ED seizure management at all. Again, it is better to have a secured airway in most situations. Cheers
  4. Hello, I have attached a link to a outstanding review article from BRAIN: JOURNAL OF NEUROLOGY on the management of status epilepticus. Very helpful information. Also, if you look at their step approach they are much more cautious than one typically see in emergency medicine (i.e. three+ seizures without recovery is status). More time is given for medications to work before intubation and general anesthesia. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol http://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/brain/134/10/10.1093/brain/awr215/2/awr215.pdf?Expires=1485878433&Signature=EYWaFW2VPwjf75aa7W90l-zxtW~X2vCN5dh0wnuXw1SgIo7wor2U3CZ75HwaPiUX5QyfF4uN0tzJlVUFYsGtr8XelQ5JbPfy7l55Gz~xqy1TXE4g1lap8KQjNGicehxghlAq6P3BP0jQ22ZD-lJnaCLJt8nxTMDMDrAvBnbrs5I72AhtoFQs8cTFuHcgCNmgTROXIpUf9FnxJfZMtnNU6raI3gl1HB2BVGYrlFeX6gZZze3Wthk~cuQqSoQTCAPMegLPzQIR9MnGXXyc2OWA~a6IwbC2dKBywvIbnQ-V8EMCK7sh0CEa~ovWSosPHINRPHgnOTn4CutQfd0LLjhz4A__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q
  5. Hello, I have been with Medavie for the past 5 years now. Sometimes, I still miss the great white North. K
  6. Hello, Very interesting. In my region, as far I know, ECMO has not been used for out-of-hospital cardiac arrests. Off Label, in the case with the young women and the PE, did they try fibrinolysis first? Cheers
  7. Hello, We use backpacks: an airway bag, a ventilator bag, a circulation bag (IV pumps, ect..) and a drug bag. Scene calls we use the airway and drug bag. ICU transfers we haul in the lot in. Also, we use the LP12 (soon Zoll) and it has compartments on the back and side for BP cuffs, EKG cables, and various cables to fit different arterial line. http://www.ehslifeflight.ca/indicationsfortransport/ADULT/Pages/default.aspx The ventilator, pumps, and LP12 all attach to our stretcher which we can transfer between fixed wing, helicopter, or ambulances. We use to use a #9 and tray but now we can load the stretcher into a King Air: http://www.provincialaerospace.com/SurveillanceSpecialists/MedivacAircraft/ Downside with the bags is keeping them dry in winter. Lay them in the snow and they get wet. Or, getting blood on them. Lastly, equipment takes more abuse in a backpack. Cheers
  8. Hello, This is a foolish question. It all depends upon the cause of the Cardiogenic Shock. MI? Valve Problem? Infection? Genetic? Auto-Immune? So, I guess I would pick A as well....
  9. Hello Everybody, My apologies for the delay. Here is some much needed information. The chest tubes: The patient was difficult to ventilate. The airway pressures (PIP and plateau) were very high and the patient blew a (L) and (R) pneumothorax. The patient was unstable and this bad turn of events has worsened the situation. A CXR shows complete whiteout of both lungs and two well placed chest tubes. The patient height and weight: As noted by all the volumes are a bit excessive. Lets say according to IBW calculations is 60kg (6cc/kg = 360 7cc/kg = 420 8cc/kg = 480) Do we drop the Vt slowly or quickly? The labs: ABG: 6.9 / 80 / 70 / -11 / 11.2 (ph/co2/o2/be/lac) WBC 25 HgB 60 K 7.0 Na 135 Mg .60 Cr 1200 Ur 50 The vent: AC 20/650/.8/+5 PIP:44 I am not an expert on scalars and loops (I suggest watching chbare YouTube videos) . What I can say is the patient was too awake. Things settle down with proper sedation (RASS-3) and a good suction (copious amounts of secretions) but work still needs to be done. After suctioning and sedation only Vt of 100-125 is being delivered. Thank you, David
  10. Hello, The ET and CT x 2 are in good position. The patient decompensated from the pneumos and the insertion of the chest tubes. The Fentanly is at 100mcg/hr and Versed at 5mg/hr. She moves her arms wealy from time to time. The patient is on AC-VC with a volume of 650cc with a rate of 20. However, the high pressure alarm is ringing madly (PIP 40). ETCO2 is 55. They are considering stopping the ventilator and bagging the patient. You start some IV fluids. You push IV pressor of choice and the BP improves some. NKDA The patient had an admission 18 months ago for an autoimmune vasulitis of her lungs. Despite an extensive workup no soild dx was made. However, she resonded to Methotrexate and was switched to oral steroids. The patient secretly stopped taking the steroids due to excessive weight gains. Also, the patient had flu-like symptoms and has developed a red lesions on her feet. Thank you, David
  11. Hello, You are dispatched for an urgent transfer from a regional hospital ICU to a larger university hospital. You arrive to a very hectic and busy room in the ICU. An 18 year-old female was admitted three days ago for worsening SOB that has progressed to respiratory failure that required intubation by day 2. Things have worsened dramatically over the past 24 hours. She is sedated (Fentanly+Versed) and ventilated. Alarms are endlessly ringing. VS as follows: HR 150 BP 70/40 SpO2 72% Lastly, bilateral chest tubes have been inserted. Thank you, David
  12. Hello, Sorry, I forgot to add this in my last post. It is about 15 minutes to the airport. The flight time is 45 minutes followed by a 15 minute drive to the university hospital. So, out of hospital time will be around an hour. I will more later. Triemal04.....very nice post. Cheers
  13. Hello All, The patient has a history of IHD, HTN and methadone use for chronic pain. He also suffered two previous head injuries (#1 was a MVC #2 was from an assault). Also, the patient has an ETOH history. He takes ASA daily, a round pill to control his mood, and Ativan for his nerves. The hospital did a FAST, CT and a CT-A and they only found the vascular injuries. The CT reports says, "...transection of right superior thyroidal artery with large hematoma that is displacing the larynx leftward....." and "....right innonimate vein transection with large hematoma that extends below the aortic arch...". Initally, in the ED, the patient was stable. He tolerated the CT/CT-A without issue. Unfortunately, he has been getting restless over the last 30 minutes or so. On arrivial, he was hypertensive (140-130/89-90) and tacychardic (100's). Now, his HR is in the 50-60 and his BP 80-90/40-50ish. The right hand was lacerated when the coffee cup he was holding shattered. There is a large laceration on the top of his hand that is oozing blood. The whole right arm is cool to the touch and looks swollen. The BP cuff is on his right arm. On exam, the patient is anxious but following commands. The left side of his head is covered in sweat while the right is dry with ptosis. He says his back, neck and hisp hurt. His voice sounds hoarse and it hurts to swollow. Lungs are clear. Abdomen is soft with a selt belt bruise. Labs are pending and they have cross matching for blood. The patient has been given Ancef 2gm IV, Morphine 2.5mg IV PRN, and NS1000cc. They have not considered TXA. In addition, they are not keen on intubation. They think he should go as is. The neck patient has been accepted at the local university hospital for a trauma team activation (to reassess before the OR). The second patient has not been accepted for transfer yet (....however they would love for you to take both patients!!!!.....the pane can fit two BTW) Cheers
  14. Hello City, You are part of a fix-wing critical transport team. You are diverted from a previous mission for a trauma patient. You receive a brief patient update: A 67 year-old male was involved in a high speed MVC. He has sustained blunt trauma to his neck. He has been assessed by the community hospital’s trauma team and a CT and a CT-A has been done. The scans have noted a transection of the right carotid artery, right superior thyroid artery, and a transection of the right innominate vein. His VS are: HR 50 BP 90/50 Resp 24 SpO2 95% on NRB. You arrive in the ED and your patient is sitting up, in pain, and anxious. Blood soaked gauze is wrapped around the patient right hand. His neck is brusied on both sides and you see bulging on the right side! In the room next door, the driver is yelling profanities, while the staff is splinting his fractured ankles. The ED staff seems quite pleased to see you. Cheers, Dave
  15. Hello, Thank you for posting. Lets start with our initial assessment. GCS? ABC? Get her on the monitor and see what happens next. David
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