medic5587

blood glucose check?

The service I work for has the standing order for D50 PO. I agree it does not taste well and other sources of higher concentrated carbohydrates should be consindered. I personally have give D50 PO many times with good results. It normally requires 2 amps (50 Grams) and onset of action is relatively slower in relation to given IV. I have D50 in my bag and I am not ready to give up my lunch.

Thanks for acknowledging my post and the utmost respect and appreciation for your impute.

My differential pre-hospital diagnosis. With the s/sx as presented. 1.) near syncope or faint feeling with exsertion 2.) stabbing chest pain 3.) c/p radiates to the back 4.) tachycardia (un-changed at rest or on your arrival) 5.) cough 6.) ecg changes 7.) pt takes oral contraceptives My opinion based on the scenario presented: Pulmonary emboli

Pt found sitting erect in chair, very pale, cool and diaphoretic, Alert and responding to questions slowly but appropriately. Sounds like too much Viagra!

This is regulated by state. In Minnesota you can apply for a part-time ALS license. I would call your state regulatory board to see what is available for your service. My opinion only; the cost for an ALS service might not be justified by that low of a call volume? Good luck.

Lateral-- I, AVL, V5, V6 Inferior-- II, III, AVF Anteroseptal-- V1, V2, V3, Some consider V4 as well Posterior-- V8, V9 Right Ventricle-- V4R, V5R Don't forget to back up your STEMI diagnostics with reciprocal changes.

The company I work for requires us to carry are controlled meds; narcs. and etc. on are belt. They are in a leather pouch. Exp. Morphine, Ativan, Versed. Does any one else have this as a requirement?

Did he respond to treatmeant? Like Dusty stated, history would be nice and you can't achieve one from the patient. Did it look like dystonia?

I know I am starting an argument that I will not win. I am not implying that you should withhold oxygen because of fear of decreasing hypoxic drive. My point is that there is no harm in titration of the oxygen, if the patient is not in severe distress or respiratory arrest. Let me have it Dusty, I enjoy your knowledge and experience that you bring to this forum.

With COPD patients you should start with lower concentrations of Oxygen first. Unless of course the pt is in severe respiratory distress or arrest, then you would have to be more aggressive in your treatment. I would have removed him from that environment in case it was to due to an irritant/allergy or toxin. Then placed him on nasal cannula at 4 lpm titrate Oxygen to pulse oximetor and entitle CO2. Assessed patient and if appropriate give a nebulized bronchodilator. Was the patient having a asthma attack or was it exacerbation. Was the onset acute? Was there any chest pain/discomfort? Was there any signs of an allergic reaction? What did lung sounds sound like?

I would be interested in hearing what the patients is taking for meds, Is the patient on digitox. I don't feel it is clear enough picture to call this anymore than psvt with proximal bigemeny premature complexes.

I work in a system that is Paramedic/EMT-A. It sucks, in comparison to Medic/Medic. The medic has to take 90% of all patient calls, so he or she does not end up in Q & A. You are responsible for the documentation as well. On transfers, if the EMT drives, you are responsible for driving back, normal transfer 2 to 3 hours. I have worked medic/medic and I can tell you the calls go much smother and the shifts are not as strenuous. I am not cutting down the EMT's, we have some awesome EMT's. The call has to be straight forward BLS before they can take the call. If the patient has any s/s of any sort that can be scrutinized into any form of ALS intervention, and it is brought in BLS we are in the Q & A office.

Anyone from an EMS system here that has a c-spine field clearance protocol? What have your experiences been so far? I heard Central DuPage EMSS (half hour west of Chicago, busy urban-suburban system) has had a c-spine field clearance protocol in use for several years. Markers include mechanism, pain, neuromotor scoring, neuro (GCS) deficits, etc. It doesn't mean they escape spinal immobilization, it means they escape riding the backboard. Dustdevil's point about a patient's post-accident frame of mind by the time a MD performs an ED c-spine clearance is rooted in absolute truth: they're just unwinding enough to finally focus on themselves (not their car, motorcycle, cellphone, purse, children, missed job interview, etc.). I'd also like to hear how often anyone here still applies a KED for high speed trauma, or if anyone applies it regularly for MVC victims as part of policy/protocol. _________________ E J C, nremtp/ccemtp I was simply answering a question. Yes we have the protocal. Here are the guidlines. The end!

This is indeed a fun debate with very intelligent views and opinions, however we are obligated to follow protocol. I hope medical directors follow this debate and perhaps change accordingly. The protocol I work under does allow me to clear spinal immobilization in the field. The following is are standing orders Spinal Precautions Full spinal immobilization should be considered for all non-ambulatory trauma patients who sustain a mechanism of injury with the potential for causing spinal injury and have one of these clinical findings. a. spinal pain or tenderness b. altered LOC or Hx of loss of consciousness c. evidence of ETOH d. significant distracting painful injuries (long bone fracture) e. any abnormal neurological findings f. extremes of age (young-old) Patients who are or who have been ambulatory and meet the criteria above should be considered for the following spinal precautions a. hard cervical collar: if complaining of neck pain or the above listed. b. secure to stretcher if complaining of neck, thoracic, or lumbar pain or above listed. Back boards may be used at any time if the attending ambulance personnel feel it is useful. If the patient is back boarded prior to the ambulance arrival, they should remain on the backboard. A cervical collar should be used on all patients with suspected neck injury unless the time taken to apply endangers the safety of the employee. medic 5587 STP

I work for North Ambulance in Minnesota. Dilaudid is 7 to 10 times more analgesic than morphine and can be given as an alternative to morphine if the individual is allergic to morphine. The only down side is that it seems to take longer to take effect verses morphine.

I did not see the number one used pharmacological intervention listed: OXYGEN

In addition to the original post are service carries the following that I did not see mentioned, perhaps an oversight on my part. Proparacain Hydrochloride (Alcaine) Hydromorphone Hydrochloride (Dilaudid) Nitronox Racemic Epinephrine