JakeEMTP

Beiber wrote: however the fact that the patient APPEARS to have clear lung sounds (which as I stated above I want to confirm after I start ventilating via BVM) with such crappy O2 sats does put PE on my list of differentials. Not trying to nitpick (seriously), unless I misread in the OP the pt. was moving some air and not very well if you ask me, but was negative for wheezing. Too bad the pt. is to weak to tolerate CPAP, that's what he needs IMHO. Good conversation going here.j .,m

Jumping into this one a little late and after reviewing the previous posts, I'd first sit the pt. up and reassess lung sounds. 02 via NRB initially while preparing a combivent. I'd hazard a guess that the pt. had attempted to self administer his prescribed Albuterol w/o relief. 12-lead ECG in the house get this guy to the ambulance. Let's start an IV and get 125mcg of Solumedrol on board. Capnography and begin transport emergency traffic. I'd be preparing my intubation and suction equipment, you know, just in case.

I can't speak for the other 3 crews that run out of our station (24/72 schedule), but my partner and I wash the outside of the ambulance every shift, preferably at the beginning of shift. We also wipe it down do to mostly me being anal about water spots. If you're not going to wipe down the truck, don't bother washing it. Water spots look like crap. The inside is wiped down and floor mopped after every call. The cab is wiped down and glass cleaned sometime during the shift. We don't always have time to do it at the beginning of the shift. We wax the truck at least twice a year.

Who works Trauma codes? Look man, like Dwayne said, you need to do some serious catching up. Intubations are great, but another poor example. The AHA doesn't even deem them necessary any more. Good, quality CPR, 2 minutes @ a rate of 100/min, will allow enough oxygenated blood to flow to the brain for some time. Also, if you can't start an IV on the run, you don't need to be in the ambulance, period. But we're discussing whether or not to transport a code. The need to start an IV in route is moot because that should have already been done while we worked it on scene. Do me a favor and post where your located so I can avoid that particular corner of the world. You're scaring me.

Sure you can do CPR in a moving ambulance. But how effective is it? Studies have proven time and time again, that the quality of chest compressions drops significantly while in the back of a moving ambulance. In essence, your rolling CPR is doing nothing for the patient. It only makes you and others feel good about yourselves. Work the code on scene. If the pt. has ROSC, transport. If the pt. does NOT have ROSC after you have exhausted all efforts, call it on scene.

Exactly. Transporting pt.'s to the hospital when there is nothing they can do that we can't do in the field just for the families sake is a poor argument. Medically, the pt.'s outcome will not change. Why give the family some sort of false hope? Explain that you have done ALL that can be done (and make sure you do it!), have consulted with a Physician and called the code. While you are transporting the deceased for no reason, another pt. who is living may need you. The amount of resources required to work a code in the hospital is significant. Do you want other pt.'s to not receive the care they should while 5 or 6 nurses, 2-3 LPN's, an RT, an Attending and 2 -3 residents work your pt. which shouldn't even be there? There is a much bigger picture here my friend. Sometimes we can't see the forest for the trees.

Why did some anonymous poster give Mobey a negative? If you disagree with his comment please explain why. If she wants to sell her virginity than that is her business. Hell, some loser offered Brittany Spears a cool Million for her's.! I'm probably to uber liberal. I see absolutely nothing wrong with it. It is her body and her decision. It's BUS 101. Supply and demand.

Sorry Brian for the use of a perhaps local slang. FSBS is a "Finger Stick Blood Sugar". I used a BGL (Blood Glucose Level) once an a PCR and was told it wasn't an approved abbreviation. We can administer Versed IM up to 5mg, which we did in this case although a lesser dose due to the pt.'s smaller stature. USUALLY (capitalised for effect), there is a very short time, less than a minute for it to start taking effect. I guess it is possible for the pt. to begin seizing again although I have never seen it in my short career. Perhaps one of the seasoned medics or MD's here could explain.

Midazolam, Lorazepam and Diazepam. We had a pt. 2 weeks ago that was actively seizing when we arrived on scene. We administered 3mg Versed to control the seizures. A FSBS was obtained and found to be 18. We fixed that too. But, it would have been difficult to establish an IV w/o the narcotic controlling the seizure activity.

Hey! No posting whilst driving!

WooHoo! Way to go Bocat!

WooHoo! Way to go Anthony!

Just a shot in the dark here, but isn't the cartoon catchprase "Don't make me angry" Marvin Martian? The "wild and crazy" guys were Steve Martin and Dan Ackroyd. Yea, SNL used to be funny! Is the "Oh, my nose!" Rudolph the Red Nosed Reindeer? Wow, I am as freakin as old as I feel!

I agree with the above responses. When I did my hospital rotations, we did patient assessments, and all interventions up to my scope of practice. IV starts, blood draws, medication administrations and intubations, etc. Even did some above my scope under direction of the EMS medical director. You are there to learn. This is a hands-on business. When you show up for your first clinical shift, introduce yourself and ask if there is anything they need help with. You are not there to be their bitch, but it doesn't hurt to make up a stretcher or two. Embrace your clinical time. It is a learning experience. Don't be afraid to ask questions from everybody! Nurse's and Doctor's. The staff get a fresh bunch of students regularly. If you show some interest, they will be willing to help you. They all have more education than you, and some are even willing to share it. Good Luck!

What's the host's problem? It must be his wife. What exactly did he expect? Yeah, I think it would catch on here. It have to be on FX though!

Here in the Tarheel State, we have 2 similar yet different forms regarding DNR. One is the DNR itself. It states that in the event of a cardiac arrest/pulmonary arrest, we are not to initiate CPR. http://www.ncdhhs.gov/dhsr/EMS/pdf/DNR.pdf The Other is a newer form called a MOST (Medical Orders for Scope of Treatment) which outlines to what level of interventions are to be preformed and is filled out by the patients PCP, signed by the patient, family and the Physician. It seems to work pretty well in eliminating the "grey" area. http://www.ncdhhs.gov/dhsr/EMS/pdf/ncmostform.pdf

Dunno there inf. There are studies and literature supporting the use of Atropine. Conversely I'm sure with little effort, you can find the same discouraging the use of Atropine. Here is but one article I found supporting it's use, with credit going to the Merck Manuals at Merck.com There is no electrical communication between the atria and ventricles and no relationship between P waves and QRS complexes (AV dissociation). Cardiac function is maintained by an escape junctional or ventricular pacemaker. Escape rhythms originating above the bifurcation of the His bundle produce narrow QRS complexes, relatively rapid (> 40 beats/min) and reliable heart rates, and mild symptoms (eg, fatigue, postural light-headedness, effort intolerance). Escape rhythms originating below the bifurcation produce wider QRS complexes, slower and unreliable heart rates, and more severe symptoms (eg, presyncope, syncope, heart failure). Signs include those of AV dissociation, such as cannon a waves, BP fluctuations, and changes in loudness of the 1st heart sound (S1). Risk of asystole-related syncope and sudden death is greater if low escape rhythms are present. Most patients require a pacemaker (see Table 4: Arrhythmias and Conduction Disorders: Pacemaker CodesTables). If the block is caused by antiarrhythmic drugs, stopping the drug may be effective, although temporary pacing may be needed. Block caused by acute inferior MI usually reflects AV nodal dysfunction and may respond to atropine Some Trade Names ATROPEN ATROPINE-CARE SAL-TROPINE Click for Drug Monograph or resolve spontaneously over several days. Block caused by anterior MI usually reflects extensive myocardial necrosis involving the His-Purkinje system and requires immediate transvenous pacemaker insertion with interim external pacing as necessary. Spontaneous resolution may occur but warrants evaluation of AV nodal and infranodal conduction (eg, electrophysiologic study, exercise testing, 24-h ECG). Most patients with congenital 3rd-degree AV block have a junctional escape rhythm that maintains a reasonable rate, but they require a permanent pacemaker before they reach middle age. Less commonly, patients with congenital AV block have a slow escape rhythm and require a permanent pacemaker at a young age, perhaps even during infancy. Last full review/revision January 2008 by L. Brent Mitchell, MD Content last modified January 2010 I have used Atropine in the very scenario provided in the opening post. My Medical Director didn't bury me. The pt. may respond to the Atropine, so why wouldn't you try it before using electricity?

Good Morning, A lot of the answers to your questions can be answered here. http://www.wakegov.com/ems/default.htm

I also agree with the good Doczilla. I actually failed a scenario test at a Fire Dept. for doing it . They offered me a position anyway but I declined. I didn't think it was a good fit for me.

Let me just say, I do not work for MEDIC nor have I. I have several friends who work there however. NC does not recognise NR. You will have to apply for reciprocity with NC before you could practice here. MEDIC is an extremely busy service. It is not unusual for you to have 8 - 9 pending when you arrive for your shift. There are no stations, only a large depot where you pick up your unit. Shifts start at various times during the day to ensure coverage. They have nice equipment and pay relatively well. They work 12 hour shifts because of how busy they are. 24's are out of the question. I don't mean to sound negative at all. My buddies have been there for some time and love it!

I use the Kila KL-770 scope seen here in the link Spenac provided. It works great for me. I like the short, thick tubing. Nice clear sounds for working in the back of an ambulance. I have it in orange too, the only one I have seen in the County which makes it easy to spot if it suddenly decided to go umm.....walkabout.

I read in an earlier post (I believe it was one of Lone Star's) explaining the pressure points as the brachial artery for a upper extremity and the femoral artery for a lower extremity. These are correct. Of course the post also mentioned how difficult it is to put enough pressure on a femoral artery. I think that's where the use of a tourniquet came into the conversation. We use a tourniquet for femoral arterial bleeding as well as field combat gauze. You will get some good advise here. Sometimes it is hard to express the proper tone intended in type. Do not take offense to posted replies. Most here are only trying to help. It is true that the EMT-B course does not spend a lot of time on hemorrhage control, which is a shame. That is one thing a EMT-B can do on a scene.

Congratulations!

Definitely going this year. I hated that I couldn't make it last year, because the first invasion of EMT City folks was cool. Hope to see some old friends and meet some new ones. The AF museum will also be on my agenda.

Dammit! We SO need that for our station!