runswithneedles

Whats the EKG showing

How long does the seizure last

Do we have a Istat to check lactate as PM requested

what is the BGL in mg/dl

Did the EKG change after the seizure

Would versed be a choice to control the seizures

So let me get this straight in my head. A compassion code may be beneficial since you are demonstrating to the family that everything is being done?

I wish I knew what AMFYOYO meant haha

Adios my friend your on your own.

I see that obesity can be in issue with intubating in general but Im sure im missing something else.

What is your question, though? Do you really want to know if anyone would work a code like what you described? Or is there something else you want to know? Why did your partner think that this code should have been worked? What good would it have done anyone to work it?

Working a code on someone obviously dead gives the family false hope, is unprofessional and is abusive to the body. I am sure it does not help with their grieving.

she just answered it. Thats what I was wondering

Pardon if this sounds cold, heartless, shameful. But if their no signs of life in the patient I feel its a waste of energy, supplies, and my blood sweat and tears to work someone who's long gone. I thought for the past 2 1/2 years that my own logic was reasonable. But when my partner brought that up I saw it in a view that I never considered. I brought my question here to see what the EMS community thinks.

BLS transfer. Im AMFYOYO. In a ALS crew. Granted we have suspicion for another stroke but im rather curious if this is a possible pulmonary embolus. Chest x-ray would be nice to rule that out real quick. RSI and place on vent to bring up the SPO2. Initiate a second IV 18 ga or largest possible set to TKO. What was the result of the initial attempted cardioversion. Did it rhythm change after the initial dose of adenocard. After the intubation did the SPO2 improve. If nothing improves than request for a medevac. 2 hours is way too long for a patient in that condition and is still deteriorating.

Dang, I was about to go to town on this scenario. But this is a text book question. Its been said by several others and I will say it too. Use common sense and read your book.

I chose to call it. My partner brought it up after the call it just made me stop and think. And for me personally I had a pile of evidence to prove that this patient would not benefit from CPR, or any ALS measures.

I came across a situation today which got me thinking. Which choice is better to the family. When you come across a patient who is obviously been dead for several hours (lividity, rigor, pupils fixed, etc) would you want to work that code for a round or two of CPR and call it or would you simply confirm asystole in all three leads and call it than. Is the trauma of seeing their family member worked outweigh the possible peace of mind of knowing that everything that could have been done was done.

Whats everyone's thoughts?

To my knowledge the way the state of texas has it written I would not be legally able to honor it. I need the OOH DNR form from the state of texas with all required signatures. CYA purposes.

The only service I know of in the area I used to work at that carried it was Johnson County Med-Act. Contact Bill Toon there. I don't know the number but you can google it or go to www.jocoems.org

He's one of their educational guys.

Capn.

Really. Does med act still use it in johnson county?

C,mon Mike. When a nurse says a naroctic antagonist is a pain killer and a fib is a shockable rhythm I draw the line for stupidity. However I will admit that there is a opiod antagonist such a nubain that is a pain killer. And depending on the stability of the a-fib it can be shocked to correct it . However it can be managed with medications also.

I kind of figured. Ive never used vecuronium before. Ive always used sux and roc but this in the OR with a anesthesiologist breathing down my neck in case i missed.

You arrive on scene to find an elderly gentleman sitting in his recliner. He is obviously disturbed that you are here. He says that his wife called you after he told her not to. When you talk with the gentleman, you find that he is having a significant amount of chest pain that radiates down his left arm and into his jaw. He says that he is tired of hospitals and does not want you to do anything for him. He tells you that he has a long history of heart problems and was recently told he needed a heart transplant. You try to convince the man to let you transport him to the hospital for treatment, but he continues to refuse care. You ask him and his wife if he has some form of advanced directive there at home, and they tell you that "the doctor is working on it but has not sent it home yet." WHAT DO YOU DO?

· What options do you have?

· Is there anything you can say or do to convince the patient to go to the hospital?

· What if he becomes unconscious before you leave; will your approach change then?

· Would your approach be any different if the patient had a valid advance directive present?

Answer to question one: If hes A/Ox3 he has the right to refuse. Just be ready to respond to the adress again for a full code in a bit

Answer to question two: Try getting the wife to convince him to go. use any other family members present, ask him if you may take a look at him. if he does use non invasive diagnostic tools only (twelve lead, lung sounds, BP, spo2, and pulse). This sounds to me like a text book case of an MI. If my theory is correct and the twelve lead shows it you can use that as evidence to back up your suggestion to go the hospital

Answer to question 3: yes if he becomes unconscious check for pulse. if none present begin cpr, begin ACLS protocols, and request back up (we call out two additional medics while working a code) , if pulse is found go under implied consent, get a EKG, Iv established, secure airway if compromised, at the very least give Hi-con O2.

Answer to question 4: depends on what the advance directive states.

Sounds like a real easy, stress free job. Why are you stressed out over it?

Would you rather see people decapitated? or suicides? I don't see how that would be easier to do. Those are the type of EMT's that I would expect to be over stressed.

I am sure it has to do with location as well. If you're in a bigger city working as an EMT, I am sure it's more exciting. The more people, the more problems.....

Son, both jobs are stressful.

For example: stupid nursing home staff call you rather than 911 for a critical patient/ ER docs calling a rig an with a hour ETA to make a three hour transport which that pt requires a bird.

sub standard equipment and pitiful protocols when your transporting unstable patients

writing 12 reports per shift with four pages of paperwork a pop

little to no respect from the 911 service (its that way no my area cant speak for the rest of the nation.)

your a patch and a pulse in private

now for the 911

getting called out twice a day for the same person because they are so drunk "they cant move"

getting called out 15 minutes before your shift end

having to drive 30 miles out to bring back a critical patient (Im out in a frontier service so that's normal)

Having to wait for the fire department to arrive on scene to cut out a severely injured patient that is circling the drain before you eyes

good luck being able to have a hot meal on shift

the biggest one especially working small town is you never know when someone you know will be the next dead on scene, cardiac arrest, car wreck, or accident.

They both are stressful. Its an occupation which if you don't care for yourself it will take your own life (heart attack, stroke) or your sanity.

Pardon if that sounds a bit harsh but this isn't like emergency.

Examples: A-fib is a shock-able rhythm. Narcotic antagonists are a class of pain medicines. Hemorrhoids are weak muscles. Give aspirin to stroke patients. These are just some examples I have recalled in the last thirty seconds. And if I pick up on these I wonder how many more there are that I simply don't know any better than what they are saying.

Really. Im sorry to laugh at their gross incompetence. But where do they get their RN license. A cracker jack box?

Why would you need to rule out possible heart transplant. The only cardiac drug I know for a fact may not work for heart transplant is atropine.

so in the case of a failed airway can a dual lumen such as the combi-tube or a king LT be used as a last resort?

to be used as the paralytic for RSI. The new protocols are not yet available for us to look at as they are still in the works. I know its a non depolarizing paralytic with an onset time of one minute given IVP at .1mg per kilogram. It is contra indicated in newborns ans myasthenia gravis (that I know of).

my critical care guide says 1 minute onset time. medscape tells me 3-5 minutes. do you know what it normally takes to go into affect

Holy smoke this is funny. Thanks for the post

My boss is considering adding norcuron as the paralytic in our revamped protocols. (RSI is new in our upcoming protocols as a whole). Ive only been around sux and rocuronium (pardon if the spelling is off).

Has anybody here used norcuron in the field to facilitate RSI?

Ive been hearing rumors that we will be putting on our truck as well. Ive heard promising things about it however I myself have done very little of my own research.

I hate GCS. They updated our ePCR and it is now a requirement to do it twice for EVERY patient. While I see its benefit in say a trauma or ALOC patient I really don't see the need for doing it twice when we have a 5 - 7minute transport time. We have to do a minimum of 2 full exams for every patient anyway.

our service requires us to do it on scene and enroute accompanied by the times

One of my friends was arrested a week ago for DWI. is he going to lose his license? what kind of repercussions are their going to be for him in the long run

1. ive only dropped one patient

2. oops wrong drug

3. its okay your my first patient

4. ive never done this before, lets give it a try

5. *starting a 14 ga IV* little poke on 3

6. hmmm that doesnt look right

7. what the f*ck

8. oh Sh*t

9. oops

anyone care to add