hammerpcp

I think the reason there is controversy on this topic is because there hasn't really been any actual research done. I recall a similar debate several years ago in school about which side to put a CVA pt on when transporting. It was the same arguments as noted above i.e. a hemorrhagic stroke should be placed semi-prone with neurologically impaired side up and normal side down (this is all assuming the pt is exhibiting hemi-plegia/paresis) in order for the blood in the cranial cavity to pool on the already injured side.

Some of the arguments against this were that: 1) This positioning may cause the pt distress since they will have no or impaired function of the free extremities (those that they are not lying on). 2) There is no evidence that this is even effective practice and therefore, the possibility of harm caused outweighing benefit is present.

Other issues that arose: In the field it is often difficult to differentiate between a hemorrhagic CVA vs. an occlusive CVA - although there are certain tell tale indicators, e.g. sz, uncosciousness, etc.

One of my instructors ended the whole debate when she said that all pt's either ride supine (with varying degrees of head inclination based on pt condition) or on their left side. This is for the reason stated by the OP, namely that you need access to the pt and therefore they should not be facing the wall. Bottom line is that the same reasoning applies to the question at hand.

:wink:

Does being physically disabled automatically raise you to a higher moral echelon?

BTW penetrating objects travelling at high velocity through human tissues often impact the spinal column at some point frequently causing neurological impairment. Perhaps a lifestyle choice?

It is a strange phenomenon that if something is not on the internet it doesn't exist.

There is an overly kind poster that sometimes accuses me of being modest, but I have to believe there are times, like this one, that I'm simply truly not as smart as many.

Are we really talking about finding landmarks through clothing on a dead person to avoid offending the modesty of said....dead person? See, I'm not that smart. Dead means a lot of things need to happen quickly in my world. CPR, airway management, Monitor, vascular access, etc. And I don't have the brains to cause, direct and monitor those things while making sure some middle aged perv. doesn't get a peek at a 16 y/o tit.

We had an Afg local that fell through a ceiling 12 feet onto a concrete floor. On the way down he slashed his face on a piece of ductwork from the R corner of his mouth to the corner of his R ear. Not full thickness (which I didn't know at first of course) but you could see the shape of his teeth on the remaining tissue when the wound was exposed...perhaps one layr of tissue remained.

While I did my 'medic thang' I ordered his clothes cut off. If you don't know, Afg men (I have no contact with Afg women who I assume feel the same, but I don't know for a fact) have a MAJOR issue with being exposed in public. When we started to cut his pants he started to freak out...puking, bleeding, freaking out, he was a busy fellow. Someone higher up in my medical chain of command was yelling that "You can't expose him in public!" The medic cutting looked at me, I yelled "Get his clothes off!!" and soon he was naked with the exception of a piece of t-shirt covering his penis when we could manage it.

Turns out that when I looked at his buttox it appeared that someone had slipped a very large bagel under the skin at the base of his lumbar spine. Would I have found it with his pants on? Yeah, probably. But I found it sooner, with much better visualization than I would have had had I simply palped or "peeked" under his pants as I see many do. I believe the MOI dictated exposure of the entire pt, and did so despite his complaints and that of a medical superior (in rank, not clear if intelligence).

Anyway, I guess my point is this. If you can do good medicine while keeping the rules of prudence in mind, then kudos to you. I simply don't seem to have the capacity to do so...So fair warning girls...if you decide to keel over in front of this dumb ol' fat medic...pray you've been working out and wore clean underwear.

Dwayne

A bagel?

Ouch.

I'm not aware of a WD40 deficiency in females. Are women in your area especially tight and squeaky?

It is an increasingly rare condition, it is even less frequently found in populations where the males have either less naturally occuring C19H28O2, or have been socialized to control its behavioural effects.

Now THAT is a brilliant piece of political advertising.

If he hasn't had any food in the last 48 hours, then his liver has used up the glycogen stores. The body has been turning to non-carb substances to convert to glucose (process called gluconeogenesis). EtOH impairs gluconeogenesis, leading to no glucose... ie this scenario. Treat it with oral carbs if the pt comes around enough to control his airway and can eat safely. If not oral, D50. He'll also need fluid resuscitatation. Thiamine is a great thought if you have it pre-hospital. EtOH-induced hypoglycemia does not respond to glucagon, although it wouldn't harm him either.

"Inhibition of gluconeogenesis has also been implicated in the etiology of alcoholic hypoglycemia in the clinical setting. Freinkel et al. (9) presented indirect evidence for the inhibition of gluconeogenesis by EtOH when they were unable to counteract EtOH-induced hypoglycemia with infusion of glucagon in normal subjects who had fasted 24–48 h. Other groups have measured a decrease in hepatic glucose production as hypoglycemia developed during the infusion of EtOH after a 2- to 3-day fast." Web Page Name

He may have been having PACs, brought on by the caffeine in Red Bull and No-Doz. That's an arrhythmia that will "fix itself."

I'm curious where the ethnicity/Muslim question came from... were you thinking G6PD deficiency?

And a razor (or five).

Dispatch center

ECG shows a dysthrythmia (I cant remember what it was but one that will 'fix it self' once his been re hydrated)

Three options 1) Sinus tach, 2)You misheard or mis-remember 3)Medic is an idiot(?)

He is Australian.

It is a combination of Albuterol and Atrovent with the trade name Duoneb by Dey Pharmaceuticals.

It was expensive when initially released and many in EMS as well as hospitals just continued to used 0.5 cc of 0.5% concentraton Albuterol which is available as individuals to mix with a unit dose of Atrovent. Some also just mixed the two unit doses.

Now there is a generic Albuterol/Atrovent mix available so Duoneb is not around as frequently as our drug buyers shop for a bargain.

Some hospitals also insisted on orders being written by RRTs and MDs as Albuterol/Atrovent combination neb just to avoid the brand name issue or for clarification and avoid confusion with other meds that may contain the same ingredients.

So, the term Duoneb may not have been heard by all. In some areas it may not have been heard at all depending on the formulary of the hospital or EMS agency.

When teaching respiratory meds for both the medical professional and the patient, we make sure they know what their meds are and not just a brand name such as Duoneb, Advair, Symbicort, etc.

An example of this is when a Paramedic is asked if the patient got albuterol and atrovent enroute to the ED and the answer may come back as "No, they got Duoneb".

Great answer, thanks for the complete lack of arrogance.

I recently had an "experienced" medic ask me what a Duoneb was... He had no clue...

What's a 'duoneb"?

One time I was called in a panic to help with a severe difficulty breathing 22 y/o female.

I arrived on scene just as the ambulance was leaving.

I jumped in the back with a 20+ yr veteran EMT who has chosen not to keep up on her/his education.

I looked at the patient, looked at the EMT, and asked What her air entry sounds were. The EMT said "I haven't had time to check them!

I stuck my head up front and told the driver to pull over and shut the siren off..../ Every patient gets assessed before they are moved!

I heard some wheezes in the lung fields, but not much to worry about. SP02 99 I think on room air (no time for 02 ya know) but resps like 40. With the carpopedal spasms present it was clear to me this was a hyperventilation.

I asked the other EMT to put 2.5mg salbutomol in a neb as I began to coach the patient.

She tore the bag open and spilled the neb parts all over the floor she was shaking so bad.

I told her "Just sit back and watch"

Anyway, the patient who was originally going in and out of Cx, eventually walked out of the rig into the hospital. And we were able to transport with no sirens!!

Why would you use L&S to transport some one who's hyperventilating?

I had to have a safety nap to make it safely through this post.

yah we had one yesterday, guy started feeling real faint, and passed, out, checked a pulse and it was 20. Got the paramedics there a few minutes later and the guy was in pea. Unfortunatly the guy didn't come back after 6 shocks, eppi and atropine. Worked on this guy for 25 mins:(

....Shocking PEA is never going to give you a perfusing rhythm....just saying. Never had one in a funeral home but they drop like flies in church.

Huh?

This thread should be called "I need A house"

Why didn't the cops instruct the young athletes and their trainer about the definitions of trespassing, menacing, battery, elder-abuse, and making terroristic threats?

Send 'em all to Guantanamo bay!

Damn kids, Get off my lawn!

Or else

[stream:8e13acbcb5]http://www.soundsnap.com/node/12534[/stream:8e13acbcb5]

Wow. That's embarrasing.

Were they headed to the same call?

Am I totally missing something here? What is "normal" for this pt? Her normal level of consciousness and function and ability to communicate? Maybe this is her normal state, other then the bloody sputum/emesis of course. BTW I would be having a high degree of suspicion towards aspiration for which albuterol would not be particularly helpful obviously. So according to incident hx 911 was called because the pt was 'unresponsive'. Lets get a bit of a description about what that actually means. i.e. has her LOC improved since the call was placed? because she isn't unresponsive now. So, how long did this episode last? was it witnessed? was there sz activity? etc. And what is this mysterious neuro disease?

I just read the OP again. Why does the pt live with mom? To me this indicates an inability to care for oneself.

Assuming the facial droop and dysphasia is new I am going to top my list of ddx with cerebral ruptured aneurysm, blood tinged sputum from the stomach ulcers brought up with the vomit. Either that or the pt had a sz and bit her tongue due to same ddx.

Awesome video! How much heroin did she do?

Yeah, WHY is his liver enlarged and apparently not functioning properly? What tx was prescribed? I was thinking small pox for sure although a dairy farmer should theorehtically be immune.