hammerpcp

So, Lidocaine is a sodium channel blocker and an antiarrhythmic, right? And we give sodium bicarbonate to tricyclic antidepressant overdose to unblock the sodium channels, are you still with me? So TCA is a sodium channel blocker, yet it causes lethal arrhythmias and that is why it is so dangerous if an OD is taken. So like WTF? What am I missing here? Why does one Na+ channel blocker prevent dysrrhythmia (usually) and the other causes them?

So like, four minutes have passed and where's the fire department?

Increased myocardial workload causes increased myocardial oxygen demand. If myocardium is already starved for oxygenat a rate of 40, do you really want to give atropine and increase the rate to 100 or would you like to pace at a rate just high enough to balance the patient's need for perfusion against killing off myocardium??

Did you read those articles?

An octopus walks into a bar and sits down and orders a drink. When it come time to pay up the octopus realises he forgot his money, so he makes a bet.

He says "I bet you a carton of beer that i can play ANY muscial unstrument that you throw my way"

The bar tender says, in his thick scottish brogue "Well laddy, thar be a piano over in them thar corner, play us a wee song"

The octopus jumps on starts playing the piano like some kind of musical genius. the bar tender think to himself holy crap! and then says;

"I say thar laddy, thar be a guitar in that thar corner, play us a wee tune"

The octopus grabs the guitar and starts cutting loose like jimmy hendrix!

The bar tender thinks for a moment, and pulls out his bag pipes, lays them on the bar. The octopus picks it up and stares at it for a while, stares even longer...................he's still staring....................

"Whatsa matter laddy? canna you play da bag-pipes?"

The ocotpus syas "Play it? Play it? If i can figure which way is up, im gonna f#%k it"

That is the funniest hting I have ever heard! LMAO! Ten points for Bushy.

One of my partners did "abdominal thrusts" on her daughters fish. It had a pebble stuck in its gullet. It lived. They named it "Heimlich". True story.

Ha ha! You are so full of sh it.

Hey dont laugh man!

I helped a vet do CPR ona horse once, while i did compressions (literally laying the knee in) his assisstant did mouth to nose and he shaved this horse with an electric shaver, pulled out the gel and shocked the crap outta it with a lifepak 10!!!!

Yes it lived...

Ahhh i defy anyone to show me "Field Surgery" like that - apparently horses, thunderstorms and fences in the dark along with arterial bleeds make horsie a vewy sick wittle pony.....................

:love4: :love5: :love7: :love1:

You all laugh, but I have picked up a pigeon and a seagull in the ambulance. Little did the pt who we subsequently picked up know that there was a bird in the garbage can all bundled up in sheets. Also, I have been called to a "pedestrian struck" and it turned out to be a four legged pedestrian who had been struck. We were cancelled prior to pt contact.

I agree that it would be silly to have EMS look after peoples pets. It just wouldn't work. However, don't be mistaken, this is not because human life is more valuable then non-human.

Dog CPR: Femoral pulse check-no pulse-compressions on left side of chest. Ratio of 15:2, compressions:ventilations. I think the new guidelines are coming out soon though..."Push harder Push faster"

Can we talk about this a bit? By what mechanism does atropine potentially worsen the myocardial infarction?

I found this so far.

EDIT: And this.

EDIT 2: And this.......

EDIT 3: This is a good article. It recommends anteroposterior placement for TCP and it suggests that if capture is not obtained pads should be moved (page 4). If that doesn't work they should be replaced. Did you try any of that?

Also, the second column on page two near the top addresses the atropine issue again. Did you have a twelve lead on this pt?

Although I have not taken an ACLS course as of yet, I didn't realize this was a new procedure...

Heart and Stroke Guidelines (here in Canada at least) for CPR - Unconscious FBAO have had 'chest compressions' rather than abdominal thrusts to clear the airway for over 5 years.... I don't think that concept is anything new.

Yep.

With all that said, I was wondering if Az, Rid or Dust or someone could shed some light as to why the pacer never captured?

He wasn't talking to you Nsmedic393.

So like, why not Atropine?

I think maybe it alludes to the fact that BLS actually is critical. I.E. If an ambulance rolls up to a cardiac arrest, down time of 8 or so minutes and no BLS has been started, the patient is gone. It wont matter what drugs you have.

Good point. Very good point.

That phrase means to me that my partner should have O2 on a pt he is treating with Nitro and has on the monitor and has an IV initiated on. It's just a reminder not to forget the basics. O2 is still the standard of care even if it doesn't actually do anything.

Atrial fibrillation isn't always irregular. A rate of over 150 for V-tach is usually the number the monitors use to defibrillate. They will not shock at a rate under that, however it is possible that the pt still has a pulse above that. Thats why we check for a pulse (do we still do that?). Maybe that is why they've gotten you all so hung up on that number. :dontknow: It sure does look like V-tach to me.

It's starting to make a little more sense to me now. Thanks Azcep. I will continue to read up on it though, because even all this does not satisfy me as far as why it is contraindicated for peds in our protocols. Perhaps they think we are too dumb to try other options first? I don't know.

WOW small world, I too had a Pt that was sprayed directly into the face no more than 1 foot away this past weekend. Bear spray is the same product as Pepper spray (OC spray) that the police carry, its just a bit stronger. When we arrived on scene the Pt was supine on the ground flushing his face with a hose yelling for help.

Wimp.

Maybe those so-called Government employees should spend some quality time with EMS workers to get an idea that lunch is never what it seems.

What does that mean?

In the town I used to volly for, we regularly got called to a local strip club for seizures. One of the dancers and one of the bouncers had some sorta seizure disorder. Other random people used to have seizures there too. It was a given we would go there at least 2-3 times a week. We also got called once to one of the many sleezy motels for a DOA. They had to go searching through the motel for her ID and such because everything was separately wrapped in ziplock baggies. Very very odd.....and smelly!

You are crazy! and cute!

God damn that common sense......

Article in the Globe and Mail

Hard at work in Nova Scotia? Let's do lunch

Government encourages its public servants to go out for a full hour, hoping to feed productivity, SHAWNA RICHER writes

SHAWNA RICHER

HALIFAX -- Getting in touch with employees of the Nova Scotia government might be difficult these days if you're trying to catch them over the lunch hour. There's an excellent chance they won't be at their desks.

Unlike most North Americans -- a recent U.S. study suggests 75 per cent of workers eat at their desks at least three times a week -- public servants are trying to take an hour lunch break out of the office most days. It sounds rebellious in this workaholic age, but they are just following orders. And employers in other provinces and outside Canada are taking notice.

Borrowing from a similar project started at the University of Toronto several years ago, the N.S. government wants its 10,000 employees to leave their desks at lunch -- to eat, exercise, run errands, even power nap -- in hopes of making people more productive in the afternoons. To drive the point home, the N.S. Public Service Commission sent out postcards proclaiming, "Take back the lunch break" with orders to "relax, refocus, refresh, re-energize."

The project, which cost about $5,000, is part of a healthy-workplace campaign based not on scientific data but rather employee surveys and a good amount of common sense.

"We all know from our private lives that when you have a chance to take a regular break while you're working it helps make you more alert and productive," said Human Resources Minister Ernie Fage.

"We've taken a pro-active approach to promote not just good nutrition but being more active. It's important to take that time, get that break and clear your head. Everyone benefits."

Lunch as a meal has long been fodder for big thoughts.

"Ask not what you can do for your country. Ask what's for lunch," said the husky Hollywood icon Orson Welles. "Lunch is for wimps," Michael Douglas as Gordon Gekko barked in the 1987 film Wall Street. And former U.S. president Ronald Reagan quipped, "I never drink coffee at lunch. I find it keeps me awake for the afternoon."

The "three-martini lunch" gained popularity in the seventies as a way of gentlemen doing business. The concept was famously condemned by Jimmy Carter during the 1976 U.S. presidential campaign on the basis that inequitable tax laws allowed boozy lunches to be written off as a business expense. In response, his opponent Gerald Ford called the practice "the epitome of American efficiency."

Only the relaxation part of such a lunch-hour activity was what Myra Lefkowitz had in mind several years ago when she thought to reclaim the lunch break at the University of Toronto.

"Even though the Employment Standards Act provides everyone with the right to take lunch nobody really does it," said the university's manager of health and well-being services.

"We wanted [the campaign] to speak to the institution, management and employees. It wasn't something over which individuals would have to fight or feel guilty or deal with the critical gaze of their colleagues as they went and did something we used to all do.

"We know that in the long run, if people don't pace themselves they run into things like burnout and stress leave -- the results of people not paying attention to themselves and their needs during the day."

Michelle Lucas has worked in communications for the N.S. government since 2001, currently for the Department of Human Resources. Like many of her colleagues, she habitually worked through lunch, grabbing something at her desk, hoping for a tasty sandwich tray at meetings or forgetting to eat at all.

"I rarely took a lunch break," she said. "I can think of days where I was driving home and I realized I hadn't eaten and I was just famished.

"So many people go steady through the day and don't take breaks for themselves. We see it all the time. It's just what you do. But it's not good. A nutrition or activity break or even running errands makes you feel less stressed in the afternoon."

Several studies have suggested that a simple 10-minute walk at lunch can provide a two-hour burst of energy through the afternoon.

Nova Scotia has already heard from other provinces interested in adopting the quirky campaign. Officials in Texas and London, England, have also made inquiries.

Since the program was quietly announced in the spring, Mr. Fage, never "a lunch guy," makes an effort to stop for a healthy meal or a brisk walk in downtown Halifax. He hopes to see the idea catch on with private companies.

Leslie Beck, Globe columnist and nutritionist, said lunch is as important to health as breakfast. She lamented a corporate culture that has ruined workers' sense of entitlement to a midday respite.

"People feel guilty for taking lunch," she said. "I talk to so many people for whom it's not part of their office culture. If their boss doesn't do it, they won't either. There's a real guilt thing going on.

"But it's been four hours or maybe five since breakfast. Your blood sugar is low. People who don't eat lunch get far too hungry and eat more later."

Nova Scotia isn't measuring the results of the program. There is no lunch-break attendance taken, though Ms. Lucas chuckled that at the beginning, some employees e-mailed Human Resources to inform they had indeed gone for lunch.

"We're not being prescriptive," she said. "No one is telling anyone else what to do. It's an awareness campaign. But it brings something out in the open that we all used to do and have gotten away from. Hopefully it will go a long way to bringing back healthy habits."

Cuz that's what your protocols say!

ha ... sorry, had to throw that in there

PFFFTTTTT.

Azcep,

Thanks teach. So, more questions.....if the parasympathetic NS is poorly developed (namely the vagus nerve) why would there be a sudden increase in vagal tone during intubation? I wouldn't expect a poorly developed system to not have much effect under any circumstances. Also i wonder why they often give atropine to peds in hospital but it is contraindicated prehospital (as Lithium mentioned)? Any ideas?

Another question (I'll allow that this may be a dumb one), but stay with me here. So Atropine is a parasympatholytic, meaning it blocks the parasympathetic nervous system (effects on the heart at least), which means that the sympathetic nervous system can then exert its effect uninhibited or unchallenged. This leads to an increase in heart rate (hopefully). So a pediatric pt experiencing bradycardia- that can not be corrected with proper or improved oxygenation- who has a poorly developed PNS in the first place should be more effected by a blocking of the PNS. No? Is any one else confused? 8-[

Why?

Does Lithium know he is toxic? Maybe someone should warn him.

Dopamine?

What would we do without ERDoc to cut and paste for us?

Look it up to make sure I am not wrong but that is pretty much what the book says.

You aren't wrong. By default you must be right!

As far as sedation goes, I don't believe we carry anything that would be appropriate for this pt given her vital signs, namely midazolam, morphine, or valium. What do you think? Also since she already has a decreased LOC sedation is not of paramount importance. Why not try some atropine first?

That's not very nice.

I am going to go ahead and take a little credit for that diagnoses. Although I was not familiar with the exact process it took all of about three seconds to get to the diagnoses since I already recognized the chronic symptoms. And VS, with todays technology it isn't too hard to carry multiple reference guides in your pockets. Obvioulsly there is alot more that we don't know then that we do know what with the length of schooling we have and all........

Thanks for enabling the expanse of my brain with this scenario.

And thanks to google:

TCP does sound like a good idea, along with some blankets, fluid replacement (and electrolyte-hyponatremia is common), possibly glucose replacement (depending on results of BG reading, but hypoglycemia would be expected), and continue to assist with ventilations. This is awesome. Thanks for the reminder aobut TCP, I didn't even condsider that as an option.

Lithium can you precept me?

Myxedema coma.

Right off the bat, i am thinking about hypothyroidism for this pt. I am not sure what would cause this acute decrease in LOC though.

As far as current treatment it will be supportive only at this point. Insert nasal airway, possibly bilat, assist ventilations and increase rate and volume, insert opa if tolerated consider intubation, attain intravenous access. Reassess. Is pt still bradycardic and hypotensive now that pt is being adequately oxygenated? (i assume since you did not state otherwise) Has she been having any other symptoms recently that are unusual? Is she a drinker? Are we seeing edema/ascites/anasarca here? Any signs of stroke? In what respect was pt not feeling well before going to bed? Chest pain/discomfort? Nausea? Dizziness? Increased weekness?SOB? Fever? Bleeding?