erice2592

Everything previously stated was done on scene minus succ's. We only have Vec. Pt. was flown for neuro. Sub A bleed and introventricular obstructive bleed. Good job fellas

I'm going to go with nasal airway & BVM,to manage the airway, not ready to paralyze him just yet. Done at your request

Severe hypoxia due to depressed resp effort. Could Be

How much Narcan did we use so far? Nobody has indicated a dose thus far

Put the pads on and be ready to code him. Done at your request

Ventilation's have poor compliance even with an adjunct.

EtCo2 is now up to 72.

Hello,

Thank you for post a scenario.

I agree, this fellow needs an airway (protect and predicted course). I would do an airway assessment, set up the equipment and brief everybody on the plan.

I am not sure about Vecuronium because I have no experience with it. If I recall it is fairly long acting.

I would go with Rocuronium 50mg IV followed by Propofol 100mg IV. My rationale for Propofol is it is neuroprotective and we have plenty of pressure to work with.

For post intubation management I would use a Propofol gtts (if you have a pump) or Propofol 50mg IV PRN. My goal ETCO2 would be 40.

If possible, I would try and get the BP below 160.

As for the ugly EKG this may be due to ICP and brain stem issues.

Cheers

Roc is in as well as propofol.

tube was placed after an IV paralytic was administered w/ direct visualization of the vocal chords, a yellow-purple color change of ETCO2 detector, regular square ETCO2 in-line waveform that correlated to manual ventilations, bilateral lung sounds, and no air movement auscultated at the abdomen. Just prior to the IV paralytic and intubation the measured ECG rate was 48 sinus bradycardia w/ frequent PVC's.

Put him on 100% oxygen and see if that fixes his SpO2.

If not and he won't take an OPA then call for an RSI capable Officer provided they can locate significantly faster than we can take him on to hospital; unless backup is very close (a few minutes away) I'd take him to the hospital.

The VT could be hypoxia related; see if some oxygen fixes it to start with.

100% doesnt do much, no resolve for VT. he is posturing, and you have RSI on board. Vec, etomidate, diprivan, and versed.

any other history? specifically addictions/ diabetes/ stroke/ cardiac? medications? WITNESSED number taken? Also check pupils...

per my level, check BGL, obtain twelve lead & transmit, obtain vitals, protect airway and assist ventilations as necessary, appropriate sized IV with .9NS, once IV is established, administer enough narcan to bring the respiratory drive back around (lets not bring him out just yet... no need to have a pissed off 54 year old in extreme pain thrashing around without need for it >.> )

Hx: Chronic Pain due to back injury X 2 years ago. No other history reported.

Medications: Oxycontin (Unknown Dose , pills were not kept in Rx bottles) 325 ASA X 1/day

No witness to medication, suspected Rx abuse.

Pupils: Constricted, sluggish

Initial Vitals:

BP:208/132

HR: 120

RR: 8/Shallow

SpO2: 78%

EtCo2: 58 W/ appreciable waveform

FSBS: 146

12-Lead: bigemnial PVC w/ palpable rate of 50 w/ occasional salvos of unifocal ectopy (runs of VT).

Rejects OPA

Post Narcan:

improvement in respiratory rate and increased depth and volume of respiration. The patient's neuro-motor tone changed from flaccid and aphasic to decerebrate posturing, deep slow sonorous respirations, and a fixed left-downward conjugate gaze.

ISLAND EMT

Pulse rate and strength? Palpable 50, Monitor shows 120

peripheral pulses? Nada

Resp rate & volume? 8/Shallow

ETCO & waveform? 58 w/ appreciable waveform

Pupils? Constricted and sluggish

What kind of pain is he taking the oxy for? Chronic back pain X 2 years dosage? Unknown (med's not in Rx bottle)

If resp volume & rate is insufficient then lets support as needed withO2 and possibly BVM: Done

as said above, 12 lead which shows? bigemnial PVC w/ palpable rate of 50 w/ occasional salvos of unifocal ectopy (runs of VT).

IV , larger bore as we may be going down the arrest pathway.

BG=146

Pull the narcan out of the box if we determine it's not cardiac related per the 12 lead.

obvious improvement in respiratory rate and increased depth and volume of respiration. The patient's neuro-motor tone changed from flaccid and aphasic to decerebrate posturing, deep slow sonorous respirations, and a fixed left-downward conjugate gaze

You are dispatched to a residence for an adult male that was witnessed to collapse spontaneously from standing position w/o prior complaint, injury, or obvious mechanism.

You AOS and found Pt. lying supine w/o obvious sign of injury or trauma; breathing very shallow at a rate of 8/min, marked pallor, diaphoresis, and cold to touch. Bystander/family stated that he had been ingesting oral Oxycontin for pain and it was their perception that he had been taking more than what was prescribed or appropriate. 54 y/o.

Treat on gentlemen. I will answer questions as they are asked

You are called to a residence at 2000 hours for a patient experiencing chest pain.

Upon arrival, you enter the residence and find a 73 year old patient laying on his bed in obvious distress. The pt. is awake and alert. Describes 9/10 substernal chest pain of sudden onset. He has a history of triple bypass surgery and took one baby aspirin prior to your arrival. Pt. doesn't take any other meds regularly. He is diaphoretic and has a rapid, strong, radial pulse.

He is moved to the stretcher and expediently to the ambulance. V/S are taken and reveal 122/92, heart rate 160, respirations 16 nonlabored. Cardiac monitor is placed and V-Tach is shown on the monitor.

Treatment?

ABC's &General Impression.

PMHX & PSHX, Allergies.

When Did it start?

Description of Pain?

Radiate?

Any motion/action relieve pain?

Did the 81mg ASA offer any relief?

Has this happened before?

When was 3Xbypass?

Any complications w/ bypass?

Pacemaker?

Cardiologist? (just to help facility obtain records for Pt. care)

Recent illness/Hospitalization's?

Coughing alot?

Hx of reflux?

Baseline vitals before moving Pt. If he can stand, grab a repeat BP/HR. Get in the rig.

High flow O2 w/ EtCo2. 3 IV attempts w/out success? Drop head and establish an EJ if possible, If no success, IO.

This Pt. presents w/ a rate of 160, but a appropriate Systolic BP of 122. If systolic is still>100mmhg;

150mg Amiodarone over 10min.

If Pt. has acute onset compromised BP, Give versed 0.1mg/kg via IOP or INP w/ atomizer.

Synch Cardiovert @ 100J w/ fast patches.

V-tach resolve?

Yes: 150mg Amio infusion

NO: Cardiovert @ 150J

Other treatment would include:

FSBS

EtCo2

12-Lead (No nitro was given for CP due to not knowing 12-Lead results, Need to Rule out right sided MI prior to nitro admin.)

If pacemaker is indicated, verify pacer spikes, if over pacing, Place magnet over pacemaker to turn it off, consult OLMC for further.

Sorry to ramble, alot of variables in initial scenario. Curious to know what outcome was

I have the brady series Paramedic School Textbooks, Paid 500 for all, will take $250.00 plus shipping. Like brand new. erice2592@gmail.com

Just wanted to get ideas from all over on what you guys do in class besides recite the textbook and do labs? Any EMS advances discussion? New treatment? New innovations in the EMS community? Case studies? I have a very cut and dry program. We go to class, read our book, and leave. Any insight would be helpful.

I am not implying i am dis-regarding ems. But when you achieve you RN (and can do so in 10 months through a bridge program), it opens up more opprutunities for an individual. EMS has came so far from what it was, and I'm sure many of you witnessed that first hand. But, Every individual has to choose what is best for them. When you have never had any parental/family support, making 9.63/hour while going to school full time and learning you have a child on the way is a tad bit of a rough road, and one would be expected to pursue higher education to benefit their family. I have and always will love EMS and have respect for all aspects of the profession. My initial question was not drivin towards leaving EMS, rather; gaining further knowledge and certification to be a more competent, well rounded health care provider.

Spelling is probably horrible. Coming back from a call trying to do the multi-task gig

Great, I appreciate it. Best of luck on your boards

I havent been on here in a while, and just wanted to check in with everybody and see how everbody was doing.

Also, I am researching doing a bridge program after i am in the field as a medic for a year or so. But, i have a little one on the way. Is there anybody out there that has done the medic to rn bridge on an online format? I am going to try my hardest to do in class, but family of course comes first. So for a plan B, I just wanted to gather some information on any online programs that are out there.

I hope everyone is doing well.

-Best regards-

I've seen many with all different kinds of outcomes, just throwing this out there, my brother was on his bike doing 35, he struck the side of an izuzu rodeo, and died 3 days later in trauma icu. so they are lethal at a very low rate of speed. All i can say is if you do purchase a bike, purchase your PPE first. best of luck and safe travels

This is mainly for kiwi, but i know there are a ton of knowledgeable medics on the forum, just looking for on-th-go methods for calculating dopamine administartion. the clock method just makes smoke come out of my ears. Thanks Guys.

on-the-go *Spell Check*

In this particular situation, i feel with the overwhelming situation he did what ever other father would of done. I feel the difference in opinion is going to be ethic based given your ethical/ geographical background. Myself, i would have laid just as many mike tyson's on the guy as he did. Curious to see what other responses are though

Thank You Sir

Thank you Dwayne, that means allot, I just want to transition from being in school to the field as a very competent and knowledgeable medic. I don't know what it is that i do, but I've had similar compliments on my clinical's, Being only 19 years old I'm glad i'll be able to provide many years of quality care to those in need. Which is why i asked about the differences in education. I just want to give 110% to whichever path i choose

Thanks everyone for the feedback, Ive been tossing it around for a while, i wouldn't mind doing the online but i just feel without running mock scenarios and keeping fresh on the skills i don't get to perform often (IO's, intubations, etc) it's going to effect how proficient i am when i hit the field full time. I've considered transferring institutions but not sure if my credits would transfer

Sorry mike my initial statement was typed when i was busy and i didn't really proof read it before i posted it, but as far the online course goes it would be my 2nd semester of my Paramedic course which consists of interpreting EKG's, drug calculations, and i believe focuses on medical emergencies instead of trauma which is P3

i know what i want to do i guess what i was getting at is trying to see if anyone has ever done online formatted pmedic classes and if they are as beneficial and worthwhile as actual classes

So for my first semester of my Paramedic course it was myself and one other student, and due to family issues, he dropped 2 weeks before the end of the semester. So in turn, the program director offered me to continue with a online format of class or take a semester off and pick up with the next class. I dont want to break my classes up simply because i want to stay fresh on everything and come out of this with not only a degree but also being a quality medic, So if you were faced with this, what would you guys choose?

Congrats, Best of Luck

Im currently working on my associates with emergency medical tech. as my major, then i will be obtaining my bachelors emergency medical response management. all the classes besides micro-biology are pre req's for my associates so i'm knocking them down along with advancing through p school. ill have a couple fire science along with that just to benefit me on the fire side. Also, do most flight agencies have a paramedic/nurse team or is that totally at the discretion of each agency?

That's my biggest focus right now, the main thing i seem to have trouble remembering is remembering all the medications and exactly what they're designed to do. any algorhythms that you guys know of to help the memory process of that matter?

No sir, EMSA is the only sole medical service in my local area, and the turnover rate there is outrageous. I just wanted to see how i liked the fire side for a while. my long term goal is working for a mediflight agency, which brings me to my next question, in your opinion, what are the most beneficial cert's to have if i intend to go that route. i have asked around at some agencies but have not really gatherd a general census on the best path to go, so about rambling on haha