ncmedic309

Cards 31 Steelers 17

3 turnovers by the losing team

I'm failing to see the benefit of this idea. Are you looking to replace the EMT with a "driver"? So in that regard we fire all the EMTs and put ambulance drivers on the truck with the medics. That means more people are now out of the job and you've put a person uneducated in medicine on an ambulance. What am I missing?

I am currently taking out multiple large loans that do not have payments due till 2013. I will never pay a dime for all this useless junk I'm buying. :twisted:

That's an awesome idea, I'll use that method to fund the "End of the World Bash"....

Anyone use 0.1mg 1:10 000 I.V. ?

We have the option for Epi 1:10,000 with a dose of 0.1 to 1.0 mg IV or IO for adults and 0.01 to 0.1 mg/kg IV or IO for pediatrics. It's a last ditch though after we've exhausted all our other drug interventions.

Shit! I guess I better get busy on my "to do" list, that's just right around the corner! I'm going to throw one hell of a bash starting a few days before and party it out all the way to the end. Everyone is invited!

We have went away from SQ injections, we do IM for both adult and pediatrics when administering Epi 1:1.

I get this crap in my email all the time and I always visit SNOPES and copy and paste the info and send it right back to the originator.

That one thing for me is tied into three - failed to restock the equipment they used, left trash behind (personal or medical) and left any sort of contamination in the ambulance. If you commit one of these sins, you can bet your going to hear about it!

The etiology of the arrest makes all the difference. The VF/VT arrest? No brainer, shock the patient, cpr, go in to the hospital. Obstructed airway? Secure it quickly, go in to hospital. Trauma? Go in to the hospital. OB? Go in to the hospital. If it is something that we can IMMEDIATELY correct, do so, otherwise we are at the hospital, provide BLS airway management, cpr and go in.

Word... 8)

I've been there before and it always sucks! I make sure we have the basics covered and then move the patient into the ED. I make sure we have at least a good BLS airway with an adjunct and BVM and we are effectively ventilating the patient, make sure we are able to perform chest compressions, have the monitor attached to the patient with pads so we can manage any rhythm disturbances as needed and move the patient into the ED.

The last one we did, the initial call-in via radio painted the picture of a rapidly declining patient but still alive. The patient coded as we pulled into the ED and we rolled inside doing CPR and ventilating the patient. We stopped in front of the triage desk to get our room assignment and a quick reassessment revealed VFIB. After yelling "CLEAR" multiple times and defibrillating the patient in front of the triage desk, we had everyones attention and our room assignment. 8)

I just feel that if your at the ED and can move the patient inside providing you have the needed assistance to do so, it's your better course of action. You have more room to work, more hands to help you work and a few more things that we don't have the pleasure of using in the back of the ambulance. I don't see much benefit to the patient sitting outside the doors of the ED and working an arrest.

It's good to get ideas on how other services do it and just as I expected we have a mix of responses. I'm going to try to get ahold of a couple manufacturers today and see what they recommend. I would imagine they would say the first of the expiration month, mainly due to the need to replace the drugs more often and increase their revenue but I may be wrong. We only operate with two ALS ambulances and one ALS QRV at my full-time service, we purchase our own drugs and pulling them anytime prior to the expiration date is just not cost efficient for us. I'll let you all know if I come up any additional information...

When do you discard your expired medications? There are some medications on the market that make it very simple; they give the month, day and year of expiration. However, most medications do not, they only list the month and year as the expiration date.

So, if the expiration on the drug is noted to be 01/09 (January 2009) do you discard the drug on the first day of the month or do keep the drug throughout the month and discard on the last day of the month?

I’m getting different answers from different people on “how they do it” but I’m having trouble finding factual information which clearly defines the true expiration date. Is there such a thing or is it left up to the individual service to define this date and procedure for discarding?

Any input?

OK - this I will buy. The doc took a reasonable position. Thank you so much for all your answers. BTW - the patient died in the ER.

That blows...

If he's got a good pressure and isn't showing signs of inadequate perfusion then there's no benefit to the patient by overloading him with fluids. If his systolic was less than 80 mmHg it would be a different story, but even then I would likely start with a 500 mL bolus and then reassess. It's still not necessary to dump an entire liter of fluid or more just because you can.

The same outcome could have been just as easily achieved using a handgun of the right caliber and load. It didn't have to be an assault rifle shooting through the walls of the residence to make it outside and strike those victims. I didn't note any mention of the rifle being auto either...

I'm all for protecting yourself and your home even with deadly force if it's warranted - but discharging your weapon in such a careless manner is criminal. The only time deadly force is warranted is to counter the same and spraying the outside of your home with an assault rifle when somebody knocks at your door is far from being justifiable, even if you had been a victim in the past.

KevKei? It's been over a year now since he's last posted on the forums. Did he take on another username and I failed to notice or did he just disappear? Does anybody keep up with him? :?:

Damn man - hate that you ended up being the patient on this one. It sounds like your doing better, thanks for the update on the case and keep us posted on any new findings. If that's a bug, I don't want it...

It's pleasant outside - how about inside the residence?

Has he ever had a case of "the chills" before associated with any cold or flu-like illness?

I would do a complete neurological exam on him, very detailed and to the point.

If this is anything significant, I'm thinking along the lines of a neurological or metabolic event. I would expect to see some different vital signs, but it could still be early yet. What else do you have for us?

That's an ALS call and a simple case of the ALS unit being too lazy to actually do their jobs... :roll:

In regards to the heart sounds - we're hearing a diastolic murmor and I'm assuming an S2 split? If this is the case, it's probable that we have some heart valve abnormalities and the heart sound would indicate a ASD or VSD. I've got a couple of the less common CHDs in mind on this one. The PGE1 medications can have some serious side effects. It's possible that we can see hypotension and bradycardia along with arrhythmias. We also want to be concerned about respiratory depression and metabolic imbalances. It's not something I would want to be administering in the out-of-hospital environment, but at the moment we're going to be working hard to keep this kid alive.

I would be concerned about the patient developing congestive heart failure at this point. In regards to keeping the PDA open, we could look at a Prostaglandin such as Alprostadil to assist with vasodilation. We could also explore the option of administering Digoxin, but with the possibility of renal problems as well, it would be a risky way to go. I guess this also depends on what he available to us in these circumstances. We're behind the eight ball and want to keep this kid alive until they can get more invasive and attempt to correct the problem.

Edit: Not that it's not already obvious, but taking this route with treatment - it would be a REALLY progressive EMS system... :wink:

I don't see the need to have a chaplain actually ride on the ambulance for an entire shift. I do like the idea of having a chaplain readily available to assist when needed. Whether it be to assist the crew after a call or to assist a patients family with a difficult situation. Our department has a chaplain that will respond to calls if requested and is available around the clock for our department along with the town police department. I actually used ours on the last shift to assist a husband who had just lost his wife. We were dispatched out for a cardiac arrest and pronounced the patient on scene. The husband who was alone at the time obviously couldn't tell which end was up at that point and bringing the chaplain to the scene ensured that he got further help and assistance needed to better manage the situation. He's also helped numerous crews in the past after difficult calls. It's a very valuable resource to have available.

It looks like the latest forecast module is now showing the storm making landfall farther west away from the New Orleans area. While it's still to early to tell, the entire gulf region should be watching this one.