chbare

AZCEP, I wonder if using a bougie would be helpful for intubation around a combitube? Take care, chbare.

Rdelisle, that is about all you can do. Even in the hospital we would run a battery of tests, consider intubation, and let them sleep if off in the ICU. As Asysin2leads stated, reversing Benzos in the field can be quite dangerous. It sounds like this patient may be on chronic benzo therapy. With chronic therapy the body can develop a tolerance and dependance upon benzos. If you were to suddenly try to reverse benzos, you could inavertantly cause withdrawl. If the patient develops seizures you will be hard pressed to stop the seizures because the primary agents for seizures are benzos. Take care, chbare.

medic53226, I am sorry to hear about your bad transfer. Did you have the option of using vasopressors? I agree that this sounds like a critical care transfer and requires a service that can provide critical care interventions. (This is not to say that a helicopter/airplane is needed.) Take care, chbare.

Jordan, if you fail again, you will be required to attend a refresher course prior to taking the exam the third time. Check out the NREMT website for more specific information on the refresher. Take care, chbare.

Emt-b_wa, check out the prior threads. I believe there was a fairly recent thread on hypertonic saline. Take care, chbare.

Medic_4_life, that sounds like a bad case. Unfortunately, pancreatic neoplasms almost always have a poor prognosis. Even surgical options for pancreatic cancer are palliative at best. (usually) Dustdevil, do you see allot of rhabdo.. in the sand box? Take care, chbare.

I may not have articulated my response very well. I just finished a little research and found a link that explains the action of succ. http://www.rxmed.com/b.main/b2.pharmaceuti...)/ANECTINE.html Take care, chbare.

Ffmedic9588, atropine may be considered in the rare event of succ OD. (Repeated doses would be the most common cause) In most cases succ causes what is caused a phase I block. Or the typical depolarizing block we all know and love. Succ attaches at the neuromuscular junction in place of acetylcholine and causes the muscle to depolarize and stay in that state. Hence, the faciculations we all talk about with succ. In cases of succ OD this phase I block may take on superficial characteristics of a phase II block. Or a non depolarizing type block. Non depolarizers attach at the junction in place of AcH, but do not cause the muscle to depolarize. Rather, they prevent depolarization. So, in succ OD we may have a pseudo phase II block. In cases of this block, we may need to give an anticholinesterase medication such as neostigmine. If we give neostigmine, we need to anticipate anticholenesterase type side effects. So, we may need to give an anticholinergic such as atropine to combat these side effects. A WORD OF CAUTION!! Phase II block must be verified and confirmed because if we have a prolonged phase I block and we give neostigmine, we have just complicated our problems 10 fold. Verification of a phase II block requires peripheral nerve stimulation, and I would advise against following your protocol in the field. I hope this helps. Take care, chbare.

Asysin2leads, hard case. I tend to agree with AZCEP and what the doc told you. I would be very hesitant to give a calcium channel blocker unless I was certain the rhythm was Fib/Flutter for the same reason AZCEP stated. Sometimes you can tell that the rhythm is very irregular and this can help differentiate A-fib from V-Tac. (sometimes) Hell, it even states in the ACLS guide line that "Expert consultation is advised" when you come across a stable wide complex tachycardia. Take care, chbare.

Atropine is also used to increase heart rate and dry up secretions in the nerve agent casualty. (organophosphates in the civilian world) Most nerve agents work by binding cholinesterase and prevent acetylcholine from being deactivated. This is the basic mechanism of nerve agent poisoning. If you do a little research, the physiological processes behind non depolarizing blockers are similar in some ways. AZCEP & Vs-eh? are correct regarding CA++ CL-. CA++ CL- helps to normalize the gradient between the resting and threshold potential of cardiac cells. Hyperkalemia results in the a drastic elevation of this potential. Remember CA++ CL- is only a stop gap treatment that will buy you about an hour. It does not eliminate the K+. Focus_911, I think you are also confusing hyperkalemia with other words. Hyperkalemia = elevated potassium Hypoxia = low oxygen Hypoxemia = low blood oxygen Hypercapnia = high carbon dioxide I hope this helps. Take care, chbare.

Boneknuckleskin, DwayneEMTB is correct. You are among several other people who think this strip is not A-Fib. However, they have given their interpretation and in many cases a rationale to back up their findings. In addition, they have not directly attacked another profession. As a Nurse I can say that I am not offended by the Nurse comment, however, you need to give us your rationale. You cannot just tell people they are wrong and then specifically point out somebody and tell them they are wrong without having some hard evidence to back up your position. You cannot continue to play the "highly educated mystery medical man." "It's time to poop or get off the pot." Take care, chbare.

Dustdevil, if repeated testing confirms this finding, here are a few conditions to consider: -Renal Glucosuria, Benign (hopefully) -Fanconi Syndrome, I would not expect to find this on in an adult. -Lowe Syndrome, I would not expect to find this in an adult either. -Wilson Disease, I would expect pronounced Hepatic & CNS S/S. -Nephritis -Tyrosinemia, another infant disease. I hope this helps. Take care, chbare.

I would go as far as to say, "giving a patient oxygen may help to drastically improve their current status." Take care, chbare.

I admit that I have never used Verapamil either. I have used Adenosine with variable results. I have used Diltiazem many times and have used it with good results. I have even used Amiodarone a few times. (complicated cases of A-Fib) Take care, chbare.

I agree with Dustdevil. Allot depends on the individual person. I do however believe that the best learning takes place when you are given time to study and reflect on the material. My initial EMT-B training was completed in 3 weeks during my initial Army medic training. At that time the EMT training was condensed into a 3 week period and consisted of about 130 hours. This was known as the "Delta Modules" for any of you old 91B's. While I passed the NREMT, I would not say that I was anywhere near competent at even the basics of first aid. If anything, I had a false sense of knowledge. Take care, chbare.

Mood. Take care, chbare.

AZCEP, I agree with your assessment. Then again you will not see me in court. :wink: Take care, chbare.

Zzyzx, I do not know that you could say Versed is strictly contraindicated with low B/P. Are you allowed to give Fentanyl? This is an option until the hemodynamic status improves and you can give Versed. In addition, you can always give less Versed and give Fentanyl along with your decreased dose of Versed. Take care, chbare.

Toysoldier, check the forums for EMT--->Medic threads. There are many discussions on this topic. Take care, chbare.

Ridryder 911, =D> . Take care, chbare.

Ridryder911, good call. This attitude is not limited to EMS. Anybody who has ever spent any time working in the hospital knows what I am talking about. Toysoldier, welcome to the city. Health care is one big dysfunctional family. What do you expect with a bunch of humans running the show? (bunch of humans thinking they run the show) :wink: If you can deal with the not so glamorous aspects of health care, you should do OK. Wow, this is my 500th post. Take care, chbare.

Ridryder911, I have seen this attitude with nursing students as well. In addition, I think nursing schools are starting to pump out ill qualified and quite frankly sub par nurses. (Even taking into account the new grad factor) I am quite disappointed by many of the students that I have seen. (No discipline, ill motivated, and lack basic understanding of human physiology.) Not to be a cliche, however, when I was in school you would fail a clinical rotation if you uniform and shoes were not up to spec, never mind not being prepared and lacking motivation and discipline. Yes, my instructors were quite liberal about getting rid of the bad apples. Education seems to be in a sad state all around. Take care, chbare.

Paramedicmike, Hextend is what the US Army is using for treating casualties with controlled hemorrhage. It is essentially Hespan. (Hespan in a Ringers Lactate base) I believe this is an issued item. Dustdevil, Nice bag, I have a STOMP II that is set up very close to your bag. It worked out very well as a support bag in LA. I tied it down to a quad and used it when we went on missions. However, I bet your bag is being used for more exciting missions than the ones I did. Do you have a medical pouch or pouches set up on your rack/plate carrier/IBA? Take care, chbare.

Cut and paste away everybody as long at it explains the process, this is all about learning. Take care, chbare.

Let us try something a little different and perhaps we can enhance our knowledge of physiology. It goes like this; you post a physiological process, somebody explains how that process works and then posts another process, the next person explains that process and posts another process of their own, etc..... "The Chloride Shift" Take care, chbare.