chbare

Joshua Benton, we use it quite a bit on sedated and intubated patients in our ICU. I have had good experiences with propofol and it is fast acting and quick to wear off. The most common side effect that I have experienced is hypotension. Check out the following link to an entire thread on propofol. http://www.emtcity.com/phpBB2/viewtopic.ph...opofol+seizures If I remember, Spock posted some good stuff on propofol. Take care, chbare.

"You should try one of those 'Dial-A-Nurse,' Hotlines, i hear they are skilled at finding all sorts of things that don't exist... ACE844" ACE844, we had a semester of "finding things that don't exist" in nursing school and even did a 300 hour clinical rotation in the Land of OZ to compliment our didactic education. Take care, chbare.

Ace844, results of Dix-Hallpike testing? (rule out any history of cervical spine disorders prior to performing this test) Take care, chbare.

Ace844, the RBC's are a little elevated but everything else pans out. Several things to consider: 1)Menier's disease 2)Labrynthitis 3)Syphilis infection involving the inner ear 4)Lyme disease 5)Inner ear tumor ie acoustic neuroma With a history of HPV it is possible for her to have other STD's. -VDRL? -Hx of tick bite or living in an endemic area? -Hearing loss? Take care, chbare.

She has a sodium of 120! Better watch out for seizures. This may be from the N/V and no PO intake times 16 hours. Any C/O tinnitus? I cannot rule out labrynthitis. We need to place a foley and monitor I/O and send a UA to the lab. Manual diff on the CBC? I would also like an ABG and along with that ABG a carboxyhemoglobin level. Continue with the fluids and oxygen and reassess after the liter bolus. Take care, chbare.

Mediccjh, I am still holding out for "Traumasurgenocaine for IV injection." Take care, chbare.

I do not know what you guys are talking about. All of the patients that come to my er by EMS have insurance. "Self pay" is a form of insurance, right? :roll: Take care, chbare.

Ridryder 911, "just a fancy Dextran" is a good description. Take care, chbare.

Ridryder 911, I have heard about using HSD for trauma. I tend to think that you are "robbing Peter to pay Paul", however, there are findings that seem to indicate the HSD may be more effective than using isotonic crystalloids. Here are some links to more information on HSD. A couple of the links may require you to pay to view the article/study. http://www.medscape.com/viewarticle/461437 http://erj.ersjournals.com/cgi/content/full/20/4/965 http://www.ncbi.nlm.nih.gov/entrez/query.f...p;dopt=Abstract http://ajpheart.physiology.org/cgi/content...act/290/4/H1642 http://content.karger.com/ProdukteDB/produ...ename=48900.pdf http://www.aast.org/00abstracts/00absPoster_083.html Take care, chbare.

Cidefex, does he take any medications? Any neurological deficits noted? Agree with the other posts on getting a BGL and trying to obtain more patient history if possible. (psych, seizures, diabetes, etc.) Try to calm him verbally if possible, however, we may need to consider restraining him if he starts to get violent. Are we able to administer medications? Try to reduce stimuli during transport and watch his ABC's. We will need to get a head CT without contrast and a tox screen when he gets to the ER. Take care, chbare.

SSG G-man, I agree with MSTC Medic. In addition, going through a military school is much easier regarding pay, travel, and logistical issues. My old unit sent me through several civilian schools such as CONTOMS, however, you run into allot of problems regarding payment and travel when you go through a non ATRRS course. However, if this is a strictly civilian role that you are taking on, a course that focuses on civilian law enforcement may help your team integrate into the civilian SWAT/SRT setting. MSTC Medic, welcome to the city. Take care, chbare.

"Do realize Cordorone side effects? As well many studies are now defending that Cordorone works well as reducing ectopic beats, but in V-fib it has no higher benefits than Lidocaine. As well there is no"special study" to detect an irritable foci, unless we are checking electrolytes, checking hypoxia, observing ischemic changes...meanwhile. hoping she does not have another episode sudden death. Again, many are getting the knee jerk effect of giving Lidocaine. Please read the studies of the amount that was studied and what even is considered to be therapeutic level. A bolus of 100 mg, and even a drip 2 mg would not be considered enough to produce toxicity. Let's be reasonable. Again, if one is not able to obtain specific history on this individual, I would lean of administering an antiarrhythmic even if prophetically to reduce sudden V-fib. It would be hard to justify a "post arrest" and knowing she had a course of V-Fib, if had a re-current V-Fib and was unable to convert the rhythm again. Be safe, R/r 911" Not to mention that Amiadarone has a longer half life than U-235. I agree with your assessment Ridryder 911. I still would have attempted to obtain some kind of history and obtain base line vitals before considering lidocaine. Hx of liver problems or allergies, you never know, even in a younger patient. However, I agree that in the absence of any other history I would strongly consider lidocaine. Take care, chbare.

Good job on getting the history everybody. This patient is indeed suffering from a diving injury. He just had to get a quick dive in before getting on the plane. Take care, chbare.

JackMaga, he was on vacation in Hawaii. No adventitious lung sounds noted and breath sounds are diminished bilaterally. ( Hard to tell, but this may be because he states it is hard to breath and his breaths are shallow) No abnormal heart tones noted. No JVD noted. Take care, chbare.

Future medic 48_234, V/S- P-118 RR-22 with dyspnea B/P 140/88 Pulse Ox-90% R/A Temp-98.8 F S- Subjective- states, "I am having chest pain, pain in my elbows, I am having a hard time breathing and I feel dizzy." Objective- External physical exam is unremarkable, diminished lung sounds noted, frequent NPC noted A-NKDA M-None PMHX-None L-Prior to boarding the plane about 8 hours ago E-Started suddenly while on the plane O-A few hours ago while on the plane P-Not really sure Q-Lots of chest pressure sub sternal and deep aching of the elbows that does not increase with movement R-None S-10/10 T-A few hours ago You will need to ask more specific questions if you want more in depth answers. This is anotyher one of those history will tell all scenarios. Take care, chbare.

You are called to the Denver airport (DIA) for a 24 year old male complaining of chest pain. What would you like to know? Take care, chbare.

I have always used the SOAPE or POMR method of charting. This comes from my military days and perhaps it is a little bit of the old dog not learning new tricks situation. This is a basic rundown of how I use the POMR/SOAPE charting method. S=Subjective information -Chief complaint -Dispatch info -Patient history -OPQRST -Symptoms O=Objective information -Vital signs -Physical exam findings -Signs -Results of tests A=Assessment -My working diagnosis (what I think is wrong) P=Plan -My interventions on scene and enroute -Transfer of care -Discharge and follow up instructions in the non EMS environment E=Evaluation -How the patient responds to my treatment -Follow up care in the non EMS environment Sorry for any spelling errors, spell check is not working. Take care, chbare.

Wrap3pull2, you can have all kinds of potential problems with morphine administration to include; resp depression, altered mentantion, hypotension, nausea and vomiting, itching, and all kinds of adverse reactions. As with any med you must be ready for adverse reactions. Do you mean morphine and trauma? I am not big on giving trauma patients morphine. I like fentanyl, less chance of hypotension and the half life is much shorter than morphine. Take care, chbare.

Ridryder 911, you got it. He does have Lyme disease. When asked about his vacation he tells you that he went to Maryland in the early summer after allot of raining and spent a few days camping in the thick woods. This raises a red flag with regard to his history and how it relates to his complaints. I wanted to create a scenario that could be solved without the use of extensive tests but let every body have their tests to show that a good history and exam can provide critical information about our patient. This is especially true of BLS providers who may not have all of the cool toys or know all about labs, however, the lost art of history taking and the physical exam can still be their best friend. (This is true for all levels of providers) Future medic 48_234, I understand that you may not know all about labs and do not feel bad about this. I try to present scenarios that require BLS and ALS techniques. I will give you some very basic lab info but highly recommend that you pick up a lab book for further reading. I really like Nursing Implications of Laboratory Tests. Pick up the latest edition you can find. In addition, formal education in A&P and biology is most helpful if you are able to take these courses. I will briefly cover a few basic labs. NA= Sodium. Sodium is a very important electrolyte (cation) when we talk about fluid movement and nervous system and muscle impulses. The normal range is 135-145 (plus or minus a few depending on the lab) Meq/L (miliequivelents per liter--> most electrolytes are measured in Meq/L) Sodium likes to live out side of the cell. At a very basic level sodium imbalances manifest with deficits in hydration and neurological changes. K= Potassium. Potassium is a very important cation when we talk about nervous transmission and cardiac conduction. the normal range is 3.5-5 (+ or -). Potassium likes to live within the cell. At a very basic level potassium imbalances will manifest with cardiac conduction problems. CL= Chloride is an anion (negative charge) and is important with fluid movement and sodium levels will roughly follow sodium because of the close relationship of sodium and chloride. WBC- White blood cell count. This tells us about the immune system. Elevation (leukocytosis) may indicate infection, trauma/stress, or inflammation. Low WBC level may indicate immune suppression. the WBC is very non specific and a diff.. is needed to tell us which type of WBC is elevated. There are several types of WBC's. Remember, Never let monkeys eat bananas. N-neutrophils, L-lymphocytes, M-monocytes, E-eisoniphils, B-basophils. Normal WBC= 4.5-11. Hbg- (Hemoglobin)is the measure of hemoglobin, the oxygen carrying substance within the red blood cells. Hct- (Hematocrit) is the concentration of red blood cells in a sample of blood. Normal=37-47 may vary depending on gender. Low Hbg & HCT may indicate anemia or acute blood loss. High H7H may indicate dehydration, asthma, or polycythemia. A good general rule is the Hct should be around 3 times the Hbg. Plt-Platelets- measure of the blood clotting pseudo cells called platelets. Tryponin is a cardiac enzyme and high levels of tryponin may indicate MI or heart damage. Myoglobin- is released by damaged muscle tissue and may indicate many problems. PT/PTT/INR tell us how well the blood is clotting. Elevated levels may indicate a clotting problem or may be a result of medications (ASA, Heparin, Coumadin, and Plavix) BUN and Creat- tell us about how the kidneys are working. Elevated BUN and Creatinine may indicate renal problems. UDS= urine drug screen UA= urinalysis-> multiple tests done on urine that tell us about the kidneys, hydration status, and presence of infection, among other things. Tilts- a tilt test is done to check for ortho static changes such as dehydration. You should be able to google this one easily. Sorry if I have spelling errors, the check is not working. ESR I hope this helps give you a tiny taste of basic labs. EDIT: here is a link to more info on Lyme Disease http://en.wikipedia.org/wiki/Lyme_disease Take care, chbare.

I think the emphasis should be on patient monitoring and finding out why a 26 y/o male was found in V Fib. His ABC's are intact and he is showing signs of brain function. Get a set of vitals, BGL, EtCo2 value and wave form printout, and try to obtain a history if possible. I cannot see pushing drugs and potentially messing up a good thing. (patient with a pulse that is showing signs of brain function) Take care, chbare.

NYAEMT-I, no history of any medical problems. Knees are not hot to the touch. The knees hurt more with activity. He cannot remember exactly what the rash looked like other than it was a red circle. You may be on to something with the Lyme disease test, however, you need to give me your rationale for ordering this test. Are there any other questions that you could ask him that may help to further confirm your suspicions? Take care, chbare.

AZCEP, the distal circulation to both legs are intact. US is negative and circulation is intact to the vessels of both legs. You do not note any redness on the patients legs. He tells you that he did have a red rash about two weeks ago while he was away from home on vacation but that the rash went away. He also states that he noticed that he started feeling a little fatigued around that time as well. Take care, chbare.

Future medic 48_234, I cannot fault you for aggressive airway management. The pain leads you to suspect osteoporosis versus infection? Is there anything in this patients history that you would like to know more about? More labs come rolling in: PT-12, INR- normal per your labs controls, PTT-35, NH3-13, tyrponin 1-0, tryponin t-0, myoglobin-35. Your partner orders an ESR for the heck of it and you get a result of 40. Take care, chbare.

Ridryder 911, he can walk on his own. He states the pain started a few days ago and has gotten worse since onset. No PMHX and no history of trauma. Denies smoking or drug use. He states he does not think he has been bitten by anything. The exam is unremarkable except the patient does look a little pale and you do not note anything significant with his knees. The pain is arthritis like when he describes it and the pain increases with movement and ambulation. There is no evidence of trauma and he has full ROM. You do not notice any neuro deficits. He states the only thing out of the ordinary was he noticed a red rash to his lower right leg that started about 2 weeks ago while on vacation but it has completely resolved. Base line VS: P- 90 reg, RR- 20 N/L, B/P-128/88, Temp-99, Pain 8/10, O2 sat-98% R/A. You got some basic labs back, but will have to wait for the others. NA-140/ K-4/ CL- 101/ Co2- 25/BGL- 115/ BUN- 8.1/Creat- 0.8 WBC 10/Hbg 12.6/ Hct 40.2/Plt 220 Tilts, UA, and UDS are negative. (EDIT: Fish bone lab diagrams would not present properly.) The 12 lead shows a sinus rhythm with borderline first degree AV block. Ridryder 911, you are thorough and informative as always. Anything else? Take care, chbare.

EMS_Cadet, can we get her on O2 and obtain a baseline set of vital signs. Any dyspnea? What does her skin color and condition look like? Lung sounds? Monitor? (O2 sat and cardiac) Can we check the apples out? (carefully) Take care, chbare.