akroeze

The most significant lesson to be learned from Seattle is how to cook the numbers to make your system look better than it really is.

Quoted for truth

every call is a minimum of 5 people

Wow

Some calls I would like that, but not many.

I don't know what to say other than that is scary! I just got off a 12 hour shift where we were run non-stop and I can't imagine that being considered only 1/4 of the way done.

Interesting. But it does beg the question, why use a sharp on an actively seizing person when you can go intranasal? Am I missing something here?

I agree with this product and/or service.

Out of curiosity, why not intranasal preloaded for public use?

My lesson learned is that orthostatic vitals make people worse. Twice in the past month I've done orthostatic v/s and they have plummeted and not come back above 90!

So we have two different interpretations. I personally was leaning towards the 2nd degree Type II/3rd degree flip-flop but what chbare said has lots of merit too. Just goes to illustrate that nothing is certain in this field.

Thoughts on how the morphology rotates between three different ones in order at the end? And how the one seems to be a fusion of the other two?

I think they are asking about SVT vs. Sinus.

I had heard somewhere that 220-age, if the HR is above that then very very likely it is SVT and not sinus.

No pacemaker in place at the time of the ECG. She was being observed in ICU due to the block diagnosis but had required no interventions. She was going for a permanent pacer insertion as it was presumed her presyncopal episodes were due to bradying down or going to a higher degree block transiently.

http://newacp.blogspot.com/2009/06/2nd-deg...i-with-bbb.html

Ok so I had this all typed up and somehow lost the entire post so I'm going to type it up again somewhat more short this time.Elderly female patient presenting to the local ED with 2-3 weeks of general weakness and presyncopal episodes. I encounter this patient as I take over her care for the trip from the local ICU to the tertiary care facility for pacemaker insertion. V/S are stable, no complaints when I cared for her.

No 12 lead available (it was on her chart so I didn't do my own). I tried as best as I could to clean it up but that was the best tracing I could do no matter what I tried.

(Can't get images to post even though the blog post before this it went just fine. Now when I post them it doesn't let you click to enbiggen.)

http://picasaweb.google.ca/lh/photo/eROyci...feat=directlink

http://picasaweb.google.ca/lh/photo/E1l29Q...feat=directlink

Physician's diagnosis? 2nd degree AVB Type I with RBBB

If I hadn't been told that I don't know that that is what I would have come up with on my own. Before my post was eaten I had gone into great detail about my step by step interpretation but I'll summarize it this time.

Regular at a normal rate with variance between wide and narrow QRS complexes. The P-waves seem to be associated to the QRS variable between a very prolonged PRI to a normal PRI. The normal PRI is attached to the narrow complex and the prolonged PRI is attached to the wide QRS.

Can BBBs be intermittent like that? To the point of the bigeminy that is shown at the end of the strip there? One could actually argue that there are three different morphologies that are rotating through at the end not two, although I think the third one is a fusion of the other two (it looks like half of one and half of the other). The QRS are regular regardless of the morphology yet the PRI flip flops, how is this possible? Can someone who knows more about this stuff answer how all this is possible?

Duct. As in what it's meant to be put on. You could try it on a duck, but I don't imagine it would like it anymore then electrical tape or even scotch tape.

I smell a Mythbusters episode in the making!

Start with an A/P class that has a module on the cardiovasuclar system. Without that solid foundation the rest doesn't help much.

Are you not issued all the equipment you would need from your organization? If not, why not and why are you putting your own money into it when they should be?

If this is for personal use then lets of band-aids and a bit of gauze and a few triangulars is all you need.

We do fewer than 500 calls per year and are paid as well as RN's in the area. No reason not to have a paid service.

My old service had a station that did roughly 40 calls per year yet maintained 100% paid coverage. There is never an excuse.

Wait, they do 1200 calls a year and are still volunteer?

27 y/o male complaining of opiate withdrawal symptoms. Hemodynamically stable. What would you call this rhythm?

Sorry, don't have a 12 lead available.

Hmmmmm, I'll take a stab and risk looking like a fool.

The first three complexes are very regular, then we see what one could call a junctional escape, then the next 3 are pretty regular, then what looks like two more junctional escapes, not enough to say what the last complex is.

Although now that I look closer those escape beats COULD be wide depending on where you are saying the complex ends and the ST begins and they are certainly a different morphology at the very tail end of them so they could be ventricular in origin possibly.

If I had to give it a name I would call it Sinus with escape beats.

I know, not really definite but I gave it a shot!

what a disgrace... deport them

Where does it say they aren't American citizens? I just skimmed it but didn't see that anywhere.

I second this.

I'll admit that the extent of my ability to interpret BBBs is the turn signal cheating method.

My ability to interpret fascicular blocks is 0.

I'd really appreciate a lesson on it too!

If it is like that, and everyone is that upset with status quo, why not change it? How hard would be for another EMS service to come in and set up shop. If they(the new company) offers better than what is given by them(the old company) then the old company will have to change its standards and practices or be shut down for lack of staff and/or business?

The ambulance service is completely controlled by the province in BC and they are the only ones who are allowed to provide it.

At least that is my understanding.

Well my orientation was:

1 day of base hospital cert

3 days riding as a third person with another ACP crew

I was supposed to do 8 shifts working partner with another ACP but that got canceled

So I am now out on my own after those initial 4 days

Just as an add to the discussion I thought I would add a couple of pertinent links

Canadian C-Spine Rule Vs. Nexus Criteria

Canadian C-Spine Rules

Very interesting the study between CCR and NEXUS. The only comment I'll make upon a quick skim of it is that it was put on by the people who created CCR so there is automatically bias.

Made my first real post (other than the introduction)

On CVAs and their grey area presentations

http://newacp.blogspot.com/

http://newacp.blogspot.com/

Hey all, I decided to jump on the band wagon with the rest of you guys and start up a blog. Please let me know what you guys think as time goes on (good and bad) so that it a) encourages me to continue posting and allows me to improve the content.

Thanks

Can someone make a teaching post about this? This is something I'd really enjoy learning more about but the information is so scattered when googled.