Great job Matt!
Looks like it is good news all around as I recently secured a permanent FT ACP job in Belleville! And I'm in the hiring pool for Kingston so I could get a PT job with them on top of it.
I'm expected to be on the road sometime in the first two weeks of June
Just saying that IF this were someone who we think is HyperK such as ARF who missed their dialysis and we have this XII-lead would you start emergent Tx?
Sorry if I'm being too simplistic here.... this is something that I really just want to have more of an understanding of.
Out of curiosity if we were to be highly suspicious that this was Hyper-K then with these ECG findings would you want to be treating it to bring it down? My understanding is as soon as you see any Hyper-K changes on the ECG it is already in the "dangerous" zone.
Hyper-K is something I am still a bit cloudy on as far as the pre-hospital role in treatment of it.
What is their potassium??
First thing that jumps out at me is those Ts in V leads
Having said that, the elevation of the ST in V2-4 is there, and the printout isn't good enough to say if V5/6 also have it. Inverted Ts III and aVF
Perhaps you did not see my post right above yours. Are you suggesting that if I have a patient who I have just resuscitated in their living room and they are hypotensive and I want to start dopamine on them I should in fact refuse to transport this patient??
My protocols state I should be starting a dopamine drip if they remain hypotensive after a fluid challenge post resuscitation but I do not have a pump as throughout Ontario it is not the accepted standard.
Or the non-interfacility option of I just raised the dead on this guy and he is hypotensive and my standards allow for dopamine but I don't have a pump. I could not give this guy the dope and just get him to the hospital... but there will be hell to pay after.
Highly highly recommend this:
http://www.amazon.ca/12-Lead-ECG-Art-Inter...8675&sr=8-1
and for rhythm interpretation:
http://www.amazon.ca/Arrhythmia-Recognitio...8675&sr=8-1
At the service I worked for there was a base that on did about 60 calls per year yet there were 2 paid staff provide round the clock coverage. How is that possible at such a low call volume when each of those two staff members are making $27ish/hour? Or rather, how is it possible that other places that get hundreds of calls per year insist they can't justify paid?
Interesting.
From a field treatment perspective does this change anything for us? Should we be calling STEMI alerts possibly for isolated aVR elevation?
Ok so what do I do when I encounter a post-arrest patient who need dopamine but I don't have a pump because it isn't standard here? Do I refuse the dopamine and lose my liscence because I didn't do the minimum care expected of me?
Exactly.
Province wide in Ontario we have termination of resuscitation for traumatic arrests but I'm getting the impression we are the exception and not the rule
Kind of a side topic but are terminations of resuscitation not that common for traumatic arrests?
I mean in general we pronounce medical arrests on scene... is trauma less common?