akroeze

We had one of those a few weeks ago... Call info: Call was for C/P with SOB. It was outside the city so our response time was maybe... 15-20mins? Guessing here. Incident Hx: First response truck was on scene (Primary Care Paramedic in a pickup truck). She had already assessed him, had him on O2, vitals, rhythm strip, whole nine yards. Before she arrived he was c/o 8/10 pain between his shoulder blades that he states felt like his usual angina, took his own Nitrox2 with total relief, now only c/o SOB speaking full sentences. Medical Hx: Past Hx of multiple MI (forget how many) and CHF. Probably other stuff but can't remember. He was on your typical Dig, Lasix, etc. Physical Assessment: General: CAOx3, no obvious distress, sitting in chair on O2 via NRB @ 12lpm. Head/Neck: No trauma noted, No JVD, PERLA 4+ Chest: No trauma noted, A/E = bilat with faint fine crackles lower lobes barely audible Abdomen: Soft, no trauma noted Back/Pelvis: No trauma noted Extremeties: CSMx4, no trauma noted, no peripheral edema Tretment/Procedures: -BLS Assessment -Vitals: Pulse somewhere on high end of normal, resps in the 18 range regular and full, BP 120 something over normal, O2 sat 98% with O2 -ECG: Lead II strip shows NSR with ST depression of I think around 2mm and no ectopy -35-A Semi-sitting for comfort, move to Ambulance -Transport Code 4, CTAS 2. (Lights and sirens, on a scale 1-5 with 1 being worst he is a 2 for triage purposes) Only went 2 d/t increasing SOB as per pt -V/S: No real change -ASA 2x80mg PO chewed and swallowed (our protocols are to give even if C/P has resolved before medic arrival) -Close Observation -Pt c/o chest heaviness about 5 mins enroute -V/S: No big changes, slight drop in BP I think -Nitro 0.4mg SL, attempted but unable to give as patient not responsive -Reassess pt: Pt semi-conscious, eyes open spontaneous but distant gaze to right, no verbal, no motor: GCS 6 -V/S: Resps adequate but slightly shallow, heart rate end of normal, BP unobtainable and unable to palpate radial pulse -Advise medic driving to get us there ASAP, yesterday if possible -ECG: Unifocal PVCs about every 10 seconds developing into Trigeminal within about 3 minutes -Unable to properly auscultate lungs due to road noise (poor road surface) -Glucometer due to decrease LOC: 6.8mmol/L (for you yanks, that's within normal limits) -Pray to EMS gods for him not to code -Frequent V/S (minus BP as per above), watch that rhythm like a hawk, discuss with preceptor if there is anything else we can do -ECG: starting to see multifocal PVCs -Clear mouth of secretions with kleenex (don't want to take ANY chances of stimulating a vagal response with suction and kleenex was adequate) -Arrival at hospital -Transfer care -Thank EMS gods and promise them to find a way to repay them Sorry if that's hard to read but I figured that was the best way to post the story. So what's wrong with him? Cardiogenic shock and pulmonary edema. In ER they tubed him and had pink frothy fluid come up the tube. They managed to get a BP in the low 50s systolic. Think he survived? Two days later we were in ICU for a stat transfer of another pt... he was there, concious, extubated with no real complaints! I was shocked![

I was told years ago an ER doc was touching the ER stretcher when they shocked and it arrested him. They got the doc back but not that patient.

Thank you to those that actually answered my question instead of criticizing it.

I do read educational books, but for the sake of sanity you have to read something other than a text book

So I just finished reading Peter Canning's book "Paramedic" and I really liked it. Although I have read it before, that was when I was in high school and only had a dream of entering this profesion. Now that I am in this setting I found I got a lot more out of his stories. Next will be to re-read Rescue 471. What do people think about his books? Do you feel they accurately represent the EMS field? Also, what other books do you recommend?

When did it get taken off the list? Didn't hear about that... have an updated list link so I can see what else has changed? Also, I heard that the BLS standards were being updated... have they been released?

Genesis is great for extended transport times in rural Ontario.

A transfer service carrying an autopulse? How often would you use it transferring patients? :shock:

I think it would be an interesting place to work in that it's not your typical environment. There will be a lot of treat and release stuff.

What more do you want than is on those pages on google? It seemed extremely detailed to me...

In this case, yes there is. Several times per day we get a thread here with people asking for info that they could get quicker by doing a quick search than posting here.

Look what I got when I googled it: http://www.google.ca/search?hl=en&q=%2...earch&meta= The very first link, in fact the entire first page of links has all the info you need.

Sorry to the admin but this is getting excessive... http://justfuckinggoogleit.com/

Interesting, but in truth it doesn't answer my question with the information and practices of today. In the field today, it is practice to elevate the feet for shock. We do that based on the (apparently flawed) principal that it will shunt blood to the core of the body. So why is it acceptable to do that when they have a beating heart but not when they don't?

Random thought just occurred to me while I was laying down which makes me think it may be wrong but I'll ask anyway. Why don't we elevate the feet during CPR? Would this not increase the amount of blood in the core?

1070 news web site Colleges Labour Standoff Thousands of college students across the province, including 24 hundred at Lambton, could be out of classes for a while. College teachers are going into their second day on the picket lines and both sides of the labour dispute say it could be a lengthy walkout. Calls are growing for Premier McGuinty to step in and help resolve the dispute but he will only say that he expects both sides to return to negotiating. 2006-03-08

Demers Ambulance Crestline Coach These two companies make most (all?) of the Ambulances used in Ontario. I haven't heard any major complaints about either of them although personally I prefer the Demers... they just seem more comfortable to work in.

Why don't you start by telling us what you came up with? We're not gonna do all the work for you... show us that you have tried and we will help.

Well I still need to get another 200hrs of PCP preceptorship done and two weeks of classes (read that as tests) before I can graduate. It kinda sucks cuz I have a job lined up for this summer as a camp nurse starting in June. If this strike goes on long enough, it could put that job in jeopardy!

I find those things dumb...

Here in Ontario A&P is part of the PCP course requirements... it's 30 wks (2x15wk semesters) at 3hrs/week at my school.

This wasn't a simple asystole, it was hyperkalemic induced.

I'm sure you're excited but do you really need to put exclamation marks after all your sentences? It seems like it's like that in every post... And why would you need a whole new Ambulance simply cuz you're going ALS?

IIRC there is no allowance in Ontario protocol for CPR on an adult unless they are pulseless. But having said that, I don't think one would be faulted for doing what is in the best interest of the pt.

At what point (or would you) consider performing compressions on a bradycardic pt? As in if they have a rate of 10... do you compress? Where do you draw the line?