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.

Educational books. You aren't finished learning yet.

You're not a wannabe anymore. You ARE the paramedic now. Move on past the sensationalism of the silly wannabe books.

Start writing your own book. Start today taking notes on each and every day of your career. Then, twenty years from now, you can write a book or two and help pay for your retirement.

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?

Well you are the only person I have ever heard of who uses it. It has just been taken off the list of mandatory ambulance equippment by the MOH. But if it helps you that is good.

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?

Wasn't there some similar contraption around in the seventies? It was discontinued because nobody ever used it, due to that it was such a pain to set up? Anybody remember that? Similar to the Genisis ventilator.....what a joke that thing is. Why do we have a zillion fire fighters around if they can't do compressions for us?

Genesis is great for extended transport times in rural Ontario.

Have seen the auto pulse and like it. Especially helpful when you dont have extra hands with you. (i work for a transfer service and only two of us for a code) The only negative thing I have heard is about a lawsuit involving broken ribs. Hmm..did not know ribs would break during compressions :? The FD here has it also and has reported quite a few saves with it.

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

any of you guys ever worked at an amusement park as an

emt or medic?? just curious, i just got hired as an emt-b at

cedar point. i am also just newly certified so i am quite nervous!

what do i have to look forward to?

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.

I had already "Googled " the subject i have already looked it up in books, but i thought that maybe someone on here may have some better info than i already had, i guess i was wrong to think that this was a forum for students who might need some information, this will be the last time i ask for info on here because it seems to be a bother to some.

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

There is no need for rudeness, if you can't be constructive don't post, we don't all use the ridiculous google search engine [that is 99.99% pornography, and false links].

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.

What a shame ....all i wanted to know was that if anyone knew of any good sites and all i get is a smart ass answer to just f#####g google it. thanks for the info

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.

Although some doctors still use calcium chloride in the treatment of asystole, it is not supported nor recommended as an effective drug to use when a patient is asystolic. There was [a while ago] a report into the use of calcium chloride [during asystole] and it showed NO effectiveness, they compared it with saline, and the results were both as futile. Most reports have been anecdotal, and have failed to substantiate its effectiveness. Calcium chloride is of no importance in resuscitating obstinate asystole in the pre hospital cardiac arrest setting. So I would just forget you ever heard it :-) if that is possible?

Cases Study - APP - BJM - 1992 pp135-149

I looked up the case, of what I remembered, as an avid Journal reader.

If anyone is interested?! Oh I am rhetorical today.

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?

PALS is < 8 years old < 60 heart rate (I believe that is our standing orders) if they are symptomatic due to bradycardia.

That is Ontario provinical too I think.

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?