BEorP

I appreciate your desire to do more assessments, but there is no sense in doing assessments that aren't truly assessing for anything meaningful. Someone could be doing perfect CPR and not generate any type of pulse and on another call there could be poor quality CPR that generates a venous pulse. By adding in this assessment we gain no information that can help us to better care for the patient.

But the lack of pulses could also mean nothing in terms of the quality of CPR... Why not just focus on adequate rate, depth, and recoil?

There has been research on it and it doesn't work: Source: Circulation How could it be hurting patients? It could give you the false impression that you are doing adequate chest compressions when you are not.

There is no evidence to support the practice so I wouldn't be wasting my time on this useless assessment if I were you. We can never truly become a profession that practices evidence based medicine if people keep doing things that they think are right or things that they do because "that's the way it's always been done."

Could you please provide evidence that the presence of a "pulse" is proof of adequate chest compressions?

Again, I appreciate all the comments. I chose not to administer nitro to this patient based on the potential of causing hypotension that I cannot do anything to correct vs. no proven benefit of nitro. Unfortunately, this decision has been criticized by some above me.

Any other thoughts on whether nitro was appropriate for this patient? (just to reiterate, no IV access or 12 lead available)

Lung were clear, no JVD, there was some peripheral edema, skin was a bit pale but normal other than that. Appreciate the feedback. Would you have been comfortable giving this patient nitro without an IV? (with no further rhythm info available due to the lack of 12 lead capabilities) Her BP was about 110/60.

Thanks for the replies. The patient was an 85 year old female complaining of chest tightness on and off since the previous day. She awoke with it that morning and her family convinced her to call 911 if I recall correctly. She had the same chest tightness from the previous day with slight shortness of breath. She did have a history of angina but described this as a worse feeling than her usual angina pain. Approximately 10 minutes before our arrival she took one spray of her nitro with no significant relief. Her BP was about 110/60 and I do not believe that the she was febrile. Unfortunately there is no 12 lead available. Based on this information, what would your treatment for this patient be? Would you be comfortable administering nitro to this patient without IV access? (neither my parter or I were certified to start IVs at the time of this call... let's leave that discussion for a different thread though) Appreciate the feedback!

I know that there is not too much to go on here, just lead II and not that great an image of a small segment of it. Any thoughts on what this is though?

Yeah... all this damn testing and book learning just to be able to drive an ambulance or work for the fire department. I can't believe it.

Keep in mind though that "BLS" in Ontario is not strictly BLS in a true sense of the word.

If I'm bringing in Mr. Elderly-and-quite-sick who is 88 years old and his 87 year old wife doesn't drive, I would have a hard time telling her that she can't come with us if another mode of transport wasn't immediately available. If things go downhill quickly once we're at the hospital, I wouldn't want to think back that if she had just come with us she could have been with him or said goodbye or whatever. I am not saying that I always take family members, but I think that it is appropriate in some cases.

From the studies I have read, there is a statistically significant decrease in driving time but this time is most likely not clinically significant. I believe most of these studies were urban based though.

Your question is vague. You need to define what you mean by "Paramedics / EMS."

Please elaborate on this. Is there a certain emergency service job that is more dangerous and one that is safer?

Did you end up finalizing it and sending it on out?

Did you just ask if the LP12 has a built in AED? Is it not standard to have automatic mode?

If I were a county counsellor (which I am not) I would want to see a citation when someone says that there is "convincing evidence" of something as serious as this. I've added some comments below in red:

It is all going to come down to money though. It may also be worth looking at the actual added cost, which wouldn't be that much if the service does not pay for anyone's ACP training.

Primary Care Paramedics can and do do 12 leads in Ontario.

I wouldn't play the 12 lead card since there is no reason that PCPs can't do 12 leads and STEMI bypass.

I just had a chat with Chris Callsen of The Optima Corporation. We had a good conversation, but the bottom line is that he was unable to provide any evidence that their software improves response times. He did stress that as a former paramedic he understands that constant posts are frustrating and that is why he says that their software has the ability to do things like only send vehicles on a post if they will be there for at least x number of minutes or limit the number of posts each vehicle does in a shift.