bassnmedic

Due to the fact that Atropine can increase the size and severity of the infarct is why we save the atropine for last line tx. I did give the ED a heads up call for the cardiac alert. The patient was sent to to have a pacemaker later that morning. It was definitely a call I don't wish to see again anytime soon! Todd

The pads were placed sternum and apex per our standing orders with good adhesiveness. I'm sorry , I forgot to mention that .5mg Atropine IVP was given post Dopamine. Yes VS, we are practicing under standing orders with out direct Med control contact. The 12 lead never did confirm Inferior MI, only junctional Bradycardia. My train of thought was that maybe the patient had been in either 2nd or 3rd degree block during the day and the location and degree of block may have played a role in blocking the pacing from working. As for the placement having to be A-P, that is not entirely correct. It does require less amps in the thinner patients. But, normal conduction through the heart runs sternum to apex, thus decreasing the threshold a little better in the avg. sized patient.

53 yo male, guest of the State of Fla at the gray bar motel. Patient reports to the infirmary at 0800 hrs with complaints of substernal, crushing chest pain and just a general weak feeling. His initial v/s were B/P- 96/46, P- 62, R-16 and Ra SpO2@ 95%. patient has PmHx of HTN and Hep C. The prison nurse tells the Dr. the patients V/S and he orders a LR drip at 75cc/hr and bed rest. At 0130 hrs(17 hours later) We get the call to come take a patient with "general illness" to ED for Eval. Upon arrival,we find the patient supine in bed, he is A+Ox 4, pale, cool and clammy, no radial pulses, nibp is 64/22 and has a weak carotid pulse of 32.....the IV is empty and my guess is has been for quite a while. chest pain is 8 with radiation to his shoulders, 3 lead EKG shows a Junctional rhythm at 32bpm w/o ectopy, this is confirmed with 12 lead minutes later. BGL is 101. We placed pt on O2 NRB@ 15lpm, reestablished IV of NS 300cc bolus with only slight improvement in B/P. Without hesitation we began pacing him starting at 70bpm and 10 mA and increasing the MA in increments of 10, eventually reaching 170 MA and 80bpm and never gained electrical or mechanical capture only the occasional contra lateral capture. Pacing was discontinued and Dopamine drip was started, ending up at 15mcg by the time we arrived at ED without significant increase in B/P. The patient ended up going to OR for pacemaker implant. With all that said, I was wondering if Az, Rid or Dust or someone could shed some light as to why the pacer never captured?

Excellent reply Becksdad, very well said. I would like to add a couple of things to this list of do's and don'ts. I know it's been said already a few times,however, remember Fitz just because you are running lights and sirens to or from a call does not mean run 104mph. Don't tell us your war stories from your 30 minutes of experience or talk badly about your previous partners, chances are I am friends of theirs. DO learn absolutely as much about your job as humanly possible and be thorough in everything you do. Give your patient, partner, yourself and your employer 100%.Don't ask us what the grossest thing we have ever seen is. Be a good partner and a good EMT and it will come back to you 10 fold, be a bad partner and it will come back to you 100 fold. Good luck in career and endeavors, Todd

I agree with Asys, looking like astroke to me too. I'd like to know the pupillary response and if he could follow any commands whatsoever. If the BGL was within normal limits, then I'd go with the stroke protocol and consider facilitated intubation(due to the gag)oxygen low flow and IV access with rapid transport to Stroke center for CT. Todd

Transported to local ED, dropped her off at triage........seen walking back home 40 minutes later. Using my 18 years in the streets and all the assessment tools at my disposal, I'd have to say that the odds of her being preggo was slim and none.......and slim just left town. Todd

21 yo female G3 P2 A0, claiming she was 11 and 1/2 months pregnant. When I asked her how come the Dr has not induced labor........" the baby is too small and doesn't weigh enough" "Ma'am where are getting your Prenatal care?.....Patient answers....."my Mom" Is the mom a Dr, Midwife or any medically trained person........no but she delivered my sister's baby......Oh i forgot to mention this chick weighed all of 110lbs..........

Our Asthma protocol starts with filterline capnography then Albuterol 2.5 mg repeated if effective, Xopenex 1.25mg which can be repeated once. Epi 1:1000 0.01mg/kg SQ max at 0.3mg.Solumedrol 2mg/kg IVP max of 125mg. CPAP with 7.5cm peep, Intubate if needed and Mag. Sulfate 50mg/kg slow IVPmax of 1 gram.

At my service here in Florida, we are having remarkable results using CPAP with the 10cm H2O peep valve in pulmonary edema patients. Intubations in these patients are notably fewer than those not given CPAP enroute. As far as Lasix is concerned it is a 4th line medication in our protocols behind NTG(SBP >120), Morphine and Xopenex.

Over the last 18 years there has been many calls and patients that I have dealt with and still have some recollection of. However, I , like Rid believe it's part of the job of telling a patient's family and loved ones that the patient has succumbed to their illness or injury. The spouse that has lived and loved their wife/husband through years of battling Bi-Polar only to come home from work to find them dead from suicide.The 80 year old man whose wife is slowly and painfully dying from Cancer that she has been fighting for 2 years and He tells you "take care of her, we've been married for 63 years and she's all I have", knowing all the while there is nothing that you can do to help her long term. Those are the types of things that stick out to me. I know it's not gross and bloody, but just some thoughts. Take care, Todd

NREMT-B, AZCEP is absolutely correct in the treatment of snakebites. Cold therapy should never be used in snakebites or other venomous bites as the same is said for the use of tourniquets. Hopefully, your Instructor didn't teach you to make an incision and suck the venom out too! Dust, I'm sure with the type of slithering critters ya'll are having to deal with, the 3 treatments you listed were dead on( pun intended). Take care, Todd

The one thing that sticks out to me, is the fact that you said you cannot give any more information about this call. Therefore, my question would be, were even on this call? You should be able to give every detail about this call if needed. I'd hate to see the documentation on this one. Todd edited for spelling

AK, best of luck and come back home safe. God speed bro. Todd

Toy, just wanted to say welcome to the city. It sounds like you have a good head on your shoulders, you should do fine in this business. Good luck. Todd

The effects and half life of the Romazicon are very much longer than the benzos and therefore the amount of Ativan needed to counteract the Romazicon would be far more detrimental. Azcep I think is dead on with his posts.

I'm sorry, but you'll have to explain to me why orthostatics would ONLY be used in dehydration patients. I use this tool on most every near syncopal patient and dizzy, weak patient i go on, most of which are not dehydrated.

Spiteful Loner You are 85% Rational, 42% Extroverted, 57% Brutal, and 28% Arrogant. You are the Spiteful Loner, the personality type that is most likely to go on a shooting rampage. In high school, you were probably that kid who wore all black and who sat alone in a corner of the lunch room, drawing pictures of dead babies. You are a rational person and tend to hold emotions in very low-esteem; not only that, but you are also rather introverted, meaning you probably bury any emotions you feel deep inside yourself, like all of the bodies in your backyard. Combine these traits with your dislike of others and your brutality, and it seems that you would be quite likely to shoot innocent people in a rampage. Most likely, you also have low self-esteem. Hell, I get low self-esteem just looking at you. This is only yet one more incentive to go on a shooting rampage, because you wouldn't care if you died as a result. Granted, you probably haven't gone on a shooting rampage and probably never will, but all the motivations are there. All you need is for someone to push you over the edge, calling you names and belittling you. Like me. But don't shoot me. I have a 101 mile-long knife, you know. In conclusion, your personality is defective because you are too introverted, brutal, insecure, and rather unemotional. No wonder no one hangs around you, you morbid, cold-hearted freak! To put it less negatively: 1. You are more RATIONAL than intuitive. 2. You are more INTROVERTED than extroverted. 3. You are more BRUTAL than gentle. 4. You are more HUMBLE than arrogant. Compatibility: Your exact opposite is the Televangelist. Other personalities you would probably get along with are the Capitalist Pig, the Smartass, and the Sociopath.

I suppose on the contraceptive aisle there are screams of "Oh Dick!!!......Oh Jane!!!" and excessant moans and groans.

The landmarks for pediatric pacing electrode placement are the same for adults and children, however, placement on a child is more challenging due to limited torso size. Anterior/posterior is the most common placement of electrodes. Anterior/Lateral is acceptable but will take up more space on an already crowded chest. In order to obtain a clear tracing on the monitor, pacing electrodes should be placed well away from ECG electrodes. Pediatric pacing electrodes should be used in kids <33 lbs(15kg), adult size in patients in which the pads will not overlap the sternum,spine and diaphragm. Capture thresholds are similar to those in adults. Studies indivate no relationship between body surface area,weight and carture thresholds and although many children will achieve capture between 50-100 MA, higher current requirements are possible. Pace at a rate high enough to achieve perfusion. Consider initial rate at 80-100 and initial MA at 60-80 Todd

Best advice I can give you is to talk with your instructor about this situation. Don't take matters into your own hands, also schedule another rotation after you speak with your instructor.

I learned long ago in this profession that there are two things you don't discuss at work....that's politics and religion. Those 2 topics will start an argument faster than most topics, at least where I'm at anyway. However, I think as a profession we are fairly tolerable of others and their individual traits. Todd

Rid, you are exactly right to expect the above items from field paramedics and I for one believe that professionalism is paramount in how we interact with patients, nurses, doctors and other medics as well as the general public. With that being said, it is the "Paragods" out there that think they are the end to all ends and God's gift to EMS that are giving "real" paramedics a bad rap. Arguing with nurses, questioning Docs and nurses as to their care only shows ignorance and arrogance, not intelligence and professionalism. Thank you for shopping at wal-mart and come again. Todd

fast

18 yrs in the field and have never given it, it's been in the box, but not given.

For whom the bell tolls---Metallica Hell's Bells----------------AC/DC Highway to hell-----------AC/DC Stairway to Heaven------Led Zeppelin Side of a bullet-----------Nickelback Enter Sandman----------Metallica Knockin' on heaven's door-GNR Bohemian Rhapsody-----Queen Fat Bottom Girls----------Queen Saturday night's alright for fighting-Elton John ( yeah yeah I know)