firefighter523

Albuterol has a roll in CHF, is should be considered after reduction of pre and afterload, however agonizing B2 receptors peripherally plays a roll in lowering afterload itself by vasodilating. It does increase 02 demand, so you must increase supply though the use of high flow 02. If given, it should be given empiretically in conjuncion with the preload reducer (nitro). It is not uncommon for clinicians to treat both for COPD and CHF at the same time. Most people are hypertensive, pillow orthopnic, and suffer from PND, are on some type of diuretic, and a B blocker of some sort. Look for a throacic scar, and ascertain wether or not they have suffered from MI, valvular dysfunction, or have a long standing hx of HTN. Look for LVH, and any type of block on the 12 lead. With all of that being said, this is not my way of treating CHF. I prefer going with nitro right away, and if they are on Lasix and are NOT febrile, then giving them their prescribed dose, maybe doubling it. Coupled with CPAP, is the standard of care for CHF. If you need help confirming dx, you could use capnography to aid in the ddx. Wheeze from lung pathology causes a shark fin appearance, vs cardiac wheeze from extravasation of plasma in the avioli will not usually show as shark fin on capnography, it will remain upright.

I would lean more towards amiodarone in the rapid a fib/flutter pt with pulmonary edema, since CCBs and BBs are both neg intotropes.

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spenec, your full of it!!! Anyone can say anything on this site to make someone's previous post look bad. A person with a sat of 95 is NOT going to be cyanotic!!! Check your pulse ox my friend!! Lets look this over 95% sats probably meen that each heme molocule is almost full of 02, which would make it bright red, NOT BLUE. HMMM..... if all of those heme mols are all almost full, and are likely to be nice and red, then I would guess that the pt is NOT blue ](*,)

I asked NOTHING of you, and could care-less who stands up for ME! I know this, I devote everyday learning as MUCH as I can about my job to better treat my community!! If I come off cocky, I don't mean to.... I would call it confidence!!! And no, unless there is some disease process going on, high flow 02 usually pinks them up!!!

IF THEIR SATS ARE IN THE HIGH 90S, THEN THEY PROBABLY ARENT GOING TO BE CYANOTIC. Whoever gave you this piss poor senario should wait in line behind you to finish CLASS!!!

Dwayne, I know you are still going through class, don't argue with me, and then when you think I am right, pull the, "Oh I'm just a student yet" card to look for sympathy, and or to try to make me look bad! I see right through you!!

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Rid I am sorry you feel that way. SPO2 below 90 on high flow 02 and a BP below 90 indicates, (not always) that the pt most likely WILL be altered enough to tolarate a needle, possibly 2, going into his chest. If he is not altered and his sats and BP are good enough to get him to a hosp before they can get him a cxr to differentiate the two, I will wait, and refrain from placing a needle into someones chest. WE DO NOT DO PROFILACTIC CHEST DECOMPRESSIONS!!!! IT SHOULD BE DONE IN AN EMERGENT SITUATION WITH UNSTABLE VITAL SIGNS!!! You call me a cowboy medic, but atleast I know when IT SHOULD BE DONE IN THE FIELD!!! It is barbaric to place a needle in a chest without sedation while they are sitting up looking at you!!!! Even if they are altered, with vitals above what I have stated, nobody is good enough to totally differentiate tension from contusion!!! BP less than 90 indicates poor cardiac output, Sats below 90 indicates poor oxygenation !!! Couple those two with a history of chest trauma and a person who is altered, then you may think about placing a needle or two. You NEVER cease to amaze me with your STUPIDITY rid!!!

Dwayne, you've indicated that his BP was not known. First... That was the crucial vital sign that you missed and before all else, if you suspected that it was a tension, you should have obtained ATLEAST that, as well as a good spo2 reading ON high flow 02. The only way to differentiate a pulmonary contusion, and tension pneumo is a chest x ray, as well as ( A hypotensive pt with an altered mental status, with a history of chest trauma , and absent lung sounds with a pulse ox of less than 90%) Not to say that if it is a pulmonary contusion, it will most likly turn into a simple pnuemo, but by the time that happens , they should be in the ED!!) LET ME SAY THIS TO YOU AGAIN, AND THIS IS WHERE THE POOR HISTORY COMES IN, you have indicated that this pt has a STRONG and FULL pulse, I would guess that STRONG and FULL probably means that he is NOT hypotensive. So until, you can give a better hx of a pt, expect some answers that you don't like in return!! Treat people like they deserve to be treated, you DO NOT decompress a person whose sats and BP are above 90!!!!!! PERIOD!!!!

Dwayne, you gave a piss pore history, but if the person is lying on the floor starving for air, and STILL BREATHING, but very tight, you need to SIT HIM UP, give in albuterol, so he starts to move some air, if it is CHF, then you should lower his BP with nitrates, and place him on CPAP. If he is unconcious, barely breathing, you should intubate him, (watch out for the pink frothy sputum that might spout out the tube like old faithful and breath for him, and give him some lasix. If it is not a respiratory issue, you NEEEEEEEEDDDD to get a BGL and treat that if need be, and then if that is not the issue you need to take a look and any meds that he or she is taking, posible OD, and then look for any electrolyte showings on a 12 lead and treat them. This is why you need to have another medic with you, sometimes you can't but it would be nice. I just had this type of call today, and all those things got accomplished , but it turned out to be just plain old respiratory arrest from a long hx of COPD.

content removed - admin Let me make this as clear as possible. If an EMT B is authorized to perform a proceedure, regardless of how dangerous it may be, and if the emtb carries such a device on that truck without the supplementation of a medic, and if a doctor authorizes him/her to perform that task, THEN IT IS A BLS SKILL!!!!

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StickEM, self control is aquired, and you obviously have not gotten it yet. Watch the language please!

Yes, you are SOOO right Lucky, I would give Bin Laden the best care in the world. :roll: Work in a city atmosphere for a while and see what kind of idiots you have to deal with on a daily basis. I do treat the truely sick like they should be treated, I give the best care I can, but If I can spot signs of terroristic activity I will surely report it when I can. Besides the city I work for has PD on scene 99% of the time before we can get there. We are not the rats, but PD has a free pass into their secret world because of the ems dispatch.

OMG, where the heck do I start. I would be honored to report anyone trying to engage in terroristic activities. What a great idea. They don't give a shit about us, so why should we give a shit about them. They killed 3000 Americans that day. @#$%EM, They can be sneaky, so can we. CIVIL RIGHTS go out the window when it comes to terrorism. !!!!

I would just be leary on giving adenosine to someone with a BBB, don't know what it would do. I know what it will do with someone with a block higher up above the R and L bundles, but not lower, sorry.

Now that I have figured out how to zoom in, I am calling this SVT with a RBBB with pathologic left axis dev. This one would get a call to the Doc, no doubt.

This strip is very hard to read in this post, maybe I need stronger glasses. It is very hard to differentiate which way the qrs is pointing, definately down in AVF. Both negative qrs's in lead 1 and AVF and with the caviot of neg qrs's in 2 and 3 points to VT. If you cant tell, you must treat the VT if it is wide. If you have amiodarone that is better, (treats narrow and wide).

Ruff, Since we are getting back to 12 leads, tell me about early repolarization, vs true MI. "You have to treat the pt, not the monitor right!" I have to go finish rolling my hose after the trash fire. Content Removed - Admin

I am way too busy to be cutting a paisting all day so I can make you happy, go find it!!

23% reduction of mortality at 35 days post MI. I found it, now you can ER Doc.

Yes sir, I think the reflex tachycardia from nitro might do a dissection harm, refer to my post below yours, just because someones states that his pain feels tearing, doesn't mean that it is automatically dissection? And, what about the person that is on profilactic ASA, will your lousy 324 kill him, or if it IS a lesion, will it increase his chances by just a little bit??? The more and more we interact, the more and more I think your are a 2nd year resident!!! Please get off the med com radio, stop practicing giving orders until you finish with your books yougin'!

vs , tearing CP doesn't mean that it is a disection. ACS can also present with tearing CP. Just because the pt thinks it might be tearing, could mean it feels more like crushing to the next person. You don't know. It is up to you if you want to withhold ASA, I do know this, ASA decreased mortality by up to 26% in MI pt's if given right away. What if the pt already takes 81 mgs a day, and the disection is not complete yet, say it is just an anyurism right now. Is your 325 mgs really going to kill the pt , since he has been taking 81 for the past 10 yrs??? Doubt it...

Rid wrote : You would increase myocardial workload if you give someone nitrates with a right sided MI, so the heart has to compensate. " If you give the patient FLUIDS like you are supposed to before you give the nitrates "cautiously" you hopefully will be ok" Fill the tank, then vasodilitate, "know it all" and quit picking fights with people!!!