firefighter523

ER Doc wrote: "Are you going to give ASA to a pt with a disection"? Someone with a possible disection is usually going to present with almost the same signs and symptoms as ACS. Chest pain, pale, cool, diaphoretic. Your answer is yes, I do not have x-ray vision. And then I would proceed to give him nitrates, to decrease his preload, and to vasodilitate, and then I would proceed to give him 2 to 5mgs of MS to decrease his pain, and to decrease preload of the possible disection! If you cant differentiate ACS from disection, you must give ASA in the field. Sorry Doc.

BTW, the question mark goes after the quotes in "knowlege?" , not before!! Have your ducks in a row before you try to correct my grammar strum job!! :twisted:

Listen up Sally, working with marines is NOT the same as earning the Title. I have earned my title in America's 911 force. It takes a very disciplined, hard, self centered, cocky son of a bitch to make it in my marine corp. Don't care how much college you've earned, probably more then myself at this point because you are older than dirt, or maybe not, maybe you are just full of shit, like I suspect. Even if you are older than 32, the only difference between you and I is time. I respect your job of taking care of our troops, sincerely, I highly respect what your job is. I do, however think there is 10% of shit in just about every endeavor out there, and you my friend fit the mold. I have been fighting the beast for almost 14 years both in the Marines and for the Navy. You want to gloat about what you have done, try entering a fully involved residence at 1200 degrees or hotter, and not being able to see your hand in front of your face. Your are right, people like me belong to the fire service, people like you don't!! You are the type of coward that would run out, leaving your brothers behind, because your pussy ass couldn't handle the heat. I have dealt with plenty of people like you, both in and out of the fire service, you are just another number.

And Paradude, my protocols arent weak , they just keep fools like you from doing something stupid, they are smart, and derived from of the very best phyicians in the country. Get over yourself, besides you probably wouldn't even have the balls to do it anyway, more so, even realize that it had to be done. Go back to school!!!

I have been in this field since 94, just because I am a new medic doesnt mean that my opinions or knowlege is mute. I have alot to learn, and I think we all do. I will never stop learning, it is part of this profession. I, however, unlike certain people on this site, do not need this site to elevate my ego. I never once stated that I know it all, nor do I think I am god. I do know this, in my region, the physicians elect not to allow surgical airways, because they are dangerous, and carry with them alot of very ill concequences if not done properly. There are alot more alternatives that can be used before the cut is made. Which brings me to my next point. I could probably count on one hand of all the practitioners on this site who have actually done that proceedure. It is not done enough out in the field to justify it being allowed to be done. And sorry, but a quick trach is NOT a surgical airway, it is a needle, a bigger one, but infact a needle. Rid, and Dust, don't fool yourselves, just because you say you have been doing this for awile, doesn't mean you are any smarter than any of the rest of us. I would rather be seen by a young, new doctor who is on the up and up of new medicine than some crusty old doc that refuses to learn the new ways of practice. I have seen it on all levels.

Just because you are allowed to do them, doesn't make it safe, or SMART!! You are your own country. There are alot of devices out there that are alot safer , provide just as wide an airway, and are alot faster (quick trach). I would love to be the fly on the wall when you do it causing a pt to aspirate blood, making his condition worse, because I am sure you practice so much. Says alot about your ems system!! Come up with the times, it is NOT advisable out in the field, but then again, you do live in Texas!!

A surgical airway is NOT easier nor is it faster, there is a high chance of bleeding into the trachea, and a whole plethora of other reasons that should NOT be performed unless 1) if a doctor is doing it in the field, or 2) a doctor says you can do it in the field. That is a skill that you and your command doc must sit face to face, and you must practice in front of him/her numerous times before he/she says yes. Then you must get past your regional ems office. In no state that I know of, you can perform that skill. If we cant do it as NREMT-P's than you CANT do it in the US.

Flight IP:To answer your question, yes, you are dumb!! Let me educate you, incase you were not aware, you must place a 14g needle into a pt's crycothyroid membrane, (that is the part with the THROAT), aspirate air, intubate the 10 cc syring, and ventilate it around 16 times a minute, if you cant get a patent airway due to massive facial trauma, all failed intubation attemts, or the inablility to reach the pt to perform intubation, and of course they probably should be almost dead. I know because you fly, you probably do not get to do alot of skills, because the medics on the ground usually have it done for you. Infact, I believe the only difference between you and I......are 1) parylitics, and 2) speed. Get back on the rig for a while, get your skills back, and then come and argue with me!!!

Dust, this well respected person, (NOT), in this little egotistical community is just another toolbag, that just because he has a few letters behind his name thinks he his god!! You impress me nill with your ability to cut a slit into someones side to place a tube. Who the heck cant be taught that!!! You are nothing special, skills are for monkeys like yourself, knowlege is power, and you impress me NILL with that also. Most flight nurses did not and will not ever go through a paramedic program, no they go through a 3 month cheezy class and call themselves a paramedic!! I will be done my nursing education very soon, something that the Marines paid for, don't worry, you will never earn that title!! And for all those firemedics out there, kudos for having the brains and the balls for doing what you do, something YOU will never have Dust, BALLS!! Keep being a puppet in the nice safe ER!!! When the medics out in the field need a bed pan, I am sure you will come running!! Enjoy, street skirt!!!!!

Rid, do me a favor, stay in the ER, every nurse that I have had contact with, would look at me like I have 3 heads if I asked them to dart a chest, or place a needle in someone's throat, or even intubate. Nurses have no clue, and never will understand what we do as medics out in the field. Never, have I ran into the problem of a nurse questioning my rx's in the field. They are always too scared to ask, because they are usually CLUELESS!!!! You might be the exception, but I am sure you were a paramedic first.

Overactive, please look closely to my post, obviously if you give MS to a systolic pressure below 100 (thats being cautious) in any case out in the field you are wrong. I was only stating the physiology of MS on susceptible arteries. I don't think I have to explain to you, that surgery is the only option in AAA.

Fiz, Usually people with AAA, have some type of hx of HTN, and, or atherosclerosis, or perhaps both. People with Marfans syndrome are also suseptable. AAAs are caused by high pressures mixed with sclerosed arteries. MS reduces preload and afterload of BP, thereby reducing the pressure placed onto suseptible arteries. It might buy them some time, but they need an appropriate diagnosis followed by immediate surgery.

Yep, when was the last time you've seen anyone take a manual BP in an ER. I definetely wouldn't trust them 100% though.

I think you need to take a manual BP. A pt in pain from a kidney stone does NOT present with a H/R of 150 and a BP of 80 systolic. Sorry.... Retake the BP, call for MS, (.1mg/kg) give it, it will help either way (kidney stone, or AAA) pending on BP.

I would not advise giving too much versed in the field, you risk the chance of causing undue chest rigidity. You will just make a sick pt sicker, more so will end up bagging your pt. We are only to give up to 5mgs IV versed, up to 10mgs IV valium, or up to 4 mgs IV, of Mag if the pt is suspected to be eclamptic. Believe it or not Narcan has worked for me to stop seizures after all else failed, it was pretty cool.

Fiz, and Rid, I think you are missing my point. I was trying to get info on whether this information is noteworthy to get a pt with a LBBB, that is hiding an AMI sent strait to the cath lab. That is why I asked a physician to help out with this.

Bringing in a Pt with chest pain, SOB, NV, pale, cool, diaphoretic skin with a rhythm with a LBBB is very scary, we all know that you must treat for the worst. Has anyone ever given a report to a facility with this scenerio, differentiating it with the use of scarbossa's criteria. - st elevation of 1mm or more in concordant st segs QRS's, - st elevation of 5mm or more in discordant st segs QRS's - st depression in V1,V2,orV3 My second question for the docs, is if you have ever taken a report over the radio consisting of this, and how noteworthy is it? I find it very interesting......

Goofy, Maybe I am not understanding why you say that pts with COPD will develope CHF. I understand what you are saying about cor pulmonale, but I wouldn't think right sided HF would manifest in the lungs. Left sided HF causes right sided HF, not the opposite. Maybe a doc could step in on this and give us a little more information. I would like to know, what came first the chicken or the egg. COPD/CHF

Ventmedic wrote: "Furosemide might be seen nebulized in the neonate more commonly." Why would you give a neonate a terotogen??

Fiznat, everyone praises you for coming out [CONTENT REMOVED - ADMIN ]. I think that, if you think that you should cardiovert sinus tach, [CONTENT REMOVED - ADMIN ] Let me break it to you [CONTENT REMOVED - ADMIN ], if you see a p wave= NO CARDIOVERSION!! Does that equation make sense? There IS a p wave PERIOD!!! NOT SVT, PERIOD!!! NO ADENOSINE, PERIOD!!! If the doc, needs adenosine to see THAT p wave, that is just a waist of time!!! That is on him, NEVER give adenosine to sinus tach, PERIOD!!!

Going by the pts vital, this pt would have gotten a slow ride to the hospital on 4lpm 02, a 12 lead and IV. No drugs!!

I think we have gotten off the beaten path. This rhythm is NOT SVT, it is sinus tach, there for Adenosine should not be given. Not even for diagnostic purposes,(in this case) there is nothing more to diagnose with this rhythm, you have 1 p wave to 1 qrs, the pr interval is consistent and wnl. And further more , I don't even think cardioversion would help this pt. This rhythm is totally compensitory with the situation. People with sepsis die, and it just sucks that he or she was with you at the very end stages. We as providers medics, nurses,and docs can only do so much. I highly agree with AZCEP, fluids, fluids, and possibly pressors.

ER Doc, You must be a resident still. For one, any experienced doc would not waist his time picking fights, and two. If you aren't aware, nitro is the first round drug for chest pain. If you are having an MI, you are not rushed to a cath lab for nitro therapy, you will recieve therapy to UNCLOG your coronarys, USUALLY a STENT. My evidence to support the statement is? You are funny!

Nitro only delays the inevitable, nitro is NOT the fix for MIs, A STENT IS! Google studies on stents, you might find what you are looking for.

Well Doc, I think you are right, and I enjoyed reading your posts, they were very informative. You learn something new everyday. Again I will tell you, we do not have beta blockers in the field in our region, we must use something else to lower their BP. You can only play with whatever is in your tool box.