firefighter523

Had an overdose of Tylenol the other day, a pt took two-hundred, 500 mg (extra strength) at 10 am. We got the call about 3pm. Arrive on location to find a 52 yom, standing in front of the sink vomiting pink stuff. Don't know what the pink stuff was, either the red caplets or blood. 15 min transport time running hot to hospital. BP: 168/82, NSR 89 w/out ectopy, R: 12 non-labored, clear lungs all around, amazingly, his belly was not tender, or upset, SPO 98 on 4lpm NC. 18 ga in left hand KVO. Wanted to give 1gm/kg charcoal, was denied with a 7 min ETA at this point. (Kinda figured that) What I was wondering was, what do you think was happening to his liver and kidneys at this point, pt was not jaundice BTW.

PARAMEDICS CAN NOT PRONOUNCE DEATH.. Yea i could have called the code. But you know that woman that he was married to for 50 yrs was watching and following tha ambulance in to town. so as much as i wanted to call it i also wanted her to know i did all that i could do for her husband including CPR for an hour if needed. Their was NO question in her mind when we were done with our job that we didn't exhuast all available avenues of treatment including transport to definitive care. One of the six points on the star of life if you remember. Even the ED worked on him another thirty minutes before calling the code. And yes by all means take ACLS to the PT. but ACLS is like us, Portable thats why we have ambulances so we can work while we are being driven to the hospital. We have everything we need and more in the back of our ambulances and yet so many of us are afraid to work in it. No where in any ACLS or Textbook i have ever read has it ever said ACLS can only be worked on scene. That is a stupid thought to have and even worse to put it in to practice. We have Ambulances LETS USE THEM!!!! They are as much a tool of our trade as the monitor and stethoscope. They were built to transport patients. Both stable and unstable. A bit of Hx. this man was a very active member of the community and had no past medical history. No CHF, No AMI's, No cancer, No hypertention, No anything. had never been on any prescriptions. Just led a simple farmers life. he was also my friend. that too made a difference. But also what good does it do a PT if they need a treatment that you can not give in the field to remain on scene? things like Hemothorax, pericardial tamponade, things like this that we can not or usually are not allowed to treat. there is not always tell tale signs on the outside to see whats going on inside. The man collapsed and his heart stopped. well ok. I guess i ll stay here and see what happens. If he opens his eyes and says quit jumping up and down on my chest ... well then ill take him to he hospial. but if he doesn't in 30 minutes well then he's dead. Never mind the fact that he was in a Minor MVA earlier in the day that his family didn't think to mention. I don't have X-ray vision, missed that day in medic class i guess. Well, I don't know about you, but I was taught that we shouldn't abuse a corps, and secondly, part of this job is being TRUTHFUL, and ABLE to break horrifying news to people. Working a code for 1 hour is a stupid, cowardly thing to do, you are only prolonging the inevitable. We talked about this in a past thread about SIDS. You need to be honest and upfront with family members when THERE IS NOTHING LEFT TO DO.

Rid, this is a direct quote from the Revised Fifth Edition of the NAEMT PHTLS book by Mosby, chapter 10, page 284. " In the case of open femur fractures, the prehospital care provider should first apply a sterile dressing to the wound and then use a traction splint to straighten the extremity and stabilize the fracture. If the bone ends return into the wound, the outcome will not be altered as long as the physician who cares for the patient is informed that the bone ends initially were outside the body. The application of traction, both manually and by the use of a mechanical device, will help promote tamponading of the internal third-space bleeding and decrease the patient's pain. " Contraindications to the use of traction splints include: Fractured pelvis, Hip injury with gross displacement, Any significant injury to the knee, Avulsion or amputation of the ankle and foot. Second, I don't appreciate the Duh's either! We are both adults!

Our protocols suggest 1 nitro ev 3 to 5 if they meet criteria, up to 3, and 80mgs lasix SIVP if they have rales, tachypnea, or peripheral edema. Febrile pts are contraindicated for lasix if they are not in HF. CPAP is also a great tool for us. It is put in use if there BP is above 90 sys, they have rales, and a hx of HF, they also have to have 2 of the following: SPO 95 or less, 25 resp per min, and use of accessory muscles.

Awesome point Rid about the shark fin, I will definately use that next time!!!

Well, the quote said that hydrofloric acid may be added to the glucagon, I think that my lower the ph in any fluid wether it be NS or water. Some people still use NS for reconsitution.

Well, I guess the sterile water that comes with it must have a PH of less than 3.0 or greater than 9.5. That would only be my guess.

Thank you JPIN, I didn't think I was going crazy.

I don't know where and who thought of the idea that open femur fractures are contraindicated for traction splining. You need to get the bone ends away from each other and main arteries. Pt will thank you for the pain relief also. What will kill them first, infection or a transected femoral artery? Before traction, make sure you flush the wound with NS or sterile water.

Need someones help finding the article explaining why Glucagon SHOULDN'T be reconsituted using 9%NS. From what I read before, it said something like, Glucagon only reconsitutes in fluids with a PH of less then 3.5 or greater then 9.0. ACE, I'm hoping you come through for me. I have to prove a point to someone!! Thanks

Asysin2, Valid concern, I agree 100% with you to treat the VT, however, this is the down and dirty way that I remember it. The ONLY way you can DIAGNOSE VT is to look on the 12 lead at leads 1 and AVF. Since VT indicates extreme right axis deviation, it will show negative deflection in both of the QRSs. If she was stable, I would do a 12 lead if you think you could get away with it. Or do like you did and treat the VT. Kudos, my friend!

CaCl stabilizes the membrane of the cell wall to control the leakage of the K. You can also use albuterol in hyper K pts, does the same thing.

Rid wrote::: I agree, for tachyarrhythmias, Adenacard is much more effective and less riskier than Calan. Just wondering the rationale for this statement. Verapamil is a calcium channel blocker, it works on "blocking the calcium channels". Adenosine, on the other hand is a natural occurring agent that chemically converts PSVT into a normal sinus, by tiring out the AV node. Adenocard will not work for rapid A-flutter, or A-fib...

I just had to add 2 cents to this when I saw it. No LSB should have been applied in this case. There was NO mech of inj, and he said it himself. He got hurt months ago. No board, nothing should have been cleared, pt should have been tx in the most suitable position of comfort. If I was a basic, and if he really was in that much pain, but stable. I would have called for ALS to give him a little morphine before we moved him. This is what we call ethics, and it is today's standard of care. Ran into this case before. Same scenario, (no car involved), or board for that matter. Pt couldn't move, called DOC for morphine and he ended up giving me orders for 4mgs MS and 2mgs Valium. He was lovin' life.

"Remember ADH is responsible for the release of Angiotension II " Juxtaglomerular cells in the kidney are responsible for the production of Renin, a hormone, which is responsible for the production of Angiotension I, which is converted in the lungs to Angiotension II by Angiotension Converting Enzyme. Now, my two cents on ADH. I pregnant females who's bag of waters has broke, or not, if they are subject to imminent birth, the standard of care is to administer warm IV fluids wide open. The mechanism for this is to suppress the release of Oxytocin from the posterior pituitary gland indirectly. I too, love to learn, and am not exactly sure of the way this is accomplished, so someone might want to take over from here. Thanks

[ He threw me two prefilleds 1 epi(1:10,000), and 1 atropine(1:10,000), which is so wrong don't even get me started. Anyways he was the lead medic and said "just do it". so I did. Why do you think that tx was wrong? And what's with the atropine (1:10,000)? You actually counted 15 times a minute? I don't know what it was, honestly. I would go with agonal resps.

Follow up: Followed up with the flight team. Nurse and Medic stated that pt did nothing but vomit in the back of the ship. Pt arrival at trauma ctr, had neg CT, was watched for 24 hrs and was sent home. I think this argument had EVERYTHING to do with money. Sup is known to be money hungry, and they only run 600 calls a year. Do the math. I don't care if you are a reputable fire dept, or a bunch of idiots. It doesn't take a rocket scientist to look at someone and relay over the radio if they are unconcious or not. Thank you all for your thoughts. And Dust, you must be in a sup's position, mine on the other hand is 3, (I REPEAT) 3 years into EMS as a whole, and he knows everything already!! Boy I wish I had that ability. I am in it 13 years, and I am still learning. I wonder how he did that.

Here's the senerio ladies and gentleman. 1700: Medic unit dispatched to a farm for a 27 yom that was riding his ATV, and after flying through his yard and hitting a jump, he lost control and was ejected from his vehicle. 12 minute ETA of MICU. Helicopter placed on standby. Fire on location shortly after dispatch, reporting a 27 yom, confused, in and out of conciousness. Longest period of LOC is 20 to 30 seconds witnessed by fire chief. Helo flown after that report. MICU still 6 minutes out. Nearest trauma center 25 minutes from scene by ground. I just got my ass reemed by a supervisor because we didn't wait until we got on location before we flew the bird. Turns out this patient was found by us with anterograde amnesia, and slurred speach after the accident. What would have you done in this situation. I think someone was pissed cause they couldn't bill for this. Your thought please.

Uhmm, 3 words.... ALS, Vertigo, call for 2mgs Valium.

Good luck to you in your studies my friend!!! By the time you are a physician, I will be retired, then we can have this debate over a game of golf!!!!

Yes I am a Firefighter, and I am a Paramedic, and I love doing both. Stop gloating about all of your supposed education as a RESP THERAPIST, we all go to school, you don't impress me. You will empress me when I see a P by your title. I could care a less what you do with your ventilators. BTW, I am 31, do the math.

My friend ACE, I am sure you are about to tell me, I have no idea, never seen an SVT code.

Further more Punisher, I would highly recommend you take some vacation from you ED job since you were 15, and go study some simple laws. In order for a paramedic to be prosecuted for misfeasance, it must be proven that the efforts that the medic made to treat the patient contributed to his or her death. Please grow up and live life before you claim to know it all. Don't threaten me with your ability to Google info off of the computer. :oops:

So, let me get this strait, If I am working a PEA code, the pt dies, and I have used CC, you actually think that a lawyer would waste his time doing research on a medication that was approved by a doctor for us to use to possibly bring that person back. Did you miss the point. The patient has, will, or is GOING to die!! I don't think ANYONE is going to be too focused on the fact that in a couple of studies, it was recommended to not be used. The fact of the matter is, it is in our guidelines for a reason (that physicians) approved for use in that situation. It can be used for a whole plethora of other things, but we would need YOU here to diagnose those in the back of our MICUs, we aren't that smart. I also suppose that if I was ever in that situation, I would have to explain the 2 large bore needles that I have placed in his chest. That might be a little too inhumane.

PS Punisher.... So you haven't seen CC used in over a decade, So you were 15 when you started working in the ER???