firefighter523

Punisher, you need to be more open minded before you make certain statements. This is America, and in America, EMS has ALOT of different regions and protocols. CC may not be in use in your system, but for us however CC is in use for asystolic, and PEA arrest, for it ability to increase cells intra, and extracellular calcium content. I am NOT trying to pick a fight with you, I am however correcting your previous statement about "Someone falling over, and finding them in a NARROW complex tachycardia. If someone falls over suddenly, and is in CA, you will more then likely find them in VF! NOT SVT!! You can win them all, if it makes you sleep better @ night. :!:

Well, you might have seen a pulsless SVT, that is called PEA!!! Chances are if you find SVT, they probably have a pulse, you just couldn't feel it. If they really didn't have a pulse and you saw SVT, it is STILL considered PEA, and the treatment is fluids, and sympathomimetics, along with Calcium, and Bicarb possibly. The definition of PEA is ANY electrical activity in the heart, without a pulse, except VT, and VF. I am clear, only on THIS!!!

"or there is a history consistent with a cardiac etiology of the arrest" ???? So you mean that if someone WAS in VF or VT, but isn't now then you should defib??? Is that what you mean? Please explain your rational....

Well Ace, you've just confused the heck out of me, what don't you get? If you have a pulsless pt in PEA, and the rate is below 60, why wouldn't you push atropine, along with the epi and the fluids?? You will have to explain the rant that you just had, maybe we are on a different page, dunno, do clarify. The defib comment is cut and dry, if they are in fib, or tach, (without a pulse) you NEED to defib. You are right, it could put them into a whole bunch of different rhythms, your other alternative is THEY DIE. Cardiovert pulses, defib the less unfortunate.

Please let me clarify, I said possibly atropine, meaning if the rate is below 60. Sorry for the confusion. Whoever said it before, to NOT push epi in a pulsless pt is just plain BAD medicine. You don't treat the underlying rhythm, you treat the causes of the problem, you need fluids, sympathomimetics ect........ The whole point of cardioversion is to keep them from becoming pulsless.

So, anyway, I hope I didn't miss anything in this post. My two cents on this is, PEA is "ANY" rhythm without a pulse EXEPT V-fib and V-tach, and obviously asystole. PEA, regardless of rate, should be treated with fluids, fluids, fluids, along with Epi, and possibly Atropine. You can also think about 2 to 4 mg/kg of Calcium Chloride, also some Bicarb, along with a bilateral thoracostomys. Remember those H's and T's. You have nothing to lose if it is late in the code, try everything.

" but I'm not going to leave it in place for too long. " I can tell ya one thing, and I am sure I speak for many medics, If I have established a patent airway with a combitube, and some hotshot comes along and takes it out, and tries to intubate someone in front of me, their will be a problem. It probably got there for a good reason, why would you take a patent airway, and possibly throw it away. Regardless if a basic or advanced provider placed it (whatever your region allows), if they have equal rise and fall, with good breath sounds, and SPO2 numbers are good, as well as CO2 levels, there is no good reason to remove it.

My friend Asysin2, Lets get real, I think you know exactly what I meant. Combitubes ARE in FACT back up airways! If you couldn't bag someone or ET tube someone, you would Combi tube someone, hence "face down in the bottom of a stairwell". That is another use for a back up airway, I did say BACK UP airway, didn't I?? Please don't insult my intelligence!

I am sorry, but for the life of me, I just cant think of ONE good reason a basic should be allowed to combitube someone. An effective seal via BVM with good Cricoid pressure with an OPA is optimum right before an ET tube goes into someones trachea. Look at all of the trauma that trachea has gone through already between you and your basic putting tubes in, and taking them out. Combitubes are meant to be a BACK-UP airway, when you cant get the ET.

"GIVE THE GLUCAGON FIRST TRY CORRECT THE UNDERLYING PROBLEM " You are kidding right? So you are going to wait the 5 to 20 minutes that it will take for the glucagon to MAYBE work. You wont have to worry about the glucagon working, they will already be dead from anoxia!! Break the siezure first, then treat the underlying prob. If you can't get the IV, then titrate valium up to 5 via nasal atomizer.

Bottom line, there are alot of people who worked VERY hard, and have given up ALOT to OBTAIN the certification of PARAMEDIC! If you want to administer ALS drugs, don't cut corners, work hard and get the cert!! 1500 hours is a little more then 215!!!! Do the math!!! It is a SLAP in the face to the PARAMEDIC, who has undergone extensive training, to be UNDERSCORED by a wanna-be. I have 2 months left, and I will have mine, NOW, GET YOURS :evil: If you are mad at this statement, then GET OVER IT!!! :twisted:

http://www.med.ucla.edu/wilkes/inex.htm Check this link out, pretty cool, hope you all enjoy.

Does anyone else use a LSB? That is common practice where I work. Very convienient to take a litter with a LSB with all the goodies up to the door, grab the board, place pt on board, work code, place pt onto litter, while on board, good compressions while on litter. Works great!

"We have one medic who likes everything on the litter, and to take it along. Luckily, she does not do that with me." Don't want to be rude in saying this, but if the Paramedic wants to take everything in, there is probably a good reason for this. Correct me if I am wrong, but we DO work for the patient at a time of need. If there is any doubts about what is going on, I surely hope the medic will error on the side of the patient. It isn't hard work to take everything in. I am sure we have all been caught with our pants down once or twice in our careers. We learn from our own mistakes!

Absolutely, You give him a mask, make him more aggitated, he breathes harder, aggrevating his already worsening breathing prob. If he doesn't want a mask, you IMPROVISE, ADAPT, and OVERCOME. Put him on a nasal with the highest amount you can give him. I agree with ACE, even if you knock his drive, and he becomes apneic, then YOU BREATH FOR HIM. It is NOT all the time text book. S#$T happens right!! You did a good job, in my opinion, and apparently in the medics, because they didn't complain.

Talk about "bad luck"! I guess, keep the epi commin'.....

Just wondering, even though it is unheard of, has anyone ever ran into at patient on a call that is allergic to Benadryl?

OK, so now I am MOST definately confused. If it were hypotonic, wouldn't it draw water into the interstital space, and not the vascular space? This was the debate that we had, some said that the sugar draws water into the interstital space by the cells rapidly using the sugar, hence the water follows,decreasing preload. Some said the the sugar remains in the blood stream, causing water to be pulled into the vascular space, (hypertonic), diuresing the pulmonary edema. I know the concentration is too low to make a difference, but it is in our protocols for a reason. This debate was after class let out, therefore we didn't get to ask the question. Kevin

So, many articles, so many people say diffent things Rid. That was my origional thought, because that would explain the hyperglycemic patient urinating alot. Since water follows sugar, well you know what I mean. Kev

AZCEP, That is what I thought also. But, as I was reading an article, it is the opposite way around. The sugar molecules are actually burned up rapidly by the body, and drawn into the cells, (interstitial space) causing them to swell with the following of the water. That causes a reduced preload from the returning blood to the right atria. Thus, the purpose of the D5W. Kev

No, he got a bad eval from the precepting paramedic, and he was just wondering why.

Thanks Rid, I know that fluids are NOT the answer, but one of our students got a bad eval for not hanging D5W in a CHF patient. We do use, up to 3 nitro, 80 of lasix, and of course CPAP. On command we have, albuterol, morphine, and dopamine. Thanks for the info. I like the idea of a lock also. Kevin

Sorry, I was referring to the osmotic pull of fluids, into or out of the vascular space. I know albumin is a heavy protein, and thus it pulls interstitial fluid back into the vascular space, (reduction of edema). My question is, does the osmotic pull of sugar pull fluid into the vascular space, or vice-versa (to reduce preload in the CHF pt). Our protocols suggest, if we have to hang fluid, it should be D5W.

Someone please help with the mechanism of D5W administration in CHF patients. I have Google'd it numerous times and came up with nothing. We got in an argument over it after class, and now I am totally confused!!