firefighter523

Thanks Rid for the link, very informative.

In our region, you must have a HR @120 or greater, along with a pressure @ or below 90, and exibiting signs of allergic reaction, ie.. flushing, edema, resp distress to get the epi and benadryl. We don't carry steriods in the field.

Our region's medical director was in the class one day, and that question came up. He said that " in the event someone is having the "big episode", the benifits outway the contraindications for the short term trip to the ED, and he said to us that we SHOULD give it.

I don't think I am confusing it. Correct me If I am wrong, but due to the chronic dyspnea and extreme work of the pt, once they are on the vent, the body says " Cool, I don't have to work anymore, someone is doing the work for me, I think I'll just hang back and kick-it" "Wait, wait, don't take that out, that means I have to work to breath again, I don't like that"!! Am I wrong, isn't that why CPAP came about?

Outstanding, thank you for the info. I forgot about the non-potassium sparing part of lasix..

So, it's amazing... You correct the underlying problem (fluid), which is causing cardiac asthma,(wheezing), and she no longer wheezes. Guess that's why the albuterol didn't work. Thanks for your input.

She was in heart failure. Also she had a left axis deviation, with a left anterior fasicular block. Also it is showing that she has left ventricular hypertrophy. Hope this helps, my concern was the elevation. I wish I could get the strip on the forum. I am not that computer literate...

I guess, since I heard rales, rhonchi, and experatory wheezes, and her age, and her not be febrile, and the fact that she had elevations in several leads, I wouldve gone with the nitro. (Her pressure was 134/68, HR 82, R 20.) I think the wheezes were from cardiac asthma. After the two treatments, she felt worn out, and she still had the same amount of audible wheezes. I know that the monitor itself is not a diagnostic absolute, but women feel MI's different then men, especially diabetic women. Not that she was a diabetic, but.. That is why I was so hesitant about the EKG. The medics were not too worried though. The medic's checked back on her condition, and she was in failure BTW.

So, I was on an interesting call today, a 78 yof, caox3, complaining of SOB for the past 24 hours. She was diagnosed with an upper resp infection a day ago. Upon arrival I listened to her lungs, she had a nice mixture of rhonchi, rales, and some experatory wheezes. She does have a cardiac history, wasn't noted in her chart, but her meds indicated that she had one, (nitro, cartizem, coreg.....) We do a baseline 3 lead, to find a sinus rhythm with some s-t elevation in leads 2 and 3. We did a 12 lead, and found s-t elevation in 2,3,AVF, and V1 through V5 (various mm's, 2 and 3 for the most part). She didn't have chest pain, nausea, vomiting. Her skin was a little pale, and she was warm and dry. This patient got albuterol (two treatments) in route to the hosp for her wheezing. I was told that the EKG was suspicious, but not definative, and that they think her elevation is chronic. I didn't want to give her the treatments because of the increased oxygen demand on the myocardium. Her pulse ox was 95 on 2lpm 02 via NC in the nursing home, so she was getting properly oxygenated. Was I wrong to think that albuterol would make this possibly worse? and if we can't trust our 12 leads, why do we use them? How can someone say that it is a chronic thing?? Just wondering!

Just because people arent good at it, doesn't mean we should stop doing it. It means we need to PRACTICE and get BETTER. Since when does the world move ahead and our treatment move in the opposite direction!

We are taught to use cricoid pressure, while we are advancing the tube, (one size smaller of course). I elected to do it once in the field (precepting) for a benzo od. (It was a known benzo od, we knew that the narcan wouldn't change anything). The cricoid pressure worked like a charm. She was silent, and all of a sudden she started whistling dixey!!

It's fine to be aggresive on the airway on the CHF'r, but here in the US, the standard of care is now CPAP, not intubation. If you intubate a CHF pt, they become dependant on the help they are getting, and some never come off the vent. CPAP is the way to go. Tube as a LAST resort....

SVT into a junctional rythym with PJC's ( I agree with the conversion ) The r to r's are spot on regular in the begining..

2 part question.... Crush syndrome patients, has anyone ever gotten orders for lasix with bicarb for these patients, to diarese these toxins along with the alkinization? (Keeping in mind to keep the fluid running wide for hypovolemia) Tricyclic antidepressants, Barbituate od's, Same question applies. I know bicarb is the treatment for these emergencies, but would lasix help the problem faster.

Thank you my friend, I am learning from some good medics, others in my opinion have not impressed me. But I am still learning.... By the way you would have gotten a 12 lead first, if you had elevation in 2, 3 and AVF, and RV4 it would have been a balancing act, not to do fluid overload, but to maintain that left ventricle feed!! Thanks for your advise, and I didn't see ABG's.

I didn't mean to start a war. Under my impression from the people that I have learned from, if you can't hear anything because a pt's tidal volume is very low, then you should administer albuterol to increase tidal volume for two reasons, 1) So they can breath, and 2) so, when they are able to take in a full breath, so you can hear whatever it is you hear. It seems to me that this issue is very controversial. This lady presented in bed, in a nursing home, on 2lpm 02 via NC. I listened to her lungs and heard clear lungs. She was breathing 32 times a minute with a pulse ox of 78%. She had a documented history of CHF in her chart, and she was ashen in color, and cold. It is my understanding that you can be in failure, and not be congested. We took this lady into an ED with a history of CHF, pale skin, breathing 32 times a minute, with a pulse ox of 80% on 15lpm 02 via NRB. The PO never increased above 80. Because she was so tachypneic, and she had a history of CHF, and she was ashen in color, I would have given her an albuterol tx to open her up, then with the nitro, lasix, CPAP. When we got to the ED, the firt thing they did was put her on BiPap!! The idiots I ran with blamed the pulse ox not functioning right, because of cold skin. I was embarassed to go into the ED. I know I have ALOT to learn, but I think I am on my way of recognizing HF. She was brought in just on 02. Not acceptable!! Sorry, I'm venting

I am a medic student who was on 2 calls (different weeks), both CHF, resp distress. Both had a history of CHF, and had the tell tale signs, peripheral edema, tachypnea of about 32 times a minute, with an SPO2 of 80%, ashen in color. I couldn't hear anything in their lungs because they just didn't have the volume to hear anything. I just wanted to know what your thoughts were to give albuterol first to open them up, and treat what you hear. Keep in mind, these patients had a documented history of CHF in their charts. Our protocols have albuterol in it, on command only. Is that the reason it could be in the protocol? It worked perfectly in the first call, then we treated the CHF, (nitro, lasix, CPAP). The second senario, I got yelled at, (different medic) he stated that it albuterol isn't a diagnostic aid for CHF. Please help out.... I am confused...