Lithium

Yes, I'm going to agree with akroeze and Dust on this one. Park where they want you to and be ready to respond (in the exact same way you would be when you're parked on a street corner for coverage). I honestly don't think I've ever been 'cleared' from a fire-standby because dispatch will pull us off it for a real call, not leave us there for a potential one. Jacob

Hello all, Alright, it's been said many times that when you are auscultating a blood pressure, your reading should always be reported in whole round numbers. (Ie. 146/82, not 145/83). WHY? I'll be honest in admitting I can't for the life of me figure it out. I may have been told once before, and if that's the case, I don't remember. But now, our student is asking us (my partner and I) after my partner told him that he should never report them like that. To me, if the needle falls between 84 and 82 when I last hear the change ... then it's 83, but anyways. I honestly told him I thought it was a whole big conspiracy theory invented by nurses to prove how dumb paramedics are ("haha .. we'll tellthem BPs can only be in whole numbers, that will show them!") and that seemed to amuse him and buy us some time to find the real answer. So, what's the reason? And why are those NIBP cuffs allowed to use odd numbers? HMMM? Jacob

I feel I have to disagree with most of the people on here, as has been discussed before. I was actually talking about this with my partner the other day after all we did all day essentially was MVAs (did anyone else get covered in snow holy cow) Anyways, the thing I don't like about non-ems personnel on car accidents is safety. It's really dangerous for people to be walking around roadways with no high-visibility clothing on, no protection for yourself (crushed/bent metal is sharp!) and a host of other hazards. In all honesty, it isn't worth the risks. Here in southern Ontario, help is rarely more then 4 minutes away thanks to the tiered syetm that sends the fire department. With that being said, I'm going to trust the report of the fire crew moreso then I would somebody in plain clothes ... Also, not to mention, most of the people I've encountered at these type of scenes are wankers, who have applied to paramedic school 4 times but never got in ... or atleast that was what was portrayed through their attitutde and communication style. So yes, in short, don't get involved. If it looks bad enough, simply call 9-1-1. Contrary to what vs-eh says (remember, he works for the centre of the universe ) I don't mind showing up on scene to having everyone cancel us off. Jacob

Yes, I am fully aware of what the conditions are :wink: , but if your patient is in extremis as you put it, I would assume you were heading that way if not already there. Back on the original topic however ...

Actually, Ontario does have a protocol for Epi use in asthma, as well as anaphylaxis and croup. Long-story short ... akroeze, depending how severe you thought your patients SOB is, you could probably get away with using Epi to relieve their symptoms. Espeically if you've already maxed out your ventolin protocol and still have a while before arrival at the ED (as can be your case up north). Don't be afraid to patch, the most they'll say is no. Jacob

Not here in Ontario ...

Yes, carotid sinus massage (CSM) is one of the methods that can be used to attempt to resolve (P)SVT. Essentially, by applying pressure to the carotid artery, the baroreceptors pick up an increase in blood pressure, and this will lead to a stimulation of the vagus nerve to slow down the heart rate in order to decrease the BP. Another method similar to this is to ask the patient to take a deep breath in, hold it and bear down as if they are trying to move their bowels. There are some risks, and one of the assessments to be performed prior is the assessment of carotid bruits. If bruits are present, consider one of the other methods of cardioversion (either pharmacological or electrical). Jacob

Short answer yes, long answer no. Don't forget with 12-lead machines, when its put into '12 lead mode' to actually acquire a 12-lead, the frequency response changes in the machine so it picks up more, where as with normal 3/4 lead, it cuts alot of stuff out. Due to this, your MCL (which I have used before 12 leads were standard) will provide you with more info than a 3 lead would, but it won't be as clear and diagnostic. Jacob

Hmm, not to sound too condescending or anything, but first off, you're a paramedic and you gave PO sugar instead of IV? Why no D50? Secondly, my service would freak if I started using supplies (especially ones that I bought myself) to give to patients instead of using what they supplied, doesn't sound like a good plan to moi. Jacob

Hello all, Thanks for your replies. It's reassuring to me that you all said you'd do what I essentially did. Essentially all I let him do was prepare equipment for me (for intubation and IV cannulation) and then CPR during transport. I believe by bringing him along instead of a firefighter, that it will allow the family to have better coping skills, as he'll be able to confirm everything went smoothly and as best as it could have. Thanks again. J

Alright, I just ran into a unique situation which I've never encountered before so I'd like some ideas or thoughts about what you guys would do with this. Perhaps it should be in the scenario section, so feel free to move. Anyways, I just finished working a cardiac arrest. Nothing surprising or atypical about the call except for the fact there was another ALS medic on scene whom I know personally, but he was off duty. He was there because the patient is his wifes mother (so his mother-in-law). He offered to help and wanted to be involved with the care, and since I was the only ALS medic around and could have used the help, I was torn between what to do. I won't mention what occured just yet, but I want to see how others would have handled this. What would you do in this situation? Jacob

Ahhh! I'm not going to comment on what you 'should' be doing, cuz what you 'should' be doing and what you probably do are two different things But! Some little insight because I love technicalities ... -PCP students ONLY complete preceptorship -ACP students complete preceptorship as well, however some services require consolidation The difference is, preceptorship you are third man on, being supervised and not paid. With consolidation, you are paired with another ACP, and are being paid, but it's kind of like a probation. Essentially, same thing as being precepted as you attend every call (but can drive to scene), except you lose the safety net of your partner when you begin transporting. Personally, I believe EVERY service should require consolidation for new ACPs, but whatever. And, browny points ... EVERY call you complete as a student, you should be filling out one of the special codes on the ACR (56 i think). Jacob

I'm going out on a limb here ... but dehydration with ensuing electrolyte disturbances. If I remember correctly, it's either hypokalemia or hypophosphatemia, either way, both would be able to account for the neuro deficits. That, and I would be thinking along the lines as the others in terms of your major neuro problems, but JPINFV has a good thought about the polioencephalitis. :?:

Well Entonox does come in a compressed gas cylinder. It needs to be mixed with oxygen, otherwise ... well if you give it to them straight, they're not receiving any O2.

Most likely it was Entonox (Nitrous Oxide). It's quite common for pain relief, and even certain provinces (BC and AB that I know of) use it on their ambulances. I'll still stick to the standard of morphine and fentanyl tho thanks!

I'm glad this was revived. Not to criticize you awolfa, but I do think that this is something every practicioner goes through. I can only speak for myself, but I often wonder if new surgeons are as eager to start 'cutting' their patients? Eventually, the novelty wears off. I remember, I was an ALS provider for about 4 or 5 years before I had the opportunity to decompress a chest. After that call, I hope I never have to do it again. Even when I was a new PCP, about 3 months in, the only drug I hadn't given at that time was Epinephrine 1:1000. We got called out for a male child experiencing extrem shortness of breath after eating at a seafood restaurant. The whole time on the way in, I remember this was going to be in. On arrival, as we walked into the restaurant, I spotted the child across a few tables and you could hear him coughing and wheezing, and he was COVERED in hives head to toe. I was getting excited, but then after patient contact and thorough assessment, we ended up just giving salbutamol for his SOB and transported. His vitals and even a thororugh physical were not indicative of a patient experience anaphylaxis, and that was one of the calls that has still stuck with me. Just because I can do something, doesn't mean I have to. And yes, I agree with northernmedic about how once you give a med, you can't take it back. peace

Just so everyone is on the same page ... Now let's see you justify the glucagon :wink:

Ooooo, I just love it when PCPs make the jump to ACP. It just radiates from them

People die ... :wink: Becksdad, great minds think for themselves! (as quoted by a person much smarter then me)

Now that the patients BP is much better, we can down him to a 3/2 first and foremost. Secondly, I'll lay off the drugs, as I'm sticking with my original presumption of a synergistic effect of the alcohol plus meds. His BP is improved and this perfusion to the brain is better, he's in no imminent threat. No sense in adding more pharmaceuticals to his system if I don't have to. I believe his HR remains bradycardic however due to the beta blockers and once again the alcohol. I'm surprised it hasn't increased even slightly however, simply due to startlings law with the fluid. Oh and with that, once he's reached 500 ml, I'll be slowing it down TKVO. peace

Obviously the trendelenberg helped somewhat if the pressure came up and his mentation is improving :wink: (heh, please note sarcasm) Now that he is improving, I'll be a little more reserved. How far out are we?

Do you have to rain on everyones parade?

As there isn't much we could do for this patient here in Ontario, I believe your care is right on. However, why both IVs in the right arm? Im curious ... ingestion was at 1900 hrs the previous evening? She took 100 500 mg tabs of ASA? I don't think her outlook is too good, especially with a 16 hour window. I'm actually surprised she was still conscious and alert. Other then the care you mentioned, I'd be preparing for a full code, or at the minimum, preparing to intubate when she goes into respiratory arrest. That and renal failure, although not much we can do. I was thinking about activated charcoal, but I think that it's way too late for her. We don't have access to it here in EMS, so I really have no idea. If you have the abilities for a foley catheter, that may be beneficial instead of letting her micturate in a urinal. Heh ... if she starts to develop chest pain, would you give her the standard ASA dose along with other 'MONA' drugs?

Yes, I'll admit, the most I read up on daily is medications. I carry a drug guide with me (and no, not a pocket sized one, a real one) and anything new that pops up I'll read about as soon as I can. Plus, there's so many side effects with the most common medications, I find myself constantly reviewing those. peace

How about ... just TALK to your partner? If he's going to fast, tell him to slow down (as diplomatically as possible), if your hands are full, tell him, I'm busy, one second! It's not about looking cool, and being suave and slick; it's about communicating with your partner. Just because you're new doesn't give you the excuse to be a "klutz". I'm not saying you are, but don't worry about what other people think. If you need an extra few minutes, tell him or her. No worries! They should be professional enough to let you do your thing. Besides, how are you suppose to develop your own routine if you keep following everyone elses? peace