AKmedik8or

Ammonia ampules BAD BAD BAD IDEA using ammonia at or near an airway in a obtunded person increases your chance of causing respiratory distress 1000 fold. This type of thearpy went out of style just like clam shell restrainting of combative patients. Don't be "that medic" that causes more harm than good more drawing attention to him / her self by treating people with shock drama type care. Less is more I agree with the above posts the more subtle you are the more control of the situation you will have; not only that but, if for some reason you miss the fact that the patient is really unconscious and you are bellowing away with " GET UP AND STOP FAKING". You will never be that caught on video tape medic.

colleagues; I apologize for the absence of the pre-treatment BGL it was 42. Again the patient presented lucid warm and dry and in not in acute distress none the less hypoglycemic. Also to address the concerns of monitor testing v/s calibration. A bench calibration is done with the high and low solution each monday of the week.

Is there a difference in BGL levels? A patient presented with an episode of near syncope after standing. Patients B/P 140/90, cardiac monitor sinus without ectopy, no orthostatic changes, 12 lead without ST changes. The patient was conscious and lucid throughout contact, warm and dry skin really in no apparent distress. The Pt did have an extensive heart history and as a new onset diabetic, who by his own admission is very non-compliant. Our treatment was oral glucose and juice, the patient went on to explain episode of fever and diarrhea increased stress from work and so on. It was our advice for the patient to seek medical evaluation, he agreed, follow up evaluation of BGL at the start of IV after 10 minutes or so which showed an expected increase in BGL at 96. On arrival at the ED Pt BGL 108 without further change. The statement from the ER doc was that there is a 10 to 20% difference between capillary blood and venous blood, further, that all pre-hospital accu-check type BGL testing devices are calibrated to test capillary blood only. I was caught off guard by his statement; I have not been able to find any information that supports his claim as to a difference between the two in testing with a finger stick v/s IV catheter return. Anyone have the answer?

Our system has had the autopulse in trial and now in-service system wide for the last 9 months. There is a cost to consider and one that we did fund raising for through local community council members. How do can you put a equal value on ineffective CPR? In all four of the patients I have used the autopulse on all four have excellent profusion, no not all had a positive out come however vast improvement over conventional chest compressions. Dust don't resist positive change.

I had a pair of Robin's safety scissors in the early 90's and managed to keep them up until about 2 years ago, I was hired as a fire fighter paramedic for a fire department and went from carrying the shears in a jailer's style key silencer to my turnout pockets. Bad move, the weight of the shears caused them to fall out all the time unless I took conscious note as to their position. At last they found a new home where I'm note sure I only hope that well after a decade of use the person that has them takes good care of them. I did really enjoy them when I worked in the private ambulance industry, I you are looking to spend money put the additional money into your stethoscope you'll use that on every patient.

Our department had the EZ IO in-service for ~ 3-4 months, you're going to find it an excellent addition to your patient care tools. With the EZ IO and the Auto pulse, codes have become nearly hands off.

The medical system is not being dumbed down as much as it is being run down. The effect is directed toward every worker in the medical field MD PA RN LPN EMT all the way down to the person slinging the prepackaged ready to warm fortified food in the hospital cafeteria. The system we work in won't stand for a higher quality; there is no cost savings in a well rounded education. The quality is measured in high volume rapid treatment / testing using the lasted and greatest diagnostic tool. Promoted by some recently fired copier salesmen newly appointed to medical sales who pushes the sale off onto the hospital or sells to your EMS director who last ran a call when emergency was on prime time. The days of having experience prior to advancing in the medical field are gone. The system is over burdened and broken. Patients are educated (brain washed) through TV ads as to the type of medications they need for their illness or lack of, heck, ASA cures all. The first thing I attempt to show 3rd riders new EMT's and Paramedic students is using your head ears eyes nose sense of touch and humanity in patient care, otherwise known as a patient rapport & exam. The first diagnostic tool on the patient is your hands. I mean really WTF are schools being forced to teach? I realize the demand for medical care workers is high, in a system of high demand you would expect to produce a high quality highly experienced worker. I too am bummed by the lack of knowledge that my colleagues. where is the desire to seek knowledge?

First step -- reassessment -- some where in this presentation something doesn't seem to add up. Either way shock him into something that does add up. The VS you have presented are unsustainable anyway you look at this. Get a Truck company enroute to start taking that back room wall down to pull your Pt from the second floor. Pray you've got some newbie 3rd rider for CPR. With any luck reassessment will provide a presentation with improved survivability.

There was a similar 24 hour work schedule in Denver CO and you may be able to find the case law that went into the settlement against AMR in the favor of their employees'. I know several employees that received back payment for wages for their "sleep time". If you have a duty to respond you should receive wages.

If the topic is still IN narcan it is a excellent route, given the nature of the social habits of patients requiring narcan it provides a route with reduced risk subjecting patient bystanders and crew to potential body fluids through exposure. Side note you are introducing fluid to an airway however small the amount have a heighten awareness for the reactive airway.

Your Kung Fu is very deep for my known pre-hospital medicine, If the issue at hand is looking at a pre-hospital LP before a CT I would suggest at holding the LP to not change the volume of CSF prior to radiology. Are we looking at a R/o meningitis? encephalitis? Also has there been considerations for immunizations or treatment for pertussis?

Question to the family as to the need for the PPD test, consider etiology seizure due to spinal TB metastasized to the CNS. What was the EKG? Consider CVA family Hx Parasitic infestation alcohol with drawl poly-pharmacological OD. Increasing / repeating benzodiazepine treatment without considering RSI, RSI increases the risk to the Pt without controlling the seizure the CNS is still in seizure, without an further information to the Hx of etiology of the seizure there is a risk of an under laying myopathy that would leave the Pt paralyzed, evaluate the Pt for hyperthyroid by medication list or prior medical complaint through family interview and hyperkalemia through EKG. Suction the airway position Pt and eval SpO2 and increase benzo dose

If you are stilling open to suggestions; may I suggest Anchorage Alaska...Check out www.afdems.net

AED Kind of stupid if you ask me... An ambulance without an AED... Albuterol Activated Charcoal ASA Epi-pens The above listed medications are not often needed in the world of transfer medicine, however as several folks have pointed out, the first step may first be cardiac monitoring if you are going to proceed down the path of patient treatment that the fore mentioned medications would be given for, however more to the point is what level of airway intervention is your service prepared for? given the type of patient these medications treat, early triage and appropriate ALS vs BLS transport treatment may keep your service from creating a very bad experience for a BLS providers war stories.