Mateo_1387

No EMS stickers, but I got out of a ticket by having my paramedic book in my back seat. The Officer looked at it, asked me if I was and emt. (yada yada yada), and let me go with just a verbal warning.

Wow, I think it is funny they will not allow comments for the video !! I guess they don't want their propaganda slandered

Where exactly on his neck is he shot? are there clear enterance and exit wounds? If airways is obstructed I want to clear it and possibly intubate. What about lung sounds? Also would want to do a trauma exam to look for other gsw's.

will want to control bleeding by at least direct pressure and possibly an occlusive dressing. Start an IV. Backboard the patient. Give high flow O2.

Yes you did, and out loud, too!

As for the guy at the downhill end after the falling down upon, is he IN goo, or IS HE goo?

I think that is what is left of the FF !

Goo= Innards, outards, and everything else left over after a human roller gets ya.

How about this uniform, no polo, no badges, and I think everyone can get over the patch.....

James Maietta should be charged with endangerment of public safety officers. The man should have moved down to a bottom floor when he realized he was going to be immobile.

Can you imagine 500 lps of human rolling over you if you were the firefighter at the end of the feet??

0 % wacker.

I have some tones on my phone but no siren, the tones and pager noises get me up in the morning ! 8)

In the U.S. very few services have field termination guidelines other than traumatic arrest or not to work fresh codes and then those that are allowed are specific to aystole prior to arrival . As well, many do not have the luxury of spending 20 minutes on the scene to work the code and then call/pronounce it and await for M.E. another few minutes, etc.. Although, recommended it is not the usual guideline as of yet in most areas.

Maybe in the future more and more would adhere to such practices.

R/r911

I agree ACLS is the same in and out of the hospital. Plus it never really made sense to me to risk yourself running emergency traffic to the hospital with a dead person.

I don't see how one person can do CPR in the back of an Ambulance and still complete ALS skills and expect a recusitation. If it were me in that case I would work the code onscene untill back up arrives, even if that means you and your partner just doing CPR untill other hands can arrive.

I wonder, if it were possible to have a concotion of drugs that would instantly paralyze an attacker? The challenge would be in the variability of administration methods that could occur in a defensive situation . Sub q, IM, and inadvertent IV admin.

Something like a tranquilizer gun might do the trick.......

I think it is funny that they say you don't get a lot of serious calls, yet almost everyone here had a serious first call.....

My first call was a mutual aid out of county call to an MVC where our patient had an open femur fracture.

http://www.wakegov.com/ems/default.htm

I suggest Wake County EMS in NC. Raleigh is in Wake County. Great place to live and work. The EMS system is top notch !

Dude don't try and restir up the bull crap that went on earlier. I know you are trying to make light but not time or place. Thanks.

certainly not my intention........just a little comedy !

:. Pulse oximetry isn't a diagnostic test that proves or disproves tension. Do you even know how a pulse oximiter works?

A person with a sat of 95 is NOT going to be cyanotic!!! Check your pulse ox my friend!! Lets look this over 95% sats probably meen that each heme molocule is almost full of 02](*,)

I got a pulse ox reading of 86 on my ambulance antenna once..........

I'm not sure how soon you'd see cardiac effects from a pneumo, if ever, assuming we're talking pressure and not hypoxia of course.

The lungs aren't really so much crushed, as made unable to inflate.

The heart is working by a completely different set of physical principles.

intrathoracic pressure would decrease the cardiac output.

You notice (The medic says this should have been one of my first questions) that the patient is thin, and approx 6'6” tall....

This should have been noted in the general impression.

Tachy @ 176. Unknown BP though pulse is strong and full

I don't understand how the man can have a tension pneumo (especially a bilat. one) and still have a strong and full pulse while not moving air. If he is not getting enough air and its compressing his heart I'd expect signs and symptoms of shock, To me this would be some signs found early...... thats just my thinking...

I enjoyed following/participating in the scenario

I'd say go ahead and give 1mg of epi 1:1,000 IM. Obviously the patient is about to code without any breathing, and we'll be giving 1 mg IV when he codes in a minute. Besides if he is a tight asthmatic it will start helping to open his lungs and also will increase his BP. I know most people are thinking OMG, he should only give up to 0.5 mg IM, but nah, give the 1 mg....

I have never hear of using CaCl- for premedication. The only plausible situation I can think of is using it if we inadvertently used succ on a patient with hyperkalemia or caused hyperkalemia on a patient with underlying pathology.

Take care,

chbare.

why use calcium for a hyperkalemic patient who you used succ. on?

I've got to make a correction to the rules.....

Rule # 2, part b should now read...........

It is OK for a man to cry ONLY under the following circumstances:

( The moment Angelina Jolie starts buttoning Up her blouse.

Thanks for complying with this new rule...............

ok, I agree about WPW. But here is my question. is it safe to cardiovert with an irregular rythm. The monitor will not be able to syncronize. How have people been told to deal with these types of problems?

Stumped me...........I thought I knew this one, and did not do any research. Since I have done some research i have a new opinion of what the problem is. From what I can tell the digitalis is affecting her extracellular potassium levels by blocking the sodium potassium pump. I'm not sure how this affects the calcium in the cells and why extra calcium proves to be deadly.

I'll definatly learn from this thread.

Am I on the right track?

too bad you weren't here, you could have saved her.

Smarty pants

I had to put some pants on before I showed up onscene, the smarty pants were the only pair left !

From what I've seen of cardiac arrests in many different hospitals they are not too much different than what we do in the field. I have seen one team shock asystole. But as far as running the code it is about the same. especially where I am we have the same meds that the hospital will push. we do the same cpr the hospital does. thats why codes are worked onscene, its much safer, more effective, and we have a very high resuscitation rate. Never did understand the logic of risking lives running emergency traffic for a dead person..........

But again I've not really seen a difference. the only think I could think of that would be different is for a trauma code the hospital can give blood, and do other evasive procedures we can't in a rig.

Here is how I feel about it. Rules to not carry knives to school are good for safety. I agree, ten year olds might not be the best people to let use knives unsupervised. children don't always think about their actions (as do certain adults too!). Ten year olds would be likely to do things like say run with sharp objects, maybe slash the knife around playing like a swordsman, or other various unsafe activities. But I think the rule should not be absolute. Let me explain. If the girl was actually responsible with the knife, used it for food, and never created a problem, she should just be warned not to bring it, contact the parents and discuss school policy, and drop it.

Also when are they going to require bulky pens and poncils so that its hard for kids to stab other kids with the sharp objects???

Ten year old charged with a felony, yet superstars can get away with so much............ neither makes sense.............

Hot grandma here was having left ventricular failure, noted by the left BBB. The decrease in work load of the left ventricle caused her BP to get low. On top of that she was treated for a metabolic problem that she probably wasn't having. Her low BP to begin with, plus calcium (which will cause peripheral vasodilation) caused her BP to drop even more. With the lack of pumping action of the left ventricle the right ventricle was pumping blood to the lungs which caused the pulmonary edema.

Had I been here to intervene earlier I'd have had a dopamine ready for if her perfusion is decreased, not given any calcium, and have given some ASA, and high flow O2, and rapid transport to a hospital. The nausea, dizziness, and what appears to be a resolving MI in the left ventricle is what I think her problem was. Not the a-fib or a metabolic problem. Also since My agency can afford field serum marker tests I would want to do one on her.

You rely on the NIBP?

I have noticed that Zoll monitors tend to find a good reading when it isn't hooked up to anything at all.

I don't always rely on the NIBP, I realize that it is just a tool. But it is a good tool if you and the machine are getting the same answers. Its nice on calls because it will take them continuously,a nd you can use the information it provides and patient information to evaluate your patient. The patient still got the same treatment even without knowing the BP, I couldn't hear it going down the rode doing emergency traffic on I 40 in raleigh. Still though my patient presented to be in shock and thats how she was treated.