Mateo_1387

You cannot use the frontal plane axis to rule out VT. This kind of thinking is extremely dangerous. Wide and fast is VT until proven otherwise! This ECG shows RBBB morphology in lead V1 and left axis deviation. In other words, bifascicular morphology (RBBB/LAFB) which is the exact morphology we could expect if the VT originated in the left posterior fascicle of the left ventricle. In other words, one of the EXPECTED morphologies of VT. ERDoc used Brugada's critiera in the only responsible way, in my opinion, and that is to rule-in VT. Failure to rule-in VT does not rule-out VT and these criteria do more harm than good, especially in the prehospital setting.... by a large margin.

Tom

Care to provide some more information on the highlighted parts? From what I read on the Brugada link by ER Doc, it is safe to rule SVT with aberrancy if the VTach criteria is not met. How do you know the criteria does more harm than good in the prehospital setting?

... You are maxed out on pain meds. This man's pain is chronic. Relieving anxiety and fear will only help.

BTW... narcotic withdrawal rebound will also increase perceived pain and anxiety. Has this patient been on narcs for a long time? He may be addicted.

Not exactly maxed out on pain meds, the conundrum is whether to give the inhaled pain med (the only one available) or to continue nebulizers, after the man has a sudden demise.

I totally agree with the idea that relieving anxiety and fear will only help. I assume that is why he is on temazepam too.

He's got asthma... exacerbated by anxiety. I'd try to calm him down with valium. Its what I got other than versed. You've maxed out on pain control and while I dont have a problem continuing the nebs, attacking on a third front may be useful.

PS.. whats his capillary blood glucose?

edited to add the ps

I'm with you, SL Ativan 0.5mg (maybe repeat once) can only help IMHO. I would not put any benzo's IV since he has narcotics on board and I don't wanna risk any resp depression.

CPAP would be nice if we have it

Continue Ventolin

MgS04 2g over 5min.

How bout an IM epi 0.5mg 1:1000

To be honest if I don't see immediate results, he probably needs intubated, but inubating asthmatics really sucks!

Are you sure it is asthma exacerbated by anxiety? It seemed to be caused by pain from Bushy's post. Quite different exacerbation causes and different treatments. The more I think about this scenario, the more I lean towards treat the pain, which I think would help alleviate tertiary anxiety... Not saying you are both wrong, just thinking out loud.

edited a sentence to make the tone nicer.

Earlier, when you ask him "what happens when you have morphine" he replies "i stopped breathing and woke up in CCU 2 days later"

Youv'e also maxed out your dose 400mcg of IN fentanyl with nil effect.

This pain + worsening SOB is normal for him, he represents today much worse than before. He has also been intubated within the past 2 weeks for asthma.

Well, even if morphine just made him nauseated, the associated histamine release on top of his asthma would probably not be a good idea...

What do you think of the one idea of giving the Ventolin for 2 minutes then the Pain med? I know it may not be standard procedure, but this isn't a standard case...

From your scenario, I assume during transport he still has the same lung sounds and but is now able to speak in sentences, so this indicates slight improvement in respiratory status. Either way, you indicate a drastic change in status during transport, all beginning when he has sudden onset of pain.

So, this chronic asthmatic, with narrowed bronchioles, already poorly controlled with steroids and Ventolin, has a sudden onset pain, takes in a deeep breath (I assume), creates in increase in thoracic pressure, causes his heart to reduce Cardiac Output, and makes him look sick.

Well, can he suck on your inhaled analgesic for a few minutes then suck on a neb for a few minutes? I must admit, I have heard of your inhaled analgesic, but am not familiar with its properties, much less its name.

Other questions...

Has this been the norm for him during his hospital stay?

What other pain medications do you have?

Maybe you could let him suck on a Fentanyl patch while receiving a nebulizer....LOL

... Yes, there is a difference between training and education... for example, would you want your daughter to get sex education or sex training? Think about it.

That is one of the best lines I've seen on here in a while !

fecal vomit....even worse when the dementia pt spews it into their 02 mask then starts eating it before you can get your seatblet off to take the mask off their face

Nasty ! I couldn't decide to give you a negative or a positive for the most disgusting thing I have read in a while...

(I decided to stay neutral about it though )

Ok, I got a few things to say...

Seems kinda hinky that you are one who puts your heart and soul into the relationship and works to fix problems as they present yet you wanted to help her get back on her feet, financially speaking. Obviously, you seem dedicated, which makes me think she dumped you. So probably not a spur of the moment decision for her. What I do not get is why you still wanted to help her through school and support her. Most people would be pissed off in your case.

Does she have access to your house, such as a key? Did you change the locks when you separated? I doubt she was nice up to the day you separated, then just turned total bitch like that. Had to have been warning signs. Not blaming you, just sayin'... Plus, when she left you, she probably had some support system to keep her off the streets, unless of course she is an idiot.

If she did have access to your home, she could have simply logged into your computer and pulled up your bank account sites from your browser history. If you have the browser save your passwords it would be simple to get into your bank account information. Also, if you use the same passwords for everything, it would be easy to figure out your account information and then just enter your commonly used password.

I would do a few things in your case. Make a police report. Secure your home and possessions. Find out when the money was moved to try and prove you were not the one who made the transfer. That may at least prove to your bank you did not take the money and may be a way to get a return of some of the money. The other thing, find out which bank account it was transferred to. If it is an account in her name, seems like a sealed deal. Hiring a lawyer may not be a bad idea either.

I hope are not taking my comments as accusing, just rather offering my perspective from what you wrote to maybe help you learn. It sounds like a crappy situation. I hope you can get some of the acute issues resolved. I also hope that you can learn from this experience, grow, move on, and find a healthy relationship for yourself.

Good luck bro !

What does NDA stand for?

Had one patient that still makes me gag to this day nearly 5 years later, been unkempt for weeks, urinated on himself, body odour and then when taking across to the stretcher, defecated himself and also had pressure ulcers and what looked like Nacrotising Fascitis on the lower extremities. Liquid bowel motion coupled with decayed skin and all the other smells, in the back of a small ambulance, it made me reetch big time. Working as an RN, nothing can compare to that smell.

You described one of my patients almost to a T. Only reason I did not post about it is lacking the ability to describe it. Only difference from yours and mine was a broken colostomy bag that had been poorly taken care of for quite some time. The odor was already there complicated by everything else, just as you have described. I would say thanks, but I'm about ready to heave...

There is not much to do at a wreck off duty. I, as an interstate/highway driver, would rather that cars pass me and keep the flow of traffic moving out of respect for the other drivers that have places to be. Slowing down, stopping, causing congestion and confusion do not help much. Add that to their inability to positively help the situation, and I say they can keep on truckin'...

The only time I could see stopping to help is if there are extreme temperatures. Offering a vehicle for air conditioning would be a nice gesture.

Forum, I am sorry for a late reply to the thread. These last few weeks have been busy. Thanks all for your replies, here is mine…

Okay, I will start.

I think we are here to learn lessons we need to, which didn't take or we didn't learn in previous lives. As in, themes for your life--like hero, builder, analyzer, controller, healer, humanitarian, etc,,,, And we return until we complete these. From there, who knows? We go onto to something further. I think many on this board are these themes. There are others, but I think I am done for now...........

Hmmm, these define us, I agree, how do you think this ties into the meaning or purpose of our existence?

We are here because some simple self-replicating nucleic acid formed on earth some time ago, and through Darwinian evolution an incredible amount of biodiversity arouse. Our purpose in life should be to maximize well-being and foster a rich, peaceful, and advanced human culture and spread well beyond the earth to ensure our eggs are in more then one basket, in order for survival of the human race. Otherwise our demise is rapidly approaching from human war and religious intolerance, asteroids, a pulsar star destroying the ozone, global warming, climate altering volcanic activity, etc.

A majority of answers I am finding are saying that we are here to better our world. That does seem noble. I think it was Ruff who said it was stupid to think we can all change the world, although some may reach that mark, we have a better chance to enrich our own corner. I can agree with that.

I think one of the most ridiculous things we do is ask questions like this. It's just so anthropocentric. The centipede and the tree don't ask what the meaning of life is. That being said, I love the discussion.

I think our job is to exist, evolve, and most importantly, obey the laws of nature. Every other species does, but somehow we think we are special and can reproduce indefinitely and manipulate our environment to an infinite extent. All creatures affect their environment, but not like we do. We are destroying the biodiversity of this planet while we continue to devolve. *Getting off soapbox.*

One of the most important things I think we can all do is stop defining good and bad. We are so preoccupied with this inane activity, and hell, I do it too sometimes. But recently, when my grandma died, people expressed to me that they were sorry and how it was so "awful." I wasn't sure how to take it. I'll miss her, but she was 92 years old and suffering from late stage dementia. It wasn't GOOD, but neither can I say it was really bad. It just...is. Take a traffic jam as another example. If you sit there and think about how "bad" it is, you will miss seeing it for what it truly is and also miss the opportunity for either introspection, conversation, listening to music, or a million other things. There are so many things in life that we could take so much advantage of if we weren't so caught up in how abstractly good or bad they were. They are.

Tom, I thought getting smacked with a goth Barbie hanging from the rafters was a bit more ridiculous than this discussion, but, then again, you might get more pleasure from goth Barbie…

Interesting though that we are here solely to exist and evolve. So, when we get better at surviving, and evolve becoming greater and greater, isn’t manipulation of nature just another step of it? What are the so called laws of nature we must or should obey?

I agree and disagree with you to an extent about defining good and bad. I am probably not going to be able to explain myself well, but I hope you get my point. Without being able to define good or bad, we are left with neutral. Neutral does not give much of a reaction in response to an event.

A bear charges at you… neutral, it just is.

Your child is screaming in pain from being in a car wreck…neutral, it just is

You just had the best goth Barbie beating from the rafters… neutral, no point in relishing this moment

I guess what I am getting at is there is has to be good and bad in order to extract feelings. Seem that without good or bad, we will not have much of a driving force to make change.

So, I guess that is where I disagree with your opinion that we should not define good and bad. I do agree that we should not occupy ourselves with the definitions though. Much time can be wasted with the practice. For sure.

Here's the rub- God is all powerful, omnipotent, and far more complex than humanity can ever understand. Therefore, God speaks to each individual as they need to be spoken to, sometimes overtly, sometimes not so much. Therefore, the way that you conceptualize God may be wholly different from the way that I conceptualize God... and it is very arrogant of me to assume that I can tell YOU how to communicate with God. That my definition is somehow better or more complete than yours. Without the grace of God, as I conceptualize Him, I would not be alive at this moment. (There are many levels to that statement; if you know me, you already know some of the levels.)

We are here to live life to its fullest and to help each other through the journey called life. Each of us has different strengths, a different purpose in life. To ignore that which we are is the ultimate dishonesty.

Existence, no matter how short, is a precious gift that should not be taken for granted or wasted. Live your life as fully as possible, live in an upright fashion that allows you to help others to reach their full potential, and never forget that there is a greater plan, even when you can't see the blueprint lines.

--Wendy

Wendy, I always love to see your comments, but as we have discussed before, you know I am going to disagree. I get the impression that your argument is that God exists, and that no matter how you view existence, except the denial that God exists, that your relationship with God is just too complicated to truly understand? Please correct me, I’m probably wrong.

The thing is religion is based on faith. I have faith that goth barbies are going to take over the world and kill all of human kind, doesn’t mean it is going to happen, just like a greater plan is not guaranteed.

I have never thought about what came before the beginning? Makes me think a little harder.

But remember, God created the act of free will. You can say you do something in God's name yet are you really doing it for God? Without the act of free will you would be fulfilling God's actions, not your own. Put free will into it and you can do anything in anyone's name.

I could go out, kill 20 women or men and say I did it in Ronald Reagans name and it makes me no less culpable than the people who do what they do in the name of religion. But I digress.

To the bold statement, this is what I think the answer is to define our existence. I have no clue what it is, I just find it interesting to think about. I try not to spend all my time thinking about it, as it could become pathologic, but I find it interesting none the less.

To the rest of your post, which I edited how much was quoted, did you just give points to the non-religious argument?

…………………………………………………………………

I am not certain why we are here. I do feel the desire to make changes for the better in life, to be a moral and ethical person, but I have no clue why. I wanted to see where other stood on this discussion. I love you all for the responses. I apologize that I don’t really have an opinion, but, should I think of one, I will do my best to share it with you folks.

Matty

Those are his brown pants... plus its an actor not like its a real patient....

Well, I admit I am wrong. I viewed this video on my desktop and could have sworn to what I saw. Looked at it on the laptop and can obviously see the pants. My bad.

Any particular reason why I got the negative two posts up?

Watch the video, go the the 3 minute 6 second mark and take a good look at that patient's exposed groin. Not a very good representation IMO.

Western Carolina University in Cullowhee NC. I have provided a link.

http://www.wcu.edu/4637.asp

Meh.

I think the Fail! in the video is at 3:06.

I don't care for the song personally and after the 3:06 section, I think it should be removed.

Hmm, quite interesting thus far.

From existence to global warming, quite a derailment. I understand though it went that direction to try and back up the original discussion.

The most difficult part of this discussion about existence is that there does not seem to be an absolutely right answer. That is why I put the question out here on the city, to see what others say. I knew you guys could put a spin on the question and provide some insight to my questioning of existence. Thanks !

I am going to wait just a little bit longer to reply. I want to see if anyone else cares to add their logic. Plus waiting will give the Monday and Tuesday slackers a chance to see this thread a reply to it, hopefully before it gets too far away from the original question.

Matt

Ruff, Eydawyn, thanks for joining in on the conversation.

I would like all kinds of responses. There have been some interesting ones thus far.

I will quote myself. Just to restate that I want those of the religious flavor to participate and I will not ignore the thought. Just as a disclaimer, I wanted it to be known that I was mostly looking for a non-religious answer, but*, I am willing to read the religious answers, I just ask for a some sustenance to back it up.

To start off with, I want to say this without stepping on everyones toes. One answer I do not accept personally for this question is the religious view. This is not to stop those who are religious from joining in on the conversation, but, I ask that we do not simply say in so many words 'we exist for God'. Follow the religious answers up with something of great sustenance. I am willing to explore the area of religion as it applies to this discussion, but, I hope too many do not get pissed off with where it may go. See what I am saying?

Again, thanks for the replies Ruff, Eydawn.

Please keep them coming folks. I like what I am reading so far. I will give some replies soon.

We are not here to merely make a living. We are here to enrich the world, and we impoverish ourselves if we forget this errand. ~ Woodrow Wilson

To start out with, I have no clue if this is a quote by Woodrow Wilson, and I frankly do not care. The content of the quote is what should be discussed. The quote gives a reason for existence, to enrich the world. In my meek world, I question quotes like this, but more importantly, the meaning of existence.

So, the question to be discussed, what is the purpose or meaning of our existence?

This thread is purely an exercise of mental masturbation. I think it would be an interesting discussion topic. I hope others concur.

To start off with, I want to say this without stepping on everyones toes. One answer I do not accept personally for this question is the religious view. This is not to stop those who are religious from joining in on the conversation, but, I ask that we do not simply say in so many words 'we exist for God'. Follow the religious answers up with something of great sustenance. I am willing to explore the area of religion as it applies to this discussion, but, I hope too many do not get pissed off with where it may go. See what I am saying?

Matt.

This will certainly make you think twice about coping documents at a gas station pay per copy machine, for sure !

Aw sweet does this mean Ima finally be on COPS

Damn dudes lets have a chillax and see what we are working with eh? Sounds like a plan to me!

Log roll and collar, scoop, move to the ambulance.

Basic vitals (BP/HR/RR/SPO2/GCS/ECG) and exam, expose, good look at pelvis and abdo.

Oxygen NRB @ 10 LPM

IV access

Traction splint broken leg

I realize you write splinting at the bottom of the list, but our newer members should be told that the bilateral femur fractures are not the main concerns of this patient, although they are probably contributing to the hypotension. This patient needs aggressive airway control, aggressive control of circulatory status, and transport to a trauma center. As described by chbare, this patient is a critical patient. Although the femurs will need attention, they will take a low priority in our facet of care. I am not harping on you Kiwi, just trying to point something out to remind others. It is something we all must learn/have learned that we have to respond to the call and emergencies presented to us, not react to the scene, family, or injuries presented to us.

Chbare, thanks for the scenario, I found it quite interesting.

Well thats better, of course factoring cost of living would still be a pay cut. I may just stay where I am at.

Looks like I pissed off some moron as they keep putting negatives on any post I make. To bad they are not man or woman enough to post why they feel a post deserves negative.

I thought it was pretty self explanatory why you deserved that negative. Nobody is here to listen to you gloat about being a well paid paramedic. The thread about about Colorado jobs, not about your awesome pay.

Exactly. To provide care you must be able to communicate. I do not agree with what many of my patients are involved with yet I still treat them to the best of my ability. I commend you for the attitude of a true health care professional.

Wow I just noticed someone gave me a negative for providing a resource. That is just low by who ever did that.

Actually, I think you are talking about the negative I gave you. I gave it to you for being a hypocrite. In your first post you asked for there to be no political discussion about learning Spanish. Then your very next sentence is you giving your opinion about why we should learn Spanish. Hypocrite fail.

Than I found I did not like the title, At least someone is giving back a little something. Like they owe it to us, as if us professionals volunteer our time, giving it away, and now someone, decides to finally give back to us. Sounds like a wacker mentality to me.

I just thought the least I could do was explain to Spenac why I gave him a negative.

Matt

*edit to add the second paragraph*

Hose monkey is always a good start.

There needs to be some video of this.

I bet her CT scan shows an old cerebral infarction and her labs show that she has acidosis.