mobey

Perhaps then, you need to work 50 of them so you can see the 1 or 2 that make it and thank you. Yes most dead people stay dead, but that is a horrible excuse to not treat them.

Should have said fresh. Point remains the same. Red-neck again JT??

Looks like a serious unibrow. I'm with you on this one.

WTF?? A warm code, and you would not work it?? This is where actually working the call, and armchair quarterbacking just do not align. There is no freaking way you are dispatched to a warm code, with no signs of obvious irreversible death, and do nothing. I do not believe youhave a law that allows that for any level of provider. Perhaps after 2 min of CPR and one shock, he recovers back to his 100% and is able to snuggle his first grandaughter that is born one week later..... we don't know, that is why we do what is in the best interest of the patient EVERY TIME!

My red neck is showing. We don't transport corpses, wheather we are doing CPR or not. Then again, a large crowd here is 5 people. I suppose if I was on a busy urban street, I would do what is nessesary to maintain post-code dignity of the patient, as well as the audience. I am not sure I would take my rig out of service for an extended period to do so..... then again, being in-service is a high priority out here where we are the only show in town.

Jumping in late here. I am still pretty quick to pull the Bicarb trigger, so we could push 1meq/kg. Otherwise, make sure he got some fluids during the code, and that's it. ASSume he had a big thrombus somewhere, and call police to ndeal with the body.

I have done Fentanyl-only intubations as well, this would be a case where that is an option in my playbook.

Perhaps I have been listening to too much emcrit podcast, but I would try manage this guy more aggressively. He is suicidal, and seems pretty serious. I am going to protect him and myself with chemical restraint. In this preticular case I'd opt for Ketamine as it will provide some analgesia as well as sedate him without having much effect on resparations. Once he is disassociated I could either introduce a tube into the existing hole, or go to the cric membrane and make a new one. If all else fails.... I can put the mask back on and leave it the F alone! With suicidal idealations, and an unprotected tracheal toilet I call this airway unstable.

Ya, chemical pneumonia was at the top of my list too. This reminded me of an airbag pneumonitis. As far as the flight goes, he was flown due to the distance to the pediatric hospital (3.5hrs by ground). I am not trying to withold any info here, his presentation did not change, and I actually walked him onto the plane. Isolation procations and prepare for transport. Thanks for bringing that up Dave. What would ya'll use? When the Dr was giving me report I was thinking "Damn... this sounds like a scene from Outbreak" I do promise I will try hard to get a diagnosis and treatment.

I am not really good at these situations as I have recently proven to my family, so I am no one to offer advice but, this right here is a red flag in my books. I am not so sure you should be investing that much into ANYONE elses choices, that you have accepted responcibility for thier actions. In my opinion, and experience, the answer is right here: BTW: You're in Canada? man I'm behind..... What province are you in? Perhaps I can offer advice on other air services that may offer you some casual.

Note: Although I did not get to see the chest x-ray, the family clinic Dr. stated it looked like a "widespread bilateral bronchial pneumonia". You can interpret that however you like. The oats were mouldy, but there was no trauma involved (asphyxiation of fall, etc) I asked if the oats had been treated (farmer slang for chemical applied to the product) but he denied any pesticides/treatments. He has shoveled oats in the past. I am trying to get a final Dx on this kid, really interesting imo

I like to use the shock index. OK, being a smartass. I have a few things that will be productive to your thread, but I want to find some studies to support them. I'll post them later tonight.

This is gonna be a little different than a normal scenario, as I do not have the final diagnosis. I just thought this was an interesting case, and it was fun going through the differential diagnosis. A 16y/o 155lb male was shoveling a bin of old oats at 1400hrs. There was some mould in the bin, as well as rats/mice. He was not wearing a mask. At 1800hrs he had sudden onset pleuritis and SOB. His mother gave him an advil (500mg) and told him to lay down. At 1830 the pleuritis became worse (9/10) and he was notably tachypneic due to splinting his breathing. He was quite lethargic and generally weak. His mother brought him to the ER: HR: 140 BP 90/42 Temp 39.8 RR 36 Sp02 98% room air Skin diaphoretic & flushed A&O X4 9/10 chest pain midsternal nonradiating pleuritic in nature. Auscltation= quiet on the left, but clear. Right apex clear but some crackles noted in the base. Overall, very hard to hear bases as patient will not take full breaths. Pt was given 1G Tylenol, and fever was gone within 30min. A 500ml bolus was administered and vitals changed to: HR 110 BP 100/44 Temp 36.4 RR 36 Sp02 98% What would you do for this patient? What kind of hospital would be most approprate? Differential Diagnosis?

I have absolutely no science to back this up.... at all. This is just something I did once, and I have serious doubts it even works. Start an IV and wrap the IV tubing around an icepack like a coil. Theoretically the solution should be a little cooler going in to the patient. Other than that, I dampen the patient and turn on the A/c, then the usual icepacks to auxilla and groin. But we have more hypothermias up here in the white north, not too many hyperthermia's.

So which text are you using?

I do believe the message of my post may have got lost in the breif delivery. I was responding to the question "Should we teach SI to EMT-Bs?" I am not saying MAP is better as a general rule, I don't know that because I have not reviewed the literature comparatively. However, for the EMT-B curriculum my opinion remains the same, I believe MAP is better for a basic to use as a diagnostic tool. Not only is it readily available when using a LP 12-15, but it is "universal" language. Just look at how many here have never heard of SI, vs MAP. Perhaps SI will be the new upcoming measurement to replace MAP in trauma patients, but should that start with EMT-B's in the USA? Prolly not. I dunno..... I have not intentionally opressed anyone here since crotchitymedic (see the thin line there?) Anyway, if Steve feels stepped on, I am sure he would stand up for himself and tell us to shut the F up, in an eloquent professional manner. I suspect you may be having a bad hairday?

Damn Asys beat me too it. I think MAP (if using LP12-15) is a way better tool. It is important that students understand systolic is a representation of preload, diastolic is a representation of vascular resistance, and a MAP of 60 is needed to perfuse the vital organs. When giving fluids/pressors, I use MAP and signs of perfusion, not BP. If I were to do any "above and beyond" training, it would be that.

What a great addition to the pool of scenario's here. Good job buddy, I prolly would not have given the Versed, but will be reconsidering now. Even as a diagnostic tool.

Being as hypotensive as he is, benzo's are a no-no in my books. To reach the sedation dose required for cardioversion, we will end up decreasing his BP even further, and feed that tachycardia through baroreceptor feedback. If anything, this guy would get Ketamine, or Fentanyl.

This is the road I was originally on as well. Thought even a SSRI overdose..... Then I noted he was not hyperthermic. I suspect you missed that? I am on the cardiac train now.

I just love how these topics always reference genitals. I have worked for these types of services. I left. I am happy now. It really can be that simple. That coming from a home owner, and father of 3.

OK, Ill pull the trigger. I have enough history to shock this dude. Sync Cardioversion at 200J please.

Remember this is Canada, 30C is pretty well a "hot summer day" here. As it is spring, we are acclimatized to -30 right now. Super stoked you are posting a scenario What does he look like? Needle marks? overweight? scars on the chest? Lets throw on a NRB @ 10lt, and a nice big IV. Start some fluids bolusing while we grab a 12 lead and prepare the chest for defib pads.

Rationale?

No my ancestors are.