mobey

When a pregnant woman codes in front of you, and you eventually choose to stop CPR, you must take into account you are essentially choosing exactly the moment her unborn baby will die right in front of you, while under your care. Sometimes being a Paramedic fucking sucks. Feel free to turn this thread into whatever you want, I just want those who do what I do, to agree, sometimes our job sucks!

I dunno where I get this but: RuffEMS

I personally have not done the South beach diet, but my ENTIRE family has. The common feedback was it is good for a short time. They all lost a bunch of weight and got whipped into shape, however, eventually the food preparation got to be too much. The recipe's take a while tto prepare, and some of the ingredients are just not available in our area. After 6mos they all quit it, and just concentrated on building thier own healthy diet with what was availabe.

No one is mocking you. We are getting frusterated, and for good reason. We get alot of patients just like you who do not understand why you were treated the way were and have questions. The problem is, your questions revolve around a seperate agenda, and it is one we are all too familiar with. Your posts give the impression you were looking to point fingers at these medics, Perhaps that is not the message you were trying to send, but that is the one recieved. When us rounded Paramedics validated the way you were treated (ie; no lights & sirens, possible hyperventilation) you rejected the idea. That only solidifies in our minds, that you are not looking for widespread reasoning or explination, you are looking for validation of your distaste for the way you were treated by EMS. Well sorry to spoil your pity party, but as EMS professionals, it is not our perogative to judge eachother behind our backs (or at least it should not be, and some still have some professional development to work on). I realize you are reading medical records, but you should really put them into perspective, do you really expect a Doctor to write "Patient appears anxious" in his notes?..... not likely. But hey if ALL the details were in those charts you would not be asking us questions right? Then stop rejecting our answers. You are an educator, you can do better than this.

I assume by Doc, you meant me? j/k... I actually just want to jump in here so I can show off a little then get knocked down a peg and learn from our resident doc's Dyspnea in Sepsis: During sepsis the patient will present with incresed lactate levels. Lactate is a byproduct of hypoxic tissues utilizing anaroebic metabolism as seen in sepsis. Lactate (Lactic acid) is transformed into C02 and H+ and creates a acidotic state. Because our resiratory drive is based on Ph values in the CSF (chemoreceptors) this stimulates tachypnea in a effort to blow off the extra c02. Done without refreshing, so excuse the errors.

Silly swype almost made you look like an a$$. Good thing this was a typo......

Panic attack? Now who is putting words in whom's mouth?

If your blood pressure was 170/100 your heart was pumping blood just fine. Increased respiratory rate would be expected in this case, but not 30. I am sure there was a fear factor playing a role here.

I never said - that you said you were at deaths door. I said I don't think you were. I get the feeling you completely ignored the message of my post.....

Thought I would fix this up for ya Many things can effect the way we transport patients, including distance to hospital, traffic, driving experience, weather. The use of lights & sirens has not been shown to reduce transport times to the hospital in the urban setting. I routinely use them on the highway during critical transport, and shut them off once in city limits. If this was a Basic life support ambulance in an urban setting, they may have been justified in everything they did, and we as professionals on this site have no buisness armchair quarterbacking thier call. The fact that you were treated with pharmacologics and not electricity immediatly speaks to the fact you were being treated as a "stable" patient. I fully realize you were suffering mentally, and a HR that high cannot be sustained for too long, however, it appears you were not at deaths door. It is very common here for EMS to stay and observe in the ER.

When I approached this patient I assumed stroke. I suctioned her, put in an NPA, nasal cannula, and hit the road. Enroute to the stroke centre (without surgical capabilities) I started 2 I.V. at TkVo. 12 lead was unremarkable. I administered 10mg Maxeran IVP I RSI'd using 100mcg Fentanyl, and 2.5Midazolam. I used Succ for paralysis. A 7.5tube was placed and confirmed by ausiltation, visualization, bulb, EtC02 waveform and numerical. I immediatly suctioned as far as I could and got quite a bit of vomit out. Sedation was maintained with 2mg bolus's of Midaz, and 50mcg Bolus's of Fentanyl. No further paralytics were used, and the patient was not making any resp effort. A CT scan was done, and showed thrombolytic stroke with significant swelling. A risk/benefit was weighed as family could not be contacted, and since the mpatient had only a history of glaucoma, TPA was administered. A chest x-ray showed significant aspiration in the left lung. Post TPA the patient did not improve, over the next 12 hrs the HR came up, and Bp decreased (normailized), this could be due to a decrease in swelling. Although I was SURE this was a bleed, I made a pretty good choice by racing to the primary stroke centre to maximize her chances of a positive outcome. This was a good call to make sure my confidence was in check since bypassing to a surgical site based on my theory this was a bleed would have been the wrong choice, as would a helo. Thanks for playing!

Naa, I am talking about standing out in front looking at a light, not that close of proximity that a small blurp from the siren will do auditory damage. I am goofing, not abusing.

I am a huge fan of the "Watch this light on the grill and tell me if it quits flashing". Then jump inside and turn the flasher on, then quickly hit the siren. Gets them every time.

What do her lungs sound like? Temp? Lets give her 20ml/kg bolus and get her to the nearest facility. Baby can have IV/IO access as well. Need a glucose here too. Baby gets a 10ml/kg bolus to start (given the sugars are not high as well). EDIT: Should have read closer

Sorry, left out an important point. EtC02 20 initially, good waveform. Sp02 still 98-99% Yes the tube is above the carina in the trachea.

Love that response!

I work in a different environment I am sure. But I would stop at 7-11 and grab milk if it meant better patient care..... of course remote settings hae different rules. After a little research.... Ph of a tooth: 6.8-7.0 Ph of saline: 7.4 (same as blood) Ph of sterile water 7.0 Ph of 2% milk: 6.8

I do think we expect this to be established when precepting a Paramedic student (This is U.S.... so NOT Primary Care Paramedic *EMT) This is a basic communication skill. Right or wrong, we do not expect to teach basics to Paramedic students.

Code status is "full code" as she has no past medical history. Anyone want to comment on Ketamine with suspected neuro problem that may include increased ICP? Once the tube is placed, the heart rate drops to 28 and BP is 178/102. Pupils are both dilated and sluggish. She is no longer making any respiratory effort. I'll let a few responses to this change, then wrap this up with final treatment diagnosis and outcome.

Happily Furosemide (Lasix) is a loop diuretic. It inhibits the reuptake of Sodium in the loop of Henle in the kidney. We all know "water follows salt" Therefore, it encourages fluid leaving the body. It also has no discrimination to chloride, calcium, or magnesium either. The body... working to remain at homeostasis.... shifts potassium out to match the new electroyte levels. So when given improperly (like to a patient who does not require it) it causes, hypovolemia, Hypokalemia, hypomagnesia, hypocalcemia, hyponatremia. All of these are potentially lethal, and will cause the patient cardiac rhythm disturbance, restlessness, polyuria, polydypsia, abdominal pain, nausea/vomiting, muscle spasms, etc etc /sarcasm: Oh yeah.... the polyuria is hilarious!! sarcasm

Super cool to see you join in Anthony. What would ya'll like to use to intubate? Repeat vitals Bp 150/98 RR 24 deep, nonlaboured Sp02 97% BGL 5,4 (normal) HR 48

I am with all the others, there has to be the right tone. I am not much of a hand holder, but I can fake it pretty good. I usually offer a "I am sorry you are going through this, we will make it as comfortable as possible", or "I am sorry for your loss" I have also thrown out: "I know you're thirsty, but I am working on saving your foot right now", and "Your heart is in a lethal rhythm, and we are going to give you some medication to try straighten it out". I really do make myself the clinical one on a scene, I am not running around giving hugs, I am not raising my voice, or using terms heard on Grey's Anatomy, but if you want clinical information, or someone to remain professional in an emotionally charges situation, I'm your guy. I don't see much wrong with the student's performance, other than missing the followup info about treatment, given it was presented professionally. I think it is important to point out that alot of the coping mechanisms seen on scenes (crying, panic, anger, etc) have to do with the unknown. Just giving a diagnosis, and verbalizing a treatment plan relieves alot of anxiety for everyone..... including the practitioners!

OPA is attempted but the patient goes apniec, once it is pulled out, she starts to breathe again. No... not obstructed airway, I mean with OPA in place she does not attempt resperation at all. No gag reflex it appears. With a NPA, and simple jaw thrust, the patient is taking deep resps at 22/min. Her air entry is clear on the left, and rhonchi heard on the right throughout. No accessory muscle use. Circulation: Pulses are exual at the radials, at a rate of 50bpm and strong. Skin is warm at the core, cool extremeties. Skin turgor is usual for an 80 year old. Pink overall. Now on the cot, the patient is responding to deep pain with only decorticate posuring. History and meds are in previous post Vitals: BP 130/90 HR50 RR22 Sp02 92% (room air) EtCo2 (nasal sidestream) 20mmHg BGL 5.1mmol Here are your transport options 1) Local clinic with GP: 5min away 2) Primary stroke centre (utilizing mini CT and teleconference) 1hr away 3) Major hospital with surgery/ct etc 3hrs 4) Helo rendezous 45min away, then 30min flight to Major hospital.

There has been multiple care homes/long term facilities in the area with patients testing positive for Noroirus. When nearly a dozen people in this home develop coughs, and feers, the public health officer locks it down under the assumption the same here. She in not responsive to verbal, but localizes pain..... just. Her vomiting has stopped now. We strip her clothes off and get her onto the cot. What now? positioning? diagnostics? I know this is a little basic for you adanced scenario responders, but maybe there is a nOob or two out there that could run us through a workup of an unknown unconcious? As I said in the title... this is no brain buster.

Ahhh I see the singular pronoun there. I thought I had a habit of letting down the other forum members here by starting a series of scenarios and then leaving. I do believe I remember the one you are referencing, no need to look it up. Working remotely like I do, I often get 10-12 hour long calls in the middle of the night that screw up my brain for a day or two which is what happened that day. Perhaps you did it with tongue in cheek humor... I really can't tell. OK, leaning forward now Snoring resps, deep at 20/min Suction done.