mobey

This is why our school systems should correct these deficits in elementary.

I am referring to him as a "doctor" because I don't know his qualifications. How many people have Doctor in front of their names? What is he a Doctor of? I have had people tell me they were doctors only to find out later they were not MD's. Not every doctor has the authority to pronounce a death. I promise you.... a podiatrist will never interfere on a code. Don't even try this sh*t here. While Doctors do not work under protocols in the sense that we do, they still have guidelines they must follow. One of which is pronouncing death. You do realize you are talking to an experienced emergency physician? Don't be condescending. Know your role, and show some respect! When I am on scene it is my call, period. Ya........ about that........ The bottom line is what can be presented in court. Time for you to wake the hell up bucko. The bottom line is Whatever is in the best interest of the patient, and healthcare overall

Seems about right for Ab. Don't forget to ask who the med director is, and do a stock check prior to leaving.

To clarify, I was not talking about a piece of paper. I meant if the patients own physician, as well as family are asking for no resusitation, then I am comfortable not bringing back an elderly person from a lodge, to put them on life support in the ICU for a few days at $25,000 a day just to feed my own interest. (estimated dollar figure there). The other way to look at it is: A Dr. has "Called the code". I am no one to undermine him in this circumstance. If this ws one of the 25y/o kitchen staff, I'd be singing a different tune of course. But this is not.

Sorry, i'm not going to read the articles in their entirety, but Arcticat pretty well summed it up. If the patients physician was on scene and states she is a DNR as per him and the patients family, that is a clear cut case for me. Please read my signature phrase and apply it to your practice.

Dwayne: The first was a awake intubation. Nothing nasal related, just cool too see. The 2nd was a nasal intubation. He simply slid a cuffed tube down the nare, and it landed right into the trachea.

That's my strategy... confuse people into a stupor then I appear somewhat right Thanks for the discussion and education Doc, I am way outta my league, but these talks are why I have been frequenting this forum for so many years. Good topic Arcticat

Doc: Please don't take this as a challenge, just curious is all. Why would one use NS to correct asymptomatic (or minor-symptomatic) hyponatremia due to hypervolemia? It appears to me, the literature suggests witholding fluids, and instead supporting excretion of the free water. Treatment would be with hypertonic saline due to the higher mmol/l of Na therefore less overall fluid, but would only be indicated for CNS dysfunction due to the possibility of osmotic demylenation. I am starting to get over my head here, so feel free to put me back on track.

This thread kinda got derailed a little, I was hoping for some more opinion on using NaCl to try increase the sodium on this patient. This can be a very difficult answer and I am not the person to provide the specifics. One of our Doc's or chbare can go into osmolality, but i'll give the grassroots answer. The simple answer is no. Hyponatremia should not be treated out of hospital with Normal saline. The concentration of sodium in 0.9% saline is not sufficient to treat the deficiency when considering the amount of fluid it is suspended in. http://cmbi.bjmu.edu.cn/uptodate/critical%20care/Fluid%20and%20electrolyte%20disorders/Treatment%20of%20hyponatremia-%20SIADH%20and%20reset%20osmostat.htm www.ucsfcme.com/.../15.Anderson.PearlsHypnoatremia.pdf

There are 2 things I always remind my entry level co-workers when discussing I.V. therapy. They have pretty well been said here, but I just feel compelled to put them in bullet form. 1) When using D5W, the body uses the Dextrose and you are left with free water. 2) The ph of NaCl is 5.5 Just a couple of important points that I feel get overlooked sometimes. According to S.Weingard: There are 3 emergency treatments for hyponatremia: 1) Send labs (if you are in clinical setting) 2) Treat CNS symptoms with hypertonic saline 3) Do nothing. http://emcrit.org/podcasts/hyponatremia/ I got a question for ya though: Could/Should Arcticat treat this patient with Normal Saline while transporting to the city? (I have NO idea if he did or not..... this is NOT an excersise in judging my Sk brother, just getting some juices flowing amongst my peers)

The availability of a casual varies between zones. Central zone is 1shift every 3mos. I will reserve my opinions on a public forum, however I would suggest working for a private company until you are used to Alberta EMS operations.

Thanks for the ego boost Dwayne, as you know I really need that I pay people dearly to say such things. You got your Ab registration yet? Dying for casuals here!! The way I approach all my students is the same. I start out with a pep talk, that pretty well sums me up as a preceptor: "Look, you're not here to do what I do on a given call, You're here to do what YOU would do on a given call. That said, you do not get any opportunity to observe me doing calls. That would only show you one style - that may or may not be right. Take what you learned in the classroom and apply it to the patients on your practicum. If you are going to hurt someone I will stop you... otherwise just do what you have been taught, and I will teach you how to adapt and overcome in the situations that the school did not cover (see cold and MVC's thread). Otherwise keep a positive learning attitude, accept critisism, and you will be successful." Paramedicmike: Please note the proper use of your, and you're

After having a 2hr discussion with my student about bleeding and how we contribute to the Trauma Triad of Death, he professed how appreciative he is about how much time I take to build on the foundation of knowledge his school built. My partner compared his practicum to the one she experienced, where she was a slave and treated like a child. That got me thinking: As a practitioner now, what would YOU like from a preceptor if you were back in the student roll?

This has signature written all over it! I think if I ever start an Ab EMS Association, this will be our motto!

Here in Canada, these situation are buisness as usual. Don't underestimate the tinfoil sheets, best to put them next to the skin if possible. Just wrap thier torso. Pocket warmers for yourself. Put them in your pockets and boots on a prolonged extrication. Biggest thing is wind. Try to keep as many windows intact as possible. ITLS does not recognize extreme weather as a "Emergency maneuver" worthy situation. But when faced with a wet patient, in -32C with a wind chill, it does not take long for hypothermia to take effect.... in fact it probably started before you're arrival. Since Hypothermia is one of the lethal triad, protection of C-Spine can become grey....

Just so you are clear about what anecdotal evidence means.... In contrast to your post, I have never worked a code with copious amounts of vomit. So shall we conclude that in your response area we should intubate, and in my response area we should not intubate?

Less of an anomaly, and more of an abnormality. I am also curious as to why so few et intubations in this study? Was it just downplayed in the education? or is a tube only put in place as a medication route if IV can't be placed? Cardiac arrest management is so variable it is hard to gain relevant data. Unless you are using EtC02 or better yet monitoring perfusion pressures invasively - to measure the quality of CPR, all the other data is skewed terribly.

2013 and we still put the disease before the patient? Not "An Epileptic EMT". It is person before disease/disorder "EMT with epilepsy".

I'll close this one up. Total Treatment: 7lt Nacl 20mcg/kg Dopamine Intubated with 7.5tube, bagged at 36/min, sedation with Ketamine PEEP at 10cm Ventolin via ET tube Position patient mid fowlers On arrival at ICU 3hrs later, patient went into cardiac arrest (that's right.... all that work and the ICU lets her code). She has ROSC after 2 rounds of Epi, and CPR. Her HR remains at 70bpm, due to the Beta-blocker. 0.1mg I.V. Epi 1:10000 pushed to try raise HR does not work. A Levo infusion is started with the Dopamine. The patient survives the night. Final diagnosis: SIRS leading to ARDS leading to MODS with renal failure, acites, and small insignificant hemothorax. Thx for playing!

http://www.telegraph.co.uk/motoring/car-manufacturers/vauxhall/9796497/Good-Samaritan-Janice-Dunlop-given-replacement-car-by-Vauxhall.html Thank goodness they made it right for her.

*Bump This one played out? Do we just stick a fork in her?

At some point we (EMS) need to learn to embrace the media and use it to advance our profession. The guy should have taken 30 seconds to make a brief statement to distract the cameraman if he was so concerned. There were plenty of people taking care of the patient. "We responded to this scene and found a male with injuries. Paramedics will begin treatment as we transport him to hospital. I have nothing further at this time." This authoritive type of "get outta my way" attitude is played out.

Alright let be help ya'll out. She had significant chest trauma 4 days ago. She probably had a pulmonary contusion. She has been splinting her breathing as well due to pain. This all led to a case of SIRS (Systemic inflammatory distress syndrome. http://emedicine.medscape.com/article/168943-overview) She does not meet the criteria perfectly, however she is beta blocked, so she cannot get tachycardic. Knowing that, what do you all think of the chest sounds? How about fluid? Do we give more fluid, or increase the Dopamine to 20? What do you think of her end-tidal? It is still reading 12 There is a very slight sharkfin on the capnography. Some MDI squirts of Salbutamol levels them out nicely.

Throughout the whole phase

First let me adress the steroids: What are we attempting to achieve with the Dex? The risk is if this is an infection and we give steroids, we could exacurbate it. Do not forget she has been in a hospital for 3 days. For those who are thinking she is fluid overloaded because of crackles: Consider 2 things. 1) Initial air entry sounds 2) Urine output. Are you sure she's overloaded? What else could be causing the crackles?