mobey

yes I do miss an occasional EMT skill every once in a while, those who say they don't are FOS!!

For the record I am educated ALS working BLS. (Moved provinces...different education standards)

Gotta ask what BLS skills do you forget?

Oxygen? History? BP? How to dress a wound?

Seems to me there are no ALS skills that can be performed without a BLS assessment and BLS intervention first!

Makes you wonder if a paramedic that forgets BLS should be performing ALS interventions and diagnostics at all!

Edit to add this....

I am not going for a personal attack... I just don't want any future medics (or current for that matter) on this forum to think it is accepted to "Forget" the basics just because you have more to think about as a Paramedic.

I believe if a EMT has to "Save a Paramedic" with his BLS skills, that paramedic has failed at his job!

If I seperated out suction skills and I made it a seperate certification, there would be people on here saying "You can't be a paramedic until you have two years behind the suction machine. Suction machines save paramedics. Paramedics forget their suction skills."

Oh my god that is hilarious!!

So true..So true!

I hate it when EMT's say $hit like that, makes me embarrassed to hold the same title.

Wondering if anyone in EMTCity land has taken the distance delivery EMT-P program through Portage in Lac La Biche.

If so, what did you think of it?

I always palpate the artery prior to inflating the cuff, then I know I am in the right spot with my stethoscope.

I was taught when you palpate a BP always add 10 to the systolic.

Great post!!

I too have always had a great interest in the past as well as the future of EMS.

It would be great to hear some stories from you [s:034b67b1c2]oldtimers[/s:034b67b1c2] Pioneers of the buisness about "The way things were"

It would be interesting to hear how the scope of practice has progressed in relationship to education, as well as some "war stories"

Good job

It was a allergy to cloths....Spandex to be exact. I did not hear the exact name but it is one of the chemicals used in treating the rubber spandex is manufactured from.

The patient would have been fine if she would have washed her new sports bra before she wore it.

The hardest part of this call was trying to talk the 22 y/o virgin to take her bra off after I found out it was new - never washed.

Could have a latex allergy as well. Which will make the next hour of your life real fun.

Has this every happened before?

Is she taking any pills for her trip to Mongolia? If so, what, for how long, ever taken any of them before?

Awesome question...but nope no pills. This has never happened before.

What would set off the latex allergy during a run?

... and the allergens are all over her clothes and hence in the back of your rig now. Ergo, your recurrence of symptoms.

Maybe?

Wendy

CO EMT-B

Gettin warmer...run with this, what else can we do?

What kind of questions can you ask?

exercise induced anaphylaxis...

i had heared of that prior to this call and thats what I had stuck in my head. Except that she excersises every day, and this has never happened before. And now the symptoms are recurring and she is lying down.

Good thinking.....But not this time

Interesting. Recurrence of symptoms is always a bummer! Any changed laundry detergent recently? How about personal hygiene products, like deodorants, etc.?

New towels perchance? How about removing the gal's shirt completely (if you haven't already done so) and wiping down the skin with wet wipes or dampened gauze? Let's try to remove the allergen if it's a contact type thing. If it's an inhaled thing... not so much luck there.

I'm still leaning towards "Mr. Wong's Fry Pan Dinner Family Combo 5" as part of our culprit here... for this to be coming back like this with her in a different environment, I'm leaning towards an ingested allergen.

Did she manage to stick herself on any of those plants she encountered? Any puncture marks noticeable at all on her? Could she really and truly be freakin' allergic to mosquitos and be having issues from a large quantity of bites?

Wendy

CO EMT-B

You remove her shirt and pants and inspect her for bites or rashes. Dammit nothing. The welts are clearing up and you don't notice a bunch of mosquito bites. You pay careful attention to her ankles but see no abraisions or needles of any sort. No Hx of detergent or deodorant changes.

Re-read your third paragraph. You really have to think outside the box for this one.

Remember she ate lunch 2 hours ago, and she has had chinese before, even at that restaurant.

You now have a young girl down to her underwear, feeling uncomfortable in your presence. Since you are a 27 y/o male. haha.

I got very frusterated on this call and ended up asking a very open ended question to which her responce gave me the answer that probably saved her life in the future with the mongolia trip coming up fast.

Another hint: The allergen has been specificaly mentioned more than once in this scenario.

Alright, let's ask the stupid question. Does she have a foreign object stuck in her throat? lol

LMAO.... No there is no object.

This "Lump" was there then left after the meds, but just came back. And she seems to be breathing faster again.

Continue high flow O2 and reassess q 5-10. Monitor patient for return of symptoms. Maybe toss in some albuterol for good measure to open her up a bit more. Have her sats improved much from the 90% they were?

You start a neb of Salbutomol and the chest loosens right up. Pt is getting more and more comfortable as time passes.

Sats are up around 96 now. You load the patient and start the trip to the hospital 1 hour away.

This patient is heading to mongolia in 2 days to go on a horseback expedition. You feel a moral obligation to get to the bottom of this episode. You have an hour....Let the detailed history begin.

Oh ya she says there is another lump in her throat about 5 mins down the highway. Same feeling of swallowing "Around" something as before.

When you put in the horse exposure that morning I was leaning towards equine passed Anthrax which had she have had pustules on her hands then that would have cinched the diagnosis but my original allergic rxn choice was right.

take care.

Holy crap that never even crossed my mind.....Thanx Ruff

Yes, 'skeeters bite through shirt and bra.. been there. Has she had any recent illness, or has there been any recent illness in the family? Other than the pneumonia? Has she had pneumonia before? Did they give her any meds for it? If so, when did she quit taking them?

Can I see the shampoo bottle and any other substances she might have had in the shower with her, just to verify they're good ol' herbal essences and not contaminated with something? Thinking devious little brothers here on this one. My brother has done more stupid stuff than I care to name...

Any molds or moldy substances in the barn? The hx of allergy to penicillin makes me wonder. Since penicillin is in fact a mold in origin...

Ah hah! Lunch at the chinee restaurant. What did she eat? Any family history of allergy to shellfish perhaps? This sounds actually suspiciously similar to what happened to my soon to be father-in-law... came home from PF Chang's, anaphylactic reaction soon afterwards. Turns out his body decided to randomly sensitize to shellfish and lo and behold, there was clam juice in the sauce... So, I want to know what she ate, if she shared entrees with anyone else, and if anyone in the family has any sort of food allergy.

What was her running route? Did she go by any chemical sheds or recently fertilized/pesticide sprayed fields? Did she run a different route than she had before?

That should do for now.

Wendy

CO EMT-B

No recent illness, Can't remember the name of the pneumonia med, it's been gone for 2 weeks. The brother fetches the shampoo, Pert Plus she has used it for years...Smells like pert plus.

She did not enter the barn, just grab some bales off the stack, put them in the half ton drive to the pen and dispence.

At the restaurant the family had "Meal for 5" included everything you can imagine, Ribs, Chicken balls, Rice, Deep fried shrimp, noodles etc etc.

No family alergy Hx.

Her running route is the same as always, through the yard, down the lane, down the road 1/2 mile and back. She came in contact with a few plants along the side of the lane...But she says she always does.

No chemicals being used on thier farm right now. Neighbors could have been spraying although it is not too likely because it had rained yesterday and now it is too hot to spray.

Just appear to be welts. None on her hands. No pustules.

You give a dose if IM Epy and IV diphenhydramine. Sorry no solumedrol in the ALS kit (gotta love rural services)

A few minutes pass and she begins to cough less, and is starting to talk. Resps seem to be deeper now.

Reasess AE, Wheezes throughout and still some stridor....A vast imrovement though.

Any urticaria? Does she feel like her throat is closing up?

Agree with the chemicals in the shower. Also, was she cleaning recently? Is this the patient's primary residence or is she visiting? Could be a severe allergic reaction to the animals.

On that note, has she taken care of or otherwise been in contact with the animals recently? Did this start before or after her jog?

Lung sounds? Vitals.

O2, IV, monitor...

Her family states she said it feels like she is swallowing "around something" she is not talking...Too busy trying to move air.

This is her primary residence.

She fed horses this morning at 9 like every other morning.

This started while jogging.

Nope it's been a while since they cleaned the shower. I like that thinking though....Gotta admit I didn't ask that

She shows you the mosquito bites on her chest (although she seems pretty hestant to do so...good catholic girl and all). They look like red welts, too big for mosquito bites. there are lots of them and she is scratching them. You check her back...yup more there. You think to yourself "Can a mosquito bite through a t-shirt and sports bra?"

S Difficulty breathing, Red spots on chest and back, AE= Silent in bases wheezes in upper lobes, Stridor in upper airways. It is hard to assess because with every breath she gags and coughs. Puffy hands, lips, eyelids, etc.

A Peniccilin

M none

P Pneumonia X 1 month ago

L Lunch @ chinese restaurant at noon

E Jogging

PQRST See above.... SOB is rapidly progressing nothing the first responder did helped,(O2 that is).

Pulse ox 90

Monitor = sinus tach

Pulse 115

BP 100/70

Resp hard to assess around 50 very shallow

ok the usual questions that are always asked

Let's ask other not so obvious questions

1. Any history recent of bee sting or insect bite?

2. Chemical exposure

3. Was she doing anything strenuous prior to the onset like strenuous coughing or did she get hit by something to cause a pneumo?

Family states she was out for a jog and came back sooner than expected because there were too many mosquitoes (multiple bites). You ask her about stings and she shakes her head no. Family states she came in, got in the shower, came out of the bathroom panting with shampoo still in her hair and told them to call an ambulance.

No chemical exposure

This is my first scenario so bear with me!!

OK this is a simple scenario based on an actual call I did. The pourpose is to take an accurate complete history, this will prove to be the only way to definitavely treat your patient.

You work for an ALS service in a rural setting. You have a 1 hour transport time to the nearest hospital. You have all the treatments a normal ALS service does except 12 lead.

It is july 2:00pm and you are called to a farmhouse at a horse ranch 10 mins out of town.

Dipatch information: Respond to 22 y/o female, difficulty breathing.

Caller states it is getting worse fast.

You recognise the land location as being the ministers of the church. ALS will arrive at the same time as you.

You arrive on scene to find a clean yard with lots of cattle, horses, chickens..etc. The house is fairly well kept considering there are 5 children in this family.

You see your patient sitting against a wall in the kitchen, a first responder is holding an NRB on her face telling her to keep breathing. Your patient is in obvious distress, you can hear coughing, and choking from the porch. Her tidal volumes suck...seems everytime she tries to take a breath she chokes and coughs.

Ok keep the questions to 2 or 3 per post, I hate it when 1 person asks every question there is and the scenario ends in 3 posts!

Back in Sask we had a "Team" of stupid kids that were good for buisness. The dumbest must have been a 22 y/o in a shopping cart being pulled by a truck. They got around 70km/hr and the front wheels came off (big surprise). He wasn't seriously injured that time, although he broke his back a while later while riding in the back of a truck that was cruising ditches. Now he has vertabrae fused and multiple pins and such holding him together....Thank god for tax payers to get him through life now that his back is screwed!!

Does a spontaneous pneumothorax present with the same signs as a tension pneumothorax?

I speciffically refer to the trachial deviation from midline, and JVD.

Simple answer....NO

You have to consider what causes the deviation and JVD. Increasing interthoracic pressure on one side pushes the mediastinum to the opposite side. The same can be said for the JVD. Think about what causes Jugular veins to distend? How can a pneumo cause this?

Simple Pneumothorax S&S include chest pain, Dyspnea, Anxiety

As it progresses you will find hyperextension of the chest wall, decreased air entry on one side, Cyanosis, Trending decrease in BP, percussion tone changes between the 2 sides.

Tension Pneumo will show further hypotension, JVD, Mental status change,Pulsus Paradoxus, abdominal distension, possible deviated trachea toward unaffected side.

Remember you have to feel trachea deviation, you cannot see it. You must feel down the trachea as far as you can. I once was involved with a trauma victim that was deceased from other injuries, his chest X-Ray showed huge mediastinum shift but you could not even feel tracheal deviation although you could see it on the x-ray.

my favorite is when you show up and the pt is DOA and you asked how long they have been this way and they say 10 min.....really Rigormortis sets in little after 10 mins sweet heart

Deathonline.net/decomposition says Rigor sets in approx 3 hrs after termination of blood flow.

Deathreferance.com says 2-6hrs

www.deathreference.com/Py-Se/Rigor-Mortis-and-Other-Postmortem-Changes.html

My personal experience tells me it's definatly not within 1/2 hr, I have transported bodies for the coroner from scenes before and never have seen rigor.

Where do you get your info?

Is that what Long QT Syndrome would present as?

I have never heard of that before today. I googled it and didn't get much smarter!!

Could someone simplify this syndrome and it's significance for us??

God I hope this isn't a dumb question.

A co-worker showed me a strip from a 3 lead which had a very prolonged st segment. I can't remember exactly what the measurements were but it was definatly > than .20 between ths end of the QRS and the start of the T wave.

I am wondering what causes such an anomoly?

BTW I have no idea what her history is other than she is 104 yr old. (the Pt. not my co-worker)

I have often wondered about how the stretcher mechanism would hold up in the event of an accident.....now I know!

Has anyone had experience with a milder crash than these? Just wondering how much force it takes for the stretcher to become dislodged from it's brackets.