mobey

Since you are just learning, it is inappropriate to make statements about ruling out seizure that you made earlier. This looks like a clear cut Dystonic reaction, and therefore I would "trial" Benadryl I.V. If that does not do the trick, I would move to Benzodiazepines under the differential diagnosis of partial complex seizure. Think horses my friend. Welcome to the forum BTW:

I am sure you know I was not speaking about you Arctic. I can sense the sarcasm in your post I will agree that tact is not SCoP's strongest areas, however, large bodies such as them paint with wide strokes, and I believe this is one of them. Although it will cause some practitioners extra work and expence and it is not always fair, this is really just a demotion for the poor job performance crowd. Leaders work hard and put in the extra effort to stay on top, as far as I am concerned the rest can be left in the dust on this one. I base my opinion on multiple experiences. If you look west into other health districts I do believe you will find stations filled with these EMT's who cannot be bothered with competence. If you do not know it is a major problem, then that simply represents you are not exposed to it, not that it does not exist. To answer your question about what I did: I reported it, the 2 practitioners were put on temporary suspension while it was investigated, They were so offended they quit. 4 weeks later the health region shut dwn thier service due to staff unavailability and all thier calls came to our station 1/2 hr away. That was the last time I reported anyone in Sk. Just too fragile of a system. We are better off trying to teach from the inside.

I disagree. I think they are demoting those hillbillies who are still harming and refusing to treat patients based on their 1976 2 week EMT course, and 30 years of repeating the same "scoop and scoot" bullshit transport on every patient. There are some very very poor practitioners in rural Sk (and Ab) and I think this is a great step towards a "S**t or get off the pot" motivation pushing them back into the classroom to increase competency, or off the ambulance. Until you do a ALS intercept to a unconcious preggo with a C-collar upside down, and a NRB at 4lt, you may not understand

I don't buy this as fact. How is a degreed paramedic supposed to render anymore care than a lay-person when he pulls over in his POV wearing shorts and a t-shirt? No PPE, No equipment = No help from me!

Truely sorry Idon't have time to offer advice. But start here: http://www.emtcity.com/topic/21642-longevity-in-ems/

For the first time, I am going to disagree with chbare, and accept my disapline for doing so. I have a real problem allowing people to decompensate in a prehospital setting. We have potentially the most Uncontrolled intubation setting there is in healthcare, and allowing patients to get severely hypercarbic/hypoxic prior to sedating and possibly paralyzing them, really stacks the odds against us. Perhaps in a constrictive event, or an edema event, where pressure support can make a dramatic difference CPAP would be first line, but in a case like this, early intubation is my first bet. These and traumatic chest injury patients are just not the ones to deploy the CPAP trials, or wait and see treatment regimes. Ok. Chbare, let me have it!

I'm with you Rock. As a sidenote, in Sask, when I used to KED someone they did not get boarded. Just put on the KED and lay them on the cot. As a third note... I have used a KED with no board for people who cannot tolerate lying down in this province (Ab), and have never been drug over the coals. Perhaps we just need a few more cowboys to break the mold and make the medical directors ask questions?

Interesting question. Although I do not make a habit of measuring PR, there was nothing that jumped out at me. As has been said, I don't imagine I would have gotten orders to do it while she was still alive on a risk/benefit basis. Of course I would prefer to do it as soon as I decide I can't maintain a BP anymore, but I doubt any Med Director is going to give the order. This is one of those cases that you hope for no cell service, so you can excersise the "do what's in the patients best interest" communication failure clause Great question! No idea....

I was a pericardial efusion, leading to tamponade (Obstructive shock). No, I didn't needle it, though if I could not have gotten her a plane, I definatly would have called for standing orders in case of an arrest. MAP is calculated by the LP15. Not the most scientific, but better than BP alone IMHO. 100mcg Fentanyl is a little much, I was giving her 25mcg increments, which took the edge off. So... anyone want to run Dopamine? Or should we run fluids?

Don't hate me But how do you account for the JVD?

Stomach is soft. As I replied to Doc, I don't know enough about heart sounds to give any feedback. 1lt fluid in BP 82/58 MAP62 HR 112 RR 22 Don't forget a MAP <65 (some will argue 60 but we are not using invasive technology here) means end organs are not being perfused. To withold BP treatment from this patient, is nearly a death sentence. Pain/anxiety, you can have whatever you want.

2 pairs of boots at one time? Hardcore

Maybe in the urban setting, but here in scenarioland (and my world) we have a 30min rendezvous with a fixed wing airplane, or 3.5hr by ground. I.V is in, bilat. BP 82/58 MAP 54 Resps 22 HR 114 Confused but alert. Still 10/10 pain

No trauma. As stated, this patient was just sitting there drinking tea. Sudden onset.

Great suggestion here Doc Reflecting on this call, I probably could have gotten orders to bypass the local clinic direct to trauma centre query spinal fracture with neuro deficit. Some might say the films shot were unnessasary radiation as CT is mandatory in these patients. As a patient advocate, I could have spared him 4-5 shots of x-ray by bypassing. Dwayne: I also need to read up on CCS, so I can't help. Hope to see ya over at last nights patient Thx all.

Forgot a medication: MTX, and arthrotec. Sorry bout that.... Bilateral radials are present. Note I said BP was bilateral OK.... so now what? Lung sounds were clear in apicies, couldn't hear much in the bases. Her Kyphosis is pretty severe, and chest wall movement is an issue. As far as heart sounds go: I'd love to say no gallop, good S1S2, but I'd be faking it. I have no idea what to listen for.... I thought her heart sounded quiet... or distant. See original post for 12 lead. No, and no for the rest of your question. Here is an example of the degree of kyphosis http://www.sciencephoto.com/media/260141/enlarge

Nope, no cardiac hx

Well, just when I think I am getting good I get presented with this: I am sure many of you will have no problem, but it as my first one, so it took like 10min beore I knew wtf I was working with..... 81 y/o female. aprox 140lbs, sudden onset chest pain while sitting drinkng tea with husband. Pain = 10/10, crushing, radiating to lower back. Nausea 10/10.... dry heaving like crazy Pale-grey, diphoreic, good turgor. No distal edema, JVD present. Complains of SOB Pulse 112 BP 74/58 Bilateral. Sp02 98% Afebrile ECG = unremarkable. Sinus tach, narrow QRS, no T,ST changes History: Spondylitis (Kyphosis noted).

Hey guys, sorry for the delay. I am quite curious as to what ERDoc's take on the x-ray is. Good call Dave, as usual. The sending GP stated the following= Central cord syndrome with possible C3 dorsal spinous process fracture (looks like the tip of a thumb broke off on the back portion of the vertebra) Upper extremity weakness was confirmed after analgesia. I have no further information, as he was transfered to a tertiary care centre. Central Cord Syndrome: Symptoms of central cord syndrome occur following trauma (most commonly falls) and consist of upper and lower extremity weakness, with varying degrees of sensory loss. Pain and temperature sensations, as well as the sensation of light touch and of position sense, may be impaired below the level of injury. Physical findings related to central cord syndrome are limited to the neurologic system and consist of upper motor neuron weakness in the upper and lower extremities. This impairment can be described as follows: Impairment in the upper extremities is usually greater than in the lower extremities and is especially prevalent in the muscles of the hand. Sensory loss is variable, although sacral sensation is usually present. Anal wink, anal sphincter tone, and Babinski reflexes should be tested. Muscle stretch reflexes may initially be absent but will eventually return along with variable degrees of spasticity in affected muscles. Surgery is rarely indicated because of the inherently favorable prognosis for patients with central cord syndrome. http://emedicine.medscape.com/article/321907-overview

Don't forget to cost in a Medical Director salary, and a lawyer.

Gotta go for a few days, so i'll leave you with this:

My wife just started reading the first book. She is away right now, but we will be seeing eachother this weekend. I'll be honest: After 10 years of marriage, I have gotten laid more in the last 2 days over text messaging, than I have in the last 3 years in the bedroom!!

I have conflicting tretments here. Backboard or not? How do we take this guy from the position he is in, and get him on a backboard?

It is a gravel lot. Rolling around? No chemicals noted