scottymedic

Time for me to bring out the dead (pardon the movie pun) . The standards have been in since begining of the year, teaching the 30:2 ratio and when a witnessed arrest occurs, your stacked shocks of 360 and then 2 mins cpr, fitting in adrenaline and intubation in that time (assuming of course the ryhthm doesnt come back in those shocks - I dont know this rhythm so I'm gonna shock you into something I do recognise ) The unwitnessed arrest is an instant two mins of CPR and then look at the monitor in that time, no pulse check unless its a rhythm that is sustainable with output, then check. In the last 30 seconds of the 2 minute cycle, the defib is charged so if its v-fib/v-tach then ready to instantly hit with 360. I get nervous about that I must admit, just with people having a live charge sitting there, lol, pray that no one gets button happy and hits shock. The child of 50kg or 8 years and above is hit at 360 joules also. Havent heard of any successes yet in my area. The comments from a lot of people, is just the change in mindset from automatically doing the stacked shocks, no pulse check and other interventions come second to CPR, but its just time and more practice in its own way . I'm still to have a code (be it ems or nursing) with the new protocols. See how it turns out. Please don't jump on me for reviving (another pun) an old thread, but be cool to see how the procedures are coming along as time progresses. Scotty

I had an issue with the paramedic (EMT-I) that cannulated my dad when he was burnt, he put the iv in the anticubical space of the right arm that was badly burnt, yet the left arm had veins sticking out like dogs B**ls and could easy cannulate and had less burns to it. I couldnt figure out why risk further infection. Protocol is avoid burn site, try another location and only as a last resort go to the burn site. Scotty

We only have them for transfers and they are part of the flight teams gear, we just have the good ol Lifepak 12, though aparently I heard the Lifepak 30 is supposed to be coming out this year at some stage, be interesting what that is life Scotty

My father suffered 45% bsa burns of multi thickness. I slit an iv bag open and emptied the contents into a container and got his hands into that and a pad soaked in it around his neck. Saline has a cooling and soothing agent and the goal is to reduce the burning, yes hypothermia can present, but id rather them a bit cold than their tissues burning up due to the heat from the burn. I was first on the scene to dad and the doctors said the saline was one of the best things for his burns as well as the inital cooling process. Quick trick i learnt, need an instant ice pack or pack for airway burns, take a towel or teeshirt etc, wet it and then empty a CO2 extinguisher into it. Fold it over and there you have an instant ice/cool pack, make sure the dry ice in there doesnt get out and it will last for a while. Scotty

Following the methodology of CWMPS *Colour, Warmth, Movement, Pulses and Sensation* can assist in assessing blood flow to the affected limb. Pulse oxy could be a good idea in the assessment of saturation, but then as other posters as have pointed out, they are affected by temperature. And ccjh, there is no harm putting a pulse oxy on, this isnt bls vs als at all, bls put pulse oxy on here, just another good vital sign to write down and compare to manual observation skills. Just like you can write on a form that they had a pulse rate of 100 but the monitor can assist that it is a sinus tachy or ventricular etc. The tool just merely helps clarify the manual finding. So original question, as medicrn said, why not try it out, and see what you can find, many great protocols were made through trial and error, I know I will try it and see what I find. Scotty

Hahahah gotta love em saggy boobies, just like an old lady and an old man are talking dirty in a rest home, he says show me your boobs, she lifts up the bottom of her skirt. Ok I'll stick to work not comedy Scotty

Thank you for posting your qeusting matey I guess initial look at the ecg would make me think it was vtach due to the wide complex and the rate, whilst being slow, is still a tachy none the less. Complexes now that I have had another look, do co incide with the explaination you gave. AZCEP, hehehe yeah hook me up with any toys you do have Thanks for that education point Chbare, appreciate it

It's also down to the scene as well and time from hospital and was the patient symptomatic to warrent a 12 lead, they are hardly done here, yes something I am not pleased with as they are great diagnositic tools, but its a judgement call at the time. I am wondering though if AZCEP is a rep for physio control lol seeing as he is continually going on about lifepak 12 etc. What deal can you cut me on one. The post was on the initial strip posted, not on a potential 12 lead, it is what do you think it is, looking at that strip, as I said before, I think it was Vtach, there, my uneducated opinion :) Scotty

YAY always good to get a feel good story in here in amongst all the doom and gloom that seems to otherwise clouds the place.

AZCEP if you look at the strip, its actually from a Zoll monitor. I am not familiar with Zolls myself as we are all Lifepak here, but do they do the 12 lead option prehospitally? I'm gonna be a goober (hey i do it ooh so well ) and I would have thought that it is vt. Wide bizzare QRS complex, rate is a little slow, but it is over 100. Good oxygen sats, seems your treatments brought his sats up nicely Scotty

Here in NZ, our procedures state that obtain IV access is a priority before 12 lead acquisition. However, 12 Lead is not routinly done here (only A/P's) have the training for 12 lead at the current moment in my area. As said previously by other posters, get the line in now cause when they code, there aint gonna be the time or ability with some patients. Personal note, pleased I read the thread properlly lol, i thought the initial topic was 4 (IV) lead as opposed to 12 (XII) lead lol. Not enough coffeee. Scotty

*giggle* Yes sorry had a momentary lapse of reason there, lol, must have been thinking straight hehe. 14G anyone?

I'm catching up with some of the A/P's tomorrow so I will run this by them, its a good question as we dont carry the glucose gels in our trucks, just glucose tabs and Dextrose (D.50) and glucagon. With the time a gel is taken to break down and absorb, surely a fluid would be absorbed faster? Direct difusion into the blood stream. I do agree, there are some needle happy medics out there, on all continents as it seems, if you can save the patient unecessary pricking and pain and if they can manage oral replacement therapy as opposed to an IV route, why not take that way? Excellent topic AZCEP and will report back when I chat tomorrow. Scotty

*scotty goes and hides under a rock* sorry I think I opened a can of worms eeeeeek. I do agree with the statement of (I'm quite sure there is elements of) sarcasm in pressure sores outweighing spinal injuries. I argued this same point but hey, what do we know? I'd rather have an ulcer on my butt that I know can be healed with grafts etc, rather than the fact I will be crapping in a bag or never walking again, because of not being immobilised properly. I don't know if you guys overseas carry them, but every officer here is issued a pocket procedures guide. Sometimes I think they are underutilised. Any feelings on that? (cautious change of topic hehe). Scotty

hey I just do the work, I don't work the logic (or lack of) that is management S

Here in my region, Scoops are used for all immobilisations, we aren't recomended using backboards for the issue of pressure sores. I argued this with my instructor, in the view that they arent on the board long enough to develop pressure areas and the idea of a spine board is to keep the spine in neutral allignment. If they develop pressure areas after we leave, well that the ER's fault not ems (Says the soon to be registered RN lol ) Most under utilised peice of equipment.... hmmmm, I agree on the KED, I love them for immobilisation but each to their own I guess, ummm what else, oh yes the manual BP cuffs too. EMT's hands also, what ever happened to putting a hand on the shoulder to slow resps down or a smile, seems soo many paramedics now adays are so anally retentive they have forgotten how to lol. Right better go shower and shave, going out for a couple hours on shift tonight. Have fun and be safe Scotty

A guy and woman under each arm What??? :?

being at the recieving end of homophobia within ems, it doesnt surprise me the way the two medics acted and if it is true how they acted, then my god it makes me sick! Scotty

Hi there all, how are you all? Right formalities out of the way, I have been doing some research on the Unilead unit for acquiring a 12 lead ecg. Instead of applying the 10 electrodes, a simple one piece is applied to the patients chest. Has anyone been involved in trials with these, both pre hospital and in hospital, and what did you think of them? did they reduce artifact? did they provide a good capture rate? and did you find that they lessened time for applying electrodes? Many thanks and for reference here is the the unilead website for more info. Unilead Ltd Scotty :):)

good ad timmy, I've been corresponding with quite a few people in the USA and they cant believe how graphic our ads are here in New Zealand and in Australia. Gets the message across. We've had one of the fire departments in our area going to local schools, and the most powerful aid he takes *the presenter* is a tarpaulin. A tarpaulin that has seen its fair share of patients on it, fair share of mangled car pieces laid on it and its fair share of dead bodies under it. It's a great wake up to the kids in the schools, thinking that they are staunch, but reailty sets in, that they could end up under that bright tarp, as a mangled corpse. Thanks Timmy Scotty

My first ambulance ride was when I was four, my brother is immune deficient and required a bone marrow transplant. We arrived in the air ambulance to auckland airport and the ambulance officer asked if I would like to ride in the front with him. From that day I was hooked and with dad being a firefighter, EMS was in my blood. Took classes, got ACLS at 18, studied my butt off and like God's medic said, when you hold someone in your arms and comfort them, when you have a patient that was in major pain when you arrived and have them arrive at hospital in lesser pain and even giggling (not always from the meds either lol ). I was first on scene at a major MVC when i was 20 on my way home from nursing class and i had four patients to care for and direct a group of bystanders and first responders to help. To hold a lady in my arms when she took her last breath, have her family come and say their good byes as we did CPR, hold a man in the back seats hand as he slipped into a coma that he would never wake from again, but talk to him and let him know that he wasnt alone, just the privledge of being part of these peoples lives to at least try to ease their suffering and pain, is a reason that up until 2 months ago, I was in EMS. I left due to bullying and harrasment as the age old practice of dog eat dog and EMS eating their young. I am almost at the end of my RN training and continue to make a difference in peoples lives in another way, one day I will return, when I finish my paramedic degree and continue what I was born to do. To be an Advanced Paramedic and to know that each day a difference is made, whether it be a transfer from hospital to home or attempting to revive a cardiac arrest, a difference will be made, and I will be serving along with my EMS brother's and sister's on this site and be part of that family again. You can take me out of EMS for a short while, but you will never take EMS out of me. Pro utilitate Hominum - For the service of mankind Scotty

Ahh the debate still rages, can't believe it is still going. But then hey, it has been the trend of ems to eat it's young. I think the thing that alot of the older medics forget, is that in this day and age, we are exposed to alot more than what they were when they were our ages. There is more blood and gore on the 6 oclock news than there is in the average horror film on late at night. And yes, I know that it is not the same to the real world, but we also have CISD systems in place for those that need it and things are alot better, even the technology of today is more improved, helping privide more concise care to our patients. What was classed as higher school biology lessons is classed as standard high school teaching at a younger grade and so things have improved. Yes there are some drongo 16 year olds, but there are some even more drongier 40 year olds. Some people on here I have had debates with about this topic as it is something that is on a case by case basis. Some people started young when the systems weren't there and are now F****d up over it, but that is unfortunatly, those own peoples past's and issues that they have to deal with. I do think alot of paragod ego still exists, I am 22 and still find I am classed more as an equal as a nurse than I do as an EMT, cause unfortunatly, this industry is very "if the face dont fit" sort of attitude. Anywho, yes Tim has made some grammitcal errors, but personally that is nitpicking on you guys, give the kid a break. Scotty 8)

Pleased im not the only one that fell for it lol

Im confused, so you have to print a strip every 15 - 30 mins to doubly confirm asystole? or is this in a reverted arrest during transport phase? *plus is trying to figure where this is in the paddle versus pads debate lol, its late at night gimme credit here rofl* Scottymedic

v-vac is in our first responder truck kits (im trying to push for a battery one though) and the trucks carry the battery ones but a back up v-vac. Yes the v-vacs are shite, but better than nothing with our patients airways clogging up, found that they are damn painful on the hands though as opposed to the resque-vac. Scotty