Medic26

Just checking, how about an EKG prior to arrest.

It would be nice to know a blood sugar, electrolites and what the patient looked like when he arrived. Any complaints he had that someone may have blown off, etc.

I wouldn't let it bother you too much, its only one of several possible causes. Given the history of this onset and symptoms you found right away its just a possible cause, we have all been there after a call or several for that matter scratching our heads wondering what we should have done different.

In paramedic school we learned that basicly anything > than a rate of 150 was SVT if you could not see P-waves. I have since learned a formula that is 220 - age = sinus tachy. This means that this 45 y/o man could achieve a sinus tachy of roughly 185 under certian circumstances. With the ronchi and supressed immune system I would have given the fluid challenge a chance to take effect, after all sepsis requires several litters of fluid to correct if that was a possibility you had considered early on. I feel your pain for the lack of information on BLS report, we see this all to often as well with a few of the agencies we assist.

Thanks for the additional info!!

Bingo and thank you.

Sure and we'll just keep awarding these damn things for patients who eventually die before they have anything but a day or two on a vent. :roll: My boss is very black and white, if he changes something he wants to be able to back it up with research, documentation, etc. Thats what I am looking for here! I understand the whole, we would have all done the same thing bit, I am just trying to help improve a poor process we have here.

I have the chance this year to serve our banquet and awards committee, in the past our company has viewed a cardiac save as any patient delivered to the ER staff with pulses that lives 24 hours. This in my opinion is in much need of change......my personal view is a patient that is ultimately discharged with some quality of life. My problem is that I cannot find any data or policy in writing that supports this theory. I belive that the AHA has a guideline similar to this and I have been unable to locate anything after extensive searching. Any help would be great!!

Maybe I am a little different but if someone is that violent that they need to be restrained, they can take the ride in handcuffs in the police cruiser. Why put me and my partner in harms way when there are fella's out there that get paid and trained to do it. Just my humble 2 cents worth.

We carry two identical drug bags on every unit, we exchange them at the hopital pharmacy near our base. Adenosine 6 mg x 5 Albuterol x 5 Amiodarone 150 mg x 3 Atropine 1 mg x 3 ASA 1 bottle Calcium Chloride x 1 Diazepam 10 mg x 2 Dextrose 50% 25 grams x 2 Dextrose 25% x 1 Diphenhydramine 50 mg x 1 Dopamine pre-mix 1600 mcg/ml x 1 Epinephrine 1:10,000 x 6 Epinephrine 1:1,000 x 2 Etomidate 40 mg x 1 Fentanyl 200 mcg Furosemide 100 mg x 1 Glucagon x 1 Solumedrol 125 mg x 1 Lidocaine HCL 100 mg x 2 Lidocaine premix 4 mg/ml x 1 Magnesium Sulfate 1 gram x 2 Morphine Sulfate 10 mg x 2 Versed 10 mg Narcan 2 mg x 2 NTG Spray Bottle x 1 NTG Paste 1 gram packets x 2 Zofran 4 mg Oxytocin 10 units Sodium Bicarb 1 amp Verapamil 5 mg x 2 We use the yellow Thomas Drug cases except the Albuterol, ASA and NTG are in the cardiac monitors so we don't have to exchange drug bags for those. The premixed Lidocaine and Dopamine are also locked seperate in the cabinet.

I used to think so, but not now. This just goes to show that you never stop learning and growing as a provider.

Thanks for the laugh.

Thanks to everyone for your input. Until recently I only performed them on classic presentations/suspected cardiac patients. I got burned twice in two weeks and after some discussion from this site I have been performing them on any respiratory patient as long as I have time. I am currently pushing this issue with our service and medical director for my agency to make it standard care for all cardiac and respiratory patients. Any help with similar protocols or standards is appreciated.

We have one for doing transports with, it has all the capabilities available except end tital as of currently. It is a great tool and I feel that the patients get better care using a transport monitor such as this because it allows the provider to constantly monitor there patient with very little effort as well as documentation is easier with attaching the code summary sheet to your chart. It just removes the excuses for those lazy providers out there.

I have had the recent misfortune of learning that 12-leads in respiratory patients are of value and plan on performing them routinely in the future. To be honest this is not something that I had been exposed to nor have many of our providers in the region done this in the past. I was just looking to see what % across the board routinely perform them. Do you perform 12-leads often on routine respiratory complaint calls? :?:

Nice Job and Great Strips to see.

I would prefer it explained but since he didn't armchair it, I'll take a short humble opinion. As far as 12-leads on SOB patients, unless they have cardiac complaints we are not required nor is it even referenced in our protocols. The only time we are required/asked to perform them is chest pain/ACS patients. You can bet your posterior that it won't happen agian. I respect your opinion but just because someone didn't treat a patient the way you would have treated a patient does not mean they were wrong. I have worked a few different regions/states in several different services, every place puts emphasis on different things but the care is generally the same. Something you find as a major delinquency in your area may be nothing but provider discretion in another, BUT IT DOESN'T make it any more right or wrong.

This was the kinda thing I was looking for, I knew before the run was over that I should have done a 12-lead. I have never done a 12-lead on a shortness of breath patient until now. You can bet that I will be doing them from now on. My frustration was with the Cardiologist, how from a 2 second glance and no history did he know/think this wasn't V-T? Yeah my measly paramedic degree is no match for his royal education, but he could have been far less arrogant and made this a teaching moment!! :x

The reason I asked is this cardiologist took one look at the patient and a 2 second glance at the monitor strip and said "your wrong" and walked out of the room. He didn't have any patient history, vitals or nothing else but he was able to make the determination. I posted this strip to see if I had missed something, wide complex, bizaar, unifocal tachycardia.......yeah maybe I should have done a 12-lead but I didn't have time. I suppose that some of you are perfect but me.....I make mistakes and have oversights on occasion.

The patient presented SOB increasing over last several hours "with a vengance" according to the patient. He was anxious and rammy with expiratory wheezes in the apex's with crackles in the bases bilaterally, rate was 28, initial B/P was 120's over 90's with no relief from his nebulizer's. The patient was vague and basically could not provide a very good history. He did complain of diaphoresis, dizziness and nausea on and off over last few hours. This patient has COPD and CHF history, also was told that he is in need of a heart transplant but is not a candidate due to other existing medical conditions. I was not able to get any follow up on this patient nor do I know what the hospital's 12-lead was after we got there, we had another call waiting and didn't make it back that night. Please explain your interpretation of this strip.

http://f7.yahoofs.com/users/7x86CYdvZhoa/_...p;saveas=strip1 Here I will try another one.

http://viewmorepics.myspace.com/index.cfm?...imageID=8397320 Patient was stable, treated with lidocaine without success. And the cardiologist was to stuck on himself to talk to some lowly little paramedic and explain it to me. :roll: And I actually didn't think about grabbing a 12 lead until it was to late. This kinda took me by surprise as I was treating this patient for SOB/Pulmonary edema.

Here is a strip from a patient I had yesterday, treated as V-tach but cardiology physician says its not V-Tach but no explanation as to why it isn't either. Whats your opinion? #-o Ok, I can't seem to make it any biger so, the leads are from top to bottom II, I, III The rate is 156. The image can be viewed in full size on my myspace page.

It looks like a similar set-up to the ones we use. I wouldn't knock em' till you try it. The ones we use are produced by Caradyne (Respironics) with a generator that uses 6 lpm of oxygen to create something like 120 liters of air delivered at 40% oxygen. They work fairly well and our latest protocol allows 10 cm PEEP to start with increase to 15 with medical control order. I was amazed when we first started using them because they really are a simple, almost idiot proof device.

These symptoms alone are not enough for me to give ASA. If we did, ASA would be like Pez in a dispenser and more common than oxygen being administered. Vague Symtoms + Normal 12-lead = Monitor & Transport in these cases.