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Timmy

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Timmy last won the day on June 1 2015

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About Timmy

  • Birthday 10/17/1989

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  • Gender
    Male
  • Location
    Rural Australia

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    Emergency Nurse/Critical Care Student
  1. I’m unaware of the requirements for the FPOS or PHEC courses but I’m quite certain first responders in Australia do not use LMAs. I’d just like to clarify your referring to first responders in the sense of a lay person who has completed the four day course and not a paramedic acting in a first responder role? Having trained volunteer first responders before I’d lean on the side of caution when it comes to advanced airway techniques. During my paramedic degree we spent quite an amount of time on LMA’s, there’s a lot involved regarding anatomy and physiology, remembering the different sizes
  2. I’ve used it twice in hospital, once for an obstetric emergency and the other was last weekend I had a 22 year old cystic fibrosis patient who had a large hematemesis event with EBL 600 to 700ml, initially hemodynamically unstable with ambulance but after fluid challenge and tranexamic acid he recovered well and maintained for 2 hour transport to specialist care. Haven’t had the chance to use it in trauma patient’s yet.
  3. I think pain management and assessment is generally undertaken in a very insecure manner. I see a lot of clinicians worrying about giving the patient too much analgesia, to little or jumping to the conclusion that the patient is seeking. There seems to be little understanding on how to assess pain thoroughly and then working on a sound management plan and selecting the appropriate analgesia. No matter what your first thought is of the patient I think it’s still important to do the appropriate assessment, diagnostics and go from there – I’d hate to think someone would base there diagnosis
  4. Try and calm things down a little to improve our chances of good assessment. What did he eat? Remove clothing. Did nana bring the child & maternal health book along? What’s the kid’s weight? Skin & appearance (cyanosis, rash, pale, flushed, moving all limbs etc.). Respiratory Assessment (rate, rhythm, depth, auscultation, SP02, use of accessory muscles). Temp & heart rate. AMPLE history, happened before? has the child ingested the same food before?
  5. It’s hard to say with the limited details provided in a media report. Obviously you need to take into consideration the time and means of getting the kids to an appropriate facility via the quickest way possible. There’s no information on what services the hospital they bypassed has nor is there any real justification on why he called a helicopter. It also doesn’t state what type of store this incident occurred in nor does it say what was sitting on the shelving (normal groceries in a convenience store VS a bags of cement in a hardware store, for example). It states the shelving fell on
  6. Well... hopefully you can cancel from the job since the patient has deteriorate but is in hospital and it’s not what you’ve been called for… If they want your involvement then: Is he maintaining his airway? If not, triple airway manoeuvre and OPA as primary intervention. I’d like to provide positive pressure ventilation with an SP02 of 91% on high flow oxygen with a GCS of 8. What are pupils doing? What’s happening on ECG? Are they giving adenosine for SVT? What’s BGL doing? I’d like bigger IV access than a 20g at this stage. A total summary of IV fluids. Recent pathology results.
  7. In the Emergency Department we use it quiet frequently to lightly sedate some paediatric patients for suturing and plaster application. While I can’t provide you with specific pre hospital care information we run off what the Royal Children’s Hospital in Melbourne recommend and are assessed by our paediatric clinical nurse specialist against their assessment sheet which is in the link below. http://www.rch.org.au/uploadedFiles/Main/Content/comfortkids/Porter_nitrous_oxide.pdf http://www.rch.org.au/clinicalguide/guideline_index/Nitrous_Oxide_Oxygen_Mix/ http://www.rch.org.au/uploadedFile
  8. Deary me, this is the first time I’ve been back on EMTCity in a while and this thread was the first to pop up. Quite frankly your post gave me vertigo and left me feeling slightly nauseous, 1309 words mashed into one paragraph doesn’t make for easy reading. If you’re going to post such a detailed question I’d suggest not doing it on a tablet device. I agree with Mike, appropriate grammar, spelling and structure of your question reflects a professional persona and makes it easier for people to respond with purposeful, helpful and meaningful answers.' I’m not exactly sure I get what your que
  9. I have dealt with this many times in the hospital setting and as far I know the ambulance service does not have a specific guideline for such a reaction, it would most likely fall under the anaphylaxis guideline. In my experience commonly people react to blood products (blood, platelets, and immunoglobulin) due to the rate of the infusion rather than intravascular haemolysis, anaphylaxis, febrile/bacterial sepsis etc. it would be interesting to know taking into consideration she has not reacted to any previous infusions, whether the staff increased the infusion rate on this occasion. Do you kn
  10. I'd like to rule out meningococcal with a petechiae/purpura rash... does this rash blanch?
  11. Pupils equal and reactive to light. Also, I’d like to add an immunisation status.
  12. PEAL? GCS? Neck pain on flexion/extension? Photophobia? Chest Auscultation? Approximate fluid balance (intake + output) Skin turgor/mucus membrane? Abdominal examination? ECG? Are any of the other 8 people displaying symptoms? Has she been in contact with anyone who is unwell?
  13. I agree with Dwayne but certainly without a comprehensive history or list of medications it’s hard to paint a full picture and formulate a constructive answer. Saying that and coming from an Australian background I find it quiet bizarre an ambulance would be taking a patient back home, but anyway… Like Dwayne indicated, non symptomatic hypertension is generally not a great cause of concern in the elderly, especially if the lady is already medicated and her BP was generally normotentsive in the ED. I’m sure if you didn’t speak a word of English and presented to a hospital your BP would be
  14. Thanks for the feedback everyone, appreciated. I’m extremely new to cannulation, my second IV ever was the other day on this patient who was in sever anaphylaxis which rebounded for 2 hours, he was semi conscious and dropped his BP so I just went for the 2 biggest veins I could find. Live and learn I guess, I’ll know for next time! Thanks.
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