chevy

I'm currently in PCP school (ont). To pass into the second year we have to demonstrate the following: 2 man crew - lift 180 lb pt into a stretcher from the floor and into/out of ambulance, and up/down stairs in a stair chair. You must be able to do this at both foot/head positions. Also, you MUST pass the fitness test. Cardio step test, Flexibility Test and Weight lift. The weight lift has 4 parts: dead lift, bench press, and 2 variants of a row-style lift (forget the names but basically hands together/part). To get max. points you must lift 440 lbs combined, with min's in each (155 dead and I think 55 lbs for the others. Note that lifting all the min's only will not get you a pass). In our neck-of-the-woods, 2-person crew max lift weight is 300 lbs, but I am told that the weight normally gets to 400 or so before people call for lift assist. (Assuming straight forward conditions. i.e not out a window and down a fire-escape!) Many of females in my class are working hard on the weight part, but are killing the big farm boys in cardio and flex, so we all have are challenges. ..chevy

No to the POV. Too far for my taste. If pt. went downhill, I'd want my hands free and access to a radio for ALS intercept if it really went sour. In our locale, paramedics (we don't have EMTs) can start IV's as a standing order. Not clear by your post whether an IV was started at camp (and running what). You did say saline at the ED though. Seems to have done the trick. nice scenario. gtg study though..A&P !

Well, lets tackle at least one of the problems. Start a saline IV to address the lithium OD. As for the other pills, double check for OTC's, especially NSAIDs which can increase lithium toxicity. It's a funny drug with chronic users being more susceptible to OD that one-time users. If the OD is serious enough, hemodialysis will be required. Stick in the saline IV and go as effects of OD can be delayed from ingestion. Get extra hx (as above) enroute.

You said it was warm outside. Lithium toxicity can account for the symptoms and is more likely to occur even at therapeutic doses, if the pt. is dehydrated. ...so, hows the skin turgor? If tenting is evident then maybe I'm on the right track.

In our neck-of-the-woods, the person (Patient Care Assistant - PCA) does the chest compressions only. The vast array of other people RT's, RN's..... do everything else. When CPR not in progress, PCA's help expose the Pt, roll-logs, get-stuff and that sort of thing.

Just starting to learn the GCS scoring system and I'm looking for input on the following scenarios: #1 Motor: How would you score the Motor component of a Pt. who cannot move one side of their body when asked. E=4,V=5. (possible CVA). -I'm thinking 5 but interested in other thoughts. #2 In the case of a normally aphasic handicapped person, how much do you rely on the usual caregiver in trying the judge normal character of a pt? btw - I'd doc this one whatever the score. #3. If the only response to painful stimuli is verbal (moan), what is the Motor score? #4. When arriving on scene, Pt has eyes covered due to forehead lac. First responder says that vision was ok. Do you re-expose the wound to evaluate? I am thinking to mark Vision as 4 but note that it was per:1st responder and unable to check due to lac. Comments? ..chevy

I'll take a stab (no pun!) Due to -JVD, trachea midline, normal sensory rxn and lung sounds, rule out tension pneumothorax, cardiac tamponade. Hypotension, reduced sat and slightly tachy point to possible hemothorax or aortic tear with accompanying hemorrhagic shock. IV - not sure (I'm a student, starting next month!), but I'm betting bigger is better here (18 -20) if pt. goes down hill due to shock or SAT's drop due to progression of hemo/rupture. Run IV at 250 ml but be prepared to increase flow to compensate for blood loss if vitals change. Transport top priority using whatever means available in your area and accounting for weather/closeness to trauma centre.