1EMT-P

Yes we do diagnose based upon our assessment & the patient's chief complaint & symptoms.

Is there any chance that some of the facilities could become critical access facilities and reduce their inpatient beds & services?

I have used IM/IV Phenergan in the field since the mid 90's & I have never had a problem with it. I usually give adults 12.5 to 25 mgs IM/IV, unless they are older then I give 6.25 mgs slowly. I usually dilute the phenergan with normal saline before administration. Other Alternatives: Benadryl, Compazine, Droperidol, Reglan, Tigan & Vistaril.

I have never heard of aspirating three times while administering D50. I was always taught that you check the line before administering the D50 and again after administering the D50.

Did anyone talk to the Paramedics to see why the used a 6.0 ETT? I was taught that you use a 7.0-7.5 ETT in female patients and a 7.5-8.0 ETT in male patients. I worked in ENT and it was not uncommon for us to see patient's with airway/vocal cord trauma following intubation... When you intubate be careful, check your equipment & visualize...

It depends on where you go to school & where you do your internship... I did all of my clinicals first, then I did my internship...

I like the SAM splint, followed by blankets & pillows.

The patient did not have a fever and she had a normal CXR per the Radiologist.

There are always two sides to every story & without having all of the information it's hard to say...

Do any of you know anything about the American Health & Safety Institute's training programs?

The patient has not had any more episodes of chest pain/tightness since having her pacer adjusted.

It sounds to me like your friend needs to be re-evaluated. If she is not tolerating her Albuterol, she might want to talk to her family doctor about changing medications and having allergy testing and spirometry done.

I totally agree with your decision to fly this patient...

First off I did not depend on a machine to do my assessment... I did a complete assessment & connected the patient to the monitor to see her rate & rhythm... The machine in question was made by Medtronic as was the patient's pacer, so it should have been able to safely analyize the patient's rhythm.

I have mixed feelings about BNI... I worked for a service that covered a ski resort & we did not have PAI or RSI. If we encountered a patient with clenched teeth sometimes we would use BNI.

The patient's 12 Lead Ecg showed a paced rhythm, which the monitor interpreted as abnormal. Her rhythm did not appear abnormal to me it appeared to be a sinus rhythm with pacing. The patient had a long history of brady-tachy syndrome & new that she could refuse the IV, so we did not push the issue we explained the risks & had the patient sign off that she was refusing. The patient's Primary Care Dr. told her that he thought she was having A-Fib & wanted to put her on Coumadin, but her Cardiologist checked her pacer & told her that she was not having A-Fib, he told me that a 12 Lead Ecg is pretty much useless in patients with pacers because they usually come back as abnormal. The patient was placed on 324mg of aspirin every day & scheduled for an Echo & Stress Test.

You respond to a 58 year old white female patient complaining of intermittent right sided chest discomfort/tightness that goes away with rest. The patient reports that she has not been feeling well for the past two weeks & that her Dr. had ordered a BMP, CBC, CK, CK-MB, ESR, LFT's, Lipids, 12 Lead Ecg & Chest X-ray. The patient reported that her ALT, AST, Cholesterol, H&H & ESR were slightly elevated and that her CXR was normal & that her Ekg came back abnormal. Allergies: IV Contrast, Motrin & Sulfa. Medications: Albuterol MDI, ASA 81mg, Ativan 4mg, Lasix 40mg, Lexapro 20mg, Lopressor 100mg, Protonix 40mg, Wellbutrin 300mg, Co Q10 120mg & Vitamin E 400IU. PMHX: Allergies, Anxiety, Asthma, Brady-Tachy Syndrome ( Dual Chamber Demand Pacer), Chest Discomfort/Tightness, Depression, HTN & SAH. GCS = 15 Head - Intact Ears - Intact Eyes - PEAR Nose - Intact Throat - - Edema or JVD, Midline Chest - Decreased Breath Sounds/+ Wheezes/ Intermittent Right Sided Chest Discomfort ( Non burning & Non radiating ) Abdomen - Soft/Non-tender - N/v Extremities - + CMS, + Edema Vitals: BP 118/84, Ekg Abnormal Paced Rythmn of 89, Resp. 24. Sp02 96% on Room Air. Treatment: Oxygen & 4 81mg Chewable ASA. The pt refused both Nitro & IV therapy. Is there anything else that could have been done for this patient? Any ideas what might be wrong with this patient?

Fanny Packs are great for carrying supplies, especially if you cover events like ATV races, concerts, festivals, mountain bike races & sporting events. The one that I have was designed with emergency care professionals like ( Athletic Trainers, EMS, First Responders & Ski Patrol ) in mind.

1. Black Pens x2 & Black Marker x1 2. Fanny Pack with alcohol wipes x10, CPR mask x1, gloves x2 pair, shears x1, small light x1, tape 1 roll & 2x2's. 3. Stethoscope 4. Cell Phone 5. Company Pager

Be careful about labeling EMT-CC's as less educated... There are some EMT-CC's who have completed undergraduate and graduate degrees in the Medical Sciences & Nursing.

A blanket, pillow, sheet, small oxygen tank with very basic airway supplies.

The most important thing for a new EMT to do is to find a good experienced mentor who can help you. A good EMS mentor is worth their weight in gold! Your mentor will be able to teach you the art of how to get along with the nice & the not so nice ER Nurses.

Based on what you have told us so far it sounds like you did the right thing!

I like animals, but I don't think EMS should treating them in the field. If you were to treat a dog in the field and then respond on a call for a patient and the patient be highly allergic to dogs that could cause problems : :shock: !:

Cooling may prove to be impractical in the field, especially on a hot summer day with limited resources :!: