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Posts posted by 1EMT-P
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The patient did not have a fever and she had a normal CXR per the Radiologist.
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There are always two sides to every story & without having all of the information it's hard to say...
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Do any of you know anything about the American Health & Safety Institute's training programs?
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The patient has not had any more episodes of chest pain/tightness since having her pacer adjusted.
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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.
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I totally agree with your decision to fly this patient...
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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.
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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.
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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.
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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?
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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.
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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
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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.
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A blanket, pillow, sheet, small oxygen tank with very basic airway supplies.
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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.
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Based on what you have told us so far it sounds like you did the right thing!
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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: !:
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Cooling may prove to be impractical in the field, especially on a hot summer day with limited resources :!:
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Have any of you taken ACEP ACLS instead of AHA ACLS?
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What's the patient's GCS? What's his skin color & condition? What's his vital signs? Does he have any allergies? Does he take any medications? What's his Past Medical History?
It appears to be V-Tach :!:
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Broselow kits are great, but they can be expensive to purchase... have you thought about purchasing the Broselow tapes and making your own color coded kits?
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So they recommend using an MDI w/ Spacer instead of Nebulizers :?: That's interesting :!:
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We usually give 2.5mgs of Albuterol followed by an Albuterol/Atrovent treatment if needed.
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What medications are in your Asthma/COPD/SOB protocol?
Your personal preferance in splinting???
in Patient Care
Posted
I like the SAM splint, followed by blankets & pillows.