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1EMT-P

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Everything posted by 1EMT-P

  1. I have seen Versed assisted intubation used in the past. They would apply both a nasal cannula & face mask connected to oxygen. Then they would place some Lidocaine in a small volume nebulizer to help blunt the cough & gag reflex. Then proceed with Versed usually 5mg IV (0.05mg/kg) titrated slowly every 5 minutes up to a maximum 0.1mg/kg. Then they would give Morphine usually 2mg IV every 5 minutes up to a maximum of 10mgs.
  2. If I were you, I would do a good assessment on every single patient & document your findings & your treatment. I also would ask for a copy of the policy & I would refuse to do any procedure which was not medically necessary. If the company is indeed billing for services at a higher level of care than is medically necessary, they could face an audit, fines & fraud charges.
  3. 1EMT-P

    Capnography

    Spock, I totally agree with you on the nasal cap ETC02. I have seen the nasal capnography used on patients that looked totally fine, but when the nasal capnography was applied it revealed a serious issue. Thanks for sharing your case study. All the best,
  4. I have tried most of the video based laryngoscopy devices, but to be honest with you none of the EMS agencies in my area currently carry the devices due. I have noticed that many of the Paramedics are using King Airways.
  5. It usually depends on the patient's condition & the procedure. I have taken staff from the surgical center to the ER with me to assist with the patient.
  6. When faced with a difficult airway there are a number of devices that can be used to improve your odds of securing the airway. If you are interested in learning some good airway techniques I would encourage everyone to check out the procedures section of http://emcrit.org/.
  7. The AHA never ceases to amaze me, they always find interesting & new ways to update their courses!
  8. I would suggest you take 20 large index cards & write different diseases on each card. You then break them up into teams & have each team give you a presentation on the disease including anatomy & physiology involved, signs & symptoms, treatment, including medications & dosages. For example Angina, Asthma etc.
  9. The facilities that I have worked at all had fluid warmers that were set to 100 F.
  10. I can understand asking Volunteer EMS agencies if they would like to help given the size of the event, but to ask 500 EMS folks to volunteer their services is silly. The Vatican would have given advanced notice that they planned to visit Philly & the federal agencies would have coordinated with the state & local agencies.
  11. I would encourage you to review your EMS textbook & to become familiar with the local laws where you live. If you aren't sure what the local laws & policies are please check with your EMS agency.
  12. I don't see either LR or NS being removed from our kits anytime soon & here is why. We are familiar with LR & NS & we know how they work, but Plasma-Lyte is fairly new & we don't really know how it works. In addition there is also the issue of cost, LR & NS cost much less than Plasma-Lyte. I have enclosed the link to an article that you may find interesting.http://www.pulmcrit.org/2015/01/three-myths-about-plasmalyte-normosol.html Cheers, 1EMT-P
  13. I would recommend that you contact MEDIC & speak with Recruitment Specialist Brittany Scott at brittanys@medic911.com Good Luck!
  14. Taylor, There are lots of things that we can recommend to help you, but we need to know what you are having difficulty with first. I would recommend that you read your textbook & note anything that you don't understand.
  15. If I were you, I would go talk with the supervisor at Transcare to find out exactly what the problem is. You should have received something in writing if there was a complaint or if there was any kind of discipline.
  16. Community EMS & expanded scope of practice can work if we, focus our efforts on provider education, disease & injury prevention,follow established protocols to address common problems similar to what CVS Minute Clinics does & the use of telemedicine.
  17. I recently went to an airway management class with 40 other providers. The instructor ask how many of us had intubated a patient this year. Only 5 out of 40 providers had intubated a patient. This class had a mix of Paramedics, Flight Medics & Flight Nurses in the class. The biggest reason given for not intubating was that BLS providers had placed alternative airways.
  18. The ER should have admitted him for observation. They should have ordered a CT Scan of his head given his signs & symptoms. They should have also ordered a 12 lead EKG plus a chest x-ray & labs.
  19. This is an interesting case. When was the last time he ate or drank anything? What type of insulin was he on? Were there any signs of stroke? Facial drooping, Arm weakness, Speech difficulties etc... Also what were his vital signs? I am concerned about: 1) Stroke/TIA. 2) Migraine Headache 3) Seizures & 4) Metabolic Disorder.
  20. I have looked at this issue from both sides & I see this as a public health emergency. I see no reason why Emergency Medical Technicians & Police Officers with the proper training shouldn't be allowed to administer Narcan to patients who have overdosed on drugs such as heroin.
  21. I am sorry, but I just can't see wasting resources on a stroke ambulance. I would much rather see the money spent on improving education, equipment, protocols & training for providers. There are some things that we can do to help, including advanced notification for the ED, improved response times, improved stroke awareness education & prevention programs & working to improve access for stroke patients to CT scans.
  22. 1EMT-P

    PE vs MI

    Please tell me what you guys think of this case. You are called for a 55 year old male for chest pain & shortness of breath. On arrival you find him seated in a recliner rubbing his chest. You notice that he is diaphoretic & pale. He tells you that he was working in the yard & developed chest pain & shortness of breath so he stopped to rest & when he told his wife who is an nurse, she gave him some Aspirin & called 911. Upon exam you note the following. His BP is 85/50, P is 120, RR is 22, Spo2 is 93% & his temp is 98.7. When you perform the 12 lead EKG you notice that he has T wave inversion in V1-V4. (Sorry I don't have a copy of the 12 lead, this is a patient I encountered after the first 911 call.) He was placed on 2 LPM via nasal cannula, an IV of normal saline was started & labs were drawn. The patients exam went as follows: 1. HEENT were WNL. 2. Lungs were slightly diminished with some wheezing noted. 3. Abdomen was soft, non tender. 4. CMS x4, 5. slight pedal edema was noted. PMHX included: Acid Reflux, Reactive Airway Disease & Hypertension. Allegies included: Benadryl, Omnicef & Morphine. Medications included: Albuterol Inhaler PRN, Zantac 150 mg BID & Vasotec 5mg. The patient was given a 250 ML bolus of normal saline for his blood pressure & he was transported to the ED. The small critical access hospital evaluated him & determined that he was suffering an MI. They started cardiac protocol & arranged for transport to an ICU 60 miles away. He was admitted to the ICU by Cardiology for treatment for 24 hours, then to the floor for an additional two days. He was started on 325mg Aspirin, Atenolol 25mg QD, Nitro Patch 0.1mg QD, Combivent Inhaler QID, Nexium 40mg QD & Simvastatin 10mg QD. He was sent home, shortly after arriving home he went to get up from his recliner & collapsed, his wife immediately called 911 & started CPR, he was coded for 1 hour, but failed to respond to any interventions. Cause of death Large PE.
  23. What is your rationale for wanting to only monitor this patient? She has an extensive medical history & is at high risk for organ damage. Plus she has been evaluated by her PCP who has determined that her BP is well above her normal baseline. What is your rationale for wanting to give Morphine to this patient? The indications for Morphine are 1. Severe Acute Pain. 2. Moderate to Severe Chronic Pain. 3. Pulmonary Edema & 4. Pain Associated with MI according Davis Drug Guide. If you give this patient Morphine you potentially risk causing altered mental status, dizziness, headache, hypotension, impaired neuro exam, nausea, respiratory depression & vomiting. Plus Increased ICP is a concern.
  24. The following were concerns with this patient. She had a significant history plus she was already on two blood presure medications. At the time I didn't feel Nitro was the way to go especially if she was at risk for a stroke. She was admitted to the hospital for three days where she under went a full cardiac evaluation and her medications were adjusted. She was placed on 40mg of Lisinopril QD, HCTZ 25mg QD & Atenolol 25mg QD.
  25. Now for the rest of the story. About 10 minutes into the 30 minute transport the patient's BP began to increase & she developed nausea & vomiting. Vitals were as follows. BP 230/115, P 100, RR 20, SP02 98% on 4 LPM. I consulted with medical command who ordered Labetalol 20mg IV x 1 dose & Zofran 4mg IV x 1 dose. Following the Labetalol the patients vitals were as follows BP 210/112, P 88, RR 20 & SPO2 98%. I checked back to see what had happened with the patient several hours later. The patient was held in the ED for several hours where she underwent additional testing & an IV drip of Labetalol was started. She was admitted to the Step Down Unit.
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