tniuqs

Just from an outsiders point of view and to be certian, I don't know all the facts for this "HAM' bones argument.

Expanding on with this short sighted $$$ based ideal, just who needs a full fledged Cardiologist when a 2nd year resident, does all that cool Angio stuff anyway, and they are way more cost effective too.

OH ASY, have you ever thought about enrolling in a self assertive type program, to overcome that shy demeanor and urge you to come out of your shell ?

:twisted:

LMFAO!

Any ideas or suggestions

Yup, look north and west young man "the colonies you say"?

Lots of hoop jumping to be assured.

Look on the ACoP website: http://www.collegeofparamedics.org/

Contact: APL, I hear that they have made some forward progress in this area? dunno but contact "PATCH" in PM.

Prairie EMS, Peace Country Health, KBR, IPS or any Industrial Operator it will not be easy

BUT paddles are very cheap, igloos are cost efficiant and wages are higher than the US counterparts.

In fact even Canadian Armed Forces are reqruiting "forgieners" :roll:

I dont think I have to explain where you would be putting your skills to work.

I cant remember much about the article except that the patients had some problem, they flooded there lungs with PFC and had them on vents (this was before my medic times)

Yesseree, the PFC have been used in ventilation patients in ICUs for a while, not as routine but in studies and to the best of my recall first trialed in neonatals with (Hyaline Membrane Disease) and in ARDS (Adult Respiratory Distress Syndrome) the 2 types were Hi meniscus vs Low meniscus or fluid levels @ the Carina vs a set point in the ETT. The ICU I worked in was on the considered list for research grant in that area but alas we didn't get funding to do it. Could it be that my request for a 45 gallon drum of the stuff was too excessive :roll: as all the lit studies and trials were really promising. A couple of passing comments:

1- The present day Ventilators are not designed to move volumes of fluid (in and out) as the "out" part becomes a very serious complication human pulmonary mechanics in expiration are passive. Hence just emptying the lungs themselves sure would screw up I:E ratios to be sure, a totally different way of looking at Ventilating! the WOB would be beyond belief in the spontaneously breathing, patient I would postulate.

2- The PFC do an excellent job at removing the normal sputum production as it "floats" to the top of the PFCs...oh, but the CXRAYS look like a snow storm.... totally whited out, making that diagnostic method a dead loss, MRIs are really costly on a "good morning before rounds type of picture."

3- Using this stuff in a prehospital setting, oh man, I would not want to be setting up the protocols on that nightmare yikes, so don't call me...K!

Talking about that 80% transfusion, thats a LONG way off. The problem is not oxygen transport, but everything else. Obviously (and we all know this but gotta say it) There is more then RBS's in blood. An major PFC transfusion would have no problem transporting oxygen, but there would be no clotting agents, no WBC's ph balance ablity would change, and etc. etc. etc. I personally see PFC's as a oxygen carrying drug, the only reason it would be in a transfusion form would be the fact that it would also normally need to be give with a volume expander.

Very true I would think, what's wrong with whole blood in the first place maybe look at means of preserving it in a new light? Dump the citrates (changes PH and affects stored Calcium) try a new one...hey what about Vitamin C...half in ernest half in jest. :? Present day volume expanders are a good stopgap I believe, and after the comparison studies of treatment of blood loss, the Viet Nam vs the Falklands experiences have really changed how we look at this "field treatment" and normal human physiology to compensate, acidosis can be a preservative adaptation (proven at the cellular level at least) "STOP THE BLEEDING FIRST" does anyone out there pack out Abdo wounds the old way, control the bleed by Tamponading from the inside just a thought there?

So to go one step further why not in induce Hypothermia in the back of the gut wagon it works for cardiac surgery....and ice is cheap stuff.....ok of topic more coffee.

The day I have to breathe liquid is the day I stop diving.

Thats odd that you say that because PFCs first came from US navel tests for very deep sea diving, the panic period is short lasted... :shock:

I have heard :shock:

The last I heard they are pulling some of those products from studies to increasing AMI's, I believe of last week.

R/r 911

Yuppers was just pulled in Britian the "blood substitute products" have gone under very serious review, as of late that said I have used Pentaspan myself and had good success (anicdotally)

Agreed it will be a long time before we see perflurocarbons on the rigs.

These new LEDs absolutly ROCK! heres another option.

You may have to surf a bit, look under light bulbs at the botton of the page, I know that sounds dumb but it did take me a while to find what I needed, btw, havent had to change batteries in 2 years...really!

http://www.theledlight.com/inova.html

[spoil:d9509e9663]The future is here. A milky white substance will soon hang in the mini-fridge (next to the sodas) on our ambulances. (forgive me my science journal is at home on the toilet so namesake will come later) Artificial bloods are improving. While they will still not replace whole blood for its ablitity to carry waste products and other biological agents it is 50 TIMES better at carrying oxygen. This new artificial blood is also so small that that one single 50x loaded molecule can squeeze 6 side by side through a single RBC capillary. Whats this mean to us? Not only does it last longer on the truck then blood, but it carries oxygen so much better, through such smaller parts that it can bypass injured sites, including Spinal, Brain and cardiac injuries. Mouse studies have shown a 90% decrease in traumatic is chemic tissue damage with its use.

How does this apply to Oxygen discussion? The whole point is getting more oxygen to the patient by giving him more to absorb, but the underlying problem is the transport system. By giving this new form of artificial blood were looking at making super blood, we both increase oxygen carrying ability and the delivery of it. In theory a near complete blockage of a coronary artery would allow MORE oxygen through with this drug in a persons system, then if it was fully open?!?! Imagine the possibilities of this new line.[/spoil:d9509e9663]

Ok then theres the magic of the computer...how the hell did you do that...sneaky bugger. :twisted:

This may be another topic, but you may want to consider precautions when using high flow O2..

Stroke - high flow O2 may decrease your Pt's respiratory drive.

CPAP with MI - This may worsen the MI. how should we oxygenate our head traumas?

Nope I believe it is on topic, I think we got a tad out of focus somewhere along the line but then again we always do.

Stroke: Perhaps let Oximetry be your guide, but walk into an ER with a patient not on O2 and you may feel the wrath of those that are "old school ideals" sure saves changing out a lot of tanks on the fly to be sure.

How should we oxygenate our head traumas?:

Just my 2 cents here but until these studies are accepted and implemented across the board (or even reproduced) Please remember that they are not generally accepted as gospel just yet, that your local protolcols should be followed. Besides, we have not invented a device that can control acurately the Fi02 delivered too in a manual resusitator, the suggestion of following the SaO2 monitor sounds very plausible to this cowboy.

CPAP: this does increase WOB, but accepted in CCUs where I have worked that low levels of PEEP do improve Cardiac function.

If one searches on the net, on the use of CPAP a study by the aforementioned author and researcher)

This a study suggests that CPAP or better yet BiPAP is indicated for CHF patients by improving C.O.

Just a passing comment on:

Hemodynamic effects of supplemental oxygen administration in congestive heart failure.

Haque WA, Boehmer J, Clemson BS, Leuenberger UA, Silber DH, Sinoway LI.

Division of Cardiology, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pennsylvania, USA.

This study had a total of 10 patients and after review: The decrease in C.O. and SV, increase in PWP, and SVR.. its assumed to be and I quote "detrimental" this was not fully explained to my way of thinking, anyway. I could postulate that because of improved oxygenation at the cellular level that this may indicate a decrease in work for the heart and work of breathing? perhaps?

100% O2 administration only increases the partial pressure of 3 mmHg at the Mitochondrial level, don't really know how this may tie in but even a very small increase at the cellular level may be of significance yet to be fully understood. So don't throw the baby/ O2 out with the bath water just yet. It again is a very small study group, repeating the findings on a larger scale would be far more impressive. Just recently in fact has it become fashionable with presenters / speakers at larger Conventions to relook at how we use Oxygen as a drug.

cheers

So EMSBrian how many successful codes have you seen ? I mean successful by having patients functioning outside the hospital confines.

Can't speak for EMS Brian and will not but I have seen quite a few, Ever had a handshake from just one that you personally made a positive influence or outcome due to your efforts, sure you have RId. It is a great feeling and I bet the wife made you cookies too.

I cancel codes all the time.. Why? They are futile. period. If one is aystole and have been down greater than 8 minutes . they are not going to respond to pharmacological agents and IF they do, they will be in a vegetative state.

ALL Rid?

Have you ever taken care of a patient in a post-arrest state ? Probably not... Try taking care of one for about 2-4 weeks in ICU. The patients meanwhile will have post arrest seizures every other hour due to the anoxia during the event or the massive cerebral edema caused by hyperventilation during resuscitation. Now, if they do so happen to survive .. without drooling for the rest of their remainder lives, they will be a cardiac crippled. Confined to bed rest, so they now can get pneumonia or multiple sepsis from the decub or the other few thousand bugs out there.. to slowly go into renal failure, then organ system shut down.... then die.

Just speaking for myself: Yes 12 years in ICU man and still on the streets for as many years as you. I do follow ups routinely seen what you have man and can't disagree sometimes we prolong death instead of supporting life, the family in conference with th MDs are responsible to make those calls, not you. Your making many assumtions here and attacking someones credibility, not like you to get personal. Your not wrong but Rid I think you need a vacation sounds like its getting to you.

Can you make that call in the field based on what negative experiances you have had in ICU, I can't.

So before we get the "hero" syndrome, our actions or even lack of has long outstanding repercussions. Not only physical but financially as well at $3000.00 to $10,000 a day.

Hero, nope just doing the job expected, just what cost do you put on a life, if a millon was spent to assist in a cure of some sort or another would that justify the cost, ICU studies reviel so much good information in the treatment of disease.

If I was to introduce a surgery or even any medical procedure that would extend a life only 0.5% of the time.. would we preform it... NO! It would be categorized as useless and non-worthy.

This is just one study, and as a researcher you know that experimentation and research leads to new discoveries, it is being reported that with the implimentation of new CPR standards ~ 3 % survival rate has increased to 9% in Seatttle (or that is what has been reported anyway)

Unfortunately, part of this job is to look at the whole picture ... not snippits. Yes, resuscitate if there is any question but let's be realistic. Why work a code to bring expectations and enormous costs to only cease immediately upon arrival at the ER ? What did we prove and perform ?

Gave that individual a chance is all, thats simple, are we to decide based on a 4 min down time, not me.

Far as the family being better in the ER .. that is B.S! I can attest working in the ER & field & being the bearer of bad news on both sides of the fence, it is much easier on the family at home. Hopefully, the ER will allow family to view resuscitation efforts (yes, it is important to them). Yes, the patient is now the family... so do your job, contact the minister, other family members, get them something to drink.. the LEO and M.E. should be able to take over by then until the other parties arrive.

I think you have misquoted me and taken my comment's out of context, EMS workers are not social sevices or clergy, these are on call in my area, your imposing your opinion here.... so how does one Quantify "the grieving process" what are milestones or markers if they do exist at all.

cheers

Oops, forgot two specific calls:

.

Ok just me here, but maybe you need a new car?

Brilliant Yellow may be a good option? :shock:

Question before comment:

Are you both new grads...?

You stated 3 weeks difference in seniority?

What kind of service matches 2 new grads together on 911 calls in the first place WTF?

Oh yea your both right with the Heroin.

OD is constricted pupils.

Dead from OD.... is dilated.

cheers.

[i believe we in EMS are too mind set in performing resuscitative efforts for ourselves and not realizing that it will not matter if we do not have early intervention prior to EMS arrival.

NOW this statement is so very, very true and insightful...... but, let us mention in passing that "fear of legal repercussions" this is a mitigating fact as well, this should seriously be reviewed before implimentation "carte banche" this would undoubtedly open up a huge can of worms.

As the study describes nearly 100% fatal... that not good odds. We need to stand back and see what we are doing that is wrong and what we need to do to change outcomes.

Yes so very true, or at least review the recient and flawed "OPALS" study. This is quoted by many politicians to reduce funding for EMS and decrease coverage models for ALS, so logically the reduction of services will result in increased response times, this is NOT rocket surgery, the comparison was "in field' vs "in hospital" arrest survival (apples and oranges) (see lettemans comentary back in other threads re: OPALS)

In addition transporting patients by speeding ambulance can cause motor vehicle injuries resulting in injury to other drivers, pedestrians and EMS personnel.”

Now this statemet is very worrysome to me, just why is this occuring or is this just a passing comentary by the writer, any stats on this or studies? Is it mandated that "lighting it up" is a protocol? Let us look at EMS MVC in a new light, perhaps reviewing the transport of the types of patients, and the many factors involved, ie type of patient, experiance of operator +++.

“The family is forced to begin the grieving process in a busy emergency department often lacking privacy and dignity rather than in the comfort of their own home,” says Dr. Laurie Morrison, lead investigator on the study and director of the Prehospital and Transport Medicine Research Program. “Many studies have shown that families’ long term grief adjustment is as good or better with in-the-home termination of resuscitation.

Ok I call bs on this: how exactly one quantify grieving in the first place? ...this is absolute Psyco babble....in my area in ER, clergy is called, social workers, family notified by police and a quiet room provided. So just leave the lonely significant others at home relying on just what? At home with a blood stained carpet and other lovely reminders like the body in the bedroom waiting for the coroner for hours....this is absolute nonsense squared!

“We did not expect to find that the guideline would show a 100 per cent probability of not surviving since there are so many unique factors associated with each cardiac arrest,” says Dr. Richard Verbeek, a co-author of the study and medical director for the Sunnybrook-Osler Centre for Prehospital Care. “That is why emergency medical responders must contact an emergency physician to discuss each individual call when the guideline is used. The emergency physician will take into account other clinical aspects of the call before any final decision to terminate resuscitation is made. This guideline helps to determine when ongoing resuscitation will not be successful, but also does not deny potentially viable patients full resuscitation and the best chance for survival.”

“I see the results of this study, not only as a way to focus our resources more effectively, but also as a strong indication of how vital it is for members of the public to receive training in CPR and to overcome their fear to provide CPR to a stranger or a loved one who suffers a cardiac arrest,” says Dr. Morrison. “It’s no myth, CPR could mean the difference between life and death.”

Hey don't the co authors talk, they have their answer...sheesh.

This was the part that should be highlighted!

Any suggesting that CPR be taught in the schools?

Any suggestion or introduction at a provincial level for funding as an incentive for easy access and low cost for CPR training?

Or give a tax break to a busness or personal income tax.

So: To answer the question:

Do you want an EMT-B pronouncing your family member? What about a Primary Care Paramedic?

And EMT-Bs, do you want that responsibility? What about PCPs, would you rather have an ACP or doctor tell them their family member is dead?

I don't want Anyone telling me a family member is dead, but thats just me.

cheers

Well interesting post and good question, yes, I too have had the police block intersections and use a leapfrog tecknique but never been requested by myself for this courtesy, this is for the pros that have appropriate training, not the average ambulance opertator. When "not" on a call I become just a regular delivery truck.

The responding unit should NOT be travelling in such a manner that would warrent assistance, if they are pushing it... the ambulance bay is the time to have a friendly little fireside chat. I have seen far too many "out of towners" lighting it up to expedite a routine transfer, with granny steping out of a rig with her suitcase in hand in the bay......OMG don't go there! The Hiway traffic act here does not give an Ambulance special rights of passage in the first place and to quote a statistic, lighting it up automatically increases your risk 15 % for a collision.

K.I.S.S principal applies here, with all the distractions on the roads these days "I" try not to add to this semi organised confusion......put the bloody cell phone DOWN people ! or pull over if you need to chat, hell I do.

I can walk and chew gum as well, but why push it ?

I have encouraged my partners to roll down the window, make direct eye contact and then use the very old "stop hand signal" and quite successful I may add, anything more and one will totally bambosal most of the "cell phone implanted in the ear crowd" just my bitch here but hands free cellular operations should be banned as well, the brain is still disconnected.

Si hoc signum legere potes, operis boni in rebus Latinus alacribus et fructuosis potiri potes!

cheers

Just for interest sake:

Introduction

Central neurogenic hyperventilation (CNH) is usually seen in deeply comatose patients following severe brain damage from head injury, intracranial infection or stroke. Its characteristic features are severe respiratory alkalosis, significantly reduced arterial carbon dioxide tension, and increased arterial oxygen tension. The diagnosis requires exclusion of pulmonary, cardiac, and metabolic disorders that can result in hyperventilation (1). CNH is very rarely encountered in an awake patient. We describe a fully awake woman with a pontine lesion who presented with CNH.

Case report

A 46-year old woman presented with occipital headache of 2 weeks' duration. There was no fever, loss of consciousness or fits. She was fully alert, with normal higher functions. There was no meningism. She had bilateral facial nerve palsy, right-sided trigeminal sensory impairment and quadri-hyperreflexia, compatible with a pontine lesion. Routine hematological and biochemical tests were normal. Chest radiograph, electroencephalogram (EEG), and CT scan of the brain were normal. Cerebrospinal fluid (CSF) analysis revealed protein 32 mg/dI, lymphocytes 85/ml, and a normal glucose level. CSF was negative for acid-fast bacilli, fungi, malignant cells, and polymerase chain reaction for Mycobacterium tuberculosis. She was commenced on anti-tuberculous therapy, along with systemic steroids.

The headache initially settled with treatment, but recurred three weeks later. She was quite conscious and alert. She had developed a right-sided motor fifth cranial nerve palsy, bilateral cerebellar signs and ataxia of gait. She was noticed to be hyperventilating, and this persisted unaltered even during sleep. The respiratory rate varied from 36 to 44/minute. Rebreathing through a paper bag, and intravenous diazepam had no effect on the over breathing. Cardiovascular and respiratory systems were normal. Basic blood tests, chest radiograph, electrocardiogram and echocardiogram remained normal. Lung function tests could not be performed reliably because of marked hyperventilation. Arterial blood gases done while breathing room air, showed marked respiratory alkalosis with partial compensation: pH 7.64, pO2 131 mmHg, pCO2 13 mmHg, O2 saturation 99.6%, and HCO3 24 mmol/l.

Further investigations were performed to determine the aetiology of the pontine lesion. Ultrasound scan of the abdomen and bone marrow trephine biopsy were normal. Antinuclear antibody, dsDNA, lupus anticoagulant, anticardiolipin antibody, C-ANCA and P-ANCA were negative, Mycoplasma and viral antibodies were negative. A repeat CT scan of the brain revealed a small enhancing lesion in the left parieto-occipital region. MRI of the head showed multiple T2-weighted lesions scattered throughout the cerebral cortex and brainstem, including the pons. A CT-guided steriotactic biopsy of the parieto-occipital lesion revealed non-specific infiltration of cerebral tissue with chronic inflammatory cells. Eleven days after admission, she became fatigued and confused, and required mechanical ventilation. She lapsed into a coma and succumbed. Consent for a pathological postmortem was denied by the family.

Discussion

A review of the literature showed that here were 19 published cases of CNH in awake patients. They included primary cerebral lymphoma (7 cases), astrocytoma (6 cases), medulloblastoma (1 case), invasive laryngeal carcinoma (I case), systemic histiocytosis (1 case), and unknown pathology, 3 cases (2,3,4,5). Primary cerebral lymphoma is an uncommon variety of extra-nodal nonHodgkin's lymphoma (2), but its high incidence in CNH is an interesting finding.

The mechanism of causation of CNH is controversial. It is believed to arise from lesions of the pontine reticular formation resulting in interruption of the inhibitory pathways to the medullary respiratory centre (6). This view is supported by the demonstration of a pontine lesion in most cases. However, this has been questioned following the report of a case with a lesion in the midbrain (7), and another in the medulla (4). Two other cases without any demonstrable brainstem lesions have also been reported (1). Another hypothesis is that abnormal amounts of lactic acid produced by the brainstem neoplasm stimulate the chemoreceptors in the medulla resulting in hyperventilation. However, positron emission tomography (PET) studies have ruled out this theory (7).

In patients with primary cerebral lymphoma, regression of tumour and remission of hyperventilation has been achieved by brain irradiation, steroids and chemotherapy (2). The prognosis was poor in patients with astrocytoma and where the pathology was unknown (1,2). CNH eventually results in fatigue and death. Hyperventilation has been shown to respond to intravenous infusion of sodium bicarbonate, and to morphine and methadone (8).

EDIT as per request;

References

Pauzner R, Mouallem M, Sadeh M, Tadmo R, Farfel Z. High incidence of primary cerebral lymphoma in tumour induced central neurogenic hyperventilation. Archives of Neurology 1989; 46: 510-3.

Shibata Y, Meguro K, Narushima K, Shibuya F, Doi M, Kikuchi Y. Malignant lymphoma of the central nervous system presenting with central neurogenic hyperventilation. Journal of Neurosurgery 1992; 76: 696-700.

Gottlieb D, Michowitz SD, Steiner 1, Wald U. Central neurogenic hyperventilation in a patient with medulloblastoma. European Neurology 1987; 27: 51-4.

Dubaybo BA, Afridi 1, Hussain M. Central neurogenic hyperventilation in invasive laryngeal carcinoma. Chest 1991; 99: 767-9.

Hool GJ, Marsh HM, Groover RV, Burgert EO, Simmons PS, Reese DF. Episodic central neurogenic hyperventilation in an awake child with systemic hystiocytosis. Journal of Paediatrics and Child Health 1993; 29: 154-5.

Plum F, Swanson AG. Central neurogenic hyperventilation in man. Archives of Neurology and Psychiatry 1959; 81: 535-49.

Bateman DE, Gibson GJ, Hudgson P, Tomlinson BE. Central neurogenic hyperventilation in a conscious patient with a primary cerebral lymphoma. Annals of Neurology 1985; 17: 402-5.

Salvesan R. Pontine tumour with central neurogenic hyperventilation: pharmacologic intervention with morphine sulfate and correlative analysis of respiratory, sleep, and ocular motor dysfunction. Neurology 1990; 40: 1715-20.

[quote="Doczilla

Someone hear hoofbeats? Must be zebras.

'zilla

The enviroment and cultural views here a as varied as the stars in the sky it may appear.

Ok, well seeing as everyone is fessing up, heres my .016 cents USD. In addition with my remote paramedic "paid hansomely I add" I work with the "volly SAR groups" actually 2 groups will call me here in the great white frozen north, it apears that the common trend is I recieve a "holler" when it is:

1- cold.

2- dark.

3-wet.

No thats not right, that is the rule I am beginning to believe fortunatly I don't get called that much.

I carry a 42 lbs kit, ALS, well except for the narcs, this is a fairly striped down version and quite equvilent to Dusts "bad ass combat pack" I have numerous hi teck goodies than most could not imagine, the SAR pack was donated to me to go and "try to break it" by a friend that manufactures "kit" for CAF in afgan land. I also carry a SKED, and enough "rope" to do helo sling rescue, cause at my day job I have to be prepared to haul some dudes ass out of the bush but then I get to pick my bird, 407, 212 or A star. In the summer I am armed with a defender, why, cause bears just need some convincing sometimes is all... go away... and they can find a downed aircraft way faster than SARSAT. Winter snowshoes.

Dragging the crap in and out of my Cruiser is really hard work so I just keep there, it is just plain unadulterated lazyness is all.

Ok, I know I will be called a Whanker for disclosing this, but "Schit Magnet" is far closer to the truth for me, I can't count how many times that I have been first on scene to roll overs, on remote lease roads in the middle of freaken nowhere with no cell signal, or assisting my brothers and sisters in rural areas, never been called a whanker by anyone hanging upside down suspended by a seat belt. Oh yea delivered a kid while working on a movie set in the Carribean now that was fun, slipery little rats..... "hey why wernt you on the set? just delivering a locals kid....yea right your so funny"

I have banged line's in and even did an Intubation in the back of a rig for a old student of mine, a really tough one thats before we carried succs.Three weeks ago driving home from work, a double fatality was a witness .... now (on my last adventure) assisting RCMP to track down a DUI leaving the scene of an MVC, My headlamp sure was handy and this just last week, was "deputized" or "whatever they call it" on the spot as a assistant to a peace officer "and we did track our man" right to a bar, where he in a drunken state became "impolite to me" should have vidieoed that one.... he looked so happy recieving an early christmas gift of "matching bracelets" LMFAO! can I say prick here? The UP side was the bar, tons of lonely farm girls needing someone to dance with, so being a good sport I obliged now that was duty calling.

Now back to the regular sheduled thread, the rules of engagement here in Alberta are that I have no duty to perform.. legally, but, I could not hold my head up if I passed by a wreck without offering to assist, unless theres an ALs provider on scene already, as for possible legal action against me....bring it on baby! Its been 20 + years, ok maybe a bit more that I have been doing this. So sucking out my EMS brain will just not happen, besides would love to make a precident.

Funny how a imaginary border (s) and a different legal system makes so much difference to the human condition, even provincial eee gads.

So I must applaude those with similar ideals but not condem those that do not.

cheers

"mediccjh"]Cut and pasted from my blog:

Come to find a 28 y/o female disabled Marine, hyperventilating. Well you see, what happened was, her cane fell out of the overhead compartment and landed on her head, giving her head and neck pain. No biggie, except for the fact she was hyperventilating so much, that her arms and hands cramped up. So even after about 20 minutes of her on a non-rebreather w/o O2, she still couldn’t break it, and someone else (NOT ME!) made the decision to land. And on the descent, she went unconscious. 4 times. So we landed in Indianapolis and offloaded her. There was also an EMT on the plane who was assisting me. Either way, there was no slowing this lady's breathing down.

Ok now this is an interesting thread, could it be possible that this individual could be suffering from Central Neuological HyperVentilation it is not as uncommon as one would think, what exactly was the disability, the cramping you describe would it be possible that this was "Midwives sign" perhaps a calcium related problem ?

Was there any meds on board at your disposal, like any benzo's? My experiance has been that the BANYAN STAT kits are carried on many overseas flights and I have had occasion to view the contents, if I can remember valium is in the kit. If I had any idea how to insert a file.... but I don't.... I do have a image that lists all the contents of the BANYAN STAT kit for those that would care to see.

cheers

Not immediately, that is.

So "logically" my next question would be this, if the survivors stagger over the border into Canada, without US passports,

get drunk with the Flight attendents for 3 weeks, under new US laws will they are not be allowed back into the US right then. If so......you following here...they get "crashed" immigrant status, they apply for reciprocity in EMS and bingo more Health care workers for Canada. Its clear now, I can see it all ...... this was all a clever government hijacking by a special undercover operative called dick.

OK so here is another thought.

"Great minds discuss ideas; Average minds discuss events; Small minds discuss people" Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

"AZCEP"

I would recommend looking at www.capnography.com for the expected waveforms

Hey great site.

Thanks for the link!

I agree' date=' if used properly and having a true understanding of the use and application of capnography, one can utilize this tool much more. It has been described as ..."just as the ECG is important for hearts, the capnography is for respiratory systems"... [/quote']

Yes understanding this device could lead to improved care.

An interesting comment, I have seen delayed response to the floors COPDer, but in most cases almost an immediate result in observed with Pulse Oximetry (with appropriate perfusion) Try this: place it on your finger, take a deep breath then push or vaso vagal yourself. One should see an almost immediate drop in heart rate... a very rapid resonse, then when everything reach's equelibrium take some really big breaths, Hypeventilate (so to speak) you should observe a drop in sats initally and then a delayed improvement in sat numbers, an interesting observation I have always wondered why?

Generally speaking Respiratory failure kills far faster than Ventilatory failure, not trying to be being picky here but there is a clear definition of both.

Please explain why bronchodilation or "not wise to give nebulizers to CHF" if this is a goal for improved oxygenation in a CHF patient an "adverse effect" ? I have never heard of this, please enlighten us, thanks.

btw Let us not got get into recient a therom that Oxygen is detrimental to the CHF patient, as that study only had only 24 patient's in that study group, and was very shody study to begin with.

Agreed: But during Grand Mal siezures the muscles can be "ineffective" so how does this assist in treatment other than the fact that they are not exchanging air?

The window in mainstream evaluation can becomed "fogged" or affected by secretions and some have delay to heat the window up as well, there are some artifacts that can be resolved easily, agreed, throw in a humidvent/Dar/ whatever you call em down there in line.

Generally speaking if one has a consistant reading its fairly reasonable to say it is giving you an accurate reading.

ETCO2 is not effected as P.O. with ambiant sunlight, not affected by wierd and wonderful heamotologic (is that a word?) stuff.

With some sidestream type ETCO2 the mls per minute should be adjusted, for the intubated or pediatric patient this giving more accurate readings ie from 90 mls per minute to 150 mls per minute (dependant on) Propac or LP 12.

Maybe that can change, I hope so.

R/r 911

We have it, and yes it can change the treatment that is provided.

Intubated cardiac arrest, for example. If the patient has minimal CO2 detected following 2 minutes of compressions, there is less likelihood that they will be resuscitated. Consideration to terminate can be made much earlier, regardless of the rhythm that is found.

Agreed:

In addition on a ventilated patient with an acceptable blood pressure and dependant on Patho one "can" make changes to numerous ventilator settings and improve ventilation and oxygenation.

Reactive airway disorders: you can gauge the effectiveness of the treatment you are providing based on the waveform. If the patient is unable to adequately ventilate the distal airways, you will see a change in the waveform and the numerical value when the treatment you are using starts to work.

COPD: Because of the pathophysiology of the disease, the waveform is different from normal to start. When treatment is effective the wave will "normalize".

Got any studies there would love to see any "sharks fin" research.

So just what is "Normal" for a "COPDer" an Asthmatic or a healthy patient?

In any of these situations, you will alter your treatment plan based on the information that you receive.

Can you explain how and why this may alter treatment, specfically what treatment, If you would be so kind.

Your assessment and the information from the capnography should work together to tell you how effective you are treating the patient. Capnography alone can't tell you, and neither can a good assessment.

Bit confused here, are you saying a good assessment is not possible without ETCO2, I don't think that is what your implying but please correct me (not trying to put words in your mouth)

Has anyone heard or read of" Volumetric ETC02 monitoring" in present applications for EMS, it maybe the future of ETCO2 ?

This tread could turn ito a great teaching post if given half chance.

cheers

Sorry. This may have been lost on some people.

Hey in real life I am a Turnip!

To answer this threads query:

When onboard aircraft...if I knew I could get free drinks I would... er .... will in future, thanks for that advice all.

But then if "I was impaired" I would be forced "ethically" to stand back and watch the fictious Air Marshall or some medic earn his wages. I am beginning to wonder just whom would be the "poser" in here.... obviously not "akroeze" even though he does look like an escape from "HULL" ?

Personally getting "put out" by some that would profess to be professional, slamming those with nothing but honorable intentions and despite the fact that proctologists, RN, and EMTs would be of any value in an onboard medical emergency ... sheesh, lord give me strength, and admin give me latitude, to speak my mind, please.

cheers and squinting.

I totally agree with the family being present during a resuscitation. I have them present whenever I can. I even did it once so that a family that would not make their mother, who was going very slowly into multisystems failure, a DNR would realize what they were putting there mother through. Sure enough, after about a minute or two they thankfully changed their mind and the pt was allowed to peacfully pass.

I commend you, I just wish that the time that I spent in ICU that more MDs would have made that very difficult choice, I bet It was not easy.

I don't think the back of the ambulance is the best place for a family to be during a resuscitation.

Agreed: Never in the back "of a rig" with seat belt on in the front well unless your on board aircraft.

Now that gets Me concerned as I have a unwritten rule "No family escorts allowed to fly" :shock:

There is just not enough room back there in most cases and pt care needs to come before the family. I think we are talking about two seperate circumstances here.

Yes, totally.

Again, I feel (and it is totally just my opinion) that in the end nothing would probably come from it. If the pt survives, great, no one is going to know any better. If the pt dies, it was not fully unexpected. Unless someone goes out of their way to tell the family this will probably not even get back to them, and if it does, will they understand what it means?

My opinion too, just brought the topic up for clearity, understanding this has made me more "comfortable"

Did I say comfortable? OMG!

cheers

Of course. Should I mention that I have a goood connection to one the best schnaps- distillery in europe:

Thats because you used the Correct Password!

Shnaps!

Are you trying to tell me that the population of the African Elephant has not tripled over the last 6 months???

Really..... Man o Man I just have to get out more!