tniuqs

:shock:

Agreed with most of the dialog here..... but anyone carry Etomidate? TWTG.

Nasals for Head Trauma.... bah humbug just asking for troubles and agree with Rid, OG is way less risky too.

Vs eh: agreed RRT's are limited with the Nasal Tube as its gosh darn hard to bronch them and trying to do a BAL the Bronchial Alveolar Wash becomes a pain, when the do get infected and they usually do, typically the ETT are smaller OD/ID.

Hey in passing, just found a new Cricky device: check it out...... but only in Canada EH? :twisted:

http://www.smiths-medical.com/catalog/cric...dotomy-kit.html

Late Entry:

For Time and 1/2 I change tires too.

Dust when you hit the border go West (Young man?) Go west....quoting somebody... :twisted:

Darn but don't you folks come up with great questions. We don't do transplants at my hospital (thank God) so I went to Cardiac Anesthesia fourth Edition by Kaplan page 994-995.

Heart rate increases only gradually with exercise and this effect is mediated by circulating catecholamines. Increases in cardiac output in response to exercise are instead mostly mediated via an increase in stroke volume. Therefore, maintenance of adequate preload in cardiac transplant recipients is crucial.

Firstly great post very consise explanation, thanks for doing the leg work.

So extrapulating from your post and I suspect cut, copy, paste..... from Kaplan.

Preload and adequate circulating volume would be of key significance a fluid challenge may be the "best first" and conservative choice for a tachycardia.

Lack of parasympathetic innervation is probably responsible for the gradual decrease in heart rate after exercise seen in transplant recipients rather than the usual sharp drop.

Pmhx may be a very serious impact (ie What was the patient doing prior to arrival? )

Could an analgisia or a benzo be a better option?

I have "anecdotally" observed an SVT suddenly convert to NSR with the use of fentynyl and just prior to elective cardioversion in an ICU setting (applause was heard from the crouwd) the explanation being a reduction in the circulating catacholamines.

It is logical Mr Spock.

So quick off the mark beta blockers "could crater the patient" (due to the delayed response of the transplanted heart?) dunno?

Denervation has important implications in the choice of pharmacologic agents used after cardiac transplantation. Drugs that act indirectly on the heart via either the sympathetic (ephedrine) or parasympathetic (atropine) nervous systems will generally be ineffective. Drugs with a mixture of direct and indirect effects will exhibit only their direct effects. Thus agents with direct cardiac effects (epi or isuprel) are the drugs of choice for altering cardiac physiology after transplantation. However, the chronically high catecholamine levels found in cardiac transplant recipients may blunt the effect of alpha adrenergic agents as opposed to normal responses to beta adrenergic agents.

So direct adrenergics are the best choice with the medication route (I haven't seen Isuprel on the Cars for quite some time) but treating hypotension 'a much more likely senario" I suspect.

So, (my analysis) beta blockers will work although if you use labetelol you would not get the alpha effect from it (labetelol is non-selective beta and alpha). Atropine won't work normally if at all.

Not sure that this helps.

Yes it does.

I have often thought this would make a good article for a journal such as JEMS but I don't have the necessary expertise to write it.

Disagree, you know how to do "cut to the chase" research to be certian.....go for it!

Quoting: Asysin2leads

Okay, now, as for me, so long as I get my paycheck, I'll mop the floors if they want me too. Anyone who thinks working a BLS bus is somehow below them needs to get a life and seriously reevaluate themselves.

Asy Dood! Let me tell you a little story K?

Did that ONCE......"nothing will happen".....So a multiple stabbing victum , 30 min transport time, no ALS available (busy) No intubation gear, no big bores to decompress chest, (or caths long enough) limited IV fluids (at the time BLS was not permitted to start lines) no meds to deal with arrythmias and the eventual the arrest, that is positivley a T-shirt I will NOT wear...... period.

Here in Mooseville we have legislation that one MUST perform to ones ability and training otherwise you could be looking at a Criminal negligence suit. Frankly the time and 1/2 is not worth the paperwork, QA investigation, Court Time and the very real possibility of a "fatalities inquiry" (I guess I forgot to mention this occured in a federal penitentary?) So when asked 4 years later to do a standby @ a Forest Fire "OC" ....Out of Control, 40 miles from the closest ER and with the normal 2 bags of N/S on board the truck.

Please fill in the blanks: _ _ _ _ ...... _ _ _ !

But for time and 1/2 I will Mop floors, and I will even do windows..

cheers

Short answer for me...NOT A HOPE IN HELL I would work this way.

I will never tell...

Hey just trying to help a V.I. get a hoof up.

Following this thread, frankly a bit confused....why exactly would one need to use Beta Blockers or Calcium channel blockers for a transplant patient in the first place? A run-away Tachycardia or Hypertension is a rarity I would think in this situation, personally I would look to other causes like the "root" cause of this senario..... using either drug "could" really comprimise this complex type of patient.

cheers

Well this post was intended to be serious…

First thread:

TRAVOIS [travois] , device used by Native North Americans of the Great Plains for transporting their tepees and household goods. It consisted of two poles, lashed one on either side of a dog or, later, a horse, with one end of each pole dragging on the ground. It had straps or wooden crosspieces between the poles near the open end that served as a carrier. Like the sledge, the travois was used by Native Americans before any use of wheels was known to them.

Just an idea here, with the use of wheel's one could invent something that may work out, some SAR teams here in the Canadian "Outback" have used these critters for that porpoise, when weather craps out and the choppers can't fly.

Second thread:

OMG do you think ak has done it with a deep sea elk? :oops:

Just an idea here but why not do your own experiment?

When you get to a facility (that has one) use an large thigh cuff and compare.

Just a side bar try an NIBP in both applications, large arm and forearm.

cheers

Don't you work close to a any Parmedic's..... maybe you should ask them to give you a hand.

Why all the screaming??

Could it be he is seriously long way away from your "tourist attractions" ....just guessing?

cheers

I am so glad that everyone here can have so much fun at my expense........

........actually it is pretty funny!

Thank god its you today, and you wear it well... just try living with handle "turnip" tis hard life all around man.

ps You sure looked "Hot" tonight, but I think I am getting a HA..........LMAO!

It wasnt specified in arrest or not...whateve bothe good posts.

It sure is foamy crap and hard to get all the bubbles out.

Just a suggestion, use a large bore cath instead of a hypo, and don't put too much suction when drawing up..

Another point is that used over a period of time pumlonary concerns should be followed up with DLCO testing.

Diffusion Limited Carbon Monoxide testing has indicated "in some studies" that pulmonary fibrosis could be a future concern.

Mortality morbidity is less than the standard Lidocaine, to door discharge.

cheers

Ok, at this point, these are the differentials I'm thinking of: cluster headache, possible reaction to food (such as wine or cheese), pressure on nerves and/or vasculature from sleep posture, psychosomatic. Nothing seems to point specifically to lesions of ear,sinus, oral cavity, so I toss that for now. Maybe some problem w/ medication (her BP is a good bit higher now than previously w/ tx). The only serious thing I can think of would be some lesion/mass in brain, but it would probably progressively get worse (I think).

For any of this, though, there's not much I can do in the field, so I'm gonna stop wasting time on scene, take off the teddy and heels, and transport. Keep her comfortable, monitor V/S, throw in a lock just in case.

Why do I feel like she's about to crash cause I missed something?

Good thinking...but where have you been?

Lets transport 30 degree head up, and run quiet.

I think we should talk after.

oops.....its been awhile....sorry.

Ok have we got a line in?

Perhaps a touch of benzo for aniety, s/l, i/m or iv?

We should do the transport thing soon we have been on scene since 08:00 hrs.... :roll:

Well thats....if we can get becksdad out of the closet.

late entry...is she menstrating?

Edit

At this point, becksdad sneaks off to the bedroom while his partner does the work. He is later found by PD snooping through her lingerie collection edit but does look very attractive in the blue teddie, and the those high heals...whoo hoo.

Has she been compliant with her atenolol? When did she start the prescription? Has she had any follow up with her MD since the prescription was started?

Pesky students...lol.

Great to see your back on duty was following this one ERDOC, your senarios are good fun.

153/88 66 RR14 100%RA

Atenolol 25mg PO bid

She's about 5'8", 135lbs, brown wavy hair down past her shoulders, sea foam green eyes, the perkiest... oh wait, I don't think that's what you are asking for. She looks pretty normal. As stated previously, no facial droop.

squint pushes rookie on car out of the way, I will take it frome here and suggests get his/her chariot needs checking out...just kidding.

Ok back to busniess:

- grips + reflexes.... any unusual findings? the history may be suggestive of cluster type HA.

- beta blocked.... hmm.... is she compliant with meds? and when was this treatment initiated?

- When was she DX HTN...any complaints of leg pains, drowsyiness, unusual dreams or dizzyness when she first awakens?

- Has she taken any OTCs to relieve her pain, or any herbal remedies?

- Since we got to the call, has the pain changed in any way and have her describe what she is feeling if any changes.

- Pulse 66 you say, ECG done yet? NSR? or any blockes?

- Chestsounds...any adventicia? any SOB?

- Any problem with urine production? (just no way to make that sound good)

cheers, as typical your senarious start out benign, then..........???

Nurses aren't evil creatures I promise. But, they do lack an understanding, for the most part, of what a medic's job entails. Back home, some nurses still believe that our medics are solely ambulance drivers; that they have a poor understanding of A & P and so on. We are noticing this as higher qualified medics are assuming some pretty techinical skills that normally were never seen in the ems before. We have ACP's that are going to shake things up around here as they enter their hospital practicum. As they will be performing skills that typically are reserved for md's or icu nurses. Most of all, Be confident, concise and don't argue with the nurse, you'll never win, whether you're right or wrong.

By the way, food never hurts. especially chocolate or sweets.

Two points here....one, most RNs are very good with the teaching portion in promoting education....these days in our neck of the continent in fact I can honestly say if It were not for the good ones my education would have been far more difficult, but I have been around pre "medicnorth" period.

Point 2 I NEVER cower from an argument with an RN that is or has the potential of negatively affecting patient care, patient advocacy is the most top priority in my philosophy period....... besides I usually win because its hard to fight with a guy using a walker, it looks so bad.

Point 2 (eh)...I don't ever get "chocolate" the connotation of Valentines or a Romantic inference could be miscommunicated........so how do you like your Tims.....double double? it is way safer!

ps where do you practice as your comment :

We have ACP's that are going to shake things up around here as they enter their hospital practicum.

These would be "students" not registered Paramedics, I sure as hell hope they DONT shake things up, they should be walking on eggshells if the program is new to you...... I would hope....as one negative incident ant the rest get painted with the same brush.

Only a couple of times in all these years do I remember some crotchety nurse getting nasty about staying around.

Is crotchety a real word? :twisted:

LMAO @ Pretty much anything in my pants could be used as a weapon.

Ok Ok I've got a good one.....What do ER RNs use for birth control.....that is right their attitudes!

Now that I have that down on paper, and having worked in ER (not as an ER tech I add) the interactions can be complex traditionally with nursing there is a pecking order, the higher you go the more "tude" you may encounter but not a firm rule.. At the same time these folks can be under a tremendous amount of stress, so don't take a curt word or 2 to be a personal attack....! It is usually hopping crazy where I worked sometime politeness goes astray, water off a ducks back man.

If one thinks this is a place to "hit on chicks" or have them "hit on you" then go back to the Bay your not in the Bar....ps I doest work for me there either....lol.

The folks that are respected are the laid back dudes, one's that have a sense of humour and are helpful ie "Can I assist with Compressions" and "you don't need to ask to help changing a patients bed sheets" pushing a stretcher to xray or even (I am not suggesting you become a Suck Up)

Stopping by "later" with a box of donuts....this is usually very appreciated, "friendly follow-up" brings the best educational experience from the MDs...... ERDOC is very right "teaching" is ingrained in the MDs, but thats when there not trying to empty beds, send patients to floors, writing on charts...or get to the donuts!

When your on a "hit the wall on hold" situation with a non-emergent patient, have the junior member of the team go look to help out the staff, they WILL remember you, if you show your "wanting" to be part of the team it goes a long way.

cheers

IDEAL BODY WEIGHT, HAMWI Method

Female:

First 5 ft (154cm) = 100 lbs (45.5 kg)

Add 5 lbs per additional inch

or add 0.9 kg per additional cm

Male:

First 5 ft (154cm) = 106 lbs (48.5 kg)

Add 6 lbs per additional inch

or add 1.1 kg per additional cm.

So in a perfect world a 6 ft man should ideally wieght 172 lbs or 78.01 kgs.

Now...stand away from the Big MACs yall.

Interesting topic.....will sit back and watch this one till to be sure, some serious "lack of" evidence based medical practice here. :twisted:

LMAO @ PVC!