redwolfef6

Excellent case study.

I am inclined to agree with Tomcbad...valsalvas and then Adenosine. Should be able to see the Flutter waves. I actually was involved in a case (during my clinicals) on a man with a very rapid tachyarryhthmia. The Doc had me given him 6mg (x2) of Adenosine. The rate slowed and showed a 2 to 1 Atrial Flutter. After that he got Diltiazem.

As far as SVT with aberrant conduction vs. V Tach... should normal to left axis and good R wave progression (V1- V6) for SVT.

Very interesting strip. (BTW sorry about chiming if this subject is already dead.)

My initial thought was A Tach converting to, possibly, a junctional rhythm. I sent a copy of the Pt hX and the link to the strip to my old paramedic instructor, he is considered an EKG guru, His thoughts were: He would like to see other leads and from what he saw thought it was a Rapid A Fib with Ashman's.

I am definitely going to do some more research on Ashman's.

Excellent strip and subsequent discussion, definitely a learning point.

In the system I work the Fire dept. is the medical authority. They called in one of our ambulances for toilet paper stuck in the nose (5 y/o).

One night we got dispatched on an possible OD with Fire. U/A pt stated she thought she might have accidentally ODed on her evening meds and wanted checked out... happened around 2300. :roll:

0600. We have 3 units covering our town. We are the earliest car, The others change at 0630 and 0700.

I always relieve 15 minutes early. Our c shifter likes to show up right at 0600 (sometimes 1 or 2 minutes late). B shifter usually shows up between 15 and 30 minutes early.

As a "baby medic" I have to agree. Thinking is more important than blind acting. The program I went through (HealthOne, Instructor Dennis Edgerly) one of the major areas was critical thinking. Yes we got all the cool techniques, but we were taught to think through our tx and prepare for what was next. I have told my medical director during my clearing interview that I wanted to be the best BLS paramedic I could be. Now before you all jump down my throat for my last comment, let me explain.

I have continually strive to think about the bls tx before I get all gungho on the als. I think as a paramedic it is more important to treat a pt with fewer drugs and shock them until they glow (unless warranted). Does the o2 relieve the nausea or alleviate the air hunger feeling, if so great!

I hope I explained this well enough.

:shock: Farking Brilliant! I am just stunned. I think the little old lady has money in her future.

The apology was less than pathetic. I can't believe someone in a position of authority can only get a day or two on the beach for being a complete tool. Frankly our medical director would have our heads for something so inept and ignorant.

Approximately 30-45 minutes nonemergent. Frankly I don't think we shave a whole lot of time when :blob6: we have to go emergent.

Our Fire and rescue are combined as well. Currently we are 100% volunteer.

We are trying to get a paid medic and emt/ff on, but money is an issue.

Had a study that showed that we lose approximately 20% of our call volume due delay in response.

I agree with AZCEP. I have a PDA and use Epocrates for my drug guide. It feature the latest formularies and I can look up several meds and see how they are going to interact.

8) Very cool thanks for the response. Where might I find more info?

To tie into Ace's last post, great information by the way, we've made it semi-policy that any patient receiving medications, or with complaints above the waist, have EtCO2 documented on them. The waveform makes it that much easier to justify what needs/doesn't need to be done.

The receiving faciltiies look rather puzzled when I explain to them the capnography is to monitor ventilation, not oxygenation.

That sounds like a great idea. In my agency we routinely use Capnography on all respiratory complaints & confirming Ett placement. I haven't heard of it being used for CPR effectiveness or pacemaker.

Could you explain the use of capnography in the pacemaker setting? Sounds very interesting.

I was just wondering if anyone else here played in the Society for Creative Anachronism (SCA) and if you use your EMS skills as a member of the Chirurgeonate?

For those folks who have no idea what I'm talking about here are a few links to help you out.

www.sca.org

www.chirurgeon.org

http://www.chirurgeon.wastekeep.org/whatis.php

For those who do know what I'm talking about, I am the Deputy Baronial Chirurgeon of the Barony of al-Barran in the Kingdom of the Outlands.

www.outlands.org

www.al-barran.org

Have you ever had to use your mundane training at an event? IE: done more than the Good Sam FA? Some of the bigger events can really generate some "NSTIW" stories.

I was the chirurgeon to the king of Adenveldt, (I think that was the name of the kingdom) also known as the Phoenix greater area. That was way back in 1994. I have since married and moved. :king:

Okay.. I know different in Denver!.. Load and go, is not highly recommended. As well driving fast went out with Mother, Jugs, and Speed. Diesel medicine KILLS!

Hint: http://www.emsnetwork.org/ambulance_crashes_2000.htm

R/r 911

I said "almost better". I am sorry for making that overt generalized comment. :oops:

What do you mean "I know better in Denver"?

Definetly need to perform a V4R before other pharmacological tx.

How about starting off with 250 cc bolus NS- prime the pump. Yes I read she has light rales, but 250 shoudln't be that taxing.

Here in Denver we have to call in for Dopamine. I would ask for 5mcg/kg/min and try to get here pressure up to around 100 systolic. From there I could go down the Nitro route (barring a RVI).

Why bother? Transport issues?

Please clarify...

Nothing like having an extra hunk of metal hanging out your ambulance.

Here in Denver we don't even carry AC. Our tx of OD's depends on what is ingested. Quite honestly everything is a call in at that point. It is almost better to maintain airway, IV with blood draws, monitor and drive fast.

You could pull this womans Pj bottoms off or leave her with her self-respect and cut up the seam on the injured side.

As far as a traction splint.... frankly why bother. With that in place you now have tranport issues. Stabilize the injured leg to the uninjured leg. Definetly pain control as lonas BP stable.

Speaking of V-fib protocols, lets have a quick scenario. You have a 26 y/o male with no cardiac history who collapsed while playing softball. Said patient converts to a NSR, a good, clean, beautiful NSR with nary a PVC or anything resembling a wide complex as far as the eye can see, with return of pulse and even takes some attempts at breathing after one defibrillation at 200 joules. IV established, patient intubated. Now the tricky part, should we be good and bolus him with Lidocaine or say "it probably wasn't an irritable foci that through in into v-fib, so lets not play with his heart rhythm since he's NSR." Discuss.

Here in Denver, we are supposed to set up an Amiodarone drip. Lidocaine is no longer in the Denver Met protocols. I am a medic in El Paso county as well (Colorado Springs area) Our protocols there don't recognize Amiodarone- strictlyLidocaine.

I am the only Paramedic with my volunteer fire depart. I have been tasked with upgrading our ambulances with either Lifepak 12's or Zoll M

's.

I have looked on Dotmed.com and tried to igure out how to write grants. I am feeling totally overwhelmed. :pale:

I checked out aed.com, but found it is only for aed's any other suggestions? :banghead:

Littman Cardiology III. Comfort and sound quality par excellence.

To top it off I got it for free. [/font:672b255e7b]:D/