itxtme

Wish I could "Thumbs Up" a moderator - nothing worst than intolerance, so your post may just give someone a little perspective!!

I completely disagree; if you lie to a patient, you lie to them! I wonder if the OP's colleague has been taken out of context. I agree that there are times where the truth must be bent for the benefit of the pt. In those scenarios we all do it. There are degrees to the lies that you tell, and that is what VentMedic is getting at, but when a definitive benefit to the patient exists most health professionals tell the odd white lie to aid in the best outcome for their patient!!

I went to an adult patient that was (his words) "intoxicated with ice-cream" last night!! No costume though

Depends what you mean by "mental disibilities" Over here we call it intellectually handicapped or IHC as grouping word; and this is not a derogatory term. That is assuming you dont mean someone with psychological problems in which case that is expressed quite differently..

Thanks for the thorough reply ERdoc; I completely agree with the realities of traumatic arrest and what skills are realistically required to decrease mortality rates. My statement in regards to Diazepam618 was disappointment with the age old attitude that I hear see and live through (at my own service) with traumatic arrest, in that its futile so don’t bother! Studies like this one provide insight into possible changes we could/need to make internationally in the prehospital environment if we want to get serious about improving decreasing mortality rates. Interesting what you are saying about ACLS drugs and lack of proven efficacy in traumatic arrests – this is one thing I certainly wasn’t aware of!

Your reversible causes for cardiac arrest include hypovalemia which is what the apperent problem is here. I have no idea why your mentor would think giving Adrenaline will lead to increased bleeding!? PEA is a loss of mechanical movement of the heart adrenaline looks to increase this to sustain a pulse. Yes given a pulse will lead to increased blood loss, however no pulse will lead to death.... Furthermore consider the pharmacokinetics of adrenaline. When given IV adrenaline has notiable effects on Beta and Alpha receptors. Specifically you want the effects of the ALpha receptor in regards to Systemic Vasoconstriction leading to "shunting" of blood back to the core of the body! Once you have pulses it is a different story/ consideration and continued fluid resus and chrono/ino trophic drugs.. I feel sorry for people living in your area. I suggest you do some further research on current Traumatic Arrest literature, you may be very suprised at people that may have lived if you had a different attitude.. Have a look at "Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest." a 2007 article

Check to see if your current ones contain iron by using a magnet on them. If they do take a hax saw or something similar and saw off the pins. Go down to a badge shop and buy the high strength magnets to hold them in place

I have the boy version, great watches!!

Wow you must be really enjoying that trust factor in your relationship!!! I often work with the opposite sex overnight and can honestly say my partner has never been in the least bit concerned.. Talk to your wife about having a little trust!

ummm yes they do... DKA (Diabetic ketoacidosis) is a form of metabolic acidosis which leads to a respiratory attempt at reducing this via blowing off CO2 (hyperventilating) as it is acidic. This breathing pattern is specifically known as Kussmaul breathing. Head Injury is often found using Cushings triad. A triad of three baselines which indicate the injury. One of the three is irregular breathing which could manifest as hyperventilation.

So what exactly is the question. You should follow the patients management plan. You are not able to tell any more info in regards to the origin of this seizure. ie. is it another Pseudo?? So my advice would be to stand aside and state there is nothing you can offer. After all your only "involved" with EMS and this has no relevance on the care of this patient. Its like pulling a random person off the street and asking them what to do despite having instructions already!

You say Tonic Clonic seizures, now if these are Pseudo seizures generally there is no visible Tonic stage. The understanding of a Tonic phase is the mass contraction of mucles which generally causes back arching. This phase lasts only a few seconds and then the patient enters the clonic phase, thisis the rapid contraction and relaxation of muscles causing the typical seizure like activity. Pseudo seizures are usually clonic seizures only. Signs of true seizures - (post seizure) -Tachycardia -Altered Level of Conciousness -Lethargy -Self injury (tongue biting etc.) -Incontenince amongest others.. If these are not present (or at least most of them) then reluctance must be placed on the validity of the seizure. Having said that without cerebral monitoring one cannot rule these out. The question should be asked why you are being asked to intervene in what sounds like a fully developed Management Plan for the patient. Do you feel there is a true danger to this patient? Then call somebody capable of assesing the pt - a paramedic

I see what you are saying and you have merit in what you have said; but in my opinion if you have the maturity, the training and the clinical experience you will put the patients mind at ease. Age is irrelevant. You don’t choose the provider when they arrive at your doorstep and often like you say people judge the cover, but I can guarantee within arriving at hospital my patients have the utmost trust in me and my abilities. [early 20 year old]

I have the axis as normal??? Dont tell me I have been doing it wrong all these years! Cant see the Q wave either, but if it is there its certainley not big enough to be pathological! Have dispersed clots travelled to his brain and heart?? Im going with AMI (inferior) - lets go with a V4R, )

Tried one of theose (Corpuls) and I have to say they unimpressed me. The biggest peeve was the lag with using the soft buttons, push it and get a response 3 seconds later!

Ah and so the misinterpretation begins!! You need to read some of the source articles to fully understand just what Bledsoe is talking about in this article. I have just completed a review of this literature for my service and I will recommend some changes to things we do! What Bledsoe is trying to get across is oxygenation is deemed of greatest importance in the pre-hospital arena and yet it is just a mere part of the equation. Look into some of the sources that have been referenced and I guarantee it will change your treatment techniques!!

I find it difficult to see why this would ever be Afib, the doctor that thought it was based on lead II soley suprises me. Anything could be causing interfernce on that lead, and the lack of disorganiztion in any of the other leads points towards a dodgy sticky, poor contact or limb movement. Like the above poster I will underline why I think it is MAT and not Afib or sinus arrythmia Decernable P waves before QRS complexes (against afib) Multiple amplitudes and morphologies of the P Waves [they look differnt] (against sinus arrythmia) For sinus arrythmia I would expect similar [same] shaped P waves in front of each QRS, this is just not the case in the strip. Somebody is right and the rest of us are wrong; wheres a cardiologist when you need one - maybe I should just mentions Nazi's and forfit the debate (godwins law for those who are confusedO.

I dont see how you are saying there are no P waves.. I have circled some (not all) of the P waves, or what I consider to be P waves. I would call this rhythm (the top one) First Degree AVB based on the prolonged PRI, however in the two complexes I compare there is no lengthining or any dropped P waves. Maybe I am misinterpreting?? Given the patients history it would appear he is failing (CHF), the presentation to me (the first ecg) would make me query right sided MI given the bradycardia now exposed (in the ecg). MI protocol while treating the failure also..

Mine was when I was 2nd or 3rd shift on the ambulance and we were sent to a big guy with abdo pain. The medic gave 5mg and 5mg of morphine justifying his big stature; this seemed to get on top of the pain. While were driving down to hospital the pt appeared to look a little pale so I took his BP 83/70; hmmm I said to myself must be too many bumps in the road so I hit it again. The pt flakes out and I call the medic in, I had no idea what was going on! Of course his BP caused the LOC and head down feet up sorted it out!! From this day on my first treatment for a decreased BP is positioning! I also believe that as a new medic you have to see some things at least once before you will fully recognize them in the field - to think how green I was

No I do not believe so. In a PJC the the pacemaker is from junctional pacemakers, this firing heads upwards to the atria causing a either missing (hidden) p wave [as in the beat I have highlighted] but ultimatley it is below the atria. During MAT the starting point of the firing is still the atria so the firing doesnt need to head up per say to fire the atria.. Hope that makes sense. As another aside apart from the missing P wave in the junctional beat you can see quite a differing pattern of the QRS (comparing to the other QRS complex's) indicating a significantly differing pace maker sight.

I disagree. 12 leads are average indicators of AMI (well maybe above average) but certainly not the gold standard. Step away from AMI's for a moment and a 12 lead is absolutely invaluable. For example we have a pt with possible CHF but differentials of double pneumonia we can use 12 leads such as axis deviation and R wave progression to help in choosing a more definite treatment plan. Merely a piece of the puzzle but if you use 12 leads for AMI recognition only you will have EMT's soon calling the cath lab for a LBBB (old onset) because they don’t know how to spot one (and we all know how ST elevated a LBBB appears!) edit sp.

lol, thats ridiculous!! There is more than one way to interpret a statement. How can a car that has an immobilizer in it still be moved!? But I do like the sound of SMR, might pinch it

I remember doing some study on G6PD in pharmo and while I did not consider it originally it does make a lot sense. Of course being the case ethnicitys at risk include african american males, asian as well as arab individules

I was thinking along the lines of you in regards to no food lately -> ramadan