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Wow, eleven pages on this. Okay, so maybe I haven't been around long enough, but I haven't come across any decapitated pregnant women, who happen to be full term, and also happen to have died just 5 minutes or so before we arrived. This scenario sounds like something they'd give you in philosophy 101. Yes, it is an interesting moral dilemma, but it really doesn't have any real-life application.

Yup, and if they'd just transported the guy that evening they would not have been woken up early in the morning to run a code.

http://www.washingtonpost.com/wp-dyn/conte...8120303696.html

I'm surprised that many of you don't carry it. I've given it often. Rarely have I seen patients vomit, and then only a little.

Vagal response due to compression of the nerve by the aneurysm...ok, that makes sense. Interesting case; thanks for sharing it.

The other week someone told that an aortic dissection can cause a vagal response. I'd never heard of this before and didn't find anything on the internet about it. Is this for real? What is the mechanism involved?

"onset was sudden while eating," No problem then. Must just indigestion. Since it sounds like it's going to take a long time to get her down to the ambulance, let's start an IV before we put her on a flat and carry her down. Is her pulse weaker now than when we first felt it? What's her BP now? Transport to an ER with cath lab. Would be nice also to go somewhere that could also stitch up an aorta.

If I were to encounter a patient with hypotension, bradycardia, and chest pain, my first thought would be inferior MI with R-ventricular involvement. The fact that she doesn't have JVD and no ST elevation in the inferior leads does not rule this out, nor that she isn't having some other type of MI. I would transport, treat for cardiac chest pain, and try fluids. Is there anything else for us to do prehospital anyway, even if it turns out she's having a PE? But I'm sure you've got something else in mind. :wink:

Anthony wrote, "For example, lately I've gotten a few where pain starts at umbilicus and then moves to right flank. I've also had some that start on one flank and move to umbilicus." You'd want to consider AAA or appendicitis, of course, but this sounds like a kidney stone to me. Nausea?

ArizonaFFCEP wrote: "Wow...talk about bad aim." A crew in the city I used to work in came within a few mm of hitting the aorta, according to our trauma surgeon.

Anthony wrote, "You'll be hard pressed to see morphine pushed in LA County for anything less than a femur fracture. Severe Abd pain, MI, non-femue long bone fractures, NOPE." So LA County Fire is still like that? Sad. Seven years ago when I was just starting my field training as an EMT, I remember we transported a guy with a dislocated shoulder. County Fire just BLS'ed him and didn't give him any morphine. It was a long and bumpy ride to the ER, and this guy was tearfully crying the whole way. I thought things had changed since then.

Thanks, Vent. That was an xlnt post, and it answered all my questions.

Is there an EMS lobby that is pushing for a national standard that would include all medics having an associate's degree? Wouldn't the firefighter lobby oppose it?

http://paramedictv.ems1.com/Clip.aspx?key=7350646A116A3395 Does anyone know the story behind this?

So how can we get to a point where there is a national standard that requires paramedics to have the same level of education as an RN, RT, etc? Is there any organization lobbying for such a change? If there was, wouldn't firefighter advocates oppose this?

Has anyone ever seen a patient convert from AF to sinus rhythm after being given verapamil? What about other calcium-channel blockers?

Does anyone know about his new EMS union, NEMSA? I vaguely remember having heard something negative about their takeover of Portland AMR. http://www.nemsausa.org/

This was a strange call. I didn't expect to be running a full arrest on a 35 y/o after being called for what was supposed to have been a seizure. Nobody in the office even realized this poor guy had coded. After the call, I was thinking that maybe he'd had a brain aneurysm, long QT syndrome, or something weird like that. I couldn't think of any complications from a routine dental procedure that could've killed him. I followed up a few weeks later and found that he'd died of an AAA. His belly was maybe a little distended, but not like another patient I'd seen who also died of an AAA. Anyway, sad case. He was even younger than me. Congenital defect? Marfan syndrome? I also felt sorry for the dental assistant who, at the time, must've been wondering if he'd done something terribly wrong.

I'll post the answer in a few days...just want to give a few more people a chance to see this scenario.

He was in PEA at a rate of around 70 before going asystole. No conscious sedation; just local anesthetic.

Here's a call I ran last month. We responded to a "seizure" at a dentist's office. When we got there, one of the dental assistants led us to one of the rooms where the patient was laying in his chair. "I think he had a seizure, but he's unresponsive now and I don't think he's breathing." You look down at the patient, and he is quite obviously in cardiac arrest. Downtime unclear. The staff did not realize that he was dead. The patient is a 35 y/o male. Normal build, no medical history, no meds. Came into the office for a toothache and was given a local anesthetic (epi/lidocaine) during the procedure. You later find out that he'd complained to his brother about not feeling well all day. When you patch him up, he's in PEA. Resuscitation efforts are unsuccessful. Any thoughts on what killed him?

The original poster has received a lot of flack here for proposing that we stop CPR. There is actually a very good argument to be made for not trying to revive out-of-hospital cardiac arrests. If you're interested in learning more about the arguments against CPR, check out "The Myth of CPR." I read this book a few years ago, and it really made me question a lot of what we do. Since the survival rate for out-of-hospital cardiac arrests is somewhere between 1 and 5 percent (the best numbers the author could come up with after looking at all the studies available when the book was written in '99), he argues that CPR is a huge waste of money that could be better used in other areas of healthcare. I actually disagree with the author's conclusions. However, I don't disagree with the logic of his argument. It's more a philosophical issue. I just peronaly feel that we should try to do everything we can. Perhaps at some later date if the save rates for out-of-hospital cardiac arrests don't improve, then maybe we should rethink what we are doing. Healthcare costs are only going to continue increasing, and with the way things are going with our economy and debt burden, in the future it may not be possible to do everything we can for everybody. Check out this Google Book link for more on the book... http://books.google.com/books?hl=en&id...result#PPA28,M1

Dust, I would also love to come hang out with you and everyone else, but I don't have much free time between work and school. I'm taking a microbiology class that's kicking my ass. I do hope to see you and other EMT City people next month in Vegas!

Eyedawn, Sorry that I misunderstood some of what you were saying. Anyway, a sad story, enough said.

Eyedawn, You're making a mistake in putting yourself in this woman's place and considering what you'd do in that situation. You are in a sane, rational state of mind. This woman obviously is not. Saying that she should just pull herself up by the bootstraps and persevere is pretty naive. Sorry, but I'm gonna have to agree with Dust on this one (though I don't support the trash talking).