cwilliams17

Did you happen to send an e-mail for clarification off to AHA? They might be able to help you.

No I haven't yet, that's my next move. I did a recert in ACLS last fall and don't remember ever hearing about it there.

chbare, cannot find any place where it says anything about it. I've looked in circulation journal and can't find it. I asked if you could cite the info.

Under the new AHA CPR guidelines, are they not recommending to confirm asystole in a second lead anymore? If you can site an article from AHA please do, thanks.

The only thing I carry during a call is my stethoscope and a pair of exam gloves. I volunteer for my local EMS department and have a career position for a busy agency. With both I just have my stethoscope. Everything I need is in the ambulance or engine. I wear a duty uniform for both that they provided. When checking my unit at the beginning of my shift I know what and where everything is.

That's tough, I'm sure you did all you could. Sometimes it out of our hands.

I'm not being an ass, you said it was quicker to stick in a drip and infuse some sugar than to put in an LMA in this patient

So naturally my next question is why suggest it if you don't think it's a good idea?

I misread the way the glucose level was presented. I thought I read it at 38 mg/dl. Sorry.

Right, but you think it's a good idea to give somebody D50 when they have a BGL of 38 mmol/l?

Your use of the term "sugar problem" leads me to wonder if you understand the pathogenesis of DKA and why D50 (or 10% glucose) is not appropriate in this situation?

Once again, no need to be an ass.

No I don't think it's a good idea to give a patient D50 with a glucose level of 684 mg/dl.

I take that back. I failed to read how the glucose level was presented. I don't use the mmol/dl, sorry.

Well you just proved you're not competent.

Giving somebody with DKA who has a blood sugar of 38 mmol/l dextrose is bad glycolojuju

Oh, and D50 went out of fashion with MAST pants and long spine boards; 10% glucose is where its at increasingly worldwide

no need to be an ass.

I work and volunteer with agencies in two states that use D50. Sorry I don't live or work where they use 10% glucose.

Potentially yes, but in the mean time ...

Oh and I don't really consider the LMA an "advanced" airway, its so bloody simple you can teach a firefighter volunteer Technician to put one in and maintain competency.

in the meantime, a competent provider should be able to start a line and give d50 in the time your volunteer technician can stick the LMA in there.

If you are worried about her airway use BVM Give the d50, if you still have problems with airway then use your airway devices.

Im my area if we suspect behavioral problem or psychotic event, we can give haloperidol 5mg, midazolam 2.5mg, benydryl 25mg. Mostly used in combative patients if we ruled out diabetic or other issue.

Hello,

Ok...Kiwi and Lytefall,

Her mouth is dry and her lips are cracked and smell of acetone. Some think emesis is suctioned from her mouth. She tolerates a LMA (...or EGD of choice...) and is easy to ventilated. Her lungs are clear and her stas perk up to 93%.

A large IV is inserted and a bolus is started. Her blood glucose level is 38 mmol/dL.

Her mother states that she has been a diabetic since she was young a needs insulin. She also has been battling a cold for the last week.

The police bring the infant to you to assess. The infant is lethargic, with flacid muscle tone. His mouth is dry and the soilded diaper is dry. The skin tents when pinched and a quick bracial pulse check shows a rapid, regular rate of 150. He is breathing 50 time a minute.

Cookie....

A second ambulance is on the way as Fire First responders.

Cheers!!!

Fix the sugar problem you wouldn't need to put in an advanced airway.

i have worked rural ems all of my career and in my opinion if possible with pts stay and play now depending on how aggressive your protocols are and what your allowed to do you can do almost everything to a person that the ER will with the exception of a cath or other surgical procedure i know fibronilytics are making their presence known in EMS even in a area like MS where we are always behind the times and in CVA and STEMI calls these can be very very useful and can actually have a pt ready where when you get to the hospital they can roll straight into the cath lab or wherever. In my personal opinion and if it was me in rural EMS or urban EMS i would stay and play if possible. the bed habit has came into EMS that if a hospital is not far then it is ok to not treat your pt too many times have i seen pts roll in with nothing done because the crew was "just around the corner" this is no excuse, treat your pts and treat them right or find another job quit trying to come to work and do nothing to get paid if your incompetent brush up on your skills if your just lazy then fix the problem or get out you make us all look bad. off my soapbox now lol anyways yes i agree the stay and play method in rural EMS is the better choice if possible

Stay and play? I can't stand that term! What are we playing, doctors? If they want to go to the hospital, then great. I can assess and treat in the ambulance. The shorter the on scene time the better for me.

I work for a department that has stations 5 minutes from hospital to about 30, and volunteer for a department that has an hour plus transport time. With both agencies I aim to keep scene time less than 10 minutes. It's just something I've always done since I've been in ems. It takes a short amount of time to gather the information needed to make a transport decision.

OK now i'm really confused. What does RSI have to do with the original question about orthostatics for abdominal pain?

To get away from work I have a few hobbies. I'm a ham radio operator, target shooting, working on cars. I enjoy shooting skeet, that really helps me relax.

Do you really need a protocol to perform orthostatics?

Yeah but from rumors i've heard im not sure how long they will recognize them. I don't keep up with West Virginia much since i've moved away. Something about they may not certify any new EMT-I's or not recert them, is there anyone here from WV that can confirm that?

Now EMT-B's can administer NTG and albuterol tx's in WV, not sure how I feel about that one.

It would be easier to list those states which do not recognise EMT-Intermediates. They are:

• Delaware

District of Columbia

Floridia

Kentucky

Missouri

New Jersey

Pennsylvania

Rhode Island

West Virgina

West Virginia recently started recognizing EMT-I's. I know its been a long time coming. If im not mistaken they have to ask permission for anything they do. Heres a link to their protocols.

http://www.wvoems.org/Portals/2/medicalDir...20protocols.pdf

Congratulations!

I have had my share of puking patients. And i'll admit some of them were pretty bad but I never puked myself because of it. I guess being puked on a few times you get used to it!

I am all for a paramedic on every ambulance. Education and experience is important when you have someones life in your hands whether it's a critical call or a BS one. I trust my EMT-B's, they have the skills to do a good assesment on a patient and know when they need my help. Their BLS care is excellent and I praise them for that.

I agree with Dust on the level of training of EMT-B's sucks. I agree it's time for a change, thats one reason I continued with my education and will continue further.

But untill things change we need to work together. Get on the trucks and answer the calls that we are requested to respond to. Work side by side to help your patient.

Congratulations! Be proud of your accomplishments, and good luck with everything you do.

I think you are being a little hypersensitive. It did not appear to me that he was impugning all EMS providers of an entire state.

You have to really, really, really stretch it to say that, dude

And speaking of professionalism, it's not very professional to make broad-sweeping assumptions either.

I think the title of the post says it all, either way like I said if the comment of Virginia was left out I dont think it would have been a problem.

Not very professional to include the almost 34,000 EMS providers in this state with your negative comments. I agree that they made a mistake, I would have carried all my equipment with me too. But to say that Virginia providers cannot render appropriate care to patients is wrong. And another thing, as a paramedic yourself you should know that even if a caller says one thing, it may not be relayed to the responding units as the same. I think I wouldn't have had a problem with your post if you left out the whole Virginia thing. Have a good day and welcome to Virginia

In our area NTG is contraindicated with a SBP <100. And if the patient never taken NTG before, we have to start a IV prior to administration. Im sure its different in some places