p3medic

If she is in the care of the RN, unless you have been called by her, or have a higher level of medical license than she does you should probably stay out of it. It isn't your kid, you aren't employed by the school, and have less knowledge about this kids condition than the nurse does. Just my opinion.

Well, its one lead, but given only that I will say atrial flutter w/4:1 conduction.

Noisy upper airway sounds and a patient gagging on their secretions might be a clue, without actually visualizing or physically stimulating a gag yourself.

On the topic of waveform capnography, why is it that the vast majority of ED's I transport to (including 4 level 1 trauma centers) don't have capnography in the ED? I can monitor an intubated pt better in the truck than they can in the ED, short of gasses.

8 hour shifts, 4 on 2 off. There are a couple of BLS trucks that work a 10 hr shift, but that is not the norm.

Most calls doesn't equal busiest. You can do 1 million calls a year with 1 million ambulances = ambulances aren't very busy, despite call volume.

Department wide where I work is 0.61. Houston, Tx is 0.35, Washington DC is 0.36, Austin Travis County is 0.39, Seattle, Wa is 0.54, Phoenix, Az is 0.54, San Diego is 0.50.

Yes, but without continuous practice "skills" deteriorate. If your department can't or won't provide the opportunities to stay profficient you can't be expected to perform as well as those that have frequent experience. I don't care if you work in an area with one tube every five years, if you can get regular OR time or intubation experience in the ED more power to you. On the other hand, if all you have for experience is the few attempts in the field, you might want to rethink things.

Systems should start their own airway registries, much like the National Emergency Airway Registry. Collect data on all your intubations. What drugs were used to facilitate intubation? How many attempts? What difficulties if any were encountered? SpO2, EtCo2, etc... If you as a system can't prove that you are helping, then perhaps you shouldn't be doing it. I don't think supraglottic airways are sufficient for all patients, however if you only intubate a few times a year, it is probably the safest choice. However, if you intubate frequently, and collect data showing a high success rate, low instance of desat or difficulty then perhaps intubation should remain in those systems. Just my opinion.

In the interest of public safety the guard remained at his post, as he is required. Subway systems are notoriously bad when it comes to radio comm's, and to go below grade, abandon his post and be out of communications wouldn't have done much good. He followed his SOP's, contacated EMS and directed them to the incident. The station in question is very large, with more than one entrance/exit blocks apart.

Are both strips from the same patient?

I believe you are talking about the MERCI clot retriever. A few of our stroke centers are using this device.

Etomidate has been shown to decreas sz threshold, it wouldn't be the drug of choice in sz management. Propofol would be a much better choice, even versed for sedation. Not saying it is wrong to induce with etomidate, it just wouldn't be my first choice, and if the patient stopped seizing, it probably wasn't the etomidate.

Well, playing Monday morning quarterback, I would disagree with the RSI and tx the sz with a benzo. RSI will help you control the airway, however paralyzing a patient just makes the motor activity of the sz go away, however the patient is still seizing. A benzo would be more appropriate, manage his airway with an adjunct and a BVM. If after you have controlled the seizure you feel the need to secure his airway, go ahead. I'm not suggesting ignoring a bad airway, but the vast majority of patient that are seizing don't require intubation. My Monday morning .02

Even Seattle, argueably the best of the fire-based EMS systems doens't staff ALS engine companies...

I agree with Scott.

How about sent the ambulance with lights and sirens and non l/s for fire? If EMS needs fire, have them step it up, otherwise cancel them. Merger? Its worked great in places like NY, DC, SF....

He's hypoglycemic with a questionable recall of events. He buys a board. If the fire medic doesn't want him boarded let him ride him in.

Giving fluid before surgery is very common IN THE HOSPITAL. Making him hypothermic begins in the ambulance. 2 liters of saline to a patient who is bleeding, without the ability to stop the bleed or replace the blood is a bad idea. Its been a bad idea for over a decade. In the field 99% of services don't have access to his H+H, so its not even a factor. Giving this patient 2 liters of saline will make him more hypothermic, coagulopathic and increase the likelyhood of increased bleeding with no benefit. Wow.

Giving fluids WITH blood is fine, the patient needs blood. Giving salt water in an ambulance does nothing for this patient other than make him more likely to present to the ED staff hypothermic. This patient needs volume resus when he has blood and a surgeon available, not before.

Why wait for the patient to exanguinate before applying a tourniquet? Every time the heart beats you could be losing another 80mL of blood, trying (and failing) to stop bleeding with direct pressure, elevation, pressure point etc will take how long? Any patient with an apparent exanguinating hemorhage in shock should have a tq applied if in a location suitable for one. There is plenty of research out there showing that the concern of limb loss or massive tissue destruction caused by tourniquets is urban lengend, the fear of causing harm is causing harm.

We use tq's fairly often, big fan. There is no reason to try direct pressure, elevation, pressure dressings etc when you have someone with an arterial hemmhorage in shock. There is no benefit to allowing continued bleeding while f'ing around with bandages and pressure points when a quickly and correctly applied tq will do. Holding direct pressure while in a moving ambulance is ineffective and dangerous, no different than doing CPR. The same retard EMT's that place a tq and never re assess it are the same ones to apply a pressure dressing and never re assess it either.

I believe I have said this before, but saying it again seems like a good idea. ANY NON-FIRE BASED EMS PROVIDER PAYING DUES TO THE IAFF ARE PAYING YOUR WAY OUT OF A JOB!!!!!

Look up to Maine since you are already in the area. One of my old partners graduated from their DO program a while back, He's an EM attending out at UMass now.

The fact that someone has consumed alcohol does not render them incapable of understanding the risk's of not being tranported. Having a couple of drinks does not forfit you civil rights, I'd suggest speaking to an attorney as to what is required to legally transport someone against their will.