Niftymedi911

Adenosine, Cardizem... would be my guess meds that prolong the action potential. And WPW morphologies within the conduction system. Specifically the alternate conduction pathways. Antiarrythmics techincally are called per ACLS post V-Fib arrest. But no matter how much, or what is given, nothing can help besides bright lights and cold steel.

It's agency specific, one of our Paramedic FTO's created the idea and system for LCEMS. Here's a link for a pic of the bins: http://www.acehardware.com/product/index.j...oductId=1288986

They're simple kinda like what you describe. We also have 2 Jump bags. Blue bag: Medications / IV start supplies / BLS. Green Bag: Airway / Oxygen. These are not speedload. We re-stock the bags from the bins. We use the supplies out of the bags first. All of the bins are numbered and orgainzed according to BLS or ALS. ALS Airway 1 CPAP, Airway 2 Adult Intubations, Airway 3 LMA's, Airway 4 ETCO2 adaptors and CareVent Circuits,) ALS 2 IV supplies, ALS 3 Zoll Monitor supplies, ALS 4 Needles, ALS 5 Cardiac Med's, ALS 6 CAM (Crash Airway)Med's, ALS 7 Nitro/Dopamine , ALS 8 Diabetic/Respiratory/GI Medications, and ALS 9 1 Complete cardiac Arrest bin ( Has everything to work 1 code with). IV 1 is specialized IV fluids ( D5W 100cc's, etc) IV 2 is IV pump supplies. BLS 1 is Adult BVM's, BLS 2 is Pedi BVM's, BLS 3 is suction supplies and BLS airway (NPA, OPA), BLS 4 is Infant BVM's, BLS 5 Trauma dressings, BLS 6 and BLS 8 are Bandaging and other various supplies. BLS 9 are Zoll Disposable B/P cuff's. OB/ GYN are not sealed in bins. BLS 10 is H2O and Peroxide. They're restocked in plastic bins like this: http://www.acehardware.com/product/index.j...oductId=1288986 Open with no lids but plenty of room for storage. Plastic bags are then placed around covering the entire bin and then heat sealed on one side. We just rip the plastic to gain access to the bins. The overall idea for the Speeload was 3 fold. One 90% accountability or higher with the supply accountability. Quicker truck check outs in the morning and less confusion. Everything organized. Every morning we do our truck check outs the bins are stocked with the necessary items per state FL DOT reccomendations and some agency specific items and par levels. It can take 15 minutes to check everything out vs just under an hour to do the check list the right way. At first I didn't like the idea. But now I really like the hassel free re-stock. I never have to count because I just swap bins out when they're open. We're in the process of obtaining 1 of those Medication vending machines for trial to place in the depots for the medications not carried in our bins (Morphine, Fentanyl, Valium, Versed, Ativan, Succ's, Ditilizem). Right now our DO's drive around the county to re-stock. But they're gonna change that too.

Young 50 y/o male of Asian decent. The history of bad nightmares would provide better understanding of undiagnosed Burgada's syndrome. It just confirms the diagnosis. I would scehdule a cardiology consult and schedule for ICD placement.

We've never had any problems (haven't heard of any as of yet nor experienced any) with supply bins missing or wrong items. They utilize off-duty or light duty personnel to stock the bins. The bins are air sealed with plasitc. When we use a certain item the plastic is removed and then prior to shift ending all the open bins are required to be re-stocked by the on-duty crew. We've got 7 depots throughout the county that carry all of our necessary supplies. *not saying there are lazy crews who refuse to re-stock the bin even if they only used a few itmes out of the bin. Then we have to count the entire damn tray. Or even better, they open the bin with a small hole, then turn the hole around to the back so it looks sealed.

Y'all have speedload as well I see........ (sealed supply bins, you re-stock at a depot) cuts down the time for check and questions that could be raised.

CHbare, here ya go.... Cases occurring during physical activity are rare. HOWEVER there is a possibility because regular physical activity may increase the vagal tone, sport may eventually enhance the propensity of athletes with Brugada syndrome to have ventricular fibrillation and sudden cardiac death at rest or during recovery after exercise. Therefore, patients with a definite diagnosis of Brugada syndrome should be restricted from competitive sports It is untreated unaware Type I Brugada syndrome. The only true definitive care or treatment is placement of a ICD. More for your Reading pleasure: Brugada syndrome is a disorder characterized by coved or saddle-shaped ST-segment elevation in leads V1 through V3 on ECG. It is associated with complete or incomplete right bundle-branch block and T-wave inversion. In its initial description, the heart was reported to be structurally normal, but this has recently been challenged (Frustaci, 2005). Moreover, subtle structural abnormalities in the right ventricular outflow tract can also be observed. The ECG abnormality may not be evident until it is unmasked by infusion of flecainide or procainamide, or is augmented by a beta-blocker. When such premature shortening of the action potential heterogeneously occurs in the myocardium, it may generate phase 2 reentries that can cause ventricular tachycardia and ventricular fibrillation. The large transmural voltage gradients generated by the short action potentials in the right ventricular outflow epicardium are thought to be the basis of the ECG patterns of Brugada syndrome. These specific alterations in cardiac electrical activity, which mainly affect the right ventricle, manifest at ST-segment elevation in precordial leads V1 through V3, with a QRS morphology resembling that of a right bundle-branch block (RBBB). Such a pattern may also be due to a J point elevation. This pattern is called coved-type when ST elevation is the most prominent feature, and it is called saddleback-type when J point elevation occurs without ST elevation. Brugada syndrome is 8-10 times more prevalent in men than in women, although the probability of having a mutated gene does not differ by sex. The penetrance of the mutation appears to be much higher in men than in women. Brugada syndrome most commonly affects otherwise healthy men aged 30-50 years, but affected patients aged 0-84 years have been reported. The mean age of patients who die suddenly is 41 years. Patients with Brugada syndrome are prone to develop ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden cardiac death (Martini, 1989; Brugada, 1992; Brugada, 2001). Brugada syndrome is genetically determined and has an autosomal dominant pattern of transmission in about 50% of familial cases. About 5% of survivors of cardiac arrest have no clinically identified cardiac abnormality; about half of these cases are thought to be due to Brugada syndrome (Alings, 1999).

Six Feet Under--- No Doubt

For your reading pleasure: Pedro Brugada and Josep brugada of Barcelona publish a series of 8 cases of sudden death, Right Bundle Branch Block pattern and ST elevation in V1 - V3 in apparently healthy individuals. This 'Brugada Syndrome' may account for 4-12% of unexpected sudden deaths and is the commonest cause of sudden cardiac death in individuals aged under 50 years. Brugada P, Brugada J. Right Bundle Branch Block, Persistent ST Segment Elevation and Sudden Cardiac Death: A Distinct Clinical and Electrocardiographic Syndrome. J Am Coll Cardiol 1992;20:1391-6. Poor dude was having the big one. Getting back to the senario. For one thing, what's the FD like in this part of town?? Is it podunk North Fort Myers or upper crust Estero?? I wouldn't cancel FD. I'll already have a King tube in place. Just revaluate the need for intubation. I will take 1 more regular 12 lead and do a V3R and V4R just to make sure. Call for orders to call STEMI alert and any medications the MD might want me to ultilize, due to the post-arrest. Large bore IV's bi-laterally and possibly an EJ. Bolus 150mg Amio for the time being and hang a Amio drip in the truck enroute. I'll also bring his B/P up a little bit more with some Dopamine 5 mcg/min ( I guessing apporx 70 kg patient so 13 or 14 qtts/min) to help the brain re-perfuse and circulation where it needs to be. Grab a FF to take with me for an extra pair of hands and tell my partner to drive fast but do not kill me.

Any seizure activity noted prior to EMS arrival?? Patient AAOX4??, blood glucose level??, Any nausea/vomiting??, pain radiation?? family Hx of Cardiac??, Medications??, Last oral intake??, Allergies?? Skin diaphoretic??? Recent surgeries?? Has he been sick recently??? Patient have HX of alcoholism, portal hypertension, or Cor pulomonale?? BTW how are the lung sounds??? Is she in any apprent distress with bretahing during these episodes??? Flight travel time 4 hours..... hmmm gotta be thinking a possible spontaneous pneumo or PE that has developed in her legs and has gotten to her lungs.

While be it I could understand rapid Ex due to safety being they're in the middle of a busy highway, there is still no reason why a KED couldn't of been utilized. I've learned the hard way, too weak c-spine can lead to a good bashing or two. Just think about it, with this video...... If the dude ended up having a c3 or 4 fracture ( I know we don't judge based on MOI, but still there is the word CONSIDER C-SPINE for a reason, with the video evidence and X-rays, it could prove very badly for the medic in charge.

No transporteh if they ainta circulatineh. Our MD allows us to call it in the field. The, well most of the time normally transport is stared if its a Pedi arrest or someone who is a viable code. ( A good chance on bringing them back, ex: hypothermia or heroin OD. Otherwise BLS, ACLS, no ROSC, no transport. Signal 7. We still have to obtain orders from a doc via OMC, but once they say cease, its over baby. Unless your like me, call em in the field, XX minutes later (while in the middle of cleaing the truck and restocking bags and report) they return with ROSC and respirations and walk out of the hospital X months later. The doc goes, guys WTF??? your seriously joking right??? Thats a negatory doc. Will never forget that day time call. Or PEA on arrival, then a something 20 minutes later I reached the bottom of my goodie bag with nothing but bi-carb left, say what the heck, and within a short few seconds, "Wait, I've got a cartoid".

It gonna be all fun and games until someone gets hurt, then its gonna be hilairious. Count me and my wife in if its not to terrible of a cost. Also in school but I'm sure a sick day or two will take care of it.

It doesn't matter wether you pay taxes or not you (if your in Lee County) still get a $450 BLS or a $500 ALS-1 bill. Not to mention if your flown out a 3 grand ride to the hospital ontop of the regular charges. It adds up. But for an agency to maintain and be 100% supported by taxes..... (yeah maybe back in the stone age), but now more and more people poke and prod their way into financies and accountability. Your agency must have some BIG pull in county or city government to get away with that. We used to be that way.... But now, everyone wants lower taxes and such, so now we charge for the ride. We're close to 60/40 at this point, 46% paid by impact fees and general taxes, 54% paid user fees. We re-couped over 54% of our budget for 2007. Our interfacility transfer divison always runs in the black and pretty much funds the agency. Total income from user fees and transfers was close to 28 million.

Dust, are they always??? We're a hybrid type of static deployment. We still have stand-by's for holes in coverages. Geographically we cover over 1026 miles throughout our county. So if two or more trucks are out running in a particular zone, it leaves a greater then 8:59 response time. We'er having a hard time meeting 90%, and they feel using the software will help ouor response times by effectively elemenating the human element with depolyment on stand-bys. They also feel if the statistical data does not respresent a stand-by, then instead of the old way where a truck is sent based on protocol, it can remain in station, thus elementating the extra wear and tear. That's what I gather from it.

My agency just annouced that they are currently in the buying process of a system management/dispathcing software tool named Siren by the Optima Corp. I was just wondering what other people thought. Background: We're not system status but static deployment. Admin is hoping to be able to better utilize by using the software by decreasing stand-by's, wear and tear and fuel on the vehicles. Post any and all ideas/comment/concerns.

I've used 2 in the past two shifts. (Both cardiac arrests) Loop,Swoop, inflate.... 15 seconds are your done. No manipulating no nothing. That combined with the new Rescue Pod are now in our cardiac arrest protocols. The coolest is the suction port. So if any air does get in the stomach you can pump it out with a NG tube, very nicely placed.

FY 2007: 74,742 9-1-1 calls 3600 transfers with our ALS/BLS interfacility transfer divison 1200 Pt's by MedStar Average population in Lee County: 850,000.

The tax reform is a freaking joke I'm getting a $114 tax credit back. Not to mention I AM voting it down. It affects all of public safety in Florida. Not just FD or PD. Our budget got sliced and cut everywhere. That's why we're not just 9-1-1 anymore. We're more of becoming "Lee County Divison of Public safety/non-emergenttransfer/interfacilitytransfer divison of EMS". The transfer divison generates almost 10 million in revenue a year. That plus the added service fees for 9-1-1 transport re-coups over 68% of our expenses. The overall budget was 26 million for EMS. People here whine, whine, whine, if you want the best you gotta pay for the best. And if you want the cut, kiss your 7 minute response or less when your sandwhiched in between a gas tanker and another semi on I-75 because you wanted to save a little, Good Bye.

Even in rural use it is asinine. The proper protocol's and education takes, time, money, and a medical director willing to put his name on someone who's had 3 months of first aid and can drive a bone box. I would definately reccomend everyone BLS to attend a 12 lead course, but like someone else had said, they would just do enough to take the training etc. In the most rural areas, sometimes your lucky even if you get an ambulance with someone skilled and educated enough to know what to do. Now, adding 12 leads to an EMT cirriculum or protocol. What's next EMT field intubations???? Simple senario, if your BLS you respond to a chest pain. He looks like shit and you recognize you might have a STEMI alert. You slap the leads on and do a 12-lead. You recognize an inferior wall MI. (if you paid attention in class). As an EMT, what do you do now. Besides rapid transport and oxygen, what other procedures can you provide??? If you didnt have a 12-lead what would you have done different??? Nothing you handle to call the same exact way. There's no point for BLS 12 leads. If you want the skills, grow some balls and GO TO MEDIC SCHOOL!!!!! Quit trying to muddy the Paramedic/EMT scope of practice. We can never be fully considered professional with people trying crap like this.

10-9 you were 10-1 10-24 is the almighty distress signal. If you use that code you better either be shot or on fire. Everyone gets sent then. Also that little orange emergency button on the top of my Motorola XTS 3000 works wonders...... Dispatch asks us 2 times if it was accidental, no response sends every PD or SO officer and FD within the vacinity 10-18 (L&S)

Niftymedi911: Is 21. To be honest, there are numerous instances where being as young as I am limited me from doing my job right and doing my job to the best of my ability. Dust hit the nail on the head with it all. It takes maturity. I'm pretty sure you all can agree with me that when I first started in EMS I was probably the worst wacker of them all. Now 3 years later I'm older, mature and understand what it takes to become not just a paramedic, but a professional paramedic. Think of it this way, you start feeling 10 out of 10 chest pn radiates to the jaw and left arm, your very weak, can't think straight. Your spouse calls 9-1-1 and you witness a 18 y/o walk out of the truck and start asking you questions..... are you really going to want to go with them??? It is a hurdle we all at one point or another must overcome. To save yourself the agony of getting asked by your patient "do you know what your doing" or "kid, listen thank you for coming out but I didn't need a bandaid". Get educated, learn as many life experiences as you can, when you hit 21 I say, hit the pavement running. I also firmly believe that a Paramedic degree should also be 4 years and an EMT cert should be 2 years.

The number one most important thing you need to remember when asking for help........ Listen to your own co-workers!!

The Sprinter's are used for Special Details and out of county transfers greater then 250 miles round trip ( like sporting events and the like)only. We almost never use them for primary 9-1-1. Unless we're really busy they'll put OT people on those trucks and ship them out. The sprinter's are sardine cans, but never the less they are easier and more fun to drive then the Frieghtliner's, much easier to manuever.

Forgive my newness to this item, I'm not quiet undertstanding the whole set-up.... I mean I get the lack of intracellular potassium in the myocardium causes the failure due to the overabundance of intracelluar calcium and fluid in her system, but what I don't understand is the rest......... The 12 lead is ugly and I could of sworn the same with what Mateo had stated. I agree with the LBBB but I also see the tall T waves. Was the hyperkalemia causing the left bundle branch block?