medic_texas

I know some of the newer studies are showing that morphine increases the death rate. Where I currently work, both in EMS or Surgical ICU, we are using morphine for the vasodilation properties along with nitro. Nitro being the primary drug obviously. Maybe his protocols are different but my protocols for EMS is morphine. If they have an allergy to morphine you omit the narcatic. They just added fentanyl to the protocols but it is replacing demerol and is used for long bone fractures. I am sarcastic sometimes, sorry if it causes confusion. So, I'm not saying every patient needs MONA but obviously THIS patient did. I should stop posting when I first wake up :?

First off, Morphine is used primarily for coronary artery vasodilation not for pain management. That is the secondary use for Morphine along with anti-anxiety (which helps decrease respirations to allow more 02 into the tissues). Also, if you are worried about a right sided AMI you should bolus your patient and rechecked a BP before giving NTG and Morphine. Those are the 2 drugs, along with aspirin and oxygen, that are given for AMI. MONA - Morphine, Oxygen, Nitro, Aspirin. I would have given the NTG and morphine after the bolus personally. Basically, you screwed up. If you really had this big of doubt and issue, call medical control and ask for orders. Put the monkey on their back and treat accordingly. I would have bitched you out myself, you ran outside of ACLS protocol and you practiced medicine without a license. Also, you lack understanding of the true reason why Morphine is giving for AMI. Tough lesson to learn I hope you learned it well. Take it upon yourself to research each drug, right sided AMI, and review your ACLS/STEMI protocol. When you work outside of protocol you make yourself liable. Time is tissue and you dropped the ball on this call. Good luck next time..

Right on Dust. ERdoc, thanks for the links and the input. It's good to have a M.D. to help us (and mostly the uneducated and BLS level paramedics out there) understand why 12-lead interpretation is important for recognizing and treating AMI (which occur on different areas of the heart FYI). I'm very tired of the trolls trying to push their opinions and thoughts about why they don't need 12 lead ECG. If you don't want to advance the profession, become a truck driver or a hair dresser.

I think "iamyourgod" should be removed from the ambulance. She is a waste of space, energy, oxygen (which she is stealing from us) and most of all, time. Also, I think she should be removed from the forums. She has no logic, doesn't listen to reason, and apparently has the worst case of vaginitis on record. It could be terminal.. Midol only masks the symptoms, you need Dr. Kevorkian therapy. I hear he has a book, Dr. Kevorkian's book of home remedies. You should check it out.

Ok, first off.. Ak is starting to speak Australian.. in his typing. How do we know GAmedic died? Did he post a message? "Hey guys, sorry I can't post here any more. I died." Just curious

First off, I can't respect anyone who calls himself my God. The attitude and arrogance in his screen name alone is offensive. If this is how someone acts in the work place, I'm willing to bet they are the least liked person on the department. From what I have read, he/she is only interested in their own opinion and rushes to judge others because of what they have spoken. Sure, some places DO have HBO and sometimes certain programs contain nudity or offensive programming. However, everywhere I have worked regarding sexual harassment the first course of action is CONFRONT THE OFFENDER. If you're partner is watching soft-core porn, ask them to change the channel because it's offensive. If they refuse, then go from there. P&P, there for a reason. I know I have worked for some places who had cable TV and HBO and other movie channels were part of the package. We never sat around and watched the inappropriate shows however sometimes a DVD was brought to the station, that everyone agreed to watch, and it may have contained inappropriate material. Was anyone offended? Who knows, but they agreed to watch the movie. If it ever became offensive they could leave the room. Incidents like these are really not much of an issue because when your employer hires you they assume you're an adult and know how to communicate with your peers. Quit being a bitch, act like an adult, and learn to communicate.

I had this game, it's worthless.

In the hospital, the cardiologists prefer Cordarone to convert A-fib. Verapamil is used for our neuro patients to decrease and stop vasosasms. The verapamil is injected directly into the vessel inside the brain during an angiogram. The patient also receives nimotop, another CCB, a few times daily to help with vasospasms. Neuro patients who have had a brain injury do very crappy when they have vasospasms of the brain. Just other uses and other treatments for meds. We used to carry verapamil on the ambulance when I first started EMS for SVT.

That's a big ass red cap to be lost in someones mouth.

Who's pregnant?

Yeah... uhm... I've never done either.. I guess I just pay attention to where I'm at and what vehicle I'm in.

Has anyone checked lung sounds, heart sounds, bowel sounds, pupils, and also the fontanels? Why did he get seen in Mexico? What sign and symptoms were they seeing to have him assessed there? Where was he born, America or Mexico? Need to find out about his/her immunization status as well. Thats a good start I think, too bad I saw this scenario several posts too late

Holy crap! I hope she gets well soon! Tell her we all have her in our thoughts and prayers. Keep us updated!

Anytime we get a trauma in the ER, we do a MANUAL BP first. This is a level 1 trauma center and that is the protocol, manual BP before NIBP. Working as a tech almost 10 years ago in that ER has stayed in my mind; need a manual BP before you utilize the NIBP. Do you really trust those stupid things? If time allows, I recheck my BP enroute. Ever have someone take your BP and you're like ok.. and going down the road you recheck and its WAY off? Yeah, that sucks. Secondly, lead placement. Leads should be placed on "meatier' surfaces meaning do not place them over boney surfaces (clavicles, ankles, ribs, etc) if possible. I know some skinny patients its more difficult but you can use the deltoids and calves. If you go too far below the ribs you will get a lot of artifact from breathing. So, I mainly use the upper arms (deltoids) and the inside of the lower leg (lower calf muscle).

I sign my name Matt, EMT-P, RN It's my first certification and I'm proud to put that down. I guess my "ego" wants me to sign the paperwork that way but I see it as something else. Not many people can say they are a paramedic and a nurse, so pride does come into this. I'm proud to be a paramedic. But at the hospital, it's my nursing license that I work under. Just like in the field, it's my medic certification that I work under. However, my titles, my credentials, I'm very proud to have because I've worked hard for them. It's not just the scope it's what we've all earned. A buddy of mine signs his blah LP, BSN, RN. LP meaning licensed paramedic (I'm not a licensed paramedic, just a certified). Don't ask what the difference is because there isn't any in Texas.

It is a additional certification for paramedics; a step further would be FP-C, which is flight paramedic-certified. To my knowledge, nobody recognizes it as a "advanced level" but it just shows that they have been through the additional training and class. I think the class is like 40 hours with a exam afterwards. CCEMTP goes through a lot of hemodynamics, x-ray interpretation, lab interpretation, and other things I'm to tired to think about. Most of your flight and CCT programs want this certification. Just got off work, pretty tired.. Sorry if the grammar sucks.

I'm pretty well known on this site and about this topic so I'll go first. Firstly, the ego. You never want to burn the ego. After you are finished preparing the ego, I like to use some brummel and brown yogurt spread (its better than butter and other crap they sell). Now, to more specifically answer your questions. What is ego? - It's a yummy frozen waffle thing that comes in whole wheat. Do you ever think about the ego? - of course How does working in this profession affect the ego? - well sometimes you get a call and it gets soggy and cold. How do you eliminate ego? - with a fork (and an occasional spork) Great topic! After a nice, light, buttery topping I go for some low carb or sugar free syrup. Why? Well because people are dying fat and unhappy. I don't care, you're never fat and happy. You're fat, diabetic, pissing all the time, and you can't see that good anymore. Who wants that? Not me. And that is how I treat my ego.

Just to clarify something and excuse me if this has already been addressed. Nurses work under ACLS protocol and RUN the code where I work. Paramedics also work under ACLS protocol. Where I work, nurses who are paramedics can intubate after we take a class (and you also have to do x amount of intubations every 6 months, which is 6 intubations). If they are not around, a RT will intubate, and finally if a doctor is availible, they will intubate. A cardiologist can come in and take over the code otherwise it is up to the nurses to run the code. I'm assuming that most hospitals are similar. Also, a lot of ICU nurses work under standing orders, protocol, and are allowed some flexibility with their patient and how they are treated. I can only speak for ICU nurses because that's all I have ever worked. I can say this because I have been on both sides of the fence. The topic starter may not mean anything by his comments but they came across as ignorant and without warrant. Hope this helps!

The A-fib threw a clot causing a embolism in the lungs.

Do you want your boss being a Fireman who has no interest, desire, or experience in EMS? What kind of leader would they be? Who would he side with if an issue came up? Who would he favor and promote when positions came up? You, the EMS professional, would be a step-child of the fire department. You run more calls and bring in the money. The fire department will use that to boost their money coming in for new equipment, add personnel, and for grants. And what will EMS get out of it? Nothing.. Especially if you're boss is a "fireman". Worst idea ever.

First off.. never.. ever.. give 250ml of fluid to a neonate. Easy med math here.. Start with the doctors order (or protocol) which is asking for d10 (7.5g) divide by how much drug you have (25 g) and multiply by how many mL's it comes in (50mL) and that will give you how many mL you need to infuse 7.5g of dextrose which comes to 15mL. Want to dilute it? 20mL syringe, draw up 15mL of D50 and 5mL of NS and that's probably the most fluid I'd give a neonate, if that. This method works for most meds... Demerol (35mg) and is supplied by 50mg/2mL. 35mg / 50mg * 2mL = 1.4mL of demerol you need to push. This is how I set this up on paper... start with mg (what is ordered/needed to give, can be mg, g, or mcg, depends on the drug) divided by mg (how many mg, g, mcg the drug is supplied in, remember keep your titles the same mg/mg, or g/g, etc) then multiply by mL it's supplied in and it will lead you to x (the answer in mL needed to give). ALWAYS START WITH WHAT IS ORDERED (or what dose is protocol) in the upper left hand corner. Hope it makes sense... I tried to make an equation but when I post it; it doesn't come out correctly.

Wouldn't a PARAMEDIC use a ET tube rather than a combi-tube? People who are aware twitch? Works every time eh... (rolls eyes).. When will this end? The grammar alone should justify him not posting any more scenarios. People come here to learn and this is a mockery..

Shallow and labored at a rate of 10? Narrowing BP with it 121/78 and then 114/76? Doesn't narrow mean coming together not dropping slightly? What IS "pulsus paradoxus?" You mean pulsEs? Wouldn't history be diabetes not "diabetic"? Would you care to elaborate on which type, because I think there is a type I and II. There is also DI however I don't think that's the case and you probably have no idea what DI is. Anyways. .. yeah.

This kid couldn't pass the NR with a cheat sheet. Anyways, he should stop now before he really makes himself like like an idiot. He's already well on his way.

This kid is FOS. He's not a paramedic, check his myspace page it says he is a basic. He tried to give me and oz a name and license number of a medic in Indiana that was licensed in 2003, obviously not him. I have screen shots and the other info if you're interested. Kid needs a life.