ohemt648 Posted August 15, 2008 Share Posted August 15, 2008 Make sure tube is still in place... Link to comment Share on other sites More sharing options...
reaper Posted August 15, 2008 Share Posted August 15, 2008 OH YEA, my pulse! Link to comment Share on other sites More sharing options...
mshow00 Posted August 15, 2008 Share Posted August 15, 2008 What about LR or even sodium bicarb, the pt is in resp and metabolic acids( - normal limits)? I mean before the mvc Link to comment Share on other sites More sharing options...
reaper Posted August 15, 2008 Share Posted August 15, 2008 Bicarb=bad rebound! Link to comment Share on other sites More sharing options...
mshow00 Posted August 15, 2008 Share Posted August 15, 2008 Bicarb=bad rebound! Can you be a little more descriptive please. brand new baby medic student here. Link to comment Share on other sites More sharing options...
Anthony Mayernik Posted August 15, 2008 Share Posted August 15, 2008 Well, aside from the usual "Did the MVC cause any additional trauma?" check, I'd be looking at the delicately placed IV as well. If you had a lot of difficulty getting it placed, chances are good that it's not going to stay put in the jarring motion of the MVC... As for sodium bicarb, my concern would be the now high level of sodium in someone that's already dehydrated...and since we're not exactly having a lot of luck with fluid replacement...and the pH imbalance it could introduce...my pucker factor's already high enough...not sure if that's the rebound issue that reaper's bringing up, but it's the thing my chemistry mind says "Hey, wait a minute" on...I don't know the LR abbreviation (maybe I should)... Link to comment Share on other sites More sharing options...
mshow00 Posted August 15, 2008 Share Posted August 15, 2008 LR/RL is lactated ringers... I'm not sure if my region and/or my company mandate we carry both NS and LR, but we do, several bags of both on all ALS ambulances. LR= gets converted to sodium bicarb in the liver when metabolized. As far as changing the pH balance the pt is already acidotic, the body(my guess) has already reverted to anaerobic metabolism releasing more lactic acid, and the the resp rate is so low that the baby is not "blowing off" the increased acid in the body, so would you not want to try to balance that (at least in theory) with the bicarb? I understand the not wanting to add more sodium to the already dehydrated body, but is not getting the pH balance more equal the higher priority at this time? What about a second IV, one running NS and the other LR (as in the ITLS cocktail)? Having not gotten into peds yet, I am at a loss, but is my thought process off on this? Link to comment Share on other sites More sharing options...
Canadian Caesar Posted August 16, 2008 Share Posted August 16, 2008 What do you want to check after being hit by the car. Is there something you want to immediately check? Things to check IMMEDIATELY after collision: - Myself (Injuries, etc.) - My Partner - My Patient (The little guy WAS restrained... right?) - The Mother (Even if she wasn't in the passenger seat where we were hit, she still needs to be checked.) - THE DRIVER OF THE CAR THAT HIT ME! (Nobody else thought about this?) Link to comment Share on other sites More sharing options...
mobey Posted August 16, 2008 Share Posted August 16, 2008 Things to check IMMEDIATELY after collision: - Myself (Injuries, etc.) - My Partner - My Patient (The little guy WAS restrained... right?) - The Mother (Even if she wasn't in the passenger seat where we were hit, she still needs to be checked.) - THE DRIVER OF THE CAR THAT HIT ME! (Nobody else thought about this?) Not to mention have my partner run around the unit to make sure it's not on fire or something stupid. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted August 16, 2008 Author Share Posted August 16, 2008 you check on all that was listed above. No injuries to anyone but the driver and he is refusing treatment. you re-check the baby and all is well You have given a 2nd bolus of fluid and the heart rate is now 160 the child seems to be a little pinker and moving a little better. You have requested 2 ambulances - one for your baby and one for the driver of the car. Your partner is now suffering his own pucker factor because he went thru the red (but followed all the rules of the company) and he is thinking of the last two guys who had this happen to them and they are still trying to find a job. You hear in the background more sirens than you can imagine ever hearing in your life. 3 fire trucks, 5 police cars, 2 ambulances and 1 supervisor along with the owner of the company arrive. You put the baby in the 1st ambulance, jump in and haul butt to the hospital leaving your poor partner to fend for himself. What now? Link to comment Share on other sites More sharing options...
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