GET LOST!

[firedoc5]

Had a crew who called us in as 2nd unit in on cardiac arrest. Not sure why we got called but I'm glad we did.

Unresponsive patient, cpr in progress.

Asked how long down and they said witnessed

Patietn passed out in the ambulance.

CPR started

I noticed that each time the medic in question compressed the chest the patients face grimaced.

We started towards the hospital and I asked to hold cpr - she did.

Patient started to moan and then cry

I asked the patient some questions and she said she felt each and every one of the countless compressions but she couldn't wake up.

she had abounding pulse of 135, a bp of 108/74 and a unassisted resp rate of 20

The monitor originally showed asystole but it was a great sinus tach of 135

The patient said she had seizures without seizure activity and it took her some time to awaken from them.

This person suffered 4 broken ribs, a broken sternum and spent a night in the hospital for pain control. A

All because a medic out of school less than 6 months panicked and started cpr on a seizure patient. Her response when confronted with the facts was that she hadn't checked a pulse and treated the monitor.

I'm not sure what happened to her after that but I know she quit the job and went to work somewhere in a rural area.

I'd say she was treating the monitor and not the pt. One of the number one rules.

[hammerpcp]

One time I was called in a panic to help with a severe difficulty breathing 22 y/o female.

I arrived on scene just as the ambulance was leaving.

I jumped in the back with a 20+ yr veteran EMT who has chosen not to keep up on her/his education.

I looked at the patient, looked at the EMT, and asked What her air entry sounds were. The EMT said "I haven't had time to check them!

I stuck my head up front and told the driver to pull over and shut the siren off..../ Every patient gets assessed before they are moved!

I heard some wheezes in the lung fields, but not much to worry about. SP02 99 I think on room air (no time for 02 ya know) but resps like 40. With the carpopedal spasms present it was clear to me this was a hyperventilation.

I asked the other EMT to put 2.5mg salbutomol in a neb as I began to coach the patient.

She tore the bag open and spilled the neb parts all over the floor she was shaking so bad.

I told her "Just sit back and watch"

Anyway, the patient who was originally going in and out of Cx, eventually walked out of the rig into the hospital. And we were able to transport with no sirens!!

Why would you use L&S to transport some one who's hyperventilating?

[hammerpcp]

I recently had an "experienced" medic ask me what a Duoneb was... He had no clue...

What's a 'duoneb"?

[Timmy]

**RANT**

I have a volunteer who is a veteran, he has no interest in EMS but it gives him something to fill in his day I guess… His very much into radios (which he is very good at and retains quiet a lot of information) maps and banging on about old war stories. I must say he is not into lights or sirens or carrying things on his belt ect.

His clinical skills are less than desirable, I have no confidence in him and dread to think of the outcome if he was in a position were he had to work as an individual. I remember being at a festival, I had gone for a walk to see a band on stage and left him with the truck, I received a radio call from this member in quiet a panicked tone to immediately return to the vehicle. Upon arriving 3 children and parents had presented with substantially minor injuries, minor abrasions and blood noses from unrelated incidents and environmental conditions. He was extremely overwhelmed by the whole situation and was unsure as to which one needed to be treated first, the parents were also going though the turn out bag trying to find dressings and assorted items to clean up their kids and control the epistaxis. Needless to say within 5 minutes all the kids were fine and I’d managed to make a few jokes and got the parents on side as they were understandably quiet upset.

I can’t even rely on him to call for paramedic assistance or help, he gets so worked up that a patient needs paramedic assistance that he can’t string a word together and gets so pedantic about the map referencing and the exact location of were we are.

He can’t even document simple observations or history on the PCR, the wording is horrible and I think he suffers from some sort of illiteracy. He does mange to get the personal details and waits for me to finish treating so I can fill out the clinical side of things. I fear that if he did fill out the clinical part of the form and there was a coroners inquest (god forbid) or some sort of repercussion that we wouldn’t have a leg to stand on.

Every time I’m partnered with him to do a Motocross standby I become weak at the knees. When I see riders fly meters in the air, bike going in each direction and officials franticly waving the medical flag I become nauseous and begin to have tremors myself as I know if something serious has happened I don’t have any backup and would get more sense out of a monkey than my partner, but Elsa I do the best I can and pray to god that someone’s parent is a nurse or someone who can offer some form of assistance.

On many occasions I have told him to go do something else but he generally lets me do my own thing and carries my bags, gets the stretcher ect. They keep pushing him through the re accreditation and courses because we have such a lack of volunteers.

Don’t get me wrong, not every standby I do is like this and he generally can handle the bandaid and ice pack requests. Some of our standbys are quiet remote and help can be quiet some time so like to have another member with me if his coming along.

[VentMedic]

What's a 'duoneb"?

It is a combination of Albuterol and Atrovent with the trade name Duoneb by Dey Pharmaceuticals.

It was expensive when initially released and many in EMS as well as hospitals just continued to used 0.5 cc of 0.5% concentraton Albuterol which is available as individuals to mix with a unit dose of Atrovent. Some also just mixed the two unit doses.

Now there is a generic Albuterol/Atrovent mix available so Duoneb is not around as frequently as our drug buyers shop for a bargain.

Some hospitals also insisted on orders being written by RRTs and MDs as Albuterol/Atrovent combination neb just to avoid the brand name issue or for clarification and avoid confusion with other meds that may contain the same ingredients.

So, the term Duoneb may not have been heard by all. In some areas it may not have been heard at all depending on the formulary of the hospital or EMS agency.

When teaching respiratory meds for both the medical professional and the patient, we make sure they know what their meds are and not just a brand name such as Duoneb, Advair, Symbicort, etc.

An example of this is when a Paramedic is asked if the patient got albuterol and atrovent enroute to the ED and the answer may come back as "No, they got Duoneb".

[hammerpcp]

It is a combination of Albuterol and Atrovent with the trade name Duoneb by Dey Pharmaceuticals.

It was expensive when initially released and many in EMS as well as hospitals just continued to used 0.5 cc of 0.5% concentraton Albuterol which is available as individuals to mix with a unit dose of Atrovent. Some also just mixed the two unit doses.

Now there is a generic Albuterol/Atrovent mix available so Duoneb is not around as frequently as our drug buyers shop for a bargain.

Some hospitals also insisted on orders being written by RRTs and MDs as Albuterol/Atrovent combination neb just to avoid the brand name issue or for clarification and avoid confusion with other meds that may contain the same ingredients.

So, the term Duoneb may not have been heard by all. In some areas it may not have been heard at all depending on the formulary of the hospital or EMS agency.

When teaching respiratory meds for both the medical professional and the patient, we make sure they know what their meds are and not just a brand name such as Duoneb, Advair, Symbicort, etc.

An example of this is when a Paramedic is asked if the patient got albuterol and atrovent enroute to the ED and the answer may come back as "No, they got Duoneb".

Great answer, thanks for the complete lack of arrogance.