crotchitymedic1986 Posted January 2, 2009 Author Share Posted January 2, 2009 Good job guys, and ER doc, your post is coming, standby. Link to comment Share on other sites More sharing options...
HellsBells Posted January 3, 2009 Share Posted January 3, 2009 Other folks: Describe, in detail, how you would handle a combative patient who may or may not be ETOH involved. You see a large head laceration and a very large drunk reeling around a circle of onlookers. Ready? Go. 1. Ensure personal safety, if the pt is out of control, and you fear assault, wait for the police. If the pt is not combative and the crowd isn't a howling mob attempt to talk to the pt, calm them and describe what treatment you are going to perform on them. 2. due to the altered LOC, C-spine precaution is required, if possible control C-spine fit with a collar and perform a standing take down onto the spine board, strap the pt in, quickly move him into the ambulance, away from the crowd 3. assess and control ABC,s, perform a rapid head to toe trauma survey, pay special attention to the head, determine if the head wound is superfical or if there is significant injury, get some vitals, Obtain a BGL, perform a neurological exam. 4. attempt to get an AMPLE Hx from the pt or bystanders if pt is or becomes agitated consider the use of restraints and assistance from LEO's during transport 5. start an IV, 18G or so - titrate fluid replacement to BGL, Vitals, Assessment findings 6. start towards the appropriate hospital. 7. preform a more detailed secondary survey, asessing pupil response, note changes in GCS and neurological assessment, take pts temp, repeat vitals, expose all areas to look for occult injury, patch to receiving facility. Ok, next question- describe the role of surfactant in regards to respiration and alveoli... Link to comment Share on other sites More sharing options...
itku2er Posted January 3, 2009 Share Posted January 3, 2009 Surfactant helps to keep alveoli from collapsing at the of expiration. It helps to keep the airways dry by drawing the moisture into the alveoli and keeping them moist. If I remember correctly its a surface-protein but dont quote me on that one. Describe step by step how you would place a nasal tube for nasal intubation. Link to comment Share on other sites More sharing options...
AZCEP Posted January 3, 2009 Share Posted January 3, 2009 1. Preparation --This step is much more important than for the laryngoscope assisted intubation. The patient and your equipment needs to be prepared so that you do not have to think about where your equipment is, or what is happening with the patient 2. Topicalization of the nasopharynx is quite helpful, but not mandatory. Some benzocaine is nice, and many will get by with some Neosynephrine, but most can be done with a little KY jelly. 3. A premedication regimen of Lidocaine/BZD/narcotic of choice is also very helpful. Because of the increased trauma that is caused, using these agents can prevent problems once the tube is placed. Use just enough to reduce the CNS response, and not so much to obliterate the respiratory drive. 4. An Endotrol tube that is properly sized, and a BAAM whistle should be mandatory equipment. The combination makes it near impossible to miss. Waveform capnography can also be used to place the tube, and should be prepared for verification once it is. 5. Introduce the tube into the nares aiming straight back. DO NOT aim to the roof of the nasal cavity. This only causes increased resistance and a greater chance of lacerating a turbinate. 6. Advance the tube to the posterior nasopharynx. Preparation for the angle will allow you to begin to curve the tube to avoid the richly innervated area that will be met. You should be advancing rather slowly at this point, so once you meet resistance some side to side rotation of the tube can assist in passing it. 7. Advance to the level of the glottis while carefully listening. The whistle should become louder as you get closer to the opening. 8. Wait for an exhalation, and pass the tube on inhalation. There will still be air moving through the whistle as you pass it, but it will become audibly louder on the exhalation. 9. Confirm placement with your capnography. Inflate the distal cuff until resistance is met. This can be very subtle so inflate a bit slower than you think you should. You only need to seal the air from around the tube. 10. Secure the tube and begin ventilations. 11. Consider further sedation measures. [NOTE: These are the steps I have used to successfully nasally intubate, and there are many other ways to perform the procedure. Your mileage may vary.] Link to comment Share on other sites More sharing options...
itku2er Posted January 3, 2009 Share Posted January 3, 2009 whats the next question? Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted January 4, 2009 Author Share Posted January 4, 2009 Describe the differences between : Abruptio placenta, placenta previa, and eclampsia Link to comment Share on other sites More sharing options...
spenac Posted January 4, 2009 Share Posted January 4, 2009 Describe the differences between : Abruptio placenta, placenta previa, and eclampsia Wow give the EMT's nightmares. Good question for discussion though. I will let my peers handle it though. Link to comment Share on other sites More sharing options...
Eydawn Posted January 4, 2009 Share Posted January 4, 2009 Eclampsia: Seizures and dangerous illness including decreased organ function. Occurs in pregnancy after the development of pre-eclampsia (hypertension). Pathophysiology in a nutshell... basically the body whacks itself out because it's not tolerating the placenta well, becoming more sensitive to pressure regulating agents due to hypoperfusion of the placenta and a bad... hm... how to put it... bad relationship between placenta and mother's body? Not sure how to phrase it. Placenta previa: the placenta is sitting lower than it should be and may be covering the cervix. Can cause bleeding during later pregnancy, and may necessitate delivery by C-section. Is not necessarily an emergency by itself, but can be dangerous if bleeding occurs... women usually end up not being able to work or lift or have any intimate relationships until they deliver. Women with this have to be really careful and vigilant about watching for bleeding, and if they are bleeding, it is an emergency. Placenta abruptio: The placenta has become detached, either fully or partially. May cause blood loss and hypoperfusion to both mother and fetus. It is a true emergency, requiring ultrasound, blood transfusion, and often emergency C-section. Can happen due to a variety of factors including trauma, dehydration, and high blood pressure. What are the signs and symptoms of a pulmonary embolism patient and how would you treat for it? Wendy CO EMT-B Link to comment Share on other sites More sharing options...
CTXMEDIC Posted January 6, 2009 Share Posted January 6, 2009 What are the signs and symptoms of a pulmonary embolism patient and how would you treat for it? Wendy CO EMT-B Hx of travel, BCP use, Trauma, Smoking, DVT, drug use, diving, recent surgery, prolonged imobilization, longbone Fx's, new onset a-fib....anything that would cause a clot Decreased o2 sat, localized wheezing, bradycardia, etCo2 in the toilet prehospital Tx includes highflow O2 via NRB, cardiac monitor, IV access, heparin and thrombolytics Link to comment Share on other sites More sharing options...
ERDoc Posted January 7, 2009 Share Posted January 7, 2009 Thrombolytics for a PE? That's a little overly aggressive, unless you are talking about a saddle embolus. Link to comment Share on other sites More sharing options...
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