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AnthonyM83

Unconcious Male At Bus Stop

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I think Richard is referring to a saline lock or a luer plug

I wouldn't piss around checking a BGL - a VT cardiac arrest is not a side effect of dysglycaemia

Craig - in the US the national scope of practice for an EMT is oxygen, OPA, NPA, oral glucose, aspirin and "assisting" a patient to take their own Rx e.g. salbutamol but only after authorisation from a medical control physician

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BLS Continue compressions, LMA, O2, Check pulses, continue to humm "Another one bites the dust". Where is my ALS unit?

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I think Richard is referring to a saline lock or a luer plug

Yes! The Saline Lock.

Continue to hum "Another one bites the dust".

Or the Bee Gees' "Stayin' Alive", as both seem to have the right rhythm

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have we ruled out and corrected (as much as possible) asys's list of causeses of PEA??

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Please note that you're in NSW.................... BLS includes a bunch of good stuff that, if I were to do here in New York Some examples are, as an EMT-Basic, I am not allowed to start an IV. I'm only allowed (under state protocols) to administer albuterol, 81 Mg chewable aspirins, glucose paste, and oxygen. BLS crews are not YET allowed to do finger sticks, as ALS only recently got the OK to do so, but my instructors foresee it coming.

Whilst I fully understand that 'our' basics are trained to a much higher lever than those in the US...to me it is backwards to allow a basic a skill and drug regime that lets them administer drugs (sulbutamol, asa, and glucose paste) with out giving them a tool to allow to get the base line for the drug they are giving.

They have a stethoscope to hear an expiratory wheeze............salbutamol waranted

They have chest pain and suspected AMI (ECG maybe)........aspirin waranted

They are ? diabetic (no BSL taken so are they Hypo/ Hyperglyceamic)......give them the glucose.....makes NO sense to me

I see that you say NOT YET.......hope that it changes soon for you guys

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Unfortunately the National EMS Agenda for the Future has been underway since 1996 and oxygen, OPA, NPA, oral glucose, aspirin and "assisting" a patient to take their own Rx e.g. salbutamol is the best they could come up with ... in nearly 20 years, fucking breaks my heart seriously

I expect no meaningful change before 2030 at least

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Back to the Patient

arrive on scene.......safety? etc

Quick look......Pt's LOC.....

ABC's yes or no

we now know there is no pulse and he is unconscious...........

CPR guys for 2 minutes. OPA with bagmask...............attempt to get some other information.......bystanders/ medialert bracelettes etc.

attach the paddles....confirm the ECG....Pulseless VT (if greater than 160 shockable rhythm)

Check pulse (if no pulse)

Lifepack 15 DC Shock 200j

CPR 2 minutes also Advanced airway procedure (ETT or LMA), bag and CO2 detector

Check pulse (if no pulse)

Lifepack 15 DC Shock 200j

CPR for another two minutes whilst you or your partner attempts to cannulate (largest bore your comfortable with)

Adrenaline 1:10,000 IV bolus

Check pulse (if no pulse), assess rhythm, if still VT....Lifepack 15 DC shock 200j

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Adrenaline 1:10,000 IV bolus

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

DEPART FOR ER ----URGENT TRANSPORT (complete the following enroute id possible)

Amiodarone 300mg IV

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Adrenaline 1:10,000 IV bolus

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Adrenaline 1:10,000 IV bolus

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Amiodarone 150mg

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Adrenaline 1:10,000 IV bolus

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Lignocaine 100mg IV bolus

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Adrenaline 1:10,000 IV bolus

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Lignocaine 100mg IV bolus

CPR for another two minutes

Check pulse (if no pulse),

Lifepack 15 DC Shock 200j

Hopefully after all that amount of shocks, he would have gone in to asystole...easier to treat, or not for that matter

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why transport him if he does not have ROSC; what can the hospital do the ambo's cannot in the field?

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Alright. So you set up IV access, intubate, push a round of EPI, round of AMI...on your 3rd shock, you convert to F-Fib. Unless someone wants something different here, we'll assume we continue with maxing out on AMI (300mg, then 150mg). Then 2nd shock, you shock him into asystole...what next?

In all of this, you get a head to toe done and go through H's and T's (this does take a bit to go through when you're rushing to do those other interventions in between the rhythm checks, so didn't give them to you right off the bat.

You have him intubated with CO2 at 18, well-oxygenated, no resistance, no signs of chest trauma, equal lung sounds, pupils non-reactive mid-range, no track marks, blood sugar normal range, skin warm and dry, no signs of dialysis ports..not sure if I'm forgetting one here. Basically, you get no help on the H's and T's.

He just went into asystole though on the 5th shock.

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run your asystole protocol......no response in greater than 20 minutes call it

by then you should be at the hospital.....let the ER doc do it........

Edited by craig

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