"It cant be PEA if the rate is over 150" -- ??

[Ace844]

"Fire,"

No Problem, I just couldn't make heads or tails of your previous post. THANKS,

ACE844

[Punisher]

Well, you might have seen a pulsless SVT, that is called PEA!!! Chances are if you find SVT, they probably have a pulse, you just couldn't feel it. If they really didn't have a pulse and you saw SVT, it is STILL considered PEA, and the treatment is fluids, and sympathomimetics, along with Calcium, and Bicarb possibly.

The definition of PEA is ANY electrical activity in the heart, without a pulse, except VT, and VF.

I am clear, only on THIS!!!

Did I disagree with any of this (although I disagree with the recommendation of calcium since it has not been standard practice for over a decade (if not longer) except in calcium channel blocker OD or hyperkalemia), no......I disagreed with defibrillating tachycardia- not as in AVNRT, but more along the lines of sinus tach. That is my dissenting point, not with giving fluid (remember that I advocated fluid resuscitation), sympathomimetics (I stood behind the use of epinephrine), etc.

You need to drop the attitude. You will not win any argument against me on this matter or any other medical matter. Ace, I am overstating my position here?

[Ace844]

Did I disagree with any of this (although I disagree with the recommendation of calcium since it has not been standard practice for over a decade (if not longer) except in calcium channel blocker OD or hyperkalemia), no......I disagreed with defibrillating tachycardia- not as in AVNRT, but more along the lines of sinus tach. That is my dissenting point, not with giving fluid (remember that I advocated fluid resuscitation), sympathomimetics (I stood behind the use of epinephrine), etc.

You need to drop the attitude. You will not win any argument against me on this matter or any other medical matter. Ace, I am overstating my position here?

"Fire,"

I've found in matters such as the one you find your self in with "punisher" it is best to do the following:

A.) Go back and re-read the posts to make sure you're sure of what you read.

B.) Have a cold one in hand

C.) SMILE before the humiliation begins

D.) Close your eyes, and picture your self as the reciepient of this short dialogue courtesy of

"Punisher," as the main orrator...

[stream:8f45cc713e]http://unclebubby.com/wav/wav/MOVIES/Snatch/balls_sn.wav[/stream:8f45cc713e]

E.) Repeat steps A-C, then decide what your going to write in your post... :shock: :shock: :shock: 8) :wink: :wink:

F.) NUF SAID??!!

Out Here,

ACE844

[firefighter523]

Punisher, you need to be more open minded before you make certain statements. This is America, and in America, EMS has ALOT of different regions and protocols. CC may not be in use in your system, but for us however CC is in use for asystolic, and PEA arrest, for it ability to increase cells intra, and extracellular calcium content.

I am NOT trying to pick a fight with you, I am however correcting your previous statement about "Someone falling over, and finding them in a NARROW complex tachycardia. If someone falls over suddenly, and is in CA, you will more then likely find them in VF! NOT SVT!!

You can win them all, if it makes you sleep better @ night. :!:

[Ace844]

[stream:f615c79831]http://members.fortunecity.com/wavjunky/swl-f/ferret.wav[/stream:f615c79831]

[stream:f615c79831]http://members.fortunecity.com/wavjunky/swl-f/frypan.wav[/stream:f615c79831]

Forum hears "PRPG," saying,

[stream:f615c79831]http://members.fortunecity.com/wavjunky/swl-g/grphugd.wav[/stream:f615c79831]

[stream:f615c79831]http://www.favewavs.com/wavs/misc/notallnice.wav[/stream:f615c79831]

[Punisher]

Punisher, you need to be more open minded before you make certain statements. This is America, and in America, EMS has ALOT of different regions and protocols. CC may not be in use in your system, but for us however CC is in use for asystolic, and PEA arrest, for it ability to increase cells intra, and extracellular calcium content.

I am NOT trying to pick a fight with you, I am however correcting your previous statement about "Someone falling over, and finding them in a NARROW complex tachycardia. If someone falls over suddenly, and is in CA, you will more then likely find them in VF! NOT SVT!!

You can win them all, if it makes you sleep better @ night. :!:

Very good! If they do drop over, they are far more likely to be in VF than any other rhythm. Obviously you weren't too busy excavating the inside of your ear canal with your index finger during that little bit of the ACLS class! Now if you would please be so kind as to stop wearing your own rectum as a turban and pay attention to what I have actually posted you will find that I have stated exactly that.

While this may be the US, and protocols do vary, it is precisely this lack of understanding of the medical literature as you demonstrated through discussing the use of CaCl[sub:1d19d40e3d]2[/sub:1d19d40e3d] in cardiac arrest- while you have a grasp on the basic physiology, you actually seem to miss the point that there was enough evidence against it's use for the AHA to pull it from the ACLS guidelines in the late 80's or early 90's.

Now you might feel secure in going to court with the argument "But my protocols said to do X" but I assure you that when the plaintiff's attorney tears into you, he will not only plop a copy of your protocols down in front of you, but also probably (if he knows what he is doing) hand your your hind end on a platter by presenting every bit of research on the use of calcium in asystole and PEA, not much of which is very supportive of the person sitting on the defendant's side of the aisle.

Maybe instead of blindly following what your medical director tells you, maybe you should try taking an active role in protocol development. But as you said, this is the US, you all can do whatever you see fit. Have fun...let me know how it turns out. :roll:

By the way, thank you for your support Ace. That's one of my favorite scenes, from one of my favorite movies. Vinnie Jones (the guy who played Bullet Tooth Tony) was the person I tried to be when I played football:

[firefighter523]

PS Punisher.... So you haven't seen CC used in over a decade, So you were 15 when you started working in the ER???

[Punisher]

PS Punisher.... So you haven't seen CC used in over a decade, So you were 15 when you started working in the ER???

No, I said it hasn't been used for that purpose in over a decade and I haven't seen described in any of the back editions of the ACLS texts (which I own) since the early 1990's. As I said, you can abandon your cause. It isn't going to get you anywhere. :roll:

BTW, yes I was a first responder at while still in high school.

[Ace844]

OK, Boys and Girls..... Here's a friendly PSA from your friend..ACE!!

[stream:060a0c7202]http://koti.mbnet.fi/badbee/wavs/bnice.wav[/stream:060a0c7202]...

Next, now because you've aroused my curiosity; "Fire," what's the incidence of SVT-PEA in Cardiac Arrest vs. V-tach?? I ask because I don't know the rates and thought you may??

Thanks,

ACE

[firefighter523]

So, let me get this strait, If I am working a PEA code, the pt dies, and I have used CC, you actually think that a lawyer would waste his time doing research on a medication that was approved by a doctor for us to use to possibly bring that person back.

Did you miss the point. The patient has, will, or is GOING to die!! I don't think ANYONE is going to be too focused on the fact that in a couple of studies, it was recommended to not be used. The fact of the matter is, it is in our guidelines for a reason (that physicians) approved for use in that situation. It can be used for a whole plethora of other things, but we would need YOU here to diagnose those in the back of our MICUs, we aren't that smart.

I also suppose that if I was ever in that situation, I would have to explain the 2 large bore needles that I have placed in his chest. That might be a little too inhumane.