CBEMT Posted May 21, 2007 Share Posted May 21, 2007 I am really confused on what needs to be rationaled. I am a basic but was taught that for a NRB mask the highest lpm of O2 is 15LPM. Since the patient is breathing more than 28 breaths per minute you may need to assist ventilations in order to ensure that they are good breaths. In the scenario scope2776 says that "pt on 15 LPM NRB" so what is the confusion? I am a newbie, but I pretty sure I know enough about airway and breathing on the basic level. LOL. Thanks dude, I needed that. Link to comment Share on other sites More sharing options...
sladey67 Posted May 21, 2007 Share Posted May 21, 2007 Why not cardiovert consious pts?? I was taught that you could give 5 mg of valium if needed. In this case her LOC is going down fast enough that she needs to be fixed now. I say forget the 5 mg of valium cardiovert here and then give it if needed. why wait til she codes on you or goes fully unconscious??? Because it is outside our current treatment protocol. I'm not saying that cardioversion is not the right tx, I just don't have it as an option. Link to comment Share on other sites More sharing options...
Dustdevil Posted May 21, 2007 Share Posted May 21, 2007 I'm still confused. Please tell me what needed rationale. Is it because that was all I include in my short message. Pretty much. You gave us no reasoning with your answer, which wasn't really a committed answer anyhow, which comes across looking like you gave us a cookbook answer instead of an actual solution that you reasoned out in your head, using the information provided. But, if you are convinced that you "know enough" about respiratory and airway management, I'll give you a chance to prove me wrong. Give us the medical rationale for your "short message." If you really know "enough," proudly show us. If you don't, well at least spend a couple of hours looking it all up, then come back and BS us into believing you know enough. Either way, I'll be proud of you. But I'd also be proud of you for just admitting you don't know "enough," but you would like to. You don't know me but I am a very persistent student. I try to learn as much as possible. I strive to know as much and definitely enough before I go out and serve the public. If I did not at least think that I knew enough at the basic level I believe that would be dangerous and I don't want to be a danger to a single patient. Lack of knowledge of your standard of care is dangerous to the patient. Not sure what you are getting at here. Are you saying that "thinking" you know enough is good enough? That it doesn't matter if you really do know enough, so long as you think you know enough? :? If all you know is flowcharts and cookbook recipes, then you are very, very far from knowing "enough." Most patients, including this one, don't fall into those neat little protocols you learned in EMT school. Consequently, you are left having to think them through and come to an educated decision about their problem and their needs that doesn't involve the regurgitation of protocols. Link to comment Share on other sites More sharing options...
ERDoc Posted May 21, 2007 Share Posted May 21, 2007 I like the idea of giving this girl some etomidate or propofol (though I worry about the BP with propofol) and spark her up. After that I say we do the same to the nurse sans the etomidate or propofol. Link to comment Share on other sites More sharing options...
AZCEP Posted May 21, 2007 Share Posted May 21, 2007 I agree with you ERDoc. However it would seem that the patient's level of consciousness is decreasing to a point that we need to move quickly, and may not have time for the happy drugs to be effective. I would be willing to give a dose of etomidate though. Link to comment Share on other sites More sharing options...
Niftymedi911 Posted May 21, 2007 Share Posted May 21, 2007 After obtaing the vitals and hx thats been posted I would: IV L 18 or 16 G any location obtainable I would like to try a jugular in this instance if a/c's are not obtainable Blood Draw O2 NRB enough to keep bag inflated* per local protcol // readying my intubation kit along with drawing up some Succ's, Etomidate and hanging a Diprivan drip in case of "Airway Alert" whats called on the radio to let dispatch now someone's getting tubed and to send an extra unit for help if necessary. By our Airway protocol dubbed CAM (Crash Airway Management) * I would also use caution though with the Diprivan as well with the local hypotension, more the likely I would just double up on the Versed and Etomidate to keep her sedated if all else fails. 12 - lead ATT I would venture to agree with most and call it WCT with definately a LBBB and maybe a hint of WPW * Call for MedStar ( aeromedical helicopter), I work in the south sector of Lee County, which is roughly 40 min by ground to any facility that can handle this pt * by local protocol Versed at 2-3 mg IV, if IV unobtainable, *administer .2 mg/kg (for a total of 8 mg)(.2*40=8) intranasal via MAD* by local protocol Defib pads on, 100 J ready, set, clear, *bam* If converted, Amiodarone 150 mg in 100 cc of D5W over 10 min Repeat Cardioversion if unsuccessful at 360 J Pray to God it converted If pt is not converted by this time and mental status is still is still declining, definately getting tubed for airway protection Haul ass to LZ, wait for Medstar 10-97 (arrival), transfer pt, call the hospital, and clean up for the next one. Link to comment Share on other sites More sharing options...
ericenglund Posted May 22, 2007 Share Posted May 22, 2007 Defib pads on, 100 J ready, set, clear, *bam* If converted, Amiodarone 150 mg in 100 cc of D5W over 10 min Repeat Cardioversion if unsuccessful at 360 J Pray to God it converted 100J or 360J? Nothing in between? Link to comment Share on other sites More sharing options...
ERDoc Posted May 22, 2007 Share Posted May 22, 2007 100J or 360J? Nothing in between? Are we talking monophasic or biphasic? Starting that high, especially if we are not going to premedicate seems cruel. Let's start at 50. Link to comment Share on other sites More sharing options...
ericenglund Posted May 22, 2007 Share Posted May 22, 2007 50 sounds good. a 360J cardioversion on this young lady seems a bit excessive. :shock: Link to comment Share on other sites More sharing options...
Dustdevil Posted May 22, 2007 Share Posted May 22, 2007 After obtaing the vitals and hx thats been posted I would: IV L 18 or 16 G any location obtainable I would like to try a jugular in this instance if a/c's are not obtainable Blood Draw [s:0469c266a4]O2 NRB enough to keep bag inflated* per local protcol // readying my intubation kit along with drawing up some Succ's, Etomidate and hanging a Diprivan drip in case of "Airway Alert" whats called on the radio to let dispatch now someone's getting tubed and to send an extra unit for help if necessary. By our Airway protocol dubbed CAM (Crash Airway Management) * I would also use caution though with the Diprivan as well with the local hypotension, more the likely I would just double up on the Versed and Etomidate to keep her sedated if all else fails. 12 - lead ATT I would venture to agree with most and call it WCT with definately a LBBB and maybe a hint of WPW * Call for MedStar ( aeromedical helicopter), I work in the south sector of Lee County, which is roughly 40 min by ground to any facility that can handle this pt * by local protocol Versed at 2-3 mg IV, if IV unobtainable, *administer .2 mg/kg (for a total of 8 mg)(.2*40=8) intranasal via MAD* by local protocol Defib pads on, 100 J ready, set, clear, *bam* If converted, Amiodarone 150 mg in 100 cc of D5W over 10 min Repeat Cardioversion if unsuccessful at 360 J Pray to God it converted If pt is not converted by this time and mental status is still is still declining, definately getting tubed for airway protection Haul ass to LZ, wait for Medstar 10-97 (arrival), transfer pt, call the hospital, and clean up for the next one.[/s:0469c266a4] You can save all the dramatics after the blood draw. That's about the point your patient died. :? Link to comment Share on other sites More sharing options...
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