chbare Posted October 12, 2007 Share Posted October 12, 2007 Agreed, thank you ERDoc. Take care, chbare. Link to comment Share on other sites More sharing options...
Doczilla Posted October 12, 2007 Share Posted October 12, 2007 I wasn't pimping YOU, ERDoc. Just gotta answer all the questions, don't ya? Gunner. 'zilla Link to comment Share on other sites More sharing options...
spenac Posted October 12, 2007 Share Posted October 12, 2007 Dang it zilla quit jacking with the ERDOC. :twisted: Link to comment Share on other sites More sharing options...
AnthonyM83 Posted October 13, 2007 Share Posted October 13, 2007 I wasn't pimping YOU, ERDoc. Just gotta answer all the questions, don't ya? Gunner. No, no, please, continue Link to comment Share on other sites More sharing options...
Asysin2leads Posted October 13, 2007 Share Posted October 13, 2007 I still say it was coxsackie B4 virus. It was and you all just don't want to admit it. Link to comment Share on other sites More sharing options...
Dustdevil Posted October 13, 2007 Share Posted October 13, 2007 Your partner ends up as a chief in the fire department. But not before I made him clean a whole lot of pee out of the back of my ambulance. Link to comment Share on other sites More sharing options...
NREMT-Basic Posted October 13, 2007 Share Posted October 13, 2007 The roads are fine (but I like your thinking). Her lungs are clear. Your partner has given her a little over a liter. The pt weighs about 35 kg. Pupils are equal. Why would this pt have cerebral edema? You are out in the middle of nowhere. There is no reliable cellular service and the radios don't reach far enough. OK...simple but this is why the patch on by BDUs says "Basic Life Support Specialist"---- 1. Nearest hospital is closed and diverting according to what we are given 2. Radios and cells dont work but I am sure the schools phone does. Assume implied consent and spin up the helo. 3. While waiting, treat aggressively and symptomatically using shock protocol. 4 Standby with suction and intubation. 5. O2 by NC @2LPM 6. repeat vitals with BGL q5m 7. .9% saline IV, fairly wide open 8. Medic tx for nausea/vomiting 9. Give flight nurse the bullet, sign over your patient, go to church and light a candle. I know Im going to get flamed, but I am actually proud of being a basic. I like that I have pretty tight protocol parameters...its makes it more simple for me to do what I need to do. Im sure that the medics are laughing their asses off, but she is compensating in some areas and decomp'ing in others. As a basic I am most worried about not having the chaplain have to say to this girls parents "we regret to inform you..." I learn so much from those of you with more experience and training, but I do so love my basics. Im gonna let the medics amongst us work on the dx and worry about not losing this child before my helo is skids down. Oh yeah....starting move anything on the playground that isnt bolted down for an LZ. Link to comment Share on other sites More sharing options...
AnthonyM83 Posted October 16, 2007 Share Posted October 16, 2007 7. .9% saline IV, fairly wide open 8. Medic tx for nausea/vomiting 9. Give flight nurse the bullet, sign over your patient, go to church and light a candle. I know Im going to get flamed, but I am actually proud of being a basic. (--break--) As a basic I am most worried about not having the chaplain have to say to this girls parents "we regret to inform you..." Maybe it's my sleep deprivation and reading this thread all in one sitting, but wasn't the point of the scenario that you did NOT want to give that IV wide open, because there was cerebral edema going on? Thus your #7 was actually what would be killing your patient....and thus an example of why basic's are limited...the less training/education to recognize events like these (not that most did anyway)... BTW, what tx does #8? Link to comment Share on other sites More sharing options...
AnthonyM83 Posted October 16, 2007 Share Posted October 16, 2007 Remember she is most likely in a state of relative hyperkalemia, but in fact will require potassium supplementation.I know we moved on from this, but for educational clarification did you mean she'd need K+ even if she's hyperkalemic? Or did you mean only after receiving bicarb? ALSO: How does DKA lead to cerebral edema? High sugar in cranial circulation (is that a correct term?) leads to water uptake?to Link to comment Share on other sites More sharing options...
chbare Posted October 16, 2007 Share Posted October 16, 2007 Relative hyperkalemia. The K is only elevated because massive amounts of K has been pushed out of the cells, replaced by hydrogen ions. Once the acidosis begins to resolve, the K will shift back into the cells. These people are usually K depleated and will require aditional K to ensure a normal serum level. It is not so much the DKA issue as it is an issue of hyperosmolarity.. When you rapidly change the osmolarity of the blood in a DKA patient, the osmolrity within the interstitial and cellular space tends to lag. So in simple terms the cell is hypertonic to the blood. Water then moves with it's gradient into the cell. ie brain Many more things are at work, but it is easier to look at this as the movement of water with a gradient that gets a little out of hand. Take care, chbare. Link to comment Share on other sites More sharing options...
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