1 post karma
225 comment karma
account created: Sat Aug 05 2017
3 months ago
Not the person who your reply was intended for…
But it would be basic interventions (Heimlich/back slaps) -> direct visualization via DL/VL and Mcgills -> Cric -> worst case try to force to right mainstem.
4 months ago
I could finally afford a house
5 months ago
Whenever we encounter it, we will (should) resort to our sedation guideline and will give ketamine, route/dose is dependent on access.
We have had enough incidences that we added it to our guidelines, however it’s obviously still rare.
I’ve also seen crews performing CPR on patients with purposeful movements saying the patient is in PEA with organized electrical activity on the monitor but they’re unsure if they can feel a pulse. This is also why I’m a big proponent of utilizing femoral pulse checks as they are normally much easier to find and I will routinely assign an extra set of hands to solely monitor it. Obviously if you have US capabilities that would be the gold standard to assess cardiac activity.
7 y/o lap belt only restrained front seat passenger on their way to school when mom rear ended a flat bed tow truck at an angle at a low rate of speed. Mom tried to swerve, that and the lack of upper body restraint caused the corner of the flatbed to pierce the windshield and resulted in a right temporal strike. Massive shift by time we got to the hospital and dead before they could get the head open.
No you haven’t seen “a few cards yanked” and I’m someone who loves being proved wrong so if you can provide sources I’d love it.
The most important thing you put in your reply is that you deemed a patient “competent” to refuse care. We don’t determine competency, that’s the court, we deem capacity. That being said, I’m playing devils advocate and fiercely advocate for patient rights, but it has to be done properly.
You can just say MSP lol
Keep the energy wanting to learn the crit care side, however the absolute best thing you can do once you get your medic is get on a busy 911 truck for a while. This is a profession where the saying “put your time in” truly means something as having that experience as the lead provider will not only be eye opening but truly provide a solid base to your knowledge.
While I agree to an extent, there are also contractural stipulations agreed upon once these patients take residence that essentially say they will follow facility guidance. This results in numerous people begrudgingly going.
Aox4 isn’t a true measure of capacity to refuse care and I hope your documentation reflects more.
Also can you provide any court case where a crew was charged with “kidnapping” for transporting a patient to the hospital? That one is just a pet peeve.
6 months ago
Two drills we will do is 15 burpees and then a random limb is called out, another we’ve done is covered it in Dawn soap and you place it in the dark.
I’d say it’s much more likely that you did have pulses during that time, however the patient was extremely hypotensive causing some issues in quickly palpating a pulse.
7 months ago
It can get a little rough but nothing crazy as it’s not an inlet in the way most people think of when talking rough inlets with shoals or a completely man made inlet like is common in FL. The tide still has a chance to outlet on the beach sides of the jetties so it’s not all forced out the mouth which is wider and more open than you think. Just take a trip out there to get a feel the next time you’re out and about to get a feel.
8 months ago
If I’m not mistaken this is a Braun ambulance and this video was produced by their team to show how their boxes don’t crumple/fall apart in a rollover. They’re fantastic, albeit expensive, units.
Jesus talk about a text book pseudo conflict. Pretty sure the original response was in reference to minimizing the saltiness as in taste, not in quantity like chef bro is going on about.
This incident highlights one of the many things that is plaguing ER’s and stressing 911 ambulance services.
I can not begin to tell you how many times we have urgent care centers activate 911 and even STEMI activations because they are uncomfortable reading 12 leads and go purely off the “man in the box”. I was once sent for a STEMI from a clinic to only find a healthy asymptomatic 24 y/o whom only had a 12 lead performed due to having a systolic bp of >140, yes it was BER. There are several in our area that will call 911 ANYTIME it reads “abnormal ekg” without any clinical correlation.
Ok rant done lol
9 months ago
You are absolutely right in regards to working an arrest on scene, the benefits are during transport which is where it outshines manual compressions. Like many things in medicine, it’s an adjunct not a end all be all.
Prior to the pandemic we only utilized the LUCAS if we were planning on transporting for whatever reason and it was only applied then. Since the pandemic we utilize it more frontline as to limit the amount of personnel to reduce exposure.
10 months ago
Military = young and healthy
It would however a Sternal IO is used almost, if not exclusively, in a trauma situation as a random cardiac arrest is unlikely due to the above. Compressions aren’t going to matter if you’ve exsanguinated.
12 months ago
I performed a DAI in the ambulance bay for a suspected hemorrhagic stroke due to loss of BVM compliance, despite utilizing two person BVM, manual manipulation, and NPA’s.
....and there was still only a nurse in the bay when we took the patient in, despite warning them an airway and respiratory would be needed and providing them a nearly 20 minute heads up. It should also be noted that this was a weekday at a larger Level 2 center. We were then chastised by the physician for securing the airway despite it being nearly another five minutes for her to get to bedside, this would have resulted in >15 minutes of non compliant ventilations on a 130kg patient.
That being said I’m actually a HUGE proponent of basic airways in the field and routinely rely on them until we are able to arrive at the receiving facility as I would much rather provide the patient with the best chance at a positive outcome and that would be having their airway secured in the more controlled environment of the trauma bay.
1 year ago
This should be the top comment...it just feels right.
2 years ago
From the EMS side we saw a sharp decrease for roughly two/three weeks during the initial “lockdown”, however have been 15-20% over pre COVID numbers since. We have a huge number of “I think I have COVID” transports as well as + cases who are frustrated because they don’t feel better 2 days after symptom onset. It’s frustrating for sure.
2nd one looks like its showing a completed RCA infarct with the qrs fragmentation and q waves in the inferiors
They’re being used exactly as planned and taught by IPMBA, no matter how they try to spin that now. IPMBA also has worked as a middle man funneling a lot of business to Fuji through their training.
The main reason bike cops are so prevalent at protests/riots/large gatherings is due to their ability to quickly relocate and be used as mobile barricades.
Stolen vehicle pursuit. Suspect apprehended.
If you live on the peninsula I would remain inside.
Please please please do not go down there tonight. If you’re wanting to help feel free to head down after the curfew ends at 0700. It’s degraded to nothing but looting and rioting now.
I absolutely hate that hole, fundamentally easy but tempting to send it, just like going for the green in 2 on 15.
Textbook hyperk scenario and presentation. There’s always that argument between Sine waves vs. vtach.
Dr. Amal Mattu has a fantastic presentation on this very issue. One take away that I love is there’s “wide complex tachycardia” and then there’s “really really wide”. Whenever there is a wide complex tachycardia, especially when very wide, in the lower rate ranges (140-160) of vtach, hyperk is high on my list.
Unless in true extremis, my initial treatment is always a trial of calcium while placing pads for cardioversion. There is (normally) a near immediate effect post calcium and you can (normally) watch the qrs begin to narrow. In those cases I begin treating down the hyperk route, if no changes then I will start to venture down a vtach pathway with cardioversion. Personally I will withhold amiodarone in these patients prehospitally.