the 100% directionless thread

Got to hang an Epi and Nor-Epi drip on a OD full arrest who we got ROSC on.
 
Anjel said:
Take a women into the ER who took too much atenolol. Brady at 41, BP 100/74, and very confused lethargic. We gave 1mg ( two doses of 0.5) of atropine. Worked great. HR came up she woke up, skin color looked a lot better.

We walk into the hospital and give report to the RN. She gets all up in a tizzy and says "you have an entire mg of Atropine! Who gave you those orders?? Not one of our docs! What do you think you're doing giving that much!?"

I looked at her and was just speechless. The doc comes in she proceeds to tell him what we did, and he just looks at us and goes "good job thanks guys". Lol
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Don't know if I would have been able to resist the temptation to cite our medical director's name, and pull up a PDF of the protocols on my phone... Saying nothing is probably best.
 
Quite a few years ago, a partner of mine had a patient with a HR of 25 that was basically refractory to atropine. Every time it was given, the HR would come up to mid-40's for about a minute and drop right back down to the 20's. I wasn't the medic on that call, nor was he. When I heard the story, I started thinking: "Call for TCP" and the medic on that call never did. Funny thing is that the county moved up the implementation of a TCP protocol because of that particular call. Regardless, TCP orders were available upon phone call to a Base Hospital...

Oh, and 2 mg of Atropine isn't exactly too much. In Sacramento County, while we can give 0.5mg of Atropine and go to TCP if the Atropine isn't effective, if it is, we can give a total of 2 mg of the stuff, 0.5 mg every 5 minutes if it is.

I doubt I'd have said anything other than "good job" for the crew giving atropine, resulting in waking up a low-HR patient.
 
Anjel said:
Take a women into the ER who took too much atenolol. Brady at 41, BP 100/74, and very confused lethargic. We gave 1mg ( two doses of 0.5) of atropine. Worked great. HR came up she woke up, skin color looked a lot better.

We walk into the hospital and give report to the RN. She gets all up in a tizzy and says "you have an entire mg of Atropine! Who gave you those orders?? Not one of our docs! What do you think you're doing giving that much!?"

I looked at her and was just speechless. The doc comes in she proceeds to tell him what we did, and he just looks at us and goes "good job thanks guys". Lol
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Our protocol is up to 3.0mg total
 
Our protocol in Santa Clara County is 0.5 mg, may repeat once (so total 1 mg) for symptomatic bradycardia. 2 mg for organophosphate poisoning q 5 minutes until asymptomatic, requires base hospital order.
 
Never. I'm a good boy and do as I'm told.





[emoji23]
 
venflon said:
Ever had to ignore protocol and make a judgment call?
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Yep. That's why our guidelines state that we cn deviate if in the best interest of the patient :p
 
The beauty of knowing your protocols inside and out is being able to make them say what you need them to.
 
Akulahawk said:
Oh, and 2 mg of Atropine isn't exactly too much. In Sacramento County, while we can give 0.5mg of Atropine and go to TCP if the Atropine isn't effective, if it is, we can give a total of 2 mg of the stuff, 0.5 mg every 5 minutes if it is.
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Absent ongoing cholinergic stimulation (organophosphate poisoning, etc.), 2-3 mg is the dose which is generally accepted as resulting in full parasympathetic blockade, which is why protocols often don't allow for more than that.

At around that point, it just stops working.
 
Today I was compelled to sit through a medicolegal class "taught" by a local attorney and volunteer FF/EMT-I.

This guy was without a doubt the worst ricky rescue I have ever met. Could not stop talking about his "QRV" which turned out to be his Jeep Grand Cherokee a siren, light bar, and poorly applied star of life decals. Homemade glove dispense/dash light combination. Several radios mounted inside despite every FF in the county being issued an 800 portable that works flawlessly in 99.9% of the county. Also visible was his "personal" LP12, a high angle rope rescue kit (because you need that working on the eastern plains of Colorado), and narcotics safe. He also had one of those Galls "rescue" vests hanging off the seat, which he made reference to at least four times throughout the class.

As you can imagine, the class was absolute garbage.

When I am in a medicolegal class I would like to learn about the laws and regulation regarding my practice. Instead he let his personal bias about being the ultimate ricky rescue get in the way and I learned nothing. I'd press him for actual state and county regulations and I get the whole "well technically you don't have to stop for TAs, but I mean morally..." type crap. I don't care about technically. Yes or no.

He also brought up that story about the FDNY dispatchers and their ill-ending trip for coffee a few years ago and completely altered the story to fry them, and then stated "karma is the fourth force of life and that EMT that was later shot (and killed) got what she had coming."

Sigh.

Did I mention he also sits on the board that administers one of the 911 contracts?
 
Tigger said:
I'd press him for actual state and county regulations and I get the whole "well technically you don't have to stop for TAs, but I mean morally..." type crap. I don't care about technically. Yes or no.
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[YOUTUBE]http://www.youtube.com/watch?v=hou0lU8WMgo[/YOUTUBE]
 
Testing for the county just north of me for a PT gig in the morning, along with 3 other medics. Our protocols are pretty good, but they have levophed, nitro drips, TXA.......all the goodies we don't have. Rumor is they plan to hire all of us assuming we don't blow it.
 
Tigger said:
Also visible was his "personal" LP12
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I'm not a ricky rescue, but I actually personally owned a LP12 at one point (Technically, I still do).

I bought it because it was just such a great deal, military surplus marked non-functional for a repair that cost me literally 6 bucks and two hours of my time, paid 300 bucks for it (It had SpO2, NiBP, CO2, too.), how could I not buy it?.

It's on permanent loan to a fire department I worked with in Honduras. I couldn't just donate it, because every time someone donated an AED or monitor to this particular department, the federal government came in and took it to give to another department.
 
Remi said:
Absent ongoing cholinergic stimulation (organophosphate poisoning, etc.), 2-3 mg is the dose which is generally accepted as resulting in full parasympathetic blockade, which is why protocols often don't allow for more than that.

At around that point, it just stops working.
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My point was more that the County's Protocols allow for up to 2 mg normally, so 1 mg wouldn't be much to really bat an eye at. However, yes, normally that's a full parasympathetic blockade. While we had to have a LOT of Atropine on board for Organophosphate poisonings, we rarely used those. Heck, we rarely used Atropine...
 
As of 37 minutes ago I no longer have a lifting restriction :D

Now to the gym all day erry day to get all swoll so I can go back to work. Doc's appointment is 9/9 so gotta be good to go by then so she can clear me for the lift test third week of September then back to the box beginning of October :wub:

Anyone got good shoulder stability exercises outside of the normal dumbbell work, resistance bands and standard PT stuff they teach? Makes me sad that 50 pushups burns out my left arm.
 
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Handsome Robb said:
As of 37 minutes ago I no longer have a lifting restriction :D

Now to the gym all day erry day to get all swoll so I can go back to work. Doc's appointment is 9/9 so gotta be good to go by then so she can clear me for the lift test third week of September then back to the box beginning of October :wub:

Anyone got good shoulder stability exercises outside of the normal dumbbell work, resistance bands and standard PT stuff they teach? Makes me sad that 50 pushups burns out my left arm.
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You're going to want to get your SITS (aka rotator cuff) muscles strong. Their main job is to provide stabilization of that shoulder joint. Without them, the shoulder is just too unstable to be truly useful. those exercises you've been given will do that job well. You'll also have to work on bringing your proprioception up to par. Good to google shoulder proprioception exercises for those. Your prime mover muscles will also get strong too. Just take care that you don't add that strength and neglect the SITS muscles too. You have to work on the total package and bring them up to strength together or you'll have problems down the road.
 
Akulahawk said:
You're going to want to get your SITS (aka rotator cuff) muscles strong. Their main job is to provide stabilization of that shoulder joint. Without them, the shoulder is just too unstable to be truly useful. those exercises you've been given will do that job well. You'll also have to work on bringing your proprioception up to par. Good to google shoulder proprioception exercises for those. Your prime mover muscles will also get strong too. Just take care that you don't add that strength and neglect the SITS muscles too. You have to work on the total package and bring them up to strength together or you'll have problems down the road.
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I will look into that. I was actually thinking of PMing you since I know you did a lot of ATC stuff before EMS and RN school.

I actually didn't injure my RC at all, somehow. Had a 270* superior -> posterior -> inferior labrum tear, and they also did a subacromial bursectomy and an anterior/posterior capsular plication.

With that said my RC is definitely weak, shouldn't say there's no damage to it since I do have impingement syndrome and also had "minor" supra and infraspinatus injuries as well. Just was looking for other exercises to do to "mix it up" since I've been doing the same damn ones for the last 8 months. 4 months pre-surgery and now 4 months post surgery. Been looking at kettle bells. They seem like they'd be a good way to work strength and stability together.

Told my DPT first thing I was doing was maxing out on snatch squats....he didn't find the amusement I did in it.

Thanks for the advice!
 
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