# OOPS!



## ffemt8978 (Sep 9, 2004)

Well, I had one of those famous 2 AM CRI's (cranial-rectal inversion) last night.

Called out to 66yoM C/C chest pain.  Pt. described pain as a weight on his chest that woke him up out of deep sleep.  Pt also stated that he had visited his doctor earilier that day for an EKG and was to schedule a follow-up with a cardiologist next week.

Pt was CAOx4, Skin PWD, Lungs clear & equal bilat, Bradycardic (mid 30's), respirs 12, BP 132/68, pain 1/10.  We throw him on some O2 and the monitor which was showing an abnormal rythm (later ID'd as 3rd degree block) and call for ALS.

As a basic, we are allowed to give 162mg ASA PO for crushing chest pain associated with light headedness.  I go to get the baby aspirin and look at the bottle.  I confuse the quantity of pills (36) as the dosage (actually 81mg) and give the patient 4 baby aspirin for a total dose of 324mg.

I didn't find this out until we had returned to the station and were talking about the call when someone mentioned that our aspirin was 81mg.  I went back and looked at the bottle, and found they were correct so I had to go back and amend my run report to include my screw-up.

It taught me a valuable lesson - Triple check the dosage!


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## rescuecpt (Sep 9, 2004)

> *later ID'd as 3rd degree block*


EWWWW - NOT GOOD!!!



> *and call for ALS.*


Good call!



> *4 baby aspirin for a total dose of 324mg.*


Well, even though you broke your protocol, rest assured you did not put the pt at risk.  324mg is the protocol in NYS for chest pain...  I would imagine that the lower dosage in your state is to guard against patients with bleeding problems, here we just ask lots of questions about that stuff to try to rule out potential complications.


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## ffemt8978 (Sep 10, 2004)

I know that the only thing I did was thin his blood out some more so I wasn't worried about that.

I was concerned that if I could make such a simple mistake with ASA, then I could do it with something else where it would do harm.  Just a good reminder to triple check the dosage.


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## rescuecpt (Sep 10, 2004)

> _Originally posted by ffemt8978_@Sep 10 2004, 07:46 AM
> * Just a good reminder to triple check the dosage. *


 Definitely - and expirations too.


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## PArescueEMT (Sep 11, 2004)

Wow. In my state, the only thing us basic's get to play with is a pulse ox. If we're lucky, we might get an automatic B/P machine.you get a monitor?? <_< 
At least, that's a good move for EMS.

But the dose thing could cause legal problems unless your med com doc is cool enough to cover you on that, tho in the long run, I don't forsee any issue's arising from that.



Zachary Krier
NRFF/PAEMT-B


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## ffemt8978 (Sep 11, 2004)

3 lead ECG that's part of our AED.  Also includes a pulse ox connection.


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## PArescueEMT (Sep 11, 2004)

> _Originally posted by ffemt8978_@Sep 11 2004, 11:30 AM
> * 3 lead ECG that's part of our AED.  Also includes a pulse ox connection. *


 even so, it's better than here. Are you also trained for ECG interp?


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## ffemt8978 (Sep 11, 2004)

Well, not exactly.  When I first went through the course (in another state) we were allowed to interpret 4 rythyms on the ECG (NSR, PEA, Asystole, and VF/VT).

Here in Washington, all we're allowed to do is print a strip and show it to the paramedic or ER and go, "Me think this is bad".


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## rescuecpt (Sep 13, 2004)

How do you interpret four rhythms but not any others?  If it doesnt fit what one of those four rhythms looks like in the textbook, then you just say "I don't know"?


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## ffemt8978 (Sep 13, 2004)

> _Originally posted by rescuelt_@Sep 13 2004, 08:22 AM
> * How do you interpret four rhythms but not any others?  If it doesnt fit what one of those four rhythms looks like in the textbook, then you just say "I don't know"? *


 "Me think this is bad".


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## PArescueEMT (Sep 13, 2004)

or is it "This line has too many squiggles in it. I think he/she needs help"


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## rescuecpt (Sep 13, 2004)

Hehe, anything that's not a sinus rhythm gets a quiet little "oh ****" from me.  Then I poke holes in people and try to make it a sinus rhythm.


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## MMiz (Sep 14, 2004)

Our AED has a little LED screen that has the time and tiny words.  Trying to see a rythym on that thing would be like trying to spell words with a calculator.

In a perfect world they'd have LIFEPAK 12s for BLS units, but we have LifePak 500 AEDs.

One day.  One day.


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## rescuecpt (Sep 14, 2004)

Well, here, BLS only needs to be able to hear "shock advised, press to shock" or "no shock advised, continue CPR"...

We have the Lifepak 12's at the ambulance corps and I love them.  We have a Zoll at the FD that is ok, but it was free (County gave it to us).  I'm working on pricing out a Lifepak 10 for the FD (because it's more affordable than a Lifepak 12, but not a Zoll).


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## PArescueEMT (Sep 14, 2004)

> _Originally posted by MMiz_@Sep 14 2004, 03:49 AM
> * In a perfect world they'd have LIFEPAK 12s for BLS units *


 another person with the same dreams as I.


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## cbdemt (Sep 14, 2004)

> _Originally posted by PArescueEMT+Sep 14 2004, 11:39 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (PArescueEMT @ Sep 14 2004, 11:39 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MMiz_@Sep 14 2004, 03:49 AM
> * In a perfect world they'd have LIFEPAK 12s for BLS units *


another person with the same dreams as I.  [/b][/quote]
 Come on over to my district - your dreams will come true!  
We carry 12's - theyre great!


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## Ray1129 (Sep 14, 2004)

> _Originally posted by cbdemt+Sep 14 2004, 11:48 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (cbdemt @ Sep 14 2004, 11:48 AM)</td></tr><tr><td id='QUOTE'>
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Come on over to my district - your dreams will come true!  
We carry 12's - theyre great! [/b][/quote]
 Likewise.  That's all most of our 911 ambo's carry.  Or a version thereof.


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## PArescueEMT (Sep 15, 2004)

> _Originally posted by Ray1129+Sep 14 2004, 11:15 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Ray1129 @ Sep 14 2004, 11:15 PM)</td></tr><tr><td id='QUOTE'>
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Likewise.  That's all most of our 911 ambo's carry.  Or a version thereof.   [/b][/quote]
 I would only be happy if I could "play" woth them as a BLS unit.


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## cbdemt (Sep 15, 2004)

> _Originally posted by PArescueEMT+Sep 15 2004, 10:52 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (PArescueEMT @ Sep 15 2004, 10:52 AM)</td></tr><tr><td id='QUOTE'>
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I would only be happy if I could "play" woth them as a BLS unit. [/b][/quote]
 what do you mean by "play"?


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## PArescueEMT (Sep 15, 2004)

I should point out that I will soon be a medic student myself. I like to attempt to interp rythms. So that is what i mean by "Play".


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## rescuecpt (Sep 15, 2004)

> _Originally posted by PArescueEMT_@Sep 15 2004, 11:56 AM
> * I should point out that I will soon be a medic student myself. I like to attempt to interp rythms. So that is what i mean by "Play". *


If you want to do yourself a favor, get a basic cardiology book and learn it before medic class starts.  Then you'll have a leg up on the competition and know some of the basics before you go in there.


I like to "play" by taking my own ECG and showing medics and seeing if they notice my "u" wave and flip out.  Most don't notice... kinda scary.


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## SafetyPro2 (Sep 15, 2004)

Even though I can't "officially" interpret rhythms, I did have a physiology class in college where we learned to interpret ECGs and even had a 12-lead hooked up to us. While I can't interpret everything, I do recognize most of the common ones (sinus, V-tach, SVT).

Our AED does have an ECG display and runs a strip, so I like to look at them after any calls and generally have somewhat of an idea of what was going on.


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## ffemt8978 (Sep 16, 2004)

Just an update:

My patient had a pacemaker installed that day at the hospital, and was released yesterday.  He is already back at work and back playing golf!

Guess the extra aspirin didn't hurt him at all.


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## PArescueEMT (Sep 17, 2004)

> _Originally posted by rescuelt_@Sep 15 2004, 06:43 PM
> * I like to "play" by taking my own ECG and showing medics and seeing if they notice my "u" wave and flip out.  Most don't notice... kinda scary. *


 I would like to see that strip myself


And congrats on the Pt. issue ffemt8978


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