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  1. Sublime

    New to HEMS, looking for advice

    Haha, thanks. Already have a life insurance policy and all those types of things taken care of. I guess what I am wanting to know is things like, how do I know when it is safe to fly? They have a 3 to go 1 to say no policy, but I have no aviation background, and I don't know when it would be...
  2. Sublime

    New to HEMS, looking for advice

    Hello all, been a long while since I posted on these forums. I'm looking for some advice. my goal ever since starting my career has been to become a flight nurse. I finally achieved that goal recently and will start orientation in a couple weeks for a local non-profit HEMS service. I've found...
  3. Sublime

    Wide Complex EKG

    Can you not click on them to open the pictures in a gallery for a much larger view?
  4. Sublime

    Wide Complex EKG

    Also, while what you're describing is correct, it is a pretty standard appearance for a ventricular pacer with a RV pacing wire and does not point toward v-tach.
  5. Sublime

    Wide Complex EKG

    A demand pacemaker will begin pacing when it is not sensing a sufficient electrical stimulus. I don't see any evidence on these strips that this is occurring because of a demand problem. But it could be failure of the pacemaker to sense. Not sure Not unheard of for a Zoll to not pick up pacer...
  6. Sublime

    Wide Complex EKG

    These EKGs belong to a 74 year old female being transferred from a small hospital to a large facility for orthopedic services due to a L2 compression fracture that happened a few days prior. She came to the ER days later due to worsening back pain. Her only complaints are feeling "dizzy" which...
  7. Sublime

    Pre-Hospital post intubation sedation

    I want to thank everyone for their posts so far. I really do appreciate your input and opinions. However Halothane you have really persuaded me and changed my perspective on this topic. Posts like your last one are why I continue to use these forums. I really do feel enlightened on the topic...
  8. Sublime

    Pre-Hospital post intubation sedation

    What do you guys believe is the optimal post intubation sedation package for pre-hospital providers? Obviously the perfect package is going to vary depending on the condition of the patient. But do you believe we should be using Fentanyl drips such as many ICU's are doing? Is using just a benzo...
  9. Sublime

    Pre-Hospital post intubation sedation

    I think Ketamine alone is sufficient for PAI induction purposes, don't have a problem with this portion of the protocol. I see what you're saying. I don't disagree either but when you're only allowed to use fentanyl for pain management purposes and want to ensure your patient is...
  10. Sublime

    Pre-Hospital post intubation sedation

    I know this has been discussed here, previously, but I wanted to bring it up in hopes that someone can help me convince my medical director to change his mind. Our current protocol for PAI (we don't rsi) is Ketamine 0.5-1.5 mg/kg for induction. Post intubation sedation is versed 2.5 mg every...
  11. Sublime

    "Keep on-scene time < 20 minutes for medical"

    I believe this rule has nothing to do with patient care and everything to do with freeing up ambulances to get back on the system.
  12. Sublime

    7 yo SOB

    My protocols allow me to nebulize 0.3mg of epi 1:10000
  13. Sublime

    ECG Case

    I just received an update from a member of the flight crew who dropped her off. I received the following information: She did have an MI, also has an infection which they are attempting to treat, they found out she had a UTI the previous week, and apparently her heart is damaged to an extent...
  14. Sublime

    ECG Case

    Are we looking at the same ECG? How do you not see gross ST-Depression in the inferior leads with mild depression in lateral and anterior leads as well? Do you not see the elevation in AVR?
  15. Sublime

    ECG Case

    I think sepsis is a good differential, and in retrospect I should have considered it. Not going to lie I probably tunnel visioned on the ECG and ACS route. I can't say I agree with your interpretation of the strip though. After thinking about it and hearing interpretations from others, I think...
  16. Sublime

    ECG Case

    Sure thing, thanks.
  17. Sublime

    ECG Case

    I was just trying to think of a scenario that could give her that presentation and ecg changes besides a coronary event. I agree there are more likely differentials. I still think LMCA is highly probable though given her presentation. Chest pain, nausea, vomiting, palor and diaphoresis...
  18. Sublime

    ECG Case

    medicsb, I appreciate the post and your perspective. I had not read the quote from Dr. Smith before, that is good information although it conflicts with some other sources I learn from. What about the other symptoms? Do you think she might have a viral infection causing the nausea and...
  19. Sublime

    ECG Case

    My thought as well. My interpretation was widespread ST-depression with elevation in AVR and some slight elevation in V1 & 2. I was concerned for possible LMCA occlusion or subendocardial ischemia and flew this patient to a cath lab facility. And the pics are working fine for me on tapatalk...
  20. Sublime

    ECG Case

    This is a 79 y/o female who was found by her daughter lying in bed difficult to arouse. She has a hx. of dementia, stroke, hypertension, and hyperlipidemia. Daughter states she is more confused than normal. Unsure of onset as she just came by her moms house and found her in bed. On arrival...
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