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This almost mirrors the scenario I posted, except without hypotension and without tachypnea and without GCS issues.

probably elevated BP due to pain from broken fingers. Pain medication should have been administered here unless contraindicates exist. This should have been a ALS call. Also in our protocols a systolic bp of >180 requires cardiac monitoring regardless of history.

Checked back on patient and she had sepsis. The pt also had DT's from alcohol withdraw and it was causing some involuntary shaking which may have also led to increased her body temp.

Call comes in as a possible seizure for a patient with seizure hx. Patient currently is not seizing is alert and breathing. Upon arriving at the residence you find the patient lying on the couch. She seems postictal, a small sign of dried blood is noted on the lower lip. Pt alert but...

Yeah I was nervous and un-sure of myself. As you get more experience that goes away. However when I expect a call will be tough I still get nervous and want to make sure I do the right thing. Anyone that tells you they aren't is burned out. Things can always go south, even on the simplest...

Here where I work we don't run lights and sirens to every 911 call. It has to meet specific guidelines to be considered a life threatening emergency. We have the lights and sirens call codes which are the life threatening emergency, then we have a non-life threatening emergency and both of...

I lowered O2 to 6L NC in the truck, I put him on a NRB for a few minutes until I could do further assessment in the truck. Also a good pulse ox doesn't mean things are well, I had someone with a H&H of 3 and 10 and he had a pulse ox of 100%. A 60mmHG systolic is strange considering a MAP of 60...

Well I had hid sit on a trauma dressing. He wasn't dripping blood so it must have clotted off. Yes I was concerned about diluting clotting factors with a fluid bolus, but it was a very small one. He was still compensated at destination. Tintinalli, Judith E. (2010). Emergency Medicine: A...

55 y/o pt c/c of rectal bleeding, states "severe", happened during bowel movement and pt has hx of such. Pt takes no meds, has hx of GI bleeds and no allergies. Upon arrival pt is sitting on couch with a towel under him. Pt is diaphoretic and complains of weakness. States bleeding started...

That is what she said :)

Also I checked heart sounds and they were also there at the same rate, any explanation for that?

That is because in those strips posted the pulse ox would keep falling off and I had to reapply it. Still good learning experience all and all.

While this is good information and will be remembered, How can you explain a pulse ox reading of 100% if the rate was still 20? I also had a good manual blood pressure measurement. Not saying anyone is right/wrong here. I know you said the skeletal muscle contraction could cause "wishful...

While it definitely does not look like classic capture, I had increased sats to 100% and good blood pressure as well as a palpated carotid rate equal to what I was pacing at. This makes me wonder if some false capture morphologies can still be true capture. Maybe the strip I posted wasn't but...

Yeah I do the best I can, its medicine and you learn everyday. BP was 100/65 at destination and she had spontaneous respirations and some hand movement probably to pain, GCS 3 on scene to GCS 6 at destination.

Yeah this was my first time pacing a real person, I need to quit being such a tough critic on myself, just because it looks like it might not be capture when all other signs point to is being capture.

Yeah it did match, but the QRS and t wave looks much like what they call "phantom QRS" in this article. http://ems12lead.com/2008/11/transcutaneous-pacing-tcp-the-problem-of-false-capture/ There are many factors that lead me to believe I had full capture, mechanical and electrical. The first...

I had a call for a 83 y/o female with SOB. We get there she is not responsive but had adequate RR with diffuse rales and a hx of CHF and heart problems, previous strokes and MI's. I put her on oxygen because I am getting sats of 65%. I then put her on the monitor and have 3rd degree HB at a...

Thanks, I read that one amp decreases pH by .1 . I didn't think it was doing harm especially after thinking about the lab values that the internal medicine doc had when he approached me asking about the call. The pH was 6.9 PaCo2 was 44 and bicarb was 28. I thought it was sound thinking at...

Yeah I was, you've never made a mistake?