CVT student's nightmare

[Protoman2050]

I hope that was a poorly worded jest?

There's nothing a medic can do for an epidural hematoma, mitral regurgitation, and pulmonary / cradiac contusions... let alone be able to detect them and confirm them in the field... 2 year college degree or not.


But hey, tension pneumo? We can dart you till your face turns blue! (Which hopefully doesn't happen...)

You can *suspect* epidural hematoma if my LOC starts going down and I become confused. Also, if I'm bradycardic and have an increased pulse pressure, that's a sign of increased ICP. If that happens, please administer furosemide and hyperventilate me, for that will decrease the amount of blood in my vessels, and cause the cerebral vessels to constrict.

Also, if you use your stethoscope, MR will be a loud holosystolic murmur. Management is Nitropress to reduced afterload and decrease regurgitant fraction.

Pulmonary contusion will cause painful breathing, decreased SaO2, dry rales, and decreased breath sounds.

Cardiac contusion will cause sternal pain and possibly arrhythmias.

Yes, this was sort of a joke.

 

[Protoman2050]

Most of the time you aren't going to see a Swan outside a cath lab or ICU unless a transport team is moving it around. Floating something through the RV in a non-sterile environment is generally a bad idea.

Why nitropress instead of straight nitro?

Nitropress is less selective than NTG for veins. This guy needs stat afterload reduction.

 

[Shishkabob]

With those ones that I named, you're merely treating the symptoms / staving off the inevitable in the field (granted, that's what a lot of what er do is). The real fixing is going to be done in the OR.


Hearing a heart murmur at the scene of an MVC... good luck with that

The fact that you already have broken ribs makes differentiating between fx ribs and a pulmonary contusion next to impossible. Sure, chances are you bruised something with the broken ribs, but again... there's nothing we can do to confirm it in the field.

As for the cardiac contusion, many things can manifest as substernal chest pain and some can lead to dysrhythmias... and the two are not mutually exclusive. You can have someone with acid reflux and SVT ^_^



Aside from that, many places around here prefer mannitol for ICP as opposed to furosemide.

And it's not really hyperventilation... it's more of a "Keep the EtCO2 at the low end of normal", ie 30ish.

 

[Protoman2050]

With those ones that I named, you're merely treating the symptoms / staving off the inevitable in the field (granted, that's what a lot of what er do is). The real fixing is going to be done in the OR.


Hearing a heart murmur at the scene of an MVC... good luck with that

The fact that you already have broken ribs makes differentiating between fx ribs and a pulmonary contusion next to impossible. Sure, chances are you bruised something with the broken ribs, but again... there's nothing we can do to confirm it in the field.

As for the cardiac contusion, many things can manifest as substernal chest pain and some can lead to dysrhythmias... and the two are not mutually exclusive. You can have someone with acid reflux and SVT ^_^



Aside from that, many places around here prefer mannitol for ICP as opposed to furosemide.

And it's not really hyperventilation... it's more of a "Keep the EtCO2 at the low end of normal", ie 30ish.

Yes, but if you guys didn't do those interventions while the pt is en-route to the OR, the pt would be going to the mourge, not the hospital.

Btw, why don't EMS medical directors have admitting privileges at the hospitals in their jurisdiction, so they can directly admit patients to the MICU/Cath lab/CCU/OR?

 

[Dominion]

Yes, but if you guys didn't do those interventions while the pt is en-route to the OR, the pt would be going to the mourge, not the hospital.

Btw, why don't EMS medical directors have admitting privileges at the hospitals in their jurisdiction, so they can directly admit patients to the MICU/Cath lab/CCU/OR?

I'm not sure what you mean by this? If we have a patient in need of cath lab we frequently bypass the ER and transport that patient directly into the cath lab. If we have a patient in need of stroke care we bypass the ER and go straight into the care of the stroke team.

Additionally while finding all that information is all well and good, and yes many services are looking at mannitol for ICP. Our protocols locally are if ICP is suspected keep ETCO2 where it needs to be if monitoring it is available (yes not all services in the state have ETCO2 capabilities, some have 1/2 capability. Some of our services still use LP10 or LP11's)

Search through the educational threads on here and you'll get a better grasp of what it takes to be a paramedic. I can think of two programs off the top of my head locally that are just a few months long with the bare min. of contact hours required.

 

[Aidey]

Also, how many non-Critical care Ambulances have nitropress? (Serious question here). I know nowhere I have ever worked has had it.

 

[daedalus]

Also, how many non-Critical care Ambulances have nitropress? (Serious question here). I know nowhere I have ever worked has had it.

I have never heard of it myself as well. This guy sounds like a troll or something, trying to make a pass at prehospital medicine.

 

[daedalus]

Btw, why don't EMS medical directors have admitting privileges at the hospitals in their jurisdiction, so they can directly admit patients to the MICU/Cath lab/CCU/OR?

*head desk*

 

[Aidey]

I've heard of it, just not on a "regular" ambulance.

 

[Protoman2050]

I have never heard of it myself as well. This guy sounds like a troll or something, trying to make a pass at prehospital medicine.

I'm not a troll, I'm just not intimately familiar with what drugs are carried on an ambulance.

Remember, I am a Cardiovascular Technology student, not an EMT student.

 

[Protoman2050]

I'm not sure what you mean by this? If we have a patient in need of cath lab we frequently bypass the ER and transport that patient directly into the cath lab. If we have a patient in need of stroke care we bypass the ER and go straight into the care of the stroke team.

Additionally while finding all that information is all well and good, and yes many services are looking at mannitol for ICP. Our protocols locally are if ICP is suspected keep ETCO2 where it needs to be if monitoring it is available (yes not all services in the state have ETCO2 capabilities, some have 1/2 capability. Some of our services still use LP10 or LP11's)

Search through the educational threads on here and you'll get a better grasp of what it takes to be a paramedic. I can think of two programs off the top of my head locally that are just a few months long with the bare min. of contact hours required.

That's what I meant.

 

[Dominion]

I'm not a troll, I'm just not intimately familiar with what drugs are carried on an ambulance.

Remember, I am a Cardiovascular Technology student, not an EMT student.

Ok typically here are some of the more common drugs an ambulance will carry: (this is not a definitive list)

Epi 1:10000
Epi 1:1000
Lidocaine
Adenosine
Atropine
Vasopressin
D50
Dopamine
Narcan
Benadryl
Morphine
Ativan
Bicarb
Phenergan
Albuterol
Atrovent

These are what we carry with them trying to get permission to carry Fentanyl.

This is not a definiative list and every service will carry different things.

Also like someone pointed out, you are not going to hear murmurs prehospital. I mean it's POSSIBLE but very unlikely.

 

[usalsfyre]

This guy does need afterload reduction, which the dobutamine will help provide. Nitropress is a BIG gun to pull out, with the posibility of serious hypotension and lots of nasty toxicologic side effects. I'd rather start with NTG and see where that takes us.

Bottom line at this point we're looking at someone who's going to be lucky to walk out of a hospital with this amount of cardic injury.

Giving lasix to a trauma pt is generally going to go in the bad idea section. Manitol is probably what your thinking and studies have shown it not to make much difference in outcomes when given in the field. Diuresing folks is generally very tricky business and in all truth should probably be left to the pros who can monitor I/O and even hemodynamic parameters as needed way more closely than us

 

[wvditchdoc]

I'm not a troll, I'm just not intimately familiar with what drugs are carried on an ambulance.

Remember, I am a Cardiovascular Technology student, not an EMT student.

And you are posting (rather smugly I might add) on an EMS Forum. EMS, Emergency Medical Services, Pre-hosptial care, something you admittedly want nothing to do with???:wacko: