Difference between BLS and ALS calls?

[Aidey]

By definition vtach with a pulse is not cardiac arrest.

 

[medictinysc]

By definition vtach with a pulse is not cardiac arrest.

Thank you I am big enough to say that I am wrong. :wacko: Don't know what I was thinking

 

[usalsfyre]

I don not need a doctor in my house, at my work, or in the ditch, I need a paramedic, EMT, first responder.

If I'm upside down in a ditch I'd much rather have this guy coming to get me than the vast majority of paramedics....

Have you ever watched a doctor give orders during a cardiac arrest, they are totally oblivious to the AHA recommendations

A quick note on ACLS....the are "recommendations" that are based on standardized responses to common problems. Depending on what your knowledge of what's going on it may make sense to do something completely different. For instance the first drug I reach for in the pre-dialysis cardiac arrest is not epi, but calcium....

I also would like to know what department the aforementioned cardiac arrest happened in. I can't imagine any doc who regularly works in EM giving an order like that.

 

[Veneficus]

Have you ever watched a doctor give orders during a cardiac arrest, they are totally oblivious to the AHA recommendations. They start spouting things out like "Give him an amp of dopamine" I actually saw a nurse say what dosage would you like? The doctor repeated "an amp". The nurse said it's weight based, the doctor said "Oh" I chimed up and said Dr ***** has us start out at 2 mcg/kg/min is that what you would like.... The doc looked at me and said fine. And walked out and left it to the common uneducated workers

I am going to have to take issue with this...

Have you ever seen me do it? I can also perform every role in a cardiac arrest as good as any nurse, tech, or medic you can summon and probably better than most.

Because I know the AHA recommendations inside and out, not only do I teach them, I am the guy the teachers call to answer the questions they cannot.

When it is in my power, I do not use the AHA recommendations. I promise you nobody is getting epi unless they have a specific pathology I can identify that requires it.

Second of all, you cannot compare military docs to civilian docs. They are in all respects 2 seperate worlds with 2 different measures of success.

Third, while the dopamine thing is disconcerting, maybe that doc works in an environment where he doesn't usually treat cardiac arrest because it is futile?

I can tell you if somebody codes in Afghanistan, from something other than penetrating trauma or a handful of immediate complications from treating it, they are 99.9% likely going to die.

Fouth, the AHA guidlines are designed for sudden cardiac arrest from the most common cause in the civilian world, which is an MI. They are not designed to work in any other etiology.

finally, a doctor at any civilian institution anywhere in the world I have been that walks out on an active cardiac arrest and doesn't leave the patient in the care of another doctor is probably looking at his last day at that facility, and will probably be answering to a legal or professional authority for such conduct.

 

[JPINFV]

First, In all fairness I have to give you the credit that your due. You sound like a wonderful student. Your very eloquent in your speech and writing techniques. Now on to the matter at hand, if I were in cardiac arrest whether it be V-FIB, pulse-less VTACH, VTACH with a pulse, or Assystole. For someone with practical knowledge on how to perform the tasks at hand. I don not need a doctor in my house, at my work, or in the ditch, I need a paramedic, EMT, first responder. Have you ever watched a doctor give orders during a cardiac arrest, they are totally oblivious to the AHA recommendations. They start spouting things out like "Give him an amp of dopamine" I actually saw a nurse say what dosage would you like? The doctor repeated "an amp". The nurse said it's weight based, the doctor said "Oh" I chimed up and said Dr ***** has us start out at 2 mcg/kg/min is that what you would like.... The doc looked at me and said fine. And walked out and left it to the common uneducated workers

Can't say I've seen that... and every resuscitation I've seen in the ED tends to flow very smoothly.

Plural of anecdote is not data. Of course I'd also expand the qualification of educated vs not educated to physicians in regards to emergency care too. There's a difference between describing, say, a dermatologist in an emergency situation and an emergency physician... unless it was an emergency dermatology patient.

 

[Veneficus]

There's a difference between describing, say, a dermatologist in an emergency situation and an emergency physician... unless it was an emergency dermatology patient.

There are emergent dermatological pathologies?

I had no idea...

I thought all of those were punted to Rheumo or Onco.

 

[JPINFV]

There are emergent dermatological pathologies?

I had no idea...

I thought all of those were punted to Rheumo or Onco.

SJS/TEN spectrum is one. I also tend to hedge my bets when ever I can.

 

[NomadicMedic]

Back on topic please.

 

[Shishkabob]

(you should probably have a very strong background before you do so).

You mean BESIDES MCRD San Diego that I have?

The Navy does provide all medical, dental, and chaplain support for the Marine Corps. USMC units have Navy corpsmen, physicians, nurses, sundry other healthcare personnel and chaplains attached.

No, see, I know that better than most considering my background.


What didn't compute was a Marine not capitalizing "Marine", but capitalizing "Navy" and "Corpsman". Hence, does not compute. Every Marine I know would jump on that miss-classification pretty darn fast.