the 100% directionless thread

Feeling the effects of playing the "If I fall asleep right now I will get __ hours of sleep..." game last night.
 
NVRob said:
Wait, aren't inotropic and contractility one in the same or is it 0400 and I'm loopy?

Epi infusion would be for more of a pressor effect as well as a chronotropic effect. Increased cardiac output plus vasoconstriction remembering CO=SVxHR. Whereas dope, depending on your dosing, would have inotropic effects before pressor effects and usually lack any type of chronotropic effects.
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Then you have Digoxin which is a + Inotrope and - chronotrope or Milrinone which is a + Inotrope but also vasodialtes = reduced afterload.

Pharm is so fun. Now explain the MOA of phosphodiesterase-3 inhibitors :P
 
NVRob said:
The toughest part about this call was when he asked me if he was going to be disfigured. I didn't know what to say. I didn't want to be the paramedic who told him he'd be fine and then end up being disfigured but at the same time I didn't want him to freak out any more than he already was.

How do you even answer that question?/quote]

I understand your feelings, it is hard, whether its a burn patient or somebody who is having a massive MI infront of you. I think you did good.

NVRob said:
I've always been told "you don't have enough narcs on your ambulance to make these patients comfortable" but 200 mcg of fent didn't even touch him, I was trying to get another 100 on board but I would've been outside of protocol as far as the time between doses goes.
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These patients will often need big doses of analgesia and are ideally suited to ketamine. Didn't give my burns guy any morphine and we had an ICP right around the corner so got her round for some ketamine.

NVRob said:
Wait, aren't inotropic and contractility one in the same or is it 0400 and I'm loopy?
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Sort of, an inotrope improves contractility

NVRob said:
Epi infusion would be for more of a pressor effect as well as a chronotropic effect.
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That's it! The word I was looking for was vasopressor, thanks mate.

ChaseZ33 said:
Now explain the MOA of phosphodiesterase-3 inhibitors :P
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Um, they inhibit phosphodiesterase-3?, which off the top of my head sounds like an enzyme that breaks down phosphodiester bonds at the #3 position on a molecule or something like that?

I know a little about biochemistry but not a whole lot and am not really in a position to be changing that anytime soon.

Ew, its raining, lots. This stinks.
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I think phosphodiesterase inhibitors block second messengers like cAMP.
 
To my understanding, cGMP causes vasodilation (not getting into the specific process). Phosphodiesterase then breaks down the phosphodiester bond in cGMP, decreasing the vasodilatory effects. PDE inhibitors help slow the breakdown caused by PDE, thus extending the effects of cGMP.

That is likely exactly what you were getting at, but I wanted to throw my .02 in :D
 
Passed my paramedic skills finals with flying colors!!!!! One of only six out of thirty who don't have to retake anything.
 
NYMedic828 said:
I think phosphodiesterase inhibitors block second messengers like cAMP.
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PoeticInjustice said:
To my understanding, cGMP causes vasodilation (not getting into the specific process). Phosphodiesterase then breaks down the phosphodiester bond in cGMP, decreasing the vasodilatory effects. PDE inhibitors help slow the breakdown caused by PDE, thus extending the effects of cGMP.

That is likely exactly what you were getting at, but I wanted to throw my .02 in :D
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PoeticInjustice gets the gold star for the day. Anyone want to name some specific situations in which PDEs are particularly useful?
 
Yessir, feels pretty good I must say.
 
I'm hoping for the same results when I take mine next weekend. My nerves are starting to get to me.
 
I feel awful, my tummy is in knots and crampy so I went home from work early. The OTM was like "we really would prefer if you stay" ... well duh but that is not going to happen.
 
Protip #1: don't drop your 12 day old baby on its head in the parking lot

Protip #2: don't let patients vomit on you or your bags
 
Having a hard time sleeping tonight, my one day off. I have a headache, sinuses ache, and just feel bleh all over. So I'm playing on my phone, jamming out to Guns n Roses on Pandora.
 
Chimpie said:
Having a hard time sleeping tonight, my one day off. I have a headache, sinuses ache, and just feel bleh all over. So I'm playing on my phone, jamming out to Guns n Roses on Pandora.
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Welcome to my world right now; I feel awful, my tummy is all crampy and I am in knots, got me some panadol and ibuprofen and I am going to hunker down for the weekend and hopefully things will get better.

If you like we can wallow in our aches and pains together!
 
White shirt brought his white cloud with him.

Well we had a decent seizure call, I guess technically a status seizure by definition. 4 times in 90 minutes without ever becoming oriented again. Conscious but a&ox0 with a gcs of 10. Of course he decides to have the 4th one while we are wheeling him through the ER with no access to any syringes to give him some versed. Luckily a doc was standing right there and some Ativan magically appeared before he flopped his *** off the side of the gurney even with the seatbelts in place.
 
I've only seen two seizures that were truly status epilepticus and required midazolam; both were darling little girls who were fitting for quite some time.

At least now Paramedic has IM and IN midazolam for seizures rather than you know, nothing, if the patient did not have something pre-prescribed.

I feel a little better after my shower but am still have an upset tummy churning away and feel pretty horrible. I need a hero in shining armour to come get me back to health, apply within.
 
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