the 100% directionless thread

Johnny MF'n HEISMAN!!



That is all.


:D
 
Of course with him having to stay all I can say is Aggies will win the SEC next year.
 
I don't think Clare was trying to put down other people or the system they work in; she was just saying the standard.

In my system, paramedics can give 0.3 mg epinephrine (1:1,000) IM only if the patient is in shock. It doesn't specify location, and to be honest, I think paramedics in my area think IM = deltoid only.

I like the posted links by KellyBracket in the anaphylaxis post we recently had here. Per those, it should be given anterolateral thigh.

Edit: I'd like to talk about something that confuses me. In his links, it talked about there being relatively no contraindication for epinephrine in anaphylaxis. I've heard and read a million times about being cautious with people who have a history of CAD, and it even says in my county protocols to consider reducing the dose and contacting base (duh, I live in CA).

I understand that epinephrine is a sympathomimetic, and it binds to all the adrenergic receptors (e.g. alpha-1 for vasoconstriction, beta-1 increase heart rate, beta-2 dilate the bronchioles are the major things they teach in paramedic school). For the heart to contract, it at minimum requires ATP at least for the Na+-K+ pump to repolarize the heart (phase 3: rapid repolarization) and ATP with Ca2+ for the heart to mechanically contract (thinking about the regulartory proteins: tropomyosin, myosin, and actin, Z lines get closer) therefore needs more ATP, which will rely on aerobic metabolism, which requires oxygen to accept electrons from NAD. I understand all of that. So increase oxygen demand cause we need more ATP.

When the SNS is stimulated, the coronary arteries dilate.

Is induced MI by epi another myth? Or what's the issue? Does their HR go up so quickly that it uses anaerobic metabolism because the coronary arteries didn't dilate enough? This is just something that confuses me.
 
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Clare said:
I can't say I know about backboards; never used them so I've never had occasion to look into the matter so it's not for me to comment.

I wasn't talking down to you, all I said was that adrenaline should not be given subcutaneously; the exact same thing could be said for giving adrenaline transdermal or giving intramuscular morphine to children. I wasn't saying anything about you, but rather what about what was suggested and if you take exception to that then I apologise, it was not my intention.
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Your post came across very condescending. Thank you for telling us epi should not be given subcutaneously however, telling us that doesn't change the fact that many people have to follow protocols that still require it be given subcutaneously. It is a good idea to establish why people do things a certain way before telling them they are wrong.
 
Aprz said:
I don't think Clare was trying to put down other people or the system they work in; she was just saying the standard.
.
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The problem is that just because something is the standard somewhere doesn't mean it is the standard everywhere. "Standard" and be a very subjective term in medicine.
 
So, did anyone ask Santa for a new stethoscope for Christmas?

(He said, as he slipped the vial of Epi out of sight...)
 
triemal04 said:
Well the first time I can remember seeing it was 7 or so years ago. Figure that where I was working then wouldn't be likely to be the first place to do it and I'd say it's a good bet that 10 years or more is about the right timeframe. If we're just going to base this on personal experience anyway. Either way, doing something that you have to even though you know there is a better way is different than doing something and not knowing there's a better way. Hard to tell which it is unless someone explains themself.

Regardless, saying something like: is definetly out of line. What should probably have been done was to tell them they're wrong and then tell them why it's wrong.

I'll just go back to lurking again in this thead...
Click to expand...

http://www.ncbi.nlm.nih.gov/pubmed?term=11692118
 
ejy7ytep.jpg
 
Are you from Canada? Because they would be better. Because they are horney Tims.
 
Aprz said:
Edit: I'd like to talk about something that confuses me. In his links, it talked about there being relatively no contraindication for epinephrine in anaphylaxis. I've heard and read a million times about being cautious with people who have a history of CAD, and it even says in my county protocols to consider reducing the dose and contacting base (duh, I live in CA).

I understand that epinephrine is a sympathomimetic, and it binds to all the adrenergic receptors (e.g. alpha-1 for vasoconstriction, beta-1 increase heart rate, beta-2 dilate the bronchioles are the major things they teach in paramedic school). For the heart to contract, it at minimum requires ATP at least for the Na+-K+ pump to repolarize the heart (phase 3: rapid repolarization) and ATP with Ca2+ for the heart to mechanically contract (thinking about the regulartory proteins: tropomyosin, myosin, and actin, Z lines get closer) therefore needs more ATP, which will rely on aerobic metabolism, which requires oxygen to accept electrons from NAD. I understand all of that. So increase oxygen demand cause we need more ATP.

When the SNS is stimulated, the coronary arteries dilate.

Is induced MI by epi another myth? Or what's the issue? Does their HR go up so quickly that it uses anaerobic metabolism because the coronary arteries didn't dilate enough? This is just something that confuses me.
Click to expand...

http://www.cjem-online.ca/v8/n4/p289
 
n7lxi said:
So, did anyone ask Santa for a new stethoscope for Christmas?

(He said, as he slipped the vial of Epi out of sight...)
Click to expand...

Ooo Aideys mad :) good luck with that. I had a hunch Clare would rub her the wrong way. I think it was the pink avatar.
 
Aprz said:
Is induced MI by epi another myth? Or what's the issue? Does their HR go up so quickly that it uses anaerobic metabolism because the coronary arteries didn't dilate enough? This is just something that confuses me.
Click to expand...

Adrenaline increases cardiac work and myocardial oxygen requirements; in somebody with a known history of coronary artery disease this can lead to myocardial ischaemia.

There are several case reports and papers listing adverse effects of adrenaline including myocardial infarction so yes, it is absolutely a possibility.

That said, a known history of myocardial infarction, angina or coronary artery disease is cause for a reduce dose, say 0.3 mg IM instead of 0.5 mg.
 
Back off topic everyone!

My guilty pleasure: watching ancient aliens.
 
bigbaldguy said:
Ooo Aideys mad :) good luck with that. I had a hunch Clare would rub her the wrong way.
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There are so many things I could say to that ....

And yes I have a new stethoscope but Santa did not bring it; Littman Master Classic II with free engraving, only cost me about $100

Not sure what I want from Santa yet but I will think of something, probably in like you know, February.
 
You did what to who for how many jelly beans?

Our white shirt tonight is awesome. Either of us have yet to talk to a patient, he's running the whole show and killing it!
 
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