the 100% directionless thread
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Anjel
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Clare
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Patients with acute congestive cardiac failure are often very, very sick and the mortality rate is quite high so yes, you need to be very aggressive with treating this group of patients, probably the closest example to compare the level of "ambo-ing" these people need is those with life threatening asthma.
Get them onto the bed and put their legs over the side, slap on a non rebreathing mask with a very high flow rate, like these patients will be profoundly hypoxic and need a much higher rate of oxygen delivery than what is normally used (we use 15 LPM) and ensure a good seal as two easy, simple first actions.
Acquire an ECG quickly and look for treatable causes of ventricular insufficiency; the most common reasons are infarction and tachydysrhythmia, particularly VT. Nothing wrong with cardioverting somebody who is in VT with cardiogenic pulmonary edema, if they have cardiogenic shock as a result of their lowered ventricular output then you're in a bit of a sticky situation; cardioverting them is going to hurt with much of the paining but it may very well save their life; I suppose if you have it you might try some fentanyl or more preferably some ketamine given the haemostatic properties.
GTN is really the only proven thing that works well for somebody who is in cardiogenic pulmonary edema, use 0.8 mg unless they have blood pressure a bit more towards the lower side of whatever limit you have (ours is 100) then it might be a good idea to use 0.4 mg.
CPAP is a good idea I reckon, I asked the Clinical Standards Unit why we don't have it, their answer was that it has not clearly demonstrated a lower mortality rate and that it will empty an oxygen tank very fast and our ambulances only carry one and refilling them can get very expensive so for now we have PEEP.
I wouldn't bother calling for an Intensive Care Paramedic with RSI because these patients have a time critical problem who need to the transported to hospital without delay and it's going to take less time to take them to hospital than it is to get RSI backup.
Get these patients into the ambulance once you've got them on the bed, given them a couple minutes of very high flow oxygen and a dose of GTN (if their blood pressure will allow) and get moving.
I'd recommend placing an early RT call to the hospital before you leave the scene or as you are doing so.
So um yeah, CHF patients are going to be crook and treat them as such!
Clare
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No problem dear, hope you do better next time, and you spelled Clare right, so bonus points!
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Time to go shadow/get dragged around the mountain by some ski patrollers, lez do diz!
Clare
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Can I come? Mind you, I have to work tomorrow day and I'll just stay at the ski lodge and sip a mochachino.
It's too hot to sleep and I just spent an hour trying to get to sleep ... thankfully its Sunday tomorrow and it should be quiet.
I wish my room had a ceiling fan!
It is just not the right time for these things to be happening! ....
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NYMedic828
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I have bronchitis for the second time in 3 months. Seriously... Whats next pneumonia?
Clare
Forum Asst. Chief
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Could be, are/were you a smoker?
NYMedic828
Forum Deputy Chief
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Na. I'm outside all day soaking wet in sweat or water from training and while we have our own facepieces for the SCBA we still share the regulator that clips into it. So we all get sick :sad:
Anjel
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JPINFV
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Anjel
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GRRRRR. I wanted to post that.
You have to share!!!
Aidey
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This may be the first time in EMTLife history that someone has beaten JP when posting a meme.
adamjh3
Forum Culinary Powerhouse
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I love that I can wear shorts to work
NYMedic828
Forum Deputy Chief
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On an ambulance? Why would you want to wear shorts when you have to get down on the ground all the time.
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Pretty sure he's working a contract as a set medic for a tv show or something of the sorts
I have a headache. Ibuprofen, coffee and breakfast didn't fix it...what next?
Anjel
Forum Angel
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Diluadid. Or so they say....
Don't forget the Benadryl. You know because it makes you "itch". Or so they say.
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Meh, my legs/knees never really touch the ground anyway; out of habit I just always squat.