the 100% directionless thread

Hmm tattoo or lift kit for the Jeep. Tough decision.
 
D. 1. Travel to country where hookers and blow are legal.
2. Hookers and blow.
 
But if I get a tattoo I will instantly turn into a horrible nurse or a drug dealer and I will never be ever find a job ever again :rolleyes:

JPINFV said:
D. 1. Travel to country where hookers and blow are legal.
2. Hookers and blow.
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I like the way you think
 
Always sad to see young adults wasting their life away. 19 year old DKA with I'm guessing sepsis as well.

Started at GCS 11, 110/70, sinus tach in the 140s, CGB "HI" (>600 mg/dL) with a ketone warning (yup my glucometer is that awesome, supposedly >80% accurate at detecting them per the manufacturer.)

8 minutes later 74/p, GCS 8 sinus tachy in the 150s and a fight to keep his airway open for 15 minutes alone in the back of the box. That pressure drop was with a liter of fluid running WFO through a 18g with a pressure bag.

Intubated as soon as we rolled into the ER, turns out he was discharged from the ICU one week prior with a dx of DKA. Been intubated multiple times and a borderline frequent flyer in the ICU.

Looking back probably shoulda drilled an IO as a second point of access but I was basically stuck at "A" for the entire 45 minutes I was with him and had no second set of hands.

First time I've ever been legitimately fuming that I couldn't RSI a patient. With a NC at 6 lpm and BVM sats were in the high 80s, clear to auscultation bilaterally.

Any ideas on why his pressure would yank so hard so fast? Never seen a DKA patient do that. My only thought was sepsis on top of the DKA and the MD seemed to agree, unfortunately didn't make it back to see his labs, definitely will try to find out mañana.
 
Chase said:
Hmm tattoo or lift kit for the Jeep. Tough decision.
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Both. Tattoo first so it has time to heal before it really turns into summer. Even then you shouldn't be exposing them to long durations of direct sunlight.
 
Robb said:
Always sad to see young adults wasting their life away. 19 year old DKA with I'm guessing sepsis as well.

Started at GCS 11, 110/70, sinus tach in the 140s, CGB "HI" (>600 mg/dL) with a ketone warning (yup my glucometer is that awesome, supposedly >80% accurate at detecting them per the manufacturer.)

8 minutes later 74/p, GCS 8 sinus tachy in the 150s and a fight to keep his airway open for 15 minutes alone in the back of the box. That pressure drop was with a liter of fluid running WFO through a 18g with a pressure bag.

Intubated as soon as we rolled into the ER, turns out he was discharged from the ICU one week prior with a dx of DKA. Been intubated multiple times and a borderline frequent flyer in the ICU.

Looking back probably shoulda drilled an IO as a second point of access but I was basically stuck at "A" for the entire 45 minutes I was with him and had no second set of hands.

First time I've ever been legitimately fuming that I couldn't RSI a patient. With a NC at 6 lpm and BVM sats were in the high 80s, clear to auscultation bilaterally.

Any ideas on why his pressure would yank so hard so fast? Never seen a DKA patient do that. My only thought was sepsis on top of the DKA and the MD seemed to agree, unfortunately didn't make it back to see his labs, definitely will try to find out mañana.
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Are you allowed to do a nasal tube? I'm curious about EtCO2 if you carry nasal prongs for that too.

I'm wondering if there was maybe some kind of positional pulmonary edema too with that quick sinus tach. I know you said lung sounds were clear, but I'm imagining he may have been supine/semi Fowler's and the fluid may have shifted to where you couldn't hear it as well. Also, fine rales can be missed in the back of an ambulance cruising code 3. Just more reason some PPV may have helped. Your BVM may have been the best thing for him, considering your circumstances. Unfortunate there was no fire rider or anyone to take along on that one too. Will your supervisor not rendezvous on a 45 minute transport of a sick patient?
 
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My first RSI was a septic 19 year old female. Found in respiratory arrest. A legitimate mess.

RSI is a great tool. But I fear it will go away for most providers within the next 5 years.
 
DEmedic said:
My first RSI was a septic 19 year old female. Found in respiratory arrest. A legitimate mess.

RSI is a great tool. But I fear it will go away for most providers within the next 5 years.
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Yup, we only do kings now.
 
chaz90 said:
Are you allowed to do a nasal tube? I'm curious about EtCO2 if you carry nasal prongs for that too.

I'm wondering if there was maybe some kind of positional pulmonary edema too with that quick sinus tach. I know you said lung sounds were clear, but I'm imagining he may have been supine/semi Fowler's and the fluid may have shifted to where you couldn't hear it as well. Also, fine rales can be missed in the back of an ambulance cruising code 3. Just more reason some PPV may have helped. Your BVM may have been the best thing for him, considering your circumstances. Unfortunate there was no fire rider or anyone to take along on that one too. Will your supervisor not rendezvous on a 45 minute transport of a sick patient?
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I'm drafting something up that you will be a part of.

We do carry NTI kits with a protocol to place them. Our hospitals really frown on it as well as our QA/I which makes no sense to me. I do not feel comfortable performing a nasal intubation, I honestly feel it would be negligent of me to attempt one with the level of training I have with them.

No sidestream ETCO2 either :-/

45 minutes was from start to finish. ~20 minutes on scene, 5 looking for the pt in the massive parking lot of the mall, 10 packaging and 5 trying to pry the information I needed from dad who had to make multiple phone calls to tell me his H/A/M, looking back I should've just said :censored::censored::censored::censored: it and left. Transport itself was 20-25 minutes. Never thought about calling for a supe to meet us. It'd probably be a no though unless we were in real trouble because they hate leaving their supe rigs behind but the one that was on today would have done it for me I think. That's a great resource I never even considered!

No fire rider was my fault, originally I didn't have any reason to suspect he was going to crump on me, so I dismissed them. I'll withhold my opinion about the crew I was with but that's for another post. Found out about the extensive intubation and ICU Hx from the hospital not dad. Made me really stop and think, am I getting too comfortable? I don't think I am, I always try and keep a high index of suspicion and go with my gut. Were there warning signs I missed?

I wondered about pulmonary edema was well but I got a good listen on scene anteriorly and posteriorly, although we rolled him to left lateral so I could listen posteriorly so potentially missed it because of that?
 
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DEmedic said:
My first RSI was a septic 19 year old female. Found in respiratory arrest. A legitimate mess.

RSI is a great tool. But I fear it will go away for most providers within the next 5 years.
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We have a few pre-hopsital physcians on fly cars that carry the drugs for RSI. Our Intensive Care Medics can tube but not sedate / paralyse. The Doctors back up trauma jobs mostly, i've seen RSI 3 times.

Once with a multi-trauma high speed motorcyclist

Ketamine + Rocuronium

Once with a severe head injury (hit by train) again Ketamine + rocuronium.

and one drowning / immersion possibly propofol and vercuronium used.

I believe the drugs used are dependent on trauma vs non-trauma and haemodynamics.
 
So, Ms. MICN, you're yelling at us because we rolled our sepsis patient in code 3 instead of upgrading to ALS when we're 4 minutes from the hospital?

Yeah, enjoy your visit from county EMS and your refresher on our protocols.

Maybe some basic mathematics would help, too. Because clearly in your mind 4 minutes to definitive care is worse than 3 minutes to dispatch ALS, a 6-10 minute response time, followed by several minutes of doing the gurney shuffle and the original 4 minute transport. They'll be able to (maybe) get a whopping 50ml of fluid on board while exponentially increasing the time to definitive care.
 
adamjh3 said:
So, Ms. MICN, you're yelling at us because we rolled our sepsis patient in code 3 instead of upgrading to ALS when we're 4 minutes from the hospital?

Yeah, enjoy your visit from county EMS and your refresher on our protocols.

Maybe some basic mathematics would help, too. Because clearly in your mind 4 minutes to definitive care is worse than 3 minutes to dispatch ALS, a 6-10 minute response time, followed by several minutes of doing the gurney shuffle and the original 4 minute transport. They'll be able to (maybe) get a whopping 50ml of fluid on board while exponentially increasing the time to definitive care.
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Gotta love this.

About twice I month I get argue with a local ER who's hospital happens to be that system's neurosurgery facility. They just dont understand why I dont go to the sister facility 6 mins closer(not passing up the sister facility, just turning right at the hi way instead of left so to speak) with stroke alerts.

Trying to explain that going straight to them saves a CCT transfer an hour later and that this gets the patient into the neurosurgeon's lap goes nowhere. They just complain about having another sick person to take care of.
 
Last night rocked. Had a couple cool old ladies as patients, one was pretty sick with a non-stemi and still was cracking jokes.

And a sick CCT patient on the vent that took some managing of sedation and BP meds. Love our new vents (Impact EMV+) and to finish it off got to annoy my favorite vollie FD on an assault call(I dont play well with a few people).

I see the weekend from here and get to go hang out with one of my two super cute 7 month old nephews.
 
shfd739 said:
got to annoy my favorite vollie FD on an assault call(I dont play well with a few people).
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Does it start with a W or a C? :lol:
 
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