adamjh3
Forum Culinary Powerhouse
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I need to just stop using my brain. I drop the slightest hint of clinical judgment and everyone loses their mind.
the 100% directionless thread
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Epi-do
I see dead people
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Why on earth would you even think that is a good idea, let alone, do it!?!?!?!?
People are into :censored::censored::censored::censored: like that... Ew.
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I think the mental health issues are endless... She could have been the victim of abuse or assault, and thought it would make her less desirable to disfigure herself.. Perhaps she was trying to do the opposite and make herself more attractive..
Physically, sometimes labias are larger than normal and can rub on clothing and become painful and irritated..
Either way, anyone with a razor blade in the dead of night who would perform self genital mutilation makes me uneasy..
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I always forget how much I enjoy teaching lab days, especially for the paramedic program when I get to do cardiology scenarios with the METI men, until I go back and do it. I still don't know if I'd be happy in education full time though, maybe sometime down the road once I get tired of sitting on street corners and if TEMS and HEMS don't work out.
Did a WPW scenario and everyone whiffed the interpretation and gave adenosine when he went into PSVT but I think that's partially my fault by the 12-lead I picked, wasn't super obvious.
Did a WPW scenario and everyone whiffed the interpretation and gave adenosine when he went into PSVT but I think that's partially my fault by the 12-lead I picked, wasn't super obvious.
This screams mental health.
How does it make you uneasy though?
What does time of night have to do with it?
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For rapid WPW, I've been taught that if you miss the delta wave or shortened PRI due to how tachy the patient is and call it SVT, treating it with adenosine really isn't a big deal. Ideally it would slow the rhythm down temporarily for better visualization and "Wow, that looks kinda funny. Wait..." At this point, you could grab the procainamide or consult for amiodarone. Obviously the big thing to avoid would be diltiazem or verapamil, but I don't believe adenosine should have any deleterious effects.
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Agreed.
The catch was he wasn't super tacky during the 12-lead. It wasn't blatant WPW but it wasn't impossible to see either. The way we designed the scenario was that after they captured the 12-lead the patient went into SVT so, theoretically, they should have picked up on it and considered amio or procainamide.
I was taught adenosine can be fatal in WPW but I've never understood how. Tachyarrythmias are common in patients with WPW and if they're going so fast you can't see the shortened PRI and delta waves there isn't much else you can do unless the patient tells you they have WPW....
Seems like "if you do this they'll die!" Is very prominent in EMS education.
HotelCo
Forum Deputy Chief
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Aidey
Community Leader Emeritus
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Adenosine is absolutely NOT safe and can kill pts with WPW. In a significant subset of patients using an AV node blocker will result in increased conduction from the atria through the accessory pathway, sending the pt into v-fib. Unless the patient has been safely converted with adenosine in the past you should not use it if you suspect WPW. Amiodarone is also associated with poor outcomes, even if the AHA says it is an option.
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See, this really doesn't seem definitive from what I've read. If I know the patient has WPW or I see it, then I can certainly avoid adenosine. It seems to be more strongly contraindicated in A-Fib or flutter with WPW, but even that isn't a consensus. At that point, treating the heart rhythm with chemistry is really dicey and varies doctor to doctor, even in the hospital. For example, my medical director is perfectly comfortable with us administering adenosine and if we see it is WPW that recurs, consulting for amiodarone or cardioversion. If you have a patient taching along at 180, it's narrow complex, and the BP isn't adversely affected to the point you need to cardiovert, adenosine is the way to go 99/100 times. I do realize procainamide is the best drug for this, but not carrying it, my options are cardioversion or amio.
Aidey
Community Leader Emeritus
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What doesn't seem definitive? It is pretty well documented that some WPW patients will go into v-fib when given adenosine.
VFlutter
Flight Nurse
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More so Calcium Chanel Blockers than Adenosine but it can and has happened before.
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That was my understanding. That while possible, it's more of a rare occurrence- while it would be much more prevalent with CCBs.
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The majority of strips I've seen with rapid WPW weren't able to be diagnosed as WPW when they were that tachycardic. Like I said, if they have a previous diagnosis they tell you about that's awesome. I'm honestly just trying to learn more here. Realistically, I was taught that a small minority of patients that are given adenosine may have an adverse outcome anyway and go into V-Fib or asystole.
Brings to mind the quote that something that bleeds for 5 days straight and doesn't die is inherently evil....
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I'm not gonna lie, I'm 35yo and still afraid of the dark. This sounds as stupid as a box of hair, and I'm being serious, but wild turkeys nest high in trees up here at night and I'm afraid one will drop on me. I hate wild turkeys.
VFlutter
Flight Nurse
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I had a fun couples days off work and finally had time to head out to the country.
While driving through a field of 3 foot grass we suddenly slammed to a stop. I was sure I broke something. Hidden in the grass was a 4 foot deep ditch. The picture does not do it justice. My rear left tire is tucked into the wheel well with only a sliver of the tire touching ground and the rear right is totally in the air. The back bumper was holding the Jeep up. Somehow a 4-Low and a little gas pulled us right out. The Jeep is completely fine. I am amazed and surprised how well it did bone stock.
I also finally bought a gun. I saw this at a gun store for really cheap and had to get it. I know it is not the most practical but there is something so sexy about revolvers. Plus it is crazy light and fits in your pocket perfectly.
While driving through a field of 3 foot grass we suddenly slammed to a stop. I was sure I broke something. Hidden in the grass was a 4 foot deep ditch. The picture does not do it justice. My rear left tire is tucked into the wheel well with only a sliver of the tire touching ground and the rear right is totally in the air. The back bumper was holding the Jeep up. Somehow a 4-Low and a little gas pulled us right out. The Jeep is completely fine. I am amazed and surprised how well it did bone stock.
I also finally bought a gun. I saw this at a gun store for really cheap and had to get it. I know it is not the most practical but there is something so sexy about revolvers. Plus it is crazy light and fits in your pocket perfectly.
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Almost got put on this call. So glad I didn't.
http://www.mydesert.com/article/20130515/NEWS0804/305150008/Woman-killed-children-injured-DHS-crash
http://www.mydesert.com/article/20130515/NEWS0804/305150008/Woman-killed-children-injured-DHS-crash
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RocketMedic
Californian, Lost in Texas
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I had a fun couples days off work and finally had time to head out to the country.
While driving through a field of 3 foot grass we suddenly slammed to a stop. I was sure I broke something. Hidden in the grass was a 4 foot deep ditch. The picture does not do it justice. My rear left tire is tucked into the wheel well with only a sliver of the tire touching ground and the rear right is totally in the air. The back bumper was holding the Jeep up. Somehow a 4-Low and a little gas pulled us right out. The Jeep is completely fine. I am amazed and surprised how well it did bone stock.
I also finally bought a gun. I saw this at a gun store for really cheap and had to get it. I know it is not the most practical but there is something so sexy about revolvers. Plus it is crazy light and fits in your pocket perfectly.
Great choice, Chase. Revolvers are nearly ideal for most realistic personal-defense scenarios, they are simple to operate, hard to jam, can be fired in contact with a threat through clothing, and are pretty instinctive to operate- it's literally "pull the trigger". Ammo-wise, they're pretty affordable in 38 Special, with an extremely diverse variety of loads and near-guaranteed feeding (no worried about hollowpoints jamming). On range days, I find that my 6 rounds makes me shoot more carefully and accurately than 15-round M9s.
That's not to say that semiautomatics aren't great pistols and a lot of fun, but for CCW, I prefer a small J-frame revolver. For a service pistol, that metric is reversed, but it's not your job to get in gunfights.
The only real failure of revolvers is when they are hit hard or if they're extremely dirty (ie mud). That can cause problems, but it's vanishingly rare in anything you'd be involved in.