the 100% directionless thread

[CALEMT]

This is the last year i get stuck working every holiday, I havent been home the last 5 Xmas', New Years or Thanksgivings. 2 years ago was supposed to be, then got promoted to engineer on a different shift, which happened to work every holiday. Oh well. Planning the prime rib dinner is fun at least.

I'm supposed to go off Christmas morning... we'll see how well that works out for me...

 

[Jim37F]

We worked Thanksgiving, but Christmas actually managed to fall on our 4 day this year. I took the following cycle off for vacation (which included New Years Day), and will actually be able to see my family for Christmas (and the first time since last year)

 

[Jim37F]

Finished my last shift with my current crew before officially transferring to a new station next shift.

EMS gods saw fit to give us for our final call together a working CPR case... at 4am (at the prison no less...)

Woulda preferred a Structure Fire, though we had the 3rd Alarm warehouse fire a couple shifts ago, then a (ridiculously small enough to kinda be funny) rubbish fire second to last shift so that was better than nothing I guess lol

Wonder how its gonna go tomorrow..

 

[ffemt8978]

It amazes me that spammers always post similarly formatted messages in the same 3-4 thread topics. Makes it much easier to find them and introduce them to the Ban Hammer

 

[fm_emt]

Luckily ASHI is acceptable in PA. The process of becoming a training center is very easy.

Why do I like it? The content is better. The instructor rules are less restrictive. The cost of content and cards is cheaper. It’s much easier to become a training center. The online management software is much better. They’re not money grabbers. The instructor content, including slide decks and video, is available on the website. The process is all electronic... I mean it’s night and day.

I'm in California, which seems hell bent on making literally everything you do harder. lol. I will look more into it. Some free time coming up here now that the semester is over.

 

[fm_emt]

I need a new avatar because I haven't been to a Dunkin in fookin' AGES now. We get stuff from Peet's and brew it all at home.

 

[DragonClaw]

Did anyone else have to reconfirm their email? I couldn't reply or send messages or do anything and the first confirmation email wouldn't even go out.

 

[DragonClaw]

I thought I got blocked for a second?

 

[Tigger]

Dear ED doc, I know I learned my cardiology at a community college. But uh, if this is not a STEMI, then what might it be?

We were able to get her pressure out of the 60s with some fluid but I was fully prepared to pace her and had mixed an epi drip she looked so bad. P waves totally gone on arrival. But the doc is telling me this is global elevation and pericarditis? Fortunately cardiology finally came down and whisked her away. I am not nearly as smart as the doc, I know that. But oh my.

We promptly brought in a second STEMI in that was much, much more subtle and the same doc had the cath team in the ED ready to take the patient up immediately and my what a day it has been.

 

[VentMonkey]

Dear ED doc, I know I learned my cardiology at a community college. But uh, if this is not a STEMI, then what might it be?
View attachment 5170

We were able to get her pressure out of the 60s with some fluid but I was fully prepared to pace her and had mixed an epi drip she looked so bad. P waves totally gone on arrival. But the doc is telling me this is global elevation and pericarditis? Fortunately cardiology finally came down and whisked her away. I am not nearly as smart as the doc, I know that. But oh my.

We promptly brought in a second STEMI in that was much, much more subtle and the same doc had the cath team in the ED ready to take the patient up immediately and my what a day it has been.

Live and learn? Looks like some impressive lateral wall reciprocal changes. Call me just a dumb paramedic, but looks like an RVMI with (possibly) some cardiogenic shock in said patient’s future...

 

[Tigger]

Live and learn? Looks like some impressive lateral wall reciprocal changes. Call me just a dumb paramedic, but looks like an RVMI with (possibly) some cardiogenic shock in said patient’s future...

Positive V4R too. They stopped our fluids because well I assume they were sleepy and the patient's pressure crapped out so some dopamine (?) was started. Really I should have started a pressor but without a pump it's kind of mister toad's wild ride with an epi infusion. I suppose pacing would be indicated but my experience has been that pacing very awake patients can be...trying.

 

[Aprz]

Nice 12-lead.

 

[CALEMT]

Dear ED doc, I know I learned my cardiology at a community college. But uh, if this is not a STEMI, then what might it be?

I mean, clearly you just read the monitors interpretation without actually looking at the 12 lead.

 

[E tank]

Positive V4R too. They stopped our fluids because well I assume they were sleepy and the patient's pressure crapped out so some dopamine (?) was started. Really I should have started a pressor but without a pump it's kind of mister toad's wild ride with an epi infusion. I suppose pacing would be indicated but my experience has been that pacing very awake patients can be...trying.

Not knowing a lot of pre-hospital protocol these days, is external pacing your only option to raise the HR, ie atropine/glycopyyrelate?

 

[NomadicMedic]

Is glycopyyrelate a common EMS drug?

 

[Tigger]

Not knowing a lot of pre-hospital protocol these days, is external pacing your only option to raise the HR, ie atropine/glycopyyrelate?

The cardiology group at one of the hospitals doesn't want us giving atropine for anything outside of overdoses anymore (?). So either pace or epi via either push dose or a drip.

 

[E tank]

Is glycopyyrelate a common EMS drug?

I wouldn't know...is it?

 

[DragonClaw]

The cardiology group at one of the hospitals doesn't want us giving atropine for anything outside of overdoses anymore (?). So either pace or epi via either push dose or a drip.

Have you ever needed it for organophosphates?

 

[DragonClaw]

One of my regular partners is a non driver. We're doble basic. The few hundred miles we go a shift plus him napping up front while I have to concentrate to stay awake and him admitting to napping in the pt compartment with a prisoner pt and guard.... yeah. Thanks buddy.

 

[Tigger]

Have you ever needed it for organophosphates?

Nope nor do I know anyone who has. Malathion is pretty rare these days is my understanding and we do not carry enough to make a difference anyway.

Can't say I am familiar with any EMS service using glycopyyrelate either.

I appreciate attempts to streamline our guidelines but I've mentioned here before, taking atropine out was kind of silly. Not saying it was what the above patient needed, but it works great for patients in a sinus brady that just feel kind of crappy. Pacing those patients or giving them epi will just make them feel even worse, and I am not about that just to treat "medium" symptoms. I also think our medical direction forgets how difficult pacing can be for...everyone.

Transcutaneous Pacing (TCP): The Problem of False Capture

Transcutaneous pacing (TCP) is perhaps the most underutilized and misunderstood intervention in all of ACLS. Why? Simple. Because it's impossible to simulate du

ems12lead.com

Watch for a jump in capno...would be great if the sensors were more accurate on non-intubated patients and not so susceptible to patient anatomy.
Correlate SpO2 pleth to EKG...would be great if sick patients didn't always just show a crappy pleth anyway.
Feel for mechanical capture...lulz as you contract the patients's musculature at the same rate that the pulse should be, while bouncing in a poorly sprung ambulance.

Obviously I pace patients when indicated, but it's not as easy as being told "well just pace 'em."