the 100% directionless thread

[chaz90]

I have to visit there next time I'm in that area of the country. What's the name of the bar?[/QUOTE]

It's Churchkey. Only 55 of them are on draft/tap with the remainder in bottles, but the on tap selection has been enough to keep me entertained.

 

[JPINFV]

So apparent I scared my third rider. I gave two ways to kill someone with just angios, a syringe, or a suction unit. From the top of my head.

Start IV, hook to suction
Start IV, IVP room air
Needle thoracotomy, inject air
Angio through the cribaform plate, inject air
Ditto fluid
Ditto hook to suction.

 

[Tigger]

Got offered a full time position at my part time, mostly-rural, third service.

GAH so happy!

 

[JPINFV]

I so want to play games in homework threads... namely...

_ _ _ _ _ / _ _ _ _ _ / _ _ _ _ _

 

[NomadicMedic]

Ugh. Somebody give me a BVM.

 

[Jim37F]

Dafuq? A call for "heart problems" just went out, and we were 1, maybe 2 minutes away from the address code 2. Instead dispatch gave the call to a unit 4 minutes away.

When we called in over the radio we were closer they simply told us to go post at where our responding unit was posted at.

We literally drove by the address (unfortunately if we had said f*** it and turned down the street we'd have been self dispatching, a big no-no and I'd probably be looking for a new job). After driving by, we passed the responding FD paramedic truck, our responding BLS ambulance, and the FD engine (don't you just love LA Co fire based EMS?)

Heck, the engine was still pulling out of the station. We could've been first on scene before anyone else got out the door, instead we got to wave at them while they drove by.

I know I have a big white fluffy cloud, but this is slightly ridiculous.

</rant>

 

[lightsandsirens5]

Oh...I've gotten the old "stand down" order myself before and had to sit there like an idiot and watch the other truck go screaming past... Sucks, don't it?

It seems to me to be a universal problem that dispatch gets the field crews in trouble all the time, while they field crews just have to sit there and take it, and there is no recourse for us when dispatch screws up.

 

[NomadicMedic]

Another issue with "private ambulance". If that happened here, I would TELL the dispatcher, "I'm in front of the residence, the other unit can go available and put me on it."

That's the way it SHOULD be done. ^_^

 

[exodus]

Ugh food poising or something...

Ate at 5 guys last night around 6, around 9 started feeling really nauseous and just sick. I figured it was because I was going back to low-carb, and went from like 600 carbs a day down to ~15 yesterday. Got home, layed down, still super nauseous, woke up at 3am projectile vomiting. Now I'm feeling weak / dehydrated, but not nauseous anymore at least. I hate calling out of work too, especially on the last day of our weeks...

 

[JPINFV]

So your 5 Guys went In-N-Out?

 

[NomadicMedic]

Tools of the trade...

 

[Epi-do]

Picked up a patient yesterday for generalized weakness. She had been in the hospital 2 weeks ago for "fluid around her heart and lungs." We were having a really hard time getting a blood pressure on her, but one of the guys finally got 90/palp. For the way she was presenting, it seemed reasonable. We moved her to the truck, and tried to get a better BP. At that point, we couldn't palp a radial pulse, but I still wasn't overly concerned about it because she just didn't seem "that sick."

While my partner was getting a line for me, I continued my assessment. I was never taught heart tones, so I don't typically listen to the heart unless something would indicate to me that I should. Since the family couldn't really tell me what her recent diagnosis was, other than "fluid around her heart and lungs," I opted to listen just in case she truly did have fluid around her heart rather than heart failure or something else entirely. I thought her heart sounded a bit muffled, and was becoming more and more concerned for her.

The entire time we were transporting her, she denied any complaints at all, except for the weakness, passing it off as not having completely recovered yet from her hospital stay.

A couple hours after we dropped her off, while at dinner, the supervisor got a phone call from the ED. Apparently, her O2 sats started dropping suddenly, she became ashen looking, and the only way they could get a blood pressure was with the doppler (and it was only 70 systolic). The family stepped out of the room, asking for the doctor because she began seizing. She had an additional seizure shortly after the first one, and then arrested.

After dinner, I went over to the ED and talked with the doc. Apparently, she had been in the hospital for heart failure, and at that time, the cardiologist told her she had a severely leaking mytral (sp?) valve and it needed to be replaced but she refused to have the surgery. (She was in her 80's.) The theory is that the valve simply failed, causing her to no longer be able to perfuse. That little voice in the back of my head was telling me that there was something very wrong, despite what the patient was telling me, and how she initially presented. I was concerned about her, but I honestly didn't think she was I'm-going-to-die-today sick. Needless to say, I was shocked!

I guess when your number is up, there's not much you can do about it.

 

[VFlutter]

I was never taught heart tones, so I don't typically listen to the heart unless something would indicate to me that I should.

Cardiac Auscultation is poorly taught, if at all. It truly is a shame and a dying art. With the availability of Echos it is just not as crucial of a skill than it once was. Some of our older cardiologist are amazing but it is more of a novelty than clinically relevant.

Since the family couldn't really tell me what her recent diagnosis was, other than "fluid around her heart and lungs," I opted to listen just in case she truly did have fluid around her heart rather than heart failure or something else entirely. I thought her heart sounded a bit muffled, and was becoming more and more concerned for her.

Pleural and Pericardial Effusions. Common complications in CHF and valvular heart disease. Muffled/distant heart tones is usually a sign of a pericardial effusion. Sometimes you will get a friction rub with pericarditis. Did you hear a murmur?

A couple hours after we dropped her off, while at dinner, the supervisor got a phone call from the ED. Apparently, her O2 sats started dropping suddenly, she became ashen looking, and the only way they could get a blood pressure was with the doppler (and it was only 70 systolic). The family stepped out of the room, asking for the doctor because she began seizing. She had an additional seizure shortly after the first one, and then arrested.
After dinner, I went over to the ED and talked with the doc. Apparently, she had been in the hospital for heart failure, and at that time, the cardiologist told her she had a severely leaking mytral (sp?) valve and it needed to be replaced but she refused to have the surgery. (She was in her 80's.) The theory is that the valve simply failed, causing her to no longer be able to perfuse.

Sounds like Flash Pulmonary Edema and Cardiogenic Shock from severe mitral valve regurgitation. It sounds like she had chronic regurg with an acute exacerbation, possibly from a papillary muscle rupture. However I am surprised there would not be an obvious murmur.

 

[Epi-do]

Pleural and Pericardial Effusions. Common complications in CHF and valvular heart disease. Muffled/distant heart tones is usually a sign of a pericardial effusion. Sometimes you will get a friction rub with pericarditis. Did you hear a murmur?



Sounds like Flash Pulmonary Edema and Cardiogenic Shock from severe mitral valve regurgitation. It sounds like she had chronic regurg with an acute exacerbation, possibly from a papillary muscle rupture. However I am surprised there would not be an obvious murmur.

No, I didn't hear a murmur. And, thanks for the educated guess about what happened to her!

 

[mycrofft]

3,249,181 views?!?!

…………...

 

[Aprz]

If I could redo my clinicals, I would by listening to everyone heart tones. I don't feel like I see enough patients in the field to learn heart tones. The Youtube video Dana posted was excellent, but I my heart tone ability right now is it either sounds normal or abnormal unfortunately.

[youtube]V5kSBrSA-sA[/youtube]

I remember the characteristics easily, but I am actually not good at describing them at all. For example, timing, try to listen if it's systolic, diastolic, or both. When he plays examples sound, I can't really hear if it's systolic or diastolic. To me, the first sound S1 (lub) is systolic, typically the shorter one. Most murmurs are systolic per the video. I know this information, but when I try to listen to his audio and real life, I can't really tell. I will think "Oh, it's definitely systolic", and he'll be like "It's diastolic... see? Not that hard."

Since watching that video (I started listening when you first posted about heart tones/murmurs so it has been awhile), I've only heard two heart murmurs (during my specialty rotation / internship / ride alongs - not at work), and like I said, couldn't really describe them except normal or abnormal. One was a 3 month old with a ventricular septal defect. The other was a guy with multiple heart issues including aortic stenosis and mitral valve regurgitation. I haven't had the pleasure of meeting somebody with an left ventricular assisting device, but my ex-partner has seen two of them now and I asked her to listen to it since I hear it makes a whirling sound, which she said it did. I am jealous.

The hostess at Olive Garden is gorgeous.

 

[Aprz]

Cause you guys brought it up again. I am rewatching the video. He actually made a new one so I am actually watching the new one instead. Maybe that will help?

 

[Tigger]

My friend locked his keys in his house and I successfully broke in without damage using only stuff out of the little bag of personal stuff I keep on the ambulance and a floor mat. This makes me happy.

 

[chaz90]

My friend locked his keys in his house and I successfully broke in without damage using only stuff out of the little bag of personal stuff I keep on the ambulance and a floor mat. This makes me happy.

This makes me wonder about the efficacy of his house's lock...






But I'm still certain you're very skilled in legalized breaking and entering!

 

[9D4]

Am I the only one wondering where the floormat came in?