Where are my Kern county Medics at? (quick question)

mrhunt

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Hey, So quick question... Why does Kern county EMS protocols still state KMC isnt a Stemi or even a cardiac facility when the KMC Website ITSELF states that it IS?:


And capable of cardiac cath's Emergent?
I know these protocols are at least a year old but just curious if im missing something here?

Had a Trauma activation that turned into a Possible inferior Stemi Halfway there. I advised KMC and asked if they wanted to re-route to a different facility but they said just continue.... The stemi itself was a bit questionable even to the trauma team and not sure of exact outcome. There were trauma mechanisms covering up and multiple layers to call so chest pain could have been from trauma OR medical who knows.....Multiple 12 leads seemed obvious however with concurrent leads and recriprocal depressions...

but im getting off track here.
 

NPO

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See the link below for requirements for STEMI Receiving Centers in California.


Keep in mind that trauma will always supersede any other time critical diagnosis (sepsis, STEMI, stroke, etc).

If you were noticing ECG changes during transport, it could be evidence of a cardiac confusion or a Type 2 MI, depending on the mechanism and severity of the particular trauma.

On a side note, it pleases me that people still call it KMC, not KM.
 
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mrhunt

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It also occured to me that KMC may be Stemi capable but not an official stemi receiving center due to One of the dozens of technical rules set forth by the county such as not meeting a specific timeline enough of the time or not having cardiology on staff 24/7 or so on so forth....
 
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mrhunt

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and yeah, There was significant traumatic mechanism which is why i never doubted Continuing to KMC but thank you for your confirmation on that as i always like to review sorta serious calls and make sure i did the right thing :)
 
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mrhunt

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Pos loc. I dunno if it was having a stemi, had loc and crashed car and then had blunt chest trauma....

Or if pt crashed car, passed out and had blunt chest trauma bad enough to cause type 2 stemi.

40mph Head on into a tree, Found slumped over wheel. seatbelt worn, Airbag deployed. Moderate chest trauma with Some deformity and pain / bruising to sternum, abdomen distended and rigid. extremely minimal dried blood noted to nose mouth with No injuries or lac's in area (no csf though) Pt had some repeatitive questioning but by the end i realized he was just being a Grumpy old man / ******* and Actually knew he kept asking for the same thing and just didnt like being told "no". So i think his chances of head injury were slim to none.

BP was good, actually a bit hypertensive. SP02 initially 70's room air with possibly diminished lung sounds and no medical history. Improvement to 92 to 95% on NRB @ 15lpm. Stemi actually developed enroute to facility and wasnt obvious or noted in 12 lead initially on scene.

Trauma and medial etiologies covering each other up.
 
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billydunwood

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Every Trauma 1 or Trauma 2 center I have seen/researched/been to was also a stroke and stemi center. Weird that they have trauma and not stemi but I guess the guidelines are different. They might be like a lot of Kaiser facilities and have PPCI capabilities during business hours
 

DesertMedic66

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Every Trauma 1 or Trauma 2 center I have seen/researched/been to was also a stroke and stemi center. Weird that they have trauma and not stemi but I guess the guidelines are different. They might be like a lot of Kaiser facilities and have PPCI capabilities during business hours
There are several of these type facilities in SoCal.
 

Aprz

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May have been a cardiac contusion. I've never seen one or been shown an ECG of one. Just something ITLS mentions and I kept in mind. It can present with STE elevation in inferior leads and right bundle branch morphology... something I've only read in the ITLS book and no ECG book.

EdIt: I pulled out the book. I must've remembered wrong or learned the right bundle thing somewhere else? I remember trying to figure out cardiac contusions awhile ago, haha.

The ITLS 7th edition book says

If the patient complains of chest pain, is found to have an otherwose unexplained irregular pulse, exhibits neck vein elevation, especially in the presence of blunt force trauma (braised or flail sternum), cardiac contusion should be suspected. Those signs are similar to pericardial tamponade and cannot be differentiated in the field so are treated the same. If available, a 12-lead ECG should be performed, which may indicate an injury pattern to the right ventricle (STEMI in lead II, III, aVF, aVR, V1, and V4R).
It is on page 122-123.

I swear I read right bundle somewhere. Seems online states a bunch of non specific ECG changes so maybe "Abnormal ECG in blunt force trauma to the chest may be due to cardiac contusion" is probably the most broad and accurate, lol. It doesn't seem any ECG change is specific to cardiac contusion.

Here is one link I Googled that talks about right bundle in cardiac contusion. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280947/
 
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mrhunt

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I was also strongly thinking direct chest trauma from mechanism and no known cardiac history but his ekg just looked really really bad.

That's why I wasn't worried too much about still processing to a trauma center. They were hesitant about treatment in Cath Lab too. Not sure if they did.
 

VentMonkey

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Had a chicken or the egg about a year or so ago. Polytrauma with a positive STEMI 12-lead.

As others have mentioned, the traumatic event superseded the cardiac event not knowing what led to what. Same as how our burn/ trauma protocol re: trauma with burns is laid out.

Trauma trumps all until they’re stable enough for a stat transfer (done that a time or ten).

When I asked the attending about it, his expression summed it up. And yes, last I heard they have cardiac capabilities but staffing was still their issue. I’ll ask next go around.

Heck, some people (including myself) forget their a stroke center as well.
 
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mrhunt

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Right on, thanks vent monkey. Yeah always good for a refresher on cardiac contusion.

I'm thinking that's DEFINITELY what was going on as well as a possibility (strong one) of hemo/pneumothorax as well.

Strong enough to break his sternum, strong enough to **** up app the goodies behind it too. Loll
 

VentMonkey

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From an ED attending~ no interventional capabilities (i.e., PCI capabilities), but they do have diagnostic capabilities. They’re said to be working on achieving the former.
 
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mrhunt

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Huh. Sooo you still think it was appropriate bringing to kmc given the trauma etiology though??
 

jgmedic

Fire Truck Driver
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Dont mean to hijack your thread but since all you KCo peeps are in here. Did KCoFD make more ALS engines or is it still just PMC and Stallion Springs? They are hiring lateral FFPM's and Im curious why if they still only have 2 ALS engines. I applied as I always liked those guys when i was at Hall. \hijack
 
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mrhunt

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Good question, I don't have an answer unfortunately.

I wonder what their ff medic pay scale is and of it's anything compared to lafd or even my current pay at my job now.
 

jgmedic

Fire Truck Driver
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It's not great, though I make less as an FAE at my current spot and it is far less than LAFD or anywhere in LACo really. The PM gives you a 10% bonus for being in the "paramedic pool" and 15% if functioning as a medic(this is all according the job announcement). Even as far back as 09 when I was at Hall there were talks of them starting in the outlying stations and moving in gradually with medics.
 
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mrhunt

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Doesn't kcfd pay really low to begin with? I remember guys telling me they were at like $15 an hour...

Now with my pay bump I'm twice that. Is it super easy to get hired on with kcfd or something for the experience? Or whAt makes it N attractive Option?
 

jgmedic

Fire Truck Driver
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For a FD in CA, the pay is pretty low. But retirement and benefits are good. It's more than i make now as an Engineer/Medic, and their schedule is pretty kick ***. I also work for the lowest paid dept in my county, hourly, I made more at AMR, but my benefits are 500/mo cheaper here and i have CalPERS, so I take home significantly more. I guess I was thinking it'd be cool to work for a larger agency that isn't in LA. I really liked working in Kern, but like hell I'll ever go back to private ambo.
 

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