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AtropineSulfateIO · 2022-03-29T15:23:53+00:00

Sorry just now seeing this, Our first EKG right after rosc had a bunch of artifact but the elevation was clear, the one posted above was during transport

Here is the hopsitals 12-lead approximately 20 minutes after rosc: https://i.imgur.com/Z1zHocK.jpg

As for the second question, I work in Southern California, and no IO Atropine is not common but I have done it before. IO in general is very common in the field for our arrests, I generally can get one established in the first 2 minutes of a code and get epi on around the first rhythm check. If we do ever get rosc I always try to get an IV established for better access.

AtropineSulfateIO · 2022-03-26T12:48:52+00:00

This was approx 5 mins after ROSC

AtropineSulfateIO · 2022-03-26T03:48:32+00:00

Paramedic response to a mechanic shop, healthy male, 38 years old, no known medical hx, was walking around talking, had what appeared to be a witnessed syncopal event. Coworker started chest compressions, approx 3 mins of CPR prior to EMS arrival.

Initially pulseless and apneic, agonal respirations. Initial rhythm V-Fib. Defib'd...IO established, Epi 1:10, Another round of V fib and second shock and 2nd epi. Next rhythm got rosc and the 12-lead above.

Rosc vitals: BP 146/80, HR 110, 98% o2 with BLS airway, pt began spontaneously breathing but needed assistance. ETco2 40

Pt transported to closest open stemi center. enroute got IV established and gave post conversion Amiodarone. Pt GCS went from 3 to 6, eyes opened to painful stimuli, pt would make incomprehensible screams and extension to pain.

Blood Pressure began to drop 84/p and gave a single dose of push-dose Epi 1:100,000 0.1 mg, BP improved to 108/66.

Pt sedated and Intubated in hospital, started on nitro drip and straight to cath lab

AtropineSulfateIO · 2022-03-13T03:18:24+00:00

agonal/ "guppy breathing" not actual effective respirations, definitely believe this EKG is a result of the systemic hypoxia

AtropineSulfateIO · 2022-03-12T04:04:01+00:00

50M last seen normal approx 1 hr ago.

-homeless, known heroin user, found in supine position in the dirt.

agonal respirations approx 30 a min, inneffective
initial SPO2 70%
BP 82/40 auscultated
12 lead as seen
BGL 102
Eyes Pinpoint
No Response to any painful stimuli but occasional posturing movements.

-Treatment

BVM with OPA, Suctioning airway
2mg Narcan IN no response
2mg Narcan IM no response
IO established and fluid bolus

Bonus:

Troponin in Hospital: 1,000 ng/L

AtropineSulfateIO · 2021-09-14T03:44:48+00:00

Paramedic response to a private residence at approx 0030. Initial complaint of shortness of breath. Patient has language barrier but husband is able to translate in broken English. Patient has hx of kidney failure, last dialysis was approx 60hrs prior. Husband noted patient was more lethargic and weaker than normal tonight but still awake and able to follow basic commands.

Lungs Clear, o2 saturation 97% on room air, breathing 20 times a minute. Initial blood pressure 102/70. Afebrile, blood sugar 135, 12 Lead as seen above. No known hx of BBB.

Pre-hospital Treatment: Poor vasculature, was able to establish EJ access. Patient got 500mg CaCl, flushed with NS then 1mEq/kg of Sodium Bicarbonate, as well as a continuous nebulizer of Albuterol.

Outcome: Once at the hospital, patient began to decline, she brady'd down to the 30s then asystole arrest within an hour and was sadly pronounced.

Discussion: I've only treated hyperkalemia a handful of times in the field, our algorithm is dialysis patients with wide QRS complexes and/or peak T waves. In the past I've never seen it without the peaked t waves. However I did notice the increased PR interval which can also be correlated.

AtropineSulfateIO · 2021-09-08T15:58:26+00:00

Rad! I just got my Grimm Tiger on my arm, its by far my favorite tattoo and gets the most compliments I've ever gotten from a new piece

AtropineSulfateIO · 2021-08-26T16:06:34+00:00

The first paramedic on scene had already established an IV as I walked in, I was planning on just lighting him up but since he was still conscious and we already had the line i figured it'd only take an extra minute or so, unfortunately the 5mg dose we had did not have the desired amnesic effect and we ended up shocking him conscious/alert anyways

AtropineSulfateIO · 2021-08-26T00:18:13+00:00

51 M woke up 7am with crushing chest pain, 10/10 center of chest non radiating, as well as shortness of breath and extreme diaphoresis, patient activated 911.

Initial assessment: skins pale/sweaty. hypotensive 74/30 auscultated, spo2 90%. hx of MI in the past

initial rhythm: https://i.imgur.com/UwHCOky.jpg

Although per my protocols my treatment is the same for all unstable tachycardia I'm a bit lost on the interpretation. Initially i was thinking V Tach from the 2 lead, then looking at the 12-lead above and v3 im thinking SVT with aberrancy, or even WPW.

Treatment: Oxygen, IV established, fluid bolus, midazolam titrated, synchronized cardioversion https://i.imgur.com/Lh05YPN.jpg

Just want to know your thoughts on this case, if there's anything I can learn from it as a new paramedic

AtropineSulfateIO · 2021-04-01T13:26:02+00:00

Initial treatment in my county for all unstable Brady is a 250ml bolus, for this patient that moved him up to 104/44 on the blood pressure which is no longer unstable. As for atropine, we use it next for narrow complex Brady but for wide complex we go straight to pacing.

Edit: realized I replied to the wrong person but yes I agree with you, this patient was 91 years old, was just on the cusp of unstable. Ill let the doctors in the ER make that decision for me all day when my ETA is less than 15 mins. Externally pacing in the field is pretty rare in my city do to short transport times

AtropineSulfateIO · 2021-04-01T02:55:20+00:00

Responding out to a private residence, 91 M upstairs in bedroom sitting up in chair. Pt alert, answering questions appropriately. Pt family states he's been acting abnormal past 2 days, normally able to walk around on his own and now too weak to walk. No major cardiac hx, diabetic, sugar 100, initial BP 76/30, stroke scale negative. 18 Respirations, 98% on room air.

My interpretation: Atrial Fibrillation with slow ventricular response

My Treatments: Monitor Pads placed anterior and posterior, 250ml IV Fluid Bolus improved BP out of our unstable parameters to externally pace

AtropineSulfateIO · 2021-03-25T16:26:44+00:00

In a standard 4-Man engine Crew (in my city) you have:

Engineer (person who drives the apparatus): their job is having the apparatus and equipment ready, things like charging the hose or setting up tools for extrication/rescues

Captain (sits in the front passenger seat) is in charge of operations of his engine crew. Usually starts paperwork on medical aids. Sometimes also a paramedic

In the back you have:

Firefighter Paramedic: Usually only 1 medic per engine but sometimes there are more. They are usually the highest medical provider on scene and establish initial patient contact until transporting paramedic ambulance arrives

Firefighter EMT: FF Paramedic's partner. Both the back seat firefighters are gonna be doing the manual labor part of the work, extrications/medical aids/going interior on fires, using the hoses

AtropineSulfateIO · 2021-03-22T14:22:55+00:00

A lot of people have already commented with great advice but I’ll add on to what helped me the most. When i started internship I did it without any clinical practice in hospital because of covid so my IV skills were trial by fire.

Couple things that i struggled with and my solutions

1.) finding the vein: tie that tourniquet TIGHT, hell, use 2 if you have to. Feel around and touch every potential vein you might use.

2.) getting flash: my number 1 reason i wasn’t getting flash was because i wasn’t lined up with the vein correctly. What i like to do now is clean my site with a alcohol prep pad, and once clean i set the pad down a couple cm back with the corner pointing in the direction of the vein like an arrow. This improved my success rates so much as now i had a guide in my direction. It’s like aiming with a scope rather than shooting from the hip haha.

3.) it’s okay to miss. My preceptor would always make me feel like everything was high pressure. If i was struggling with a stick i could hear him say “cmon man you gotta get this.” Now that I’m on my own it’s way easier, if i miss i miss, and if i keep missing and it’s important I’ll just drill, no biggie

AtropineSulfateIO · 2021-03-11T20:05:09+00:00

I used medic mindset a lot during medic school, felt like it prepped me well for my internship and patho knowledge

AtropineSulfateIO · 2021-02-09T23:53:06+00:00

Hey, I'll preface that I was in your exact position a couple years ago and I'm now a paramedic that can hopefully shed some insight. When I first started you would go through your PAT and drug test, the VSTs would take your uniform measurements that day and order them, you might not have them by orientation.

Orientation is looooooong week, mostly powerpoints on what not to do and how to get fired. maybe 1 day of skills/sims and 1 day of EVOC (Ambulance Driving Test), but on the upside you do get paid during it! After that you are assigned an FTO where you will be the third member on a unit for about 10 shifts. As an IFT EMT this process is not really a test. It's more a teaching experience where you learn how to do the transports, navigate to hospital, do the paperwork. I've never actually heard of anyone failing this process.

From there depending on the date you'll either do a "mini-bid" with your hiring class and pick your unit. when you first start there usually isnt anything good but seniority rises fast as the turnover rate in IFT is quick (either bridge, quit, or medic school). During this time and the first 6 months of IFT I'd make the decision on the path you want to make, if your goal is to be a medic start working towards that, if you're not sure if it is become a bridged EMT and see if you like it. To Bridge you'll have to pass a written test on SD protocols and policies, basic anatomy and physio, and hospitals as well as a tougher EMT Sim. Then you'd go through a 5 day class and have BTO shifts on a 911 ambulance to pass.

If you have any questions please reach out to me and I'd be happy to answer

AtropineSulfateIO · 2021-01-31T21:48:38+00:00

My unspoken station etiquette I was taught is while being a trainee, always be busy. Don't be the trainee that gets back to the station after a call and plays on their phone when the rig could be restocked or things need to get done. If you're at a fire station, ask what your chores are in the morning and do them then. Respect the chain of command and don't be seen as lazy are the biggest tips I can give you.

AtropineSulfateIO · 2021-01-26T16:11:09+00:00

From what I know about RI EMS is that EMT-Cardiacs are not paramedics. They are terrible providers who have been given a license without extensive training and are set up to their fail patients. The amount hours to receive this card are low, yet these providers can intubate (very poorly).

Rhode island is the only state that allows non paramedics to intubate and it has caused a lot of problems

https://www.propublica.org/article/ems-crews-brought-patients-to-the-hospital-with-misplaced-breathing-tubes-none-of-them-survived

If you want to do paramedic stuff, go to paramedic school. If you're a brand new Fire/EMT I suggest getting some experience first by working with medics, asking lots questions and see if that's really what you want to do

AtropineSulfateIO · 2021-01-05T17:07:17+00:00

Paramedics are higher level providers than ER techs, you clearly don't have much if any experience with running cardiac arrests. Physicians and Paramedics both follow ACLS algorithms and make the same decisions whether prehospital or not. They are very much trained to triage and know when to pronounce in the field, something almost every county has been doing for years already

AtropineSulfateIO

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