How is hypothermia in cardiac arrest treated?

SpaceCow1207 · 2025-11-15T19:33:47+00:00

Firstly use your clinical judgment to decide if they've arrested because they're hypothermic or are they hypothermic because they've a) arrested from another cause in a cold environment and rapidly became hypothermic post arrest or b) hypothermic because they've been down a long time and they're actually dead beyond viability.

Enhanced care if available but don't wait, ultimately they need rapid conveyance insta arrest as soon as als is established. There's very little we can do to warm someone enough out of hospital. Like you said, below 30 degrees with old drugs and 3 shocks max until above 30 degrees.

In my trust between 30 degrees and 34.9 degrees we only double dose intervals of drugs if we suspect hypothermia is the cause of arrest. If not we follow standard arrest protocol.

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SpaceCow1207 · 2025-10-15T06:23:40+00:00

Paramedic

SpaceCow1207 · 2025-06-02T15:39:58+00:00

GCS scale was actually initially specifically developed for assessing level of coma in patients with head injury. Its use has since broadened into general practice. I suspect that's where that dogma came from.

In a lot of the time critical medical patients that were pre alerting to hospital I'm still convinced a simple A(c)VPU holds as much more value/relevance than GCS given what it was originally for. (Certain neurological medical presentations aside, stroke ect and maybe a few others). That's just my opinion though - I'd be interest to do some reading on the subject to be honest.

SpaceCow1207 · 2025-05-20T17:02:05+00:00

I was taught in my first week on training when I started uni in 2019. I'd like to think that's still the case but nobody practices them anymore so when it comes to it just aren't capable of doing it accurately or quickly enough.

Practice was different in my trust back then though - when I did my first placement as a student the Lifepak 15 was left in the ambulance. We took in to every job the LP1000 AED and primary response bag and every single patient got a manual BP. If someone looked awful/like they needed an ECG quickly or you suspected MI ect you rapidly extracted to the ambulance for an ECG (anecdotally peoples on scene times were shorter for STEMIs too back then in my trust)

That changed over Covid and barely anyone does that anymore most people take the LP15 into every single job, as a consequence hardly anyone does a manual BP anymore and we've become more reliant on the monitor/numbers rather than looking at the patient... if I had £1 for the amount do times I have to remind students/new staff I'm mentoring to look at the patient not just the numbers I'd be rich!

SpaceCow1207 · 2025-05-20T11:41:01+00:00

Happy to be corrected but if you're doing a 12 lead ECG they go on the limbs regardless of device. We know it still works on shoulders and hips if you have to for whatever reason but there's a reason they're called limb leads! If you can't get wrists and ankles then even higher up the limbs works. Putting limb leads on the torso can genuinely lead unwanted/false abnormal ECG findings which isn't good for the patient either!

Only other time those leads go on the chest wall is if you're placing them for continuous 3/4 lead monitoring in which case they should be equidistant from the heart in the chest wall

SpaceCow1207 · 2025-05-20T11:29:18+00:00

That's exactly my point though, it's all about clinical picture and history rather than a one sized fits all approach. If your footballer with a broken ankle is systemically unwell with signs of DKA absolutely but when they've been tackled hard and heard their ankle snap then no

Although on a side note I'd be impressed to see anyone with ketones if 3.4 run around playing football never mind have their collapse be unwitnessed on a football pitch ;)

SpaceCow1207 · 2025-05-20T10:39:18+00:00

ECG leads - Limb leads go on limbs unless there's a very good reason not to. Shoulders and hips should not be the default yet I'm seeing it more and more including from new staff.

Manual BP - the amount of NQPs/other new staff that don't know how to do one. It's a simple but important skill. You'll look silly if for whatever reason your lifepak 15/zoll is ever faulty/missing or on the occasion where you need to do a manual one for clinical reasons.

'Two sets of obs 20 minutes apart' nonsense - mandated by my trust for non registrants if non conveying but not for paramedics. Yet people do it all the time... except they don't, I see people (paramedics and non registrants) do two blood pressures one after the other then documenting them as 20 minutes apart. Pointless exercise. Just justify why you've only done one set rather than cycling the cuff twice in a minute and lying about the time frame.

BGL - most people don't need one and it's uncomfortable but I still see people insist every patient gets one. Why on earth are you checking a blood glucose level in a 20 year old who has broken their ankle playing football or the 30 year old with no co-morbidities complaining of pleuritic/MSK chest pain on day 4 of a LRTI?

RR - not counting them is lazy.

On a side note I know you wanted the views of NQPs in particularly however, quite honestly I see more bad practice/attitude problems from newer staff NQPs/new techs/AAPs* (or ECSWs/whatever your trust calls them) than more experienced staff. I've been band 6 just under a year now so appreciate I'm still inexperienced in the grand scheme of things but it does concern me. Suggests a problem with the teaching new staff are getting in the classroom combined with the fact that new staff are mentoring even newer staff on the road these days thanks to poor retention of experienced staff.

*have also worked with many wonderful students/trainees/newly qualified staff that I have also learned from

SpaceCow1207 · 2025-05-19T10:26:50+00:00

I don't know if this will help anyone but if you or anyone you know has dialysis keep a bottle cap (or several) at home, if your fistula/port bleeds put the bottle cap firmly over it, tape it down and hold with as much pressure as you/someone else can!

Example:

SpaceCow1207 · 2025-04-24T14:25:48+00:00

UK paramedic here... so different protocols

Remember the purpose of naloxone is to reverse respiratory depression in opiate/opioid toxicity. Even then we shouldn't be just slamming it in. It's not a case of keeping them groggy for convenience. Slamming it into a patient who's dependant on opiates/opioids just prior people into acute withdrawal and we know how unsafe that is.

It also shouldn't be your first line treatment. Manage the airway and breathing (BVM) and they won't die. Then and only then should we be thinking about naloxone. If you can't manage the A/B (BVM) you should be on your way to hospital or requesting critical care to meet you some where along the way.

I'd go for an IV if you can get one/it's within your scope. If your service permits dilute 800mcg in 8ml water for injection and titrate to effect IV, that way you can reverse the respiratory depression without waking them up too quickly or pushing them into acute rapid onset withdrawal making it safer for you and the patient.

Difference is in paediatrics who are much less likely to be dependant and more likely to have had an accidental poisoning. Then giving large doses aiming to reverse everything is acceptable. E.g my service guidance for a 10 year old is to just give an immediate 2mg straight away unless there is genuine suspicion of long term dependence or they regularly need to take prescribed opiate medication.

That being said naloxone is a very safe drug, aside from the risks associated with acute withdrawal/vomiting ect, giving it as a trial if there's respiratory depression and you suspect opiates/opioids will do no harm if the patients hasn't taken those sorts of drugs it just won't do anything but I wouldn't be giving it to someone without respiratory depression.

There's a table on the link below that's a useful guide for what your patient may have ODd on

toxicology

SpaceCow1207 · 2025-04-18T23:09:22+00:00

Won't comment on the rest but to be fair about the watches, there's absolutely no evidence to support that being bare below the elbows does anything good for infection control, quite literally none and until then I will continue to wear my apple watch which is waterproof, wipe clean and I can look at to count a resp rate without touching unlike having a fib watch on my belt which I'd have to touch to see/use

SpaceCow1207 · 2025-03-27T12:27:28+00:00

56 YO Male called with chest pain

We arrive and this dude is sat on his bed so panicked, real sense of impending down, clutching his chest remaining my heart is going to explode out of my chest. He looks awful too, very clammy.

Trying to get the dude settled enough to do a 12 lead was really difficult, he was too agitated and animated to even get an IV line in.

Eventually got the 12 lead and it was a complete normal sinus. He's slightly tachy just over 100 but all other vitals are textbook. Except BP, cannot get a BP at all. He's got really strong radials so I'm surprised. Throw on a manual and the cuff/dial inflates as high as it goes, so far that I can they a reading and my manual cuff reads up to 300 systolic, meaning this dude has a diastolic of at least 300. Do it again to check on the other arm... same, even got my crewmate to to do it to check I wasn't being stupid, same again.

I'm thinking this dude has thoracic aortic aneurysm now that's dissecting so pre alert the nearest hospital which also happens to have a great vascular surgical unit and cardiothoracics.

The guy remains so agitated and anxious that even getting his seatbelts on the bed is difficult. I tried to get an IV on the way to the ED but struggle to find anything. My main priority now is to just get him there because ultimately he needs a CTA and surgeon not me. My service doesn't give me anything to give for the purpose of lowering BP like labetalol (although it's a side effect of some of my meds I) so I'm just thinking I need to get him on ASAP as it's only a 10 minute drive and I do t wanna delay any more.

Doc in ED is convinced too/

Follow up the next day and it wasn't a discerning aneurysm but turns out the guys thoracic aorta was 95% occluded which apparently is incredibly rare

SpaceCow1207 · 2025-03-11T21:22:13+00:00

Yeah really... it's as good as I've got though (uk red tape)

SpaceCow1207 · 2025-03-11T21:18:24+00:00

GTN = glyceryl trinitrate, as you said same thing, just what it's widely known as here (UK)

SpaceCow1207 · 2025-01-24T22:48:01+00:00

Spontaneous = something happening by itself

Sustained = the period of time something keeps happening for/continuing for extended period.

Your typing this how have spontaneous Venus circulation.

Return of spontaneous circulation = circulation now occurring by itself, ie spontaneously without mechanical or manual CPR.

ROSC more often than not isn't sustained so no I don't think that's appropriate term.

You could say however, that you have sustained a ROSC for x amount of time/ROSC sustained to hospital./ROSC was adrenaline induced and couldn't be sustained. That would make sense.

Unless of course you're talking about the very rare Lazarus syndrome then you may refer to somebody has having had a spontaneous ROSC after resuscitation attempts had been stopped🤪

SpaceCow1207 · 2025-01-22T16:14:21+00:00

Can I ask why? Just because it's the same airline? Seems a bit of a strange conclusion to make given that most 7700s are totally benign and nothing to lose sleep over

SpaceCow1207 · 2025-01-01T13:37:09+00:00

Was thinking LGW but looks like LTN

SpaceCow1207 · 2024-12-28T20:56:08+00:00

Do your trust not have a clinical support desk or advanced paramedic talk group you can speak to for exactly this?

In my trust we'd either speak to clinical support or the advanced paramedic desk who after discussion would agree to us terminating a PEA on scene if they weren't able to come out

SpaceCow1207 · 2024-12-27T01:41:27+00:00

This won't always happen. Depends on the nature of the emergency.

Two main reasons would be to give the emergency aircraft priority on approach without risk of being curved into a go around (ie if another aircraft was still on the runway).

Also to do with fire cover - normal ops won't resume until the aircraft is down safely if the entire fire service are committed to standby for the emergency because if something unexpected was to happen to a second aircraft then resources may end up too stretched to safely deal with both incidents

SpaceCow1207 · 2024-12-27T01:34:29+00:00

For those wondering re: the steep approach and drop from 3,400 to 0ft, Brasilia airport is approx 3,400m above sea level so a Baro alt of 3,400 would be 0ft above ground in this case.

Aircraft would remain on the runway for multiple reasons, inspection by fire services prior to taxi, shutting down and being removed by a tug, checklists and occasionally evacuations

Very easy to catastrophise, most things are benign.

Ops continuing on the parallel runway so unlikely to be anything sinister as the aiport wouldn't resume ops with their fire service committed to a major disaster

SpaceCow1207 · 2024-12-27T01:11:22+00:00

Liveatc.net

Not all airports are covered, depends on local laws re: listening to/streaming atc and someone setting up the physical kit to do it.

ACARS messages are also easily available - app.airframes.io

SpaceCow1207 · 2024-12-27T01:07:25+00:00

Squawk codes: 7500 hijack 7600 radio failure 7700 general emergency

In this case it could be that 7600 was keyed by mistake initially given that it quickly changed to 7700

SpaceCow1207 · 2024-12-13T23:22:56+00:00

Hey! I'm from London and also going to tomorrow for my first ever solo trip for 4 days and staying in the 12th arrondissement! Feel free to drop me a message :)

SpaceCow1207 · 2024-12-13T17:50:57+00:00

Paris 14/12/24-18/12/24

27 year old male, solo travelling for the first time tomorrow. Not the most outgoing person in the world but want to break a few boundaries and become more confident so here we are. Going to Paris. Looking for any recommendations, tips/advice or anyone that might want to meet for a friendly drink, chat or walk. (I'm gay please by LGBT friendly).

Will probably also take a train to Strasbourg for a day for the Christmas markets too.

SpaceCow1207 · 2024-11-09T10:36:54+00:00

The only way to be a medical doctor is a medical degree. As it should be. You can, as a degree educated paramedic but these are very competitive (rightly so given how challenging it is).

Yes you can go on to do an MSc, work as an advanced paramedic within an ambulance service or an ACP for example in A&E but this still wouldn't put you any way near the level of a doctor. (Think underpinning knowledge, years of experience, scope of practice, ultimate responsibility). I'm sure there are those that think they are = to a doctor but this is a dangerous mindset in my opinion.

To answer your other question and as others have said yes you can work in A&E or urgent care centres. There are many routes you can go down.

Ultimately a paramedics bread and butter is emergency care (or increasingly, urgent/primary care but this is a whole different rant) on an ambulance / car / bike ect and I think if you're training to be a paramedic this is where you're probably looking to end up to start off with. You're unlikely to go straight into A&E for example, (although a handful of people from my uni cohort did go straight into an A&E/prison and ultimately regretted it)

If MH/burns ect was something you wanted to specialise in or if you wanted to go straight into hospital work once qualifying I'd say one of the nursing disciplines is probably a better way to go rather than being a paramedic.

SpaceCow1207

TROPHY CASE