Ask A Medic

Krazie Sj · Oct 19, 2011

Oat said: ↑

Alright, i got a round for some emt's and medic's.

1) What do you do typically at a heart attack call, and what is the most advance thing a paramedic can do on it?

2) Can Paramedics/EMT stitch people up (did i spell that right)?

3) What do you guys typically do when someone complains they cant breathe/chest pains?

4) What is the most advance and the most typical thing you guys do to control bleeding?

5) When you're not on a call what do you do...(i know this sounds like a stupid question)?
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O2, Nitro, ASA, 12 lead, paddles, IV Large bore, Diesel Bolus. Most advanced thing? Probably thrombilyze someone.

Not here, but Army Medics can.

If they're complaining of it, it can't be that bad. Tell them to calm their breathing and get in the back of the ambulance. If it's legit, O2, listen to breathing sounds, try to figure out if it musculoskeletal, pathogenic or another fucking panic attack at 3am.

Bandages, lots of them.

You mean when I'm working but not on a call? Surfing TW of course. Duh. Or getting coffee...again.

SACTOWN · Oct 19, 2011

NewMexiTaco said: ↑

Huh. thats a new one to me. will have to remember that...Vacuum splint is almost always my first choice for hip Fx since (other then MVCs or Skier vs tree type trauma), Hip Fx seem, in my experience, to be 99% geriatric pts, who benefit greatly from not being stuck on a rigid backboard. that being said a vacuum splint should be packaged to a LSB to actually be rigid. Ive seen some providers skip that step, and its not great. it could fold in half if the vacuum seal is lost.

Another old school trick is to wrap a sheet around the abdomen-to-thighs area and twist it tight to kind of snug and secure the area. we did that at the service that was too cheap to supply vacuum splints. ("they cost WAY too much, and we seem to lose one every time it goes to the hospital" Anyone ever heard that excuse ? )
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We don't have vacuum splints here in my area, why....... you said it $$$$$$$$$.
I have seen the sheet method too..

NewMexiTaco · Oct 20, 2011

Disclaimer..... this is all partial treatment descriptions.... dont nobody bust out the jumper cables after reading this!!!!!

Oat said: ↑

Alright, i got a round for some emt's and medic's.

1) What do you do typically at a heart attack call, and what is the most advance thing a paramedic can do on it?
There is a whole lot that goes into these questions.Like semesters of schooling.... they are good questions, just not simple answers. Here is a little bit of what goes into Cardiac treatment....

Acronyms:
for any generic call (one to remember to get you through a scenario):
V.O.M.I.T.
Vitals, O2,Monitor, IV, Transport. not necessarily in that order.

for a Chest pain call:
M.O.N.A.
Morphine, O2 (oxygen), NTG (Nitroglycerin) ASA (aspirin). not necessarily in that order.

For Cardiogenic shock/Pulmonary Edema call:
O.N.M.Fo. (ohnomofo)
O2,NTG,MSo4 (morphine), Furosemide (lasix).
And CPAP:
(Continuous Positive Airway Pressure).
not necessarily in that order.

for cardiac chest pain, suspected AMI *(acute myocardial infarction or heart attack) the Patient usually needs at least one or more of:
*Oxygen, (that is what the heart tissue is starving for, from a clogged coronary artery)

*an IVx 2 for fluids,meds;
*medication for relieving chest pain (Morphine or Fentanyl);

*Aspirin onboard asap(if no allergies, or GI bleed History) to prevent further clotting of the blockage;

*Nitroglycerin to reduce High blood pressure and relieve chest pain by Direct vasodilation.

continuous 12 lead ECG monitoring.

(there is always exceptions to every treatment, and each call,each patient is different, so no one treatment plan works for everyone.(For instance NTG and morphine can kill a pt. with a right sided MI, but are crucial for a Left sided MI with high blood pressure.)
there is also a consequence for every action. No treatment is completely benign.

The most invasive procedures paramedics do for cardiac interventions involve electricity (ride the lightning ) and medications. Syncronized cardioversion(zap a fast heart rate in time with a heart beat to slow it down); Transcutaneous pacing (electrical stimulation to speed up a slow heart rate)
Defibrillation is not timed with a heart rate, because in order to do it the heart has already stopped.

BASICALLYYY If its too fast, slow it down; If its too slow, speed it up, if it stopped...jumpstart it!

* the medication Adenosine STOPS the heart, and (hopefully) resets it to a normal rhythm from a Tachy (fast) Dys-(bad) Rhythmia. Yikes.

2) Can Paramedics/EMT stitch people up (did i spell that right)?
As a special skill, with certification, or as stated as a military medic, or under wilderness protocols.

The most invasive procedures for trauma are surgical Cricothyrotomy and needle chest decompression. as well as Intraosseous access for fluid resuscitation and medication administration (drilling into the leg bone or sternum to gain IV access.)

3) What do you guys typically do when someone complains they cant breathe/chest pains?
See above. . SOB= shortness of breath with wheezing = 90% of the time is asthma exacerbation.
*Breathing Treatment is Albuterol nebulized with Atrovent (Ipratoprium bromide).
Further ALS treatment includes Albuterol Via BagValve mask (positive pressure medication administration)
* Solumedrol Via IV (steroid to reduce inflammation in the lungs)
* Magnesium Sulphate IV (smooth muscle relaxant)
* Epinenphrine
* Airway Control (intubation)

4) What is the most advance and the most typical thing you guys do to control bleeding?
Same as previously stated; Direct pressure, Elevation, Pressure dressing;Tourniquet; Diesel therapy.
Military treatments are far more advanced and aggressive, with quick clot and advanced tourniquets, synthetic blood. as they should be. It would be great to have some of that technology and treatments for civilians, but it takes a while to make big changes... But at least its there for our Boys out there putting it all on the line for us.

5) When you're not on a call what do you do...(i know this sounds like a stupid question)?
Click to expand...

should definitely be asleep.... thanks TW....
...and I should totally submit this for an hour of CE's...lol.

Heres what I really do: Play firefighter

.... oops got a call.guess i wont be going to sleep...

tanzak88 · Oct 21, 2011

http://www.youtube.com/watch?v=Xf4aTzjcTGE

fuzz master · Oct 21, 2011

http://www.youtube.com/watch?v=s4mslLtmWgQ

SACTOWN · Oct 21, 2011

Great video fuzz!! Haahaa

Alderleet · Dec 7, 2011

So how bad is it, if a patient has to help a EMT put a IV in?

After I wrecked my sport bike, my clavicle and bike were both totalled.

On the ambulance ride to the ER, the emt working on me tried 6 different times to start a IV, and failed miserably. I finally grabbed his hand with my fucking broken arm, and helped guide it.

All of this though, was while the ambulance was cruising at about 30, since i evidently wrecked a little over a mile from a hospital...

In my mind i was thinking "Really mother fucker, they train me to give IV's, seal a sucking chest wound, and Needle-D a chest to re inflate a collapsed lung all while getting shot at on the battle field, yet you cant even start a IV here in the comfort of your Whaaaambulance with almost zero movement..."

That wonderful experience also taught me, Diluadid doesnt fucking work on me.

Oat · Dec 7, 2011

Medic's/EMT's; what do you do with consistant projectile vomiting?

fireturk41 · Dec 7, 2011

http://www.youtube.com/watch?v=D5fX2s_lqS0

Krazie Sj · Dec 7, 2011

Oat said: ↑

Medic's/EMT's; what do you do with consistant projectile vomiting?
Click to expand...

Get them a barf bag of course. And try to figure out why they're barfing. Cause if it's cardiac, bad bad things are happening if they're barfing that bad.

That and try to make sure they empty their stomach in their house before they get into the back of the ambulance...

Alderleet said: ↑

So how bad is it, if a patient has to help a EMT put a IV in?

After I wrecked my sport bike, my clavicle and bike were both totalled.

On the ambulance ride to the ER, the emt working on me tried 6 different times to start a IV, and failed miserably. I finally grabbed his hand with my fucking broken arm, and helped guide it.

All of this though, was while the ambulance was cruising at about 30, since i evidently wrecked a little over a mile from a hospital...

In my mind i was thinking "Really mother fucker, they train me to give IV's, seal a sucking chest wound, and Needle-D a chest to re inflate a collapsed lung all while getting shot at on the battle field, yet you cant even start a IV here in the comfort of your Whaaaambulance with almost zero movement..."

That wonderful experience also taught me, Diluadid doesnt fucking work on me.
Click to expand...

Pretty bad. Must have been a new person. I always try to start my IVs in the ambulance on the way to the hospital. Cause if I can get it then, I can sure as fuck get it when grandpa is sitting in his rocker suffering from mild dehydration but demands to go to the hospital.

montgomery_30824 · Dec 7, 2011

Could have been his first time. Cut them a break.

fuzz master · Dec 8, 2011

everybody has to start somewhere

markmatters · Dec 8, 2011

futuretacoowner said: ↑

is a KED only for automobile extraction or lets say you have someone with a spinal injury in a place where you can't fit a backboard, like in thick woods, would it be good to use in that situation also??
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we've used a ked on an infant...it worked. Not something I would recommend every day...but at the moment...you think of some pretty cool stuff and the ked stabilized the baby really good.

markmatters · Dec 8, 2011

NewMexiTaco said: ↑

thats correct, as long as they are extricated to a spine board, litter, toboggan or vacuum splint asap, because its not a full body splint. KEDs can be used as spinal immobilization for babies. it works really well for that.
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nevermind, *backs off*

futuretacoowner · Dec 8, 2011

markmatters said: ↑

we've used a ked on an infant...it worked. Not something I would recommend every day...but at the moment...you think of some pretty cool stuff and the ked stabilized the baby really good.
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I saw that one of our suppliers sells them, I will talk to some of the other patrollers, see if it would be beneficial. I gotta say taking the ski patrol course was one of the best things I did. it's certainly not like an EMT course, but the course is pretty sweet. I am thinking of possibly getting into paramedicine because of this.

Krazie Sj · Dec 9, 2011

You're out of Nova Scotia right?

futuretacoowner · Dec 9, 2011

Krazie Sj said: ↑

You're out of Nova Scotia right?
Click to expand...

N.B. but might move to Halifax.

Krazie Sj · Dec 9, 2011

That's what I meant. Sorry.

I'm pretty sure it's NS that has a really good EMS system. It's run by private company/companies, but they have comparable protocols with Alberta. Pay just sucks balls, which is why all of them are coming to work oilfield here.

futuretacoowner · Dec 9, 2011

Krazie Sj said: ↑

That's what I meant. Sorry.

I'm pretty sure it's NS that has a really good EMS system. It's run by private company/companies, but they have comparable protocols with Alberta. Pay just sucks balls, which is why all of them are coming to work oilfield here.
Click to expand...

right on. does Alberta have a province run ambulance service, like here in N.B. or is it mostly private?? how does it work out there??

Oat · Dec 9, 2011

What do you guys do when someone has a fever over 103?

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