Ask A Medic

You have a hypoglycemic pt presenting with stroke like symptoms do you push D50 or no?

 

Our protocols say to treat a suspected cva pt for hypoglycemia if their bgl is below 50mg/dl

 

Always. The blood sugar could be a factor

Same here

 

Treat the hypoglycemia first. Some differential diagnosis skills should tell you pretty quickly what you have.

 

Reason I ask is that the drug profiles I was given while in school said that a stroke was a contraindication, and while looking at different protocols it said bgl under 80(U.S.) and under 4(Canada) to give d50. Just goes to show that you don't learn everything in school I suppose.

 

I've always believed that you learn a base in school and learn more while on the job. I wouldn't give the D50 orally but can hurt to give it IV

 

I believe that also, but sometimes I need that little reminder

 

exactly.

If you have a pt on scene w/ no Hx of DM, and now they are all zonked out, sudden onset, facial droop, weakness, hemiplegia....I would lean toward stroke and probably not give D50...unless it was very low.

Even in an ischemic stroke D50 can worsen the cerebral infart by drawing oxygen from the non-infarcted tissues to try and metabolize the sudden influx of sugar.

 

I agree with this. I think it would depend on the overall situation. And if you have any questions I would make a call to the on call docs and put it in their hands

 

http://mobile.nytimes.com/2013/12/08/us/in-mass-attacks-new-advice-lets-medics-rush-in.html

What are your guy's thoughts on this?

 

I will never do that unless I am properly trained and a part of a tactical team where I am the medic surrounded by trained SWAT. Until then the fire department can take all the credit for being hero's and bring the pt out to me in a safe place.

 

This is the future of EMS operations in the 'tactical' environment and I feel very comfortable going into the 'warm' zone in this type of situation. Our current approach to mass shootings costs lives.

I would actually argue that you are safer in this scenario than other day to day calls. Here, you are being escorted by police officers whose primary duty is providing protection to you while you triage victims. On your typical day to day call these officers are not going to be as alert and prepared even if they are present. Any scene has the potential to turn violent...

I attended the EMS World Expo in Las Vegas, NV this year and watched a demonstration by Las Vegas Fire Department. They aren't even using ballistic protection (vests) and I think their approach makes sense.

 

Nope I am not trained for this and it is not what I signed up for. I do however love the idea of cross training LEOs. When I was at the paramedic academy we had LEOs from all over and get trained medically. Some of them can do more than I can as a Primary Care Paramedic. I know a few officers that were Medics before turning to police for various reasons, why not have them go. I have much more of a possibility of helping someone if I am ALIVE.

 

anyone elses states/counties pulling things off the truck or delaying usage even though they work?? The reason i ask is over the past couple years they have pulled things in our county that the state allows... For instance we can not RSI in my county but the next one over can. Some of our transport times are to long to not have this (some being 30 min to the closest hospital.) Also we have now put the IO gun as a last resort, and we just received King Vision on the trucks. Also told not to use the kings unless there is no other option...

 

The RSI thing is probably based on the statistics of usage/attempts/failures/efficacy. If RSI is only used 10 times a year out-of-hospital, and only one of those patients ever left the hospital, then it doesn't neccessarily make sense to keep it within the protocols (from the perspective of the county/company - I personally think it's important in areas with long transports).

The king tube is considered a BLS airway if the EMT is trained and allowed by their county - intubation is the only definitive ALS airway. King tube is still an amazing tool and undeniably better than any other BLS airway or combitube.

IO is always a last resort. I'm not going to drill anyone who doesn't need a line RIGHT fucking now and there's no option., I've also seen people start IV's in less time than it takes to set up/start an IO, but they have their place.

 

Text book "shark fins" on ETCO2 wave form on a pt w/ bronchospasm secondary to COPD exacerbation.

 

Nice. What monitor is that on? I like the time stamps

 

Its from a zoll m series. But what I took a picture of was the zoll pcr code review program.

 

Do y'all keep jump bags in your pov? If so what do you keep

I just ordered a basic bag, oral airways, king airways, adult and infant bvm

 

Nope. If I'm not at work I'm not carry equipment......liability