Search results

Never seen it. However I do remember a nightshift when I was called to a hotel for a lady with severe swelling of the tongue. We couldn't find any other evidence of a systemic anafylactic reaction. The lady had been sleeping for a few hours and woke up with a funny feeling in her mouth. The...

I think it works like this: Serotonin is involved in a number of physiological functions in the body. But first it needs to connect with a serotonin receptor. There are a number of different serotonin receptors, each triggering a different physiological reaction. One of those receptors is...

We were called to a homeless shelter at the end of our evening shift the other day for a 41yo male with seizures. Upon arrival we find the man under his blankets. He is alert, oriented and agitated. His skin is flushed, warm and diaphoretic, he is drooling. He is complaining of palpitations and...

If the problem is not in the liver itself, it is in bile ducts or pancreas (obstruction or inflammation). I have never seen it without other symptoms like fever, pain, nausea, anorexia, etc. but it does happen.

Used to be on that spot too...we would start shift by asking ourselves which of one of the rigs would have the best chance of not breaking down during a call. One of the older ones even caught fire once while loading a patient. After evacuating and calling the FD we called the manager. Instead...

But is this patient really breathing adequately? He is not hypoxic now, but taken the work that he has to do for it, how long is it going to last? I would say that despite the sats this is an unstable patient with inadequate breathing, who is compensating, but will soon face exhaustion.

I meant sedation for the purpose of getting muscle relaxation and ease down the heavy work of breathing, while taking over ventilations. But I guess that would be tricky under these circumstances.

Thank you very much for your input, Nova1300 ! You're saying that the CPAP would increase his ICP? Or is there another reason? One more thing...would sedation with midazolam, eventually with assisted ventilation have been a bad option?

What actions have been taken by your agency, to support the physical wellbeing of your EMS personnel? For example our ambulances are build, with ergonomics in mind: the attendant seat is facing forward instead of facing the stretcher, the monitor and Thoughbook can be reached without getting...

Ever since events started hiring private EMS as a prerequisite to get their permit, we have seen a decline in drug OD's. Cases get solved on the spot by ALS teams who have extra training and lots of experience with party drugs. They are fully equipped to treat the patients for a few hours, up to...

I personally seldom give fentanyl intranasally, as most patients will get an IV anyway, and have the fentanyl in combi with IV paracetamol and sometimes ondansetron as well. However in pediatric patients the intranasal route it is my prefered route, as it is with midazolam for the status...

Our medical directors don't dictate the protocols. They are formulated at a national level, after a broad consensus, in which different specialist groups are involved. Based on research, therapies are adapted where needed. Indeed...choices may differ between the USA and other countries...

It's listed as a contraindication in our protocols. I am not sure why. Maybe someone else can help. Entonox was often used as a first step drug in combination with IV paracetamol, often with unsufficient results. Many of loved it , especially when repositioning luxations. We tend to use...

We might go the same way in the future. Do you give the NTG infusion over a 60cc syringe pump?

We give it as a preload and afterload reducting agent, after NTG. But it also reduces the anxiety and stress associated with the acute respiratory failure. We are taught to first do the oxygen and NTG. Next bring in the IV and supply lasix. If that doesn't give sufficient effect, put on the...

A spontaneous femur fracture. The underlying cause was found to be undetected breastcancer with metastasis in the leg.

That's correct. I work in the Netherlands.

Morphine would be contraindicated in case of COPD, liver failure or in combination with alcohol. We don't use it anymore as a prehospital analgesic drug. The only protocol in which morphine appears is for severe CHF. Ocassionally we would give it via the subcutaneous route to terminally ill...

Indeed. We had the BVM ready, but felt that we wouldn't help him much by assisting ventilations (as in decreassing his work of breathing) and what he needed was paralizing his respiratory muscles and taking over the ventilations. If his sats dropped, I would have bagged him anyway. Please...

Good point. In this case we decided to get moving (level 1 facility at 10 min), instead of waiting for HEMS (20+ min), but if the times were different, we would probably have opted for the RSI. Although when we arrived at the ED the emergency physician did not want to intubate, before having...