you COULD take your time helping him. (within professional responsibility of course) odds are you would outrank him soon enough

Maybe slip an air bubble in the syringe. That could make for quite a painful death!

As for the Surgical Tech one of my roommates was one two year degree but made good dough at Arnold Palmer. I'm thinking about volunteering at the hospital. Actually, I was thinking of asking a good friend who is a chaplin at Florida Hospital South to do a shadow with him for a day. He is the chaplin for the life flight team ATM oh I wouldn't mind doing a day on the chopper! He is sooo happy to be doing it (he loves choppers) think I may stop in at the Army Navy store tomorrow and pick him up a set of chaplins crosses for his new flight suit!

I know helping people is my calling. Nothing in my life fulfilled me more than being an EMT. But, I guess it was not in God's plan so maybe this is.

Have fun in the ED. It is no where near as exciting as TV portrays it. More like Scrubs than ER! If your patient has a head injury have a bed pan in you hand to block the projectile vomit. Don't ask me how I know! Be prepared to be treated like a developmentally disabled child in the ED as well. I believe I told every person that the drunk guy that they had strapped down and forced a foley in till he bled that he had CSF coming out his ear. Had just learned the gauze trick earlier that day. After two hours they took him to CT and found the bleed! Neurologist was screaming at everyone ED doc said no way to know that then I blurted "I told you two hours ago" Neurologist said "how did you know probie?" "Gauze in the ear blood in the center and clear fluid around that" "Jesus Christ a student can now do what a DR. Can't" Let's say I was sent home early!

Mary

It's actually pretty hard to kill someone with an air bubble in a syringe.  If I had to go any certain route I'd probably use succinylcholine. Something about being paralized and awake while you smother. Eww...scares me just thinking about it. Pretty undetectable too.

My advice for the ER.  Give fluids before vasopressors. You can't get the vasculature to constrict on what isn't there. Not everyone needs stress ulcer proph. or DVT proph. If they do need SUP, use an H2RA unless there's an actual indication for a PPI. They cost less, work as well for SUP and you avoid a couple other issues.  Propofol is a negative chronotrope and inotrope. Careful with it.  Levofloxacin doesn't cure everything. 1gm q12 of vanc is NOT a once size fits all dose. It's weight based. Order in units of 250mg please. Phenytoin and and fosphenytoin are weight based too. Please load with 15mg-20mg/kg instead of the lovely 1gm. Clin specs in the unit will make fun of you if you get that one wrong. Oh, and please don't be the guy who writes "amiodarone" per protocol, or any other drug for that matter. Just write the directions and paramaters and save everyone some trouble of figuring it out. This came up at work today and a nurse was freaking out about it.

And finally, if you have a narcotic addict screaming in pain be sure to call security if you hear someone say "just give him some Talwin". It WILL send them into withdrawl, and you will have a hell of a time with them.

Hope atleast one of those things helps you out. Although I know you're a smart person, it might have been just a refresher for you.
Goodluck in the ED! 

Chris

Come on! 
You know undergrads aren't given that kind of information.  Explain, please!  Everything after vasoconstriction.  At least about Propofol!


My wife's gonna be pissed.  She wanted to go to a movie tonight. 

Quote from: wladziu on July 01, 2009, 09:48:59 AM
Just sucks that I'll hve to go back into the Army.  But, I'll be patching up guys like I used to be.  And, maybe I'll get a chance to run into my old LT...
What exactly do you do to a guy that tried to leave you for dead? 

WhaWhaWhat!?!?!?  If ya come across some busted up sh!thead who's giving you a lot of lip with my name on the tape just kick him in the ass, give him some ibuprofen and send him back out.


I didn't say this, but.............you have heard of the term fragging right?

I was thinking you were in med school already. My bad.
Chronotrope is heart rate and inotrope is about contractility. Propofol has calcium channel blocking activity(heart rate, vasodilation, force of contraction). So if you give it to someone who is oh say septic and having a hard time keeping their blood pressure up. Something that makes the heart work less efficiently would not be a great idea.
Here's a good quote about it:
Propofol causes vasodilation with a subsequent decrease in systemic vascular resistance. Likewise, because it's both a negative inotrope (causing the heart to pump less forcefully) and a negative chronotrope (causing the heart rate to decrease), propofol can cause a decrease in cardiac output. The combined impact on systemic vascular resistance and cardiac output often manifests through hypotension.

I'm afraid it'd take several posts to explain all that stuff. I can try to go over any part of it that you'd like though. Most med residents and many MD's get the stuff I told you wrong. The DVT and SUP stuff, important no doubt, but not as important as the vasopressors and phenytoin dosing parts. Those can have life and death consequences if you get them wrong.

Don't feel bad about not knowing something. It took me 3years undergrad, 4years gradschool and a year residency to understand all that stuff. lol I'm not a MD though. Just a PharmD

I thought that was what the drug reps were supposed to do you know on those wonderful retreats for CE credits! They will tell you everything . No sarcasam dripping from that at all 

Here's ya a case study: 25 y/o female working at hospital has sudden onset of central to left sided chest pain with shortness of breath. Has history of hypertrophic cardiomyopathy, AICD implant, Bp 80/20, Resperations labored at 24, pulse 52, O2 sat 92%, troponins 1.2, CKMB neg, positive D-dimer, EKG shows inverted T waves with high QRS voltage, C02 19%, glucose 65, CBC normal ......

Okay what's wrong?

Thought I'd have a little fun

Mary

Hey mary was that you when the gal ran out of room at some point ? ( somehting about lack of a pulse or bp or somehting?

Quote from: Toogoofy317 on July 01, 2009, 10:28:19 PM
Here's ya a case study: 25 y/o female working at hospital has sudden onset of central to left sided chest pain with shortness of breath. Has history of hypertrophic cardiomyopathy, AICD implant, Bp 80/20, Resperations labored at 24, pulse 52, O2 sat 92%, troponins 1.2, CKMB neg, positive D-dimer, EKG shows inverted T waves with high QRS voltage, C02 19%, glucose 65, CBC normal ......

AICD didn't activate?  Vagus nerve problem? 

I'm still not 100% on 'tropes (thanks, CStilt!).  I'll get it, just had to help the wife write a report last night.  Cut my reading short. 

I know you already have the answer (of course, it's not you we're discussing...), but is the cardiac tissue being stimulated correctly?  Don't laugh at the idiot pre-med, though.  Let me try, at least. 
I dont' know the levels, yet, but is 19% CO2 high enough to stimulate an autonomic response from the CO2 "sensor" in the peak of the aorta (forget it's name)?   If CNS communication to the heart was disrupted along the vagus (leaving the heart to depend on autonomic function), but the autonomic stimulators or channels were fatigued or momentarily synaptically saturated, would you have the same results?  But, wouldn't that also suggest long-term dizziness and fatigue previous to presentation?   
Potassium abnormality?  no...
Certainly not valve calcification...
Cerebral ischemia presenting without stroke symptoms, somehow?  Nah...

Crap!  I just don't know enough about the heart, yet!  Or very much of anything! 
But, thanks for pointing out areas of improvement, Terminatrix ( ).  And, you too, CStilt!





Feel free to post more of this stuff, guys.  Please. 
There's no one around to talk about things like this, and my family's tired of me picking their medical issues apart.  Online patient studies have gotten so boring, for lack of interactivity.  A fella could be stabbing around in the dark for centuries, reading without any real direction. 

Nope no firing of AICD. Potassium was low normal but enough to activate protocol if I'm not mistaken it was 3.0. Patient was in ED waiting approximately 2.5 hours when 02 sats dropped to 82% was sent to trauma room for 02 stabilization bp dropped to 72/30 with dizziness and severe left sided pain. EKG remained the same with hr of 60. CT scan was done 1.2cm mass found in left lung.......

Mary

1.2 cm mass Eh? whatlocation in lung?

Here's my wild shot in the dark. The patient threw a PE

Ding! Ding! We have a winner! BTW PE's suck A$$. Heperain is a close second.

Mary

a pulmonary embolism?

Yup!

Mary

Did I mention I have a tendency to look for the hardest problem to fix?

Yup youve been workin on me for the last lil while lmao 

Well, it took 2.5 hours in the waiting room and me almost crashing before they brought me back. At least you were "looking". I almost died in my own hospital!

Mary

i tell ya mary, there AINT no excuse whatsoever for that sh|t

it's sad really, the care given in some ER's.