I mean, I don't think they can come after you if they haven't actually filed formal charges yet... though, then again, maybe they can? Like, just expand the existing indictment or something. I honestly have no clue. Someone who actually knows their way around a courtroom should probably weigh in here...
Probably talking about training injuries... you know, things like pulled muscles, nasty bruises, or just general soreness... Octenisept is an antiseptic and Bivacine is an antibiotic... they have absolutely nothing to do with closed tissue trauma. Those are meant for open wounds, not stuff under the skin...
So, here's the deal... you've got a few different options out there. There’s the Deep Relief line, and then you’ve got the stuff that actually heats up or cools you down. I usually stick to the cooling ones myself. But when we're out working in the field, we tend to use that Piccov Ice spray... $33... maybe even a little less than that, depending on how much we go through.
So, look... When it comes to accuracy, those old-school manual ones are still the gold standard. You know, the ones with the little bulb you squeeze? You can even get them with a built-in barometer if you want to feel fancy, but honestly, that’s getting into territory for the pros. I don't even trust myself to take my own blood pressure—I mean, sure, you *can* do it, but why risk it? I always feel way more confident when someone else handles the cuff. It’s not exactly rocket science to learn how to do it properly, though. As for the digital ones? They exist, obviously, but people are always questioning if they're actually giving you the real story. Personally, I've always had a soft spot for the stuff from Abbott Laboratories.
I was looking at that Decal lipstick, but man, it feels like such a rip-off... like, almost 90-$40 bucks? I mean, sure, it probably works wonders, but still...
Thanks, but I actually stumbled upon the answer while just sitting around waiting for nothing... hehehe... anyway, here’s another one for you. You know those AEDs (Automated External Defibrillators)? Which company actually manufactures them? And I want your take on this... should an EMT really be expected to know drug dosages... or perform defibrillation... things that are usually considered doctor territory? We had a bit of a debate about this recently. Personally, I think it'd be perfectly fine. If you understand the algorithm and the flow of ALS, you can basically anticipate what the doctor is going to ask for, which lets you move way faster when every second counts.
I mean, what’s he gonna do? Lose his cool and kick me out on the street? I don't even work there full-time; I'm just an intern trying to learn the ropes...
He wasn't even in the ER; it was just post-op recovery... they had him prescribed an IV, but the issue was we were completely out of the larger ones... and I know he’d have absolutely lost his mind if I hadn't made it work... honestly, he's the worst. Nobody can stand him... but yeah, there you go.
So, when you're looking at transfusions or heavy IV fluids, you really want to go big—ideally an 18G or maybe even a 16G, assuming the patient's veins can actually handle it without collapsing. But here’s what I was wondering: can you get away with using a 20G for an infusion? I tried using one the other day, and the doctor absolutely lost his mind. He started yelling at me about how I messed up, lecturing me on why it "had" to be an 18G and all that nonsense. I tried explaining that we just didn't have those larger sizes in stock at the moment, but he just snapped back that I shouldn't have used anything at all if I couldn't do it right. I just stood there kind of staring blankly... I mean... the fluid was flowing just fine, so I don't see what the big deal was.
Look, considering how much illness runs in your family—most of it being genetic stuff—and just looking at where you're at right now physically... I really don't think you should be messing around with this. You need a doctor who can actually manage your case properly. Find someone reputable... and get those tests done immediately.
Are you seeing any actual flaking on that area? Like, skin peeling away along with some redness? If so, you might be looking at psoriasis... I'll drop a link here so you can do your own digging and see if it matches up.
Scott Allen10 said:In resuscitation medicine, the idea of giving a drug "slowly as a bolus" doesn't even exist... which makes me pretty skeptical about whether that specific case you mentioned was actually handled correctly. Also, we have to ask—which ICU are we talking about? Honestly, almost every hospital ward has some little corner or room they call "the ICU." But most of the time, it's just a tiny nook with an oxygen tank and maybe a pulse oximeter, if you're lucky... The term "ICU" gets thrown around so loosely in American hospitals that basically any little storage closet or side room gets slapped with the label, even if there isn't a shred of intense medical activity happening in there... Sure, maybe that specific example was actually a perfectly handled amiodarone case, but you’d still need DC cardioversion and continuous chest compressions along with proper ventilation and oxygenation... It's just hard to judge a single individual case or the flow of a crisis like that based on one anecdote... You're spot on regarding those new compression-to-ventilation ratios... It turns out that during resuscitation, the absolute priority is maintaining blood flow through the vessels, and you achieve that through compressions. Doing just one or two breaths for every 30 compressions is plenty to ensure the body gets enough oxygen as that blood is pumped through the system, especially to the brain.... Still, I think those breaths have to be high quality, with a full volume of well-oxygenated air... which brings us right back to the "A" and "B" of the airway and breathing alphabet. You have to secure a safe airway and make sure lung ventilation is sufficient. And honestly, in the middle of all that chaos during a code, the best way to do that is via endotracheal intubation, which needs to happen ASAP—right in the thick of compressions, DC shocks, and trying to find a vein. Using a mask with an Ambu bag is pretty questionable... Not because it's useless, but because people do it so poorly! You wouldn't believe how incredibly hard it is to ventilate someone using an Ambu bag. If you haven't tried it, you probably can't imagine it, but trying to get a good seal between the mask and the face while performing compressions and dealing with the madness around the bed—all while tilting the head back to keep the airway open so the tongue doesn't block it, and squeezing the Ambu bag at the same time—you have to be seriously skilled. Sometimes it feels like you need an extra hand just to keep up...
Unfortunately, we see similar issues with "intensive care" at my hospital too... over at our surgery department... they have an outpatient clinic and an ER... I don't know what it's like where you are, but even though we're short on gear and equipment, we have an entire floor dedicated to intensive care (well, half a floor) including two shock rooms, two trauma rooms, and three ICU beds staffed by specialized techs... We manage to scrape by...
Yeah... when we're talking about layperson first aid, we can settle for them just tilting the head back... since they're mostly working on instinct and limited knowledge. But when it comes to professional medical help, I completely agree that intubation is much more efficient and lets the provider focus on other things... though I think you really have to master intubation before attempting it. I know people who showed up to a car wreck and didn't even know how to place a tube... but regardless, I'll always take the bag over mouth-to-mouth, since you get about 16% more oxygen that way.
Scott Allen10 said:There aren't any set rules here. It’s a highly individual process. Basically, before you make a call on which vein to hit, you need to check their history and really, truly palpate them... I don't mean just looking at the vein, I mean feeling it. Don't rely on visual assessment for any single vein. Over 50% of veins aren't even visible, but they are easy to gauge once you feel them under the skin—their direction, hardness, flexibility... you can feel that "springiness" right under your fingertip. Make sure the vein is straight for at least 2 or 3 cm so you aren't dealing with some bumpy mess that's going to pop the second you perforate the wall. Better to spend ten minutes assessing the vein than to poke blindly and then go hunting for it with the needle... Generally speaking, for blood draws, the veins in the antecubital region (like the v. basilica or v. cubitalis) are the easiest, whereas for a Brown cannula, you should start by checking the veins on the hand first, and only move up toward the antecubital area if those aren't viable. Leg veins can also work for both blood draws and Brown cannulas. Of course, not for patients who are mobile and walking around, but for bedridden patients, absolutely. You're mostly looking at the veins on the foot or around the ankle area... In more extreme scenarios, you might have to use the v. jugularis in the neck or the v. femoralis in the inguinal region...
Yeah... yeah... I get it... so... what matters is feeling for the vein... the one that feels better under my fingers is the one I should go for... even if... I can see a different one clearly...
Scott Allen10 said:but there’s really nothing complex to figure out here. If you need to give 0.5 mg of Atropine and you have an ampule containing exactly 0.5 mg, you just pop it open and give the whole thing.... If you’ve got a 1 mg ampule instead, you still open it, draw up the full amount into the syringe, and then just pull back until you hit that 0.5 mark, leaving the rest in the barrel.... simple enough....
Now, Adrenaline is always 1ml = 1mg... but you have to be careful because in practice, it's frequently diluted to a 1:10 or 1:100 ratio.... sometimes even 1:1000. So, when a doctor tells you, "give 1 ml of 1:10 adrenaline," here is what you actually have to do: - grab the ampule and crack it open - take a 10 ml syringe and draw up the entire dose of adrenaline. That’s your 1 ml, as we established. - grab a bag of saline and draw another 9 ml of saline into that same syringe with the adrenaline. - now you’ve got a 1:10 adrenaline solution, and you administer 1 ml of that from the syringe intravenously.
If the order is for 1 ml of 1:100 adrenaline, the process changes: - grab a fresh, empty 10 ml syringe and attach a needle - hold your previously prepared 1:10 adrenaline syringe in your other hand - use the empty syringe and needle to aspirate 1 ml of that 1:10 adrenaline from the first syringe into the second one.... - then top it off with 9 ml of saline so you're back at a total of 10 ml... and there you have it, a 1:100 adrenaline concentration. - from that syringe, you administer 1 ml of the medication.
One thing I can't stress enough when you're messing around with all this pharmacology: label your syringes immediately. Write exactly what is in them right away, because lord knows you won't remember which is which five minutes later.