I really shouldn't say anything... but I saw a case just like this in the ER about two weeks ago... not that I'm making any comments or anything... but honestly, I think you should head out and get some diagnostic tests scheduled ASAP. Just a few quick questions for you... are you feeling any pain in your upper right abdomen? And have you been running a fever?
Scott Allen10 said:That last part isn't quite right. Epinephrine is the first line of defense in CPR regardless of what the rhythm looks like—whether it's asystole or VF. The only difference is that with VF, you need to hit them with a DC shock first. You keep doing chest compressions for both types of arrest, but with VF, you only pause the compressions long enough to deliver the DC shock... take a quick look at the ECG, and if the fibrillation is still there, get back to compressions, give the epinephrine, and then hit them with another DC shock... What I'm trying to say is that while ventricular tachycardia is definitely life-threatening and often leads to VF, it’s technically not the same thing as ventricular fibrillation. With VT, if the patient is stable, you can primarily treat them with amiodarone without jumping straight to a DC shock... but VF is a true cardiac arrest situation. There's no time to mess around with amiodarone there, especially not at the start when there isn't even a recognizable rhythm on the ECG. Lately, vasopressin has been popping up more in resuscitation protocols. Over here, we have it available as Pitressin. In CPR, whether it's asystole or VF, you can start with it by giving a bolus of two ampules of vasopressin (40 units). We've seen some really solid results from it, but it hasn't really become the standard practice in our hospitals yet. Mostly because epinephrine is still considered the "gold standard" and that's what everyone is trained on... but honestly, a huge reason is just that Pitressin is incredibly expensive. Depending on which supplier you use, an ampule can cost hundreds of dollars! Just a side note: all this talk about "C" (circulation) and "D" (drugs) only matters if you've already handled "A" (airway) and "B" (breathing) right at the start of resuscitation... which, if I'm being honest, doesn't always happen perfectly in our hospital settings... hm... sometimes things get a bit messy...
Sure, epinephrine is used for asystole, VF, pulseless VT, and PEA. But listen to this: when treating VF and pulseless VT, amiodarone is administered as a slow 300 mg bolus, followed by a second dose that's half that size—150 mg IV. At least, that's what one ICU doctor told me. I know because I saw them prescribe that exact regimen for a female patient in VF over in the ICU.
I completely agree—BLS (basic life support) always comes before ALS (advanced life support). What I find really interesting, though, is that according to the latest CPR guidelines, the ratio for compressions to breaths is 30:2. So, 30 chest compressions followed by two breaths...
Take adrenaline, for example. I know 1ml equals 1mg... but if someone asks for 1mg, do I just hand over the whole vial? And if they want 0.5, do I give them half? Or is there already a pre-measured 0.5mg vial out there somewhere? It’s all so incredibly vague... especially when you're doing clinical rotations. The doctor turns to you and says, "Give me 0.5mg of atropine," and honestly, I usually just pass the task off to a colleague because my brain simply refuses to process it.
My bad... I really messed that one up. It’s all still a bit too fresh in my mind for me to be making silly mistakes like this... I managed to mix up Rytmonorm (propafenone), which you'd typically use for rapid atrial fibrillation, paroxysmal supraventricular tachycardia, or even paroxysmal ventricular tachycardia, with Cordarone (amiodarone), which is what we look toward for ventricular fibrillation or rhythm issues tied to WPW syndrome, atrial fibrillation, and flutter...
I know, I know—even though epinephrine is the go-to during CPR, when you're actually dealing with ventricular fibrillation or pulseless tachycardia, amiodarone is the move.
Alright, here’s my next question... How am I supposed to convert something like 0.3 mg of atropine given IV into milliliters? I mean, it doesn't really matter if it's this specific drug or something else entirely... Is there a universal way to do this, or does the process change depending on what you're working with?
So, there’s this Maltese order that’s been operating out in places like Lourdes since the late nineties. They actually managed to get the green light from our Department of Health and stuff to train people starting at sixteen to work in medical roles. The catch? For now—at least until they push for more licenses—those trainees can only work within their own facilities. It all came down to a massive labor shortage over in Germany, apparently. Their system is tiered, too. You’ve got nursing assistants, then Level II nurses who finished vocational school, and finally Level I professionals who completed a two-year college program. Those Level I folks are the ones who eventually move up to head nurse or lead technician positions. Anyway, side note: I just burst a vein on a patient...
Yeah... I guess I'm getting there... hehehhehehe... I'm actually just starting my nursing internship, though this whole training program is a bit of a headache. It’s designed to qualify you as a Level 3 technician, which eventually opens the door to working in the ER. I’ve already knocked out a few preliminary courses, but back then, I wasn't even allowed to touch anyone with meds, let alone administer them. Once I wrap this up, though, I'll finally have that clearance. It's all part of a volunteer medical training initiative run by the Knights of Malta... Anyway, thanks for the help. By the way, the internship is going pretty well so far... I've mastered IM injections and subcutaneous shots, but IVs are still giving me some anxiety. Honestly, I'm a little terrified of hitting a vein wrong or causing damage. I’m doing fine on the practice mannequins, but I haven't quite worked up the nerve to try it on a real person yet. And soon enough, we'll be moving on to cannulation...
PS... one more thing... which vein is generally the easiest to puncture? You know, the one where there's the least risk of messing things up... Also, for intramuscular shots, should I be aiming for the deltoid or the thigh?
I’ve been chewing on the different ways you actually inject stuff with a syringe—you know, the whole intramuscular, subcutaneous, intravenous, and intradermal spectrum. I need someone to break down the specifics for me: what kind of angles are we talking about here, and where exactly does each one go? Just keep in mind that we're dealing with ampulated medications intended for first aid scenarios. I can't exactly show up to my clinical rotation totally clueless; I'd really like to make a decent impression instead of looking like a total amateur.
Brian Lopez8 said:That’s precisely my point, I suppose; one really ought to head down to the courthouse on the day a ruling becomes final and request access to the case files through the clerk's office, perhaps even bringing along some witnesses to formally verify that the statute of limitations hadn't already expired by the time the decision was handed down...
Of course, that is all just somewhat theoretical, isn't it? When you consider how things actually play out in practice, well, I must admit I am feeling rather skeptical about the whole thing...🙄
I don't know, man. I haven't heard of anything like this ever happening before, and I suspect it might set a massive precedent... let them try, I guess... Great theory, though. Truly.👍