Ep 21 A Stable Rhythm

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[audio:21_StableRhythm.mp3] (35:08) This week Ron experiences his first dead patient and CPR on them. We talk about capnography, and symptomatic bradycardia. Newbie asks about clearing C-spine and moving the head to a neutral position. And Kelly tells how to give informed consent to spinal immobilization. We also answer a number of listener questions.

Mentions:
Mediccast Ep 240 on EMS Clinical Precepting, and Education.

Nexus Protocol for Clearing C-Spine

Listener Questions
Shaun:
As a new EMT-B I am about to start IV Therapy class. Any hints or tips for me? Other than the obvious humility that I am about to learn. lol

Matthew:
In a recent episode, treatment for drunk patients was brought up and Kelly stated that dehydration was the biggest problem (and the primary cause of hangover headaches). He then went on to say that he would personally take 1000 mgs of Tylenol and drink a bottle of Gatorade to avoid this.
I was surprised to hear him mention Tylenol since it’s been my understanding that taking acetaminophen before or after consuming alcohol can put a strain on the liver and possibly even cause damage to it. Is this true or have I been misinformed?

Christine Springfield:
Prilosec for anaphalaxis. Going along with your discussion on drugs and how/why they work, in the ER, we had a patient come in with a severe reaction to an unknown substance and the protocol was Epi 1:1,000, Benadryl and Prilosec, all IV. The doc told me that the Prilosec is also a histamine blocker that addresses the receptors that Benadryl doesn’t affect. Do y’all have any experience with this and is this something we can expect to be rolled out to EMS at some point?

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  • Ssteinbach

    Prilosec Zantac and some other GI meds block the H2 receptor sites. Benedryl and other common anti-histamines block H1 receptor sites

  • JPINFV

    In regards to the conversation about NEXUS criteria, it’s important to understand exactly what NEXUS actually is. NEXUS actually has absolutely nothing to do with clearing c-spine. It’s actual intent is to give physicians a clinical tool to determine who needs to get an x-ray. Now it’s a very small jump to go from “patient doesn’t need an x-ray” to “patient doesn’t need to be immobilized.” Of course this also helps sell selective immobilization to the “but we don’t have x-rays” crowd, since these patients shouldn’t be getting x-rays anyways. Of course the problem is that if you put the patient on a board, they will almost always develop back pain, which would make them positive for NEXUS, but because of the treatment, not the injury.

    On a side note, I took an informal poll of all of the orthopedists who taught at my school during musculoskeletal and every one said that they try to get the patient off ASAP. One went so far to say that he tells his residents that the backboard is the first thing to come off when the patient comes through the doors since a mattress works just as well.

  • Katie B.

    Sorry, I’m WAY behind on the podcast….I’m just getting to this episode now. But I wonder if you guys have ever seen this:

    Even in First Responder training we were told all about “mechanism of injury” and this is just a hilarious portrayal of how out of control things can get when you pay too much attention to the “mechanism of injury” instead of the patient!

    Cheers,
    Katie

  • I had seen that one. Made me smile when fire was being stupid, less
    when EMS showed up and was stupid too. 🙂

  • Katie B.

    Well, it was written by a cop, so you know he’s gotta make fire and ems look bad! 😉

    Still, I bet it’s based on some truth. I think it can be a lesson to us all: While we do (and should) rely on our training to help us along when caring for patients, that’s no reason to forget how to use our brains. I like to think that EMS providers are more than robots programmed to do certain things in certain situations (like one massive flow chart–if a certain mechanism of injury is present, then c-spine is necessary, for example). The video hyperbolizes what a mess that can be made when we resort to that and neglect to THINK.