69 NICU and Geriatrics

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(24:42) Ron and Kelly talk about the upcoming Texas EMS conference, Syncopal episodes in geriatric patients, the rainbow of newborns and why or why not there can be male L&D nurses.

What I Did This Week

Medical Emergencies

Had a test. Don’t know what I made, but still improving.

Special Populations

Geriatrics
What’s the most common reason you see for syncope in older people?
How obvious do you see the signs for a CVA?
Transporting TIAs?

Clinicals

NICU
Still no vaginal birth
Saw 3 C-sections
Baby color
NICU nurse who said, “I can’t be an L&D nurse. Moms are too picky.”

Mentions:

Listener Questions

My name is Danny and I work for BC Ambulance in British Columbia, Canada. I am a Primary Care Paramedic, which roughly aligns with an EMT in terms of qualifications. I listen to your podcast weekly and heard your appeal for more listener questions. I gave it some thought and came up with the following.
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In school I was taught “wet side down” in reference to packaging a trauma patient with a penetrating chest wound. Also, we have protocols that state a patient with a pneumothorax should be positioned affected side down. I’m not sure, but I think the rationale to support this thinking is, keep the good lung up so it is in the best position to promote ventilation and, therefore, has the best chance of oxygenating the body.
While I was in the ED at our local hospital, I observed a doctor drain 2 liters of fluid from a patient’s lung. The doctor began asking me patho questions. He wanted to know how I would position his patient for best perfusion. I bumbled through the “wet side down” theory, thinking it applied to this situation.
He had no time for the affected lung down theory. He graciously explained how the bad lung should be positioned up in order to allow the greatest blood flow to the good lung. He talked about shunting… how the ineffective lung was still receiving oxygen poor blood, but was unable to oxygenate that blood. Positioning the good lung down ensured the greatest amount of venus blood flowed past the good lung, increasing the percentage of total blood oxygenation.
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I was hoping Kelly could comment on the “wet side down” way of thinking and why one might choose that patient positioning.

Also, it would be interesting to hear a comment regarding when your protocols do not align with good thinking or sound statistics. Examples of this might be 30 to 2 cpr compared to uninterrupted compressions or using D50 rather than D10 in the hypoglycemic patient. It’s hard for me to think about doing something that is detrimental to my patient in the name of following our treatment guidelines.
– Danny

Also, can I get some suggestions for pulse oximeters, what are some tips you have when someone either has fingernail polish or other problem with there finger. Would a toe work? I have seen the side of a finger. Maybe an ear? Any suggestions would be greatly appreciated.

Love the show,
Sam

On the podcast, Kelly said something about EMS shouldn’t do CPR on
traumatic arrest patients. Last week, a girl stabbed 20 times, who
arrested three times en-route, was discharged today. Given this story
shouldn’t EMS do CPR on traumatic arrest patients?

http://www.seattlepi.com/news/article/Doctors-describe-teen-stabbing-victim-s-injuries-2242373.php
Timothy

Since you said you haven’t had many listener questions, i figured i would ask one for the heck of it. Here in west michigan, we are serviced by AeroMed flying a Sikorsky S-76, (Apx. 52ft in length, with a 44ft wingspan.) From what i’ve been told, it’s pretty darn big for a Medical Chopper. What do you usually see down there, and what are the advantages for a large chopper and for a small one?
Thanks! – Ryan