Tamingthesru
Nobody Expects the Spanish Inquisition! (or, for that matter, the Cormak-Lehane Grade 4 Laryngoscopic View!)
A 68 year-old man presents by squad with shortness of breath. He is noted to have a nearly quiet chest with very poor air movement, to be using accessory respiratory muscles, and to be slightly lethargic. Quick perusal of old records discloses a history of severe COPD, steroid and O2 dependence, HTN and ulcer disease. The squad reports that his O2 sat was 86% at the scene, improving to 92% on a NRBM and two nebs.
His vitals are: p 138, r 22 and labored, bp 156/96, O2 sat 92% on a high-flow NRBM. His POC renal returns with a pCO2 of 88. His estimated weight is about 175 lbs.
A decision is made to intubate.
EMS Scope of Practice
Recently, I had the pleasure of sitting down with Dr. Dustin Calhoun, EMS faculty member within the Department of Emergency Medicine at the University of Cincinnati.
Dustin had been responsible for an EMS fellow didactic session covering EMS scopes of practice and EMS licensure. While on the surface these topics may seem a bit “boring,” I found our examination of the complexities quite interesting. In fact, I found the session so useful that I asked Dustin to record this podcast with me (and I’m a former EMT!).
Grand Rounds Recap - 10/22/14
Acetaminophen can be one of the most dangerous drugs in overdose, as the toxic dose of acetaminophen is 250 mg/kg
There are 4 stages of acetaminophen overdose:
- Stage 1 from 0-24 hours when labs may be normal but the patient has nonspecific symptoms such as nausea, vomiting, and fatigue
- Stage 2 from 24-72 hours when labs may be normal or be trending upward but the patient is asymptomatic
- Stage 3 from 72-96 hours when significant metabolic derangement can occur such as profound metabolic acidosis, florid liver failure, and AKI.
- Stage 4 takes place only if you are able to get them through the acute illness precipitated in Stage 3 when hopefully recovery takes place, though there is no guarantee of liver recovery