Guest guest Posted February 24, 2006 Report Share Posted February 24, 2006 Ok Gene here goes. My overall concern with this patient is possible upper airway obstruction, pulmonary edema and cardiac dysrhthmias. HF will form hydrofluoric acid with contact with water such as in the respiratory system. It may cause burns and corrosion of the tissues of the upper airway. HF binds with Calcium and Magnesium resulting in hypocalcemia and hypomagnesemia. These conditions can potentially cause cardiac dysrythmias including Ventricular Fibrillation and death. Hypomagnesemia can also result in tetany which include muscular spasms and laryngeal spasms. Hyperkalemia can occur as well. Seizures are possible also. I would wear protective gear to avoid an exposure myself. I would remove the patient from the area and make sure the patient is decontaminated, declothed and flushed with water for several minutes. Some places that work with HF have topical calcium gluconate available. After decontamination, I would not let the grass grow under my feet, that is rapid transport is indicated. The patient should be given high flow oxygen initially and preparations should be made for aggressive airway management (intubation) since her hoarsness and coughing sounds like an impending upper airway obstruction. Early calcium and magnesium replacement is considered. The 7-11 store should have items such as calcium containing antacids, Milk of Magnesia, Malox and Epsom salts. The extreme pain in her hands and arms sound like the calcium in her bones is already starting to be depleted. I would most definitely have the patient on the EKG monitor and monitor vital signs as well as having an IV line established. Things to look for on the EKG: hypocalcemia can typically produce a prolong QT. Hyperkalemia presents with peaked T wave with possible progression to a wide QRS complex with tachy or brady dysrythmias. Hypomagnesemia can result in a prolonged QT, T wave inversion, widening of the QRS, torsades de pointes, ventricular or atrial fibrillation. Medical control orders (if not standing orders) may include Morphine for pain, magnesium sulfate, IV calcium gluconate or nebulized calcium gluconate. e, LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2006 Report Share Posted February 24, 2006 Ok Gene here goes. My overall concern with this patient is possible upper airway obstruction, pulmonary edema and cardiac dysrhthmias. HF will form hydrofluoric acid with contact with water such as in the respiratory system. It may cause burns and corrosion of the tissues of the upper airway. HF binds with Calcium and Magnesium resulting in hypocalcemia and hypomagnesemia. These conditions can potentially cause cardiac dysrythmias including Ventricular Fibrillation and death. Hypomagnesemia can also result in tetany which include muscular spasms and laryngeal spasms. Hyperkalemia can occur as well. Seizures are possible also. I would wear protective gear to avoid an exposure myself. I would remove the patient from the area and make sure the patient is decontaminated, declothed and flushed with water for several minutes. Some places that work with HF have topical calcium gluconate available. After decontamination, I would not let the grass grow under my feet, that is rapid transport is indicated. The patient should be given high flow oxygen initially and preparations should be made for aggressive airway management (intubation) since her hoarsness and coughing sounds like an impending upper airway obstruction. Early calcium and magnesium replacement is considered. The 7-11 store should have items such as calcium containing antacids, Milk of Magnesia, Malox and Epsom salts. The extreme pain in her hands and arms sound like the calcium in her bones is already starting to be depleted. I would most definitely have the patient on the EKG monitor and monitor vital signs as well as having an IV line established. Things to look for on the EKG: hypocalcemia can typically produce a prolong QT. Hyperkalemia presents with peaked T wave with possible progression to a wide QRS complex with tachy or brady dysrythmias. Hypomagnesemia can result in a prolonged QT, T wave inversion, widening of the QRS, torsades de pointes, ventricular or atrial fibrillation. Medical control orders (if not standing orders) may include Morphine for pain, magnesium sulfate, IV calcium gluconate or nebulized calcium gluconate. e, LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2006 Report Share Posted February 24, 2006 Good going, . I think intubation might be contraindicated. There is an intervention that you can do to reverse the effects of the inhalation. What is it? GG > Ok Gene here goes. My overall concern with this patient is possible upper > airway obstruction, pulmonary edema and cardiac dysrhthmias. HF will form > hydrofluoric acid with contact with water such as in the respiratory system. > It may > cause burns and corrosion of the tissues of the upper airway. HF binds with > Calcium and Magnesium resulting in hypocalcemia and hypomagnesemia. These > conditions can potentially cause cardiac dysrythmias including Ventricular > Fibrillation and death. Hypomagnesemia can also result in tetany which > include muscular > spasms and laryngeal spasms. Hyperkalemia can occur as well. Seizures are > possible also. > > I would wear protective gear to avoid an exposure myself. I would remove the > patient from the area and make sure the patient is decontaminated, declothed > and flushed with water for several minutes. Some places that work with HF > have > topical calcium gluconate available. After decontamination, I would not let > the grass grow under my feet, that is rapid transport is indicated. > > The patient should be given high flow oxygen initially and preparations > should be made for aggressive airway management (intubation) since her > hoarsness > and coughing sounds like an impending upper airway obstruction. Early > calcium > and magnesium replacement is considered. The 7-11 store should have items > such > as calcium containing antacids, Milk of Magnesia, Malox and Epsom salts. The > extreme pain in her hands and arms sound like the calcium in her bones is > already starting to be depleted. I would most definitely have the patient on > the EKG > monitor and monitor vital signs as well as having an IV line established. > > Things to look for on the EKG: hypocalcemia can typically produce a prolong > QT. Hyperkalemia presents with peaked T wave with possible progression to a > wide QRS complex with tachy or brady dysrythmias. Hypomagnesemia can result > in a > prolonged QT, T wave inversion, widening of the QRS, torsades de pointes, > ventricular or atrial fibrillation. > > Medical control orders (if not standing orders) may include Morphine for > pain, magnesium sulfate, IV calcium gluconate or nebulized calcium > gluconate. > > e, LP > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2006 Report Share Posted February 24, 2006 Good going, . I think intubation might be contraindicated. There is an intervention that you can do to reverse the effects of the inhalation. What is it? GG > Ok Gene here goes. My overall concern with this patient is possible upper > airway obstruction, pulmonary edema and cardiac dysrhthmias. HF will form > hydrofluoric acid with contact with water such as in the respiratory system. > It may > cause burns and corrosion of the tissues of the upper airway. HF binds with > Calcium and Magnesium resulting in hypocalcemia and hypomagnesemia. These > conditions can potentially cause cardiac dysrythmias including Ventricular > Fibrillation and death. Hypomagnesemia can also result in tetany which > include muscular > spasms and laryngeal spasms. Hyperkalemia can occur as well. Seizures are > possible also. > > I would wear protective gear to avoid an exposure myself. I would remove the > patient from the area and make sure the patient is decontaminated, declothed > and flushed with water for several minutes. Some places that work with HF > have > topical calcium gluconate available. After decontamination, I would not let > the grass grow under my feet, that is rapid transport is indicated. > > The patient should be given high flow oxygen initially and preparations > should be made for aggressive airway management (intubation) since her > hoarsness > and coughing sounds like an impending upper airway obstruction. Early > calcium > and magnesium replacement is considered. The 7-11 store should have items > such > as calcium containing antacids, Milk of Magnesia, Malox and Epsom salts. The > extreme pain in her hands and arms sound like the calcium in her bones is > already starting to be depleted. I would most definitely have the patient on > the EKG > monitor and monitor vital signs as well as having an IV line established. > > Things to look for on the EKG: hypocalcemia can typically produce a prolong > QT. Hyperkalemia presents with peaked T wave with possible progression to a > wide QRS complex with tachy or brady dysrythmias. Hypomagnesemia can result > in a > prolonged QT, T wave inversion, widening of the QRS, torsades de pointes, > ventricular or atrial fibrillation. > > Medical control orders (if not standing orders) may include Morphine for > pain, magnesium sulfate, IV calcium gluconate or nebulized calcium > gluconate. > > e, LP > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2006 Report Share Posted February 24, 2006 , BINGO! That's what I was waiting for somebody to say. Good call. You not only don't have to go to Ladonia, you also don't have to have lunch with . GG > You can also nebulizer calcium gluconate to reverse inhalation. > > > > > > > > > > -- > No virus found in this outgoing message. > Checked by AVG Free Edition. > Version: 7.1.375 / Virus Database: 268.1.0/269 - Release Date: > 02/24/2006 > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2006 Report Share Posted February 24, 2006 You can also nebulizer calcium gluconate to reverse inhalation. -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.0/269 - Release Date: 02/24/2006 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2006 Report Share Posted February 25, 2006 Gene, I wonder how long it will take to reverse the effects of HF inhalation using the nebulized calcium gluconate? I am assuming that it depends on how long she was exposed and the amount inhaled. Since I am not sure I am still going to have my airway equipment ready. Also, thanks for coming back to the list and posting scenarios. These are learning experiences and the spirit of this list should be just that. What time am I leaving for Ladonia? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2006 Report Share Posted February 25, 2006 The information I have, from Goldfrank's Toxicological Emergencies, 6th edition, is that the nebulized calcium works very quickly. Of course, this is given along with IV calcium gluconate and/or magnesium. Calcium choride can be given also, but it is very irritating to the vascular system and is best given through a central line which, of course, most of us do not do. There are many, many variations on treatment modalities, depending on which source you read, but all of them involve calcium administration, generally by multiple routes. Because of your excellent responses, I am granting you a reprieve from Ladonia. Gene > Gene, > > I wonder how long it will take to reverse the effects of HF inhalation using > the nebulized calcium gluconate? I am assuming that it depends on how long > she was exposed and the amount inhaled. Since I am not sure I am still going > to > have my airway equipment ready. > > Also, thanks for coming back to the list and posting scenarios. These are > learning experiences and the spirit of this list should be just that. > > What time am I leaving for Ladonia? > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2006 Report Share Posted February 25, 2006 No. Flushing with copious amounts of water is the first intervention. It will require lots of flushing, maybe 15 or 20 minutes. All the time you're getting all the other stuff ready, the patient should be getting lots of water on it. Go to eMedicine Online for a good article. There are also excellent articles in Tintinalli and in Goldfrank. Gene > hhhmmmm? HF in water is hydrofloric acid-why decon someone exposed to HF > with water? Wouldnt that do more harm than good? > > ambubag@... wrote:Â Ok Gene here goes. My overall concern with this > patient is possible upper > airway obstruction, pulmonary edema and cardiac dysrhthmias. HF will form > hydrofluoric acid with contact with water such as in the respiratory system. > It may > cause burns and corrosion of the tissues of the upper airway. HF binds with > Calcium and Magnesium resulting in hypocalcemia and hypomagnesemia. These > conditions can potentially cause cardiac dysrythmias including Ventricular > Fibrillation and death. Hypomagnesemia can also result in tetany which > include muscular > spasms and laryngeal spasms. Hyperkalemia can occur as well. Seizures are > possible also. > > I would wear protective gear to avoid an exposure myself. I would remove the > patient from the area and make sure the patient is decontaminated, declothed > and flushed with water for several minutes. Some places that work with HF > have > topical calcium gluconate available. After decontamination, I would not let > the grass grow under my feet, that is rapid transport is indicated. > > The patient should be given high flow oxygen initially and preparations > should be made for aggressive airway management (intubation) since her > hoarsness > and coughing sounds like an impending upper airway obstruction. Early > calcium > and magnesium replacement is considered. The 7-11 store should have items > such > as calcium containing antacids, Milk of Magnesia, Malox and Epsom salts. The > extreme pain in her hands and arms sound like the calcium in her bones is > already starting to be depleted. I would most definitely have the patient on > the EKG > monitor and monitor vital signs as well as having an IV line established. > > Things to look for on the EKG: hypocalcemia can typically produce a prolong > QT. Hyperkalemia presents with peaked T wave with possible progression to a > wide QRS complex with tachy or brady dysrythmias. Hypomagnesemia can result > in a > prolonged QT, T wave inversion, widening of the QRS, torsades de pointes, > ventricular or atrial fibrillation. > > Medical control orders (if not standing orders) may include Morphine for > pain, magnesium sulfate, IV calcium gluconate or nebulized calcium gluc > onate. > > e, LP > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2006 Report Share Posted February 25, 2006 No. Flushing with copious amounts of water is the first intervention. It will require lots of flushing, maybe 15 or 20 minutes. All the time you're getting all the other stuff ready, the patient should be getting lots of water on it. Go to eMedicine Online for a good article. There are also excellent articles in Tintinalli and in Goldfrank. Gene > hhhmmmm? HF in water is hydrofloric acid-why decon someone exposed to HF > with water? Wouldnt that do more harm than good? > > ambubag@... wrote:Â Ok Gene here goes. My overall concern with this > patient is possible upper > airway obstruction, pulmonary edema and cardiac dysrhthmias. HF will form > hydrofluoric acid with contact with water such as in the respiratory system. > It may > cause burns and corrosion of the tissues of the upper airway. HF binds with > Calcium and Magnesium resulting in hypocalcemia and hypomagnesemia. These > conditions can potentially cause cardiac dysrythmias including Ventricular > Fibrillation and death. Hypomagnesemia can also result in tetany which > include muscular > spasms and laryngeal spasms. Hyperkalemia can occur as well. Seizures are > possible also. > > I would wear protective gear to avoid an exposure myself. I would remove the > patient from the area and make sure the patient is decontaminated, declothed > and flushed with water for several minutes. Some places that work with HF > have > topical calcium gluconate available. After decontamination, I would not let > the grass grow under my feet, that is rapid transport is indicated. > > The patient should be given high flow oxygen initially and preparations > should be made for aggressive airway management (intubation) since her > hoarsness > and coughing sounds like an impending upper airway obstruction. Early > calcium > and magnesium replacement is considered. The 7-11 store should have items > such > as calcium containing antacids, Milk of Magnesia, Malox and Epsom salts. The > extreme pain in her hands and arms sound like the calcium in her bones is > already starting to be depleted. I would most definitely have the patient on > the EKG > monitor and monitor vital signs as well as having an IV line established. > > Things to look for on the EKG: hypocalcemia can typically produce a prolong > QT. Hyperkalemia presents with peaked T wave with possible progression to a > wide QRS complex with tachy or brady dysrythmias. Hypomagnesemia can result > in a > prolonged QT, T wave inversion, widening of the QRS, torsades de pointes, > ventricular or atrial fibrillation. > > Medical control orders (if not standing orders) may include Morphine for > pain, magnesium sulfate, IV calcium gluconate or nebulized calcium gluc > onate. > > e, LP > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 25, 2006 Report Share Posted February 25, 2006 hhhmmmm? HF in water is hydrofloric acid-why decon someone exposed to HF with water? Wouldnt that do more harm than good? ambubag@... wrote: Ok Gene here goes. My overall concern with this patient is possible upper airway obstruction, pulmonary edema and cardiac dysrhthmias. HF will form hydrofluoric acid with contact with water such as in the respiratory system. It may cause burns and corrosion of the tissues of the upper airway. HF binds with Calcium and Magnesium resulting in hypocalcemia and hypomagnesemia. These conditions can potentially cause cardiac dysrythmias including Ventricular Fibrillation and death. Hypomagnesemia can also result in tetany which include muscular spasms and laryngeal spasms. Hyperkalemia can occur as well. Seizures are possible also. I would wear protective gear to avoid an exposure myself. I would remove the patient from the area and make sure the patient is decontaminated, declothed and flushed with water for several minutes. Some places that work with HF have topical calcium gluconate available. After decontamination, I would not let the grass grow under my feet, that is rapid transport is indicated. The patient should be given high flow oxygen initially and preparations should be made for aggressive airway management (intubation) since her hoarsness and coughing sounds like an impending upper airway obstruction. Early calcium and magnesium replacement is considered. The 7-11 store should have items such as calcium containing antacids, Milk of Magnesia, Malox and Epsom salts. The extreme pain in her hands and arms sound like the calcium in her bones is already starting to be depleted. I would most definitely have the patient on the EKG monitor and monitor vital signs as well as having an IV line established. Things to look for on the EKG: hypocalcemia can typically produce a prolong QT. Hyperkalemia presents with peaked T wave with possible progression to a wide QRS complex with tachy or brady dysrythmias. Hypomagnesemia can result in a prolonged QT, T wave inversion, widening of the QRS, torsades de pointes, ventricular or atrial fibrillation. Medical control orders (if not standing orders) may include Morphine for pain, magnesium sulfate, IV calcium gluconate or nebulized calcium gluconate. e, LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 In a message dated 25-Feb-06 22:12:13 Central Standard Time, docdragonfly@... writes: hhhmmmm? HF in water is hydrofloric acid-why decon someone exposed to HF with water? Wouldnt that do more harm than good? while it is generally accepted that dry powder contaminants are best handled by brushing off as much of the powder as possible before wetting the patient down, I can think of few chemical contaminants on the human body where the human body will not benefit from a large amount of fresh water, preferable with some sort of wetting agent (Dove or Dreft soap flakes come to mind as they are among the mildest of those agents) initially, but followed by copious amounts of plain water. Calcium Carbide is one of the few that come to mind. There is truth to the adage: The Solution to Pollution is Dilution...even if you do need to make a temporary pond to catch the run off water... S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 Oh gee, pardon me. I may just be a dumb lawyer and ground medic, but could someone point me to the DSHS regs where it states that only a flight medic or RN can install a central line? If so, please let many of the Houston area providers know so they can cease doing it. More importantly, can you point me to any scientific reason why a central line is needed? Which reference recommends the installation of a central line? Regards, Wes Ogilvie, MPA, JD, EMT-B Attorney at Law/Emergency Medical Technician Austin, Texas In a message dated 2/26/2006 9:37:26 PM Central Standard Time, flymedic1@... writes: but if you had a FLIGHT CREW a cental line would be placed and the patient mght survive > From: wegandy1938@... > Date: 2006/02/25 Sat PM 08:06:23 CST > To: AmbuBag@..., > Subject: Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 Whatever. You've completely disconnected with what I said. Calcium gluconate is preferred, and SURELY AS A FLIGHT CREW YOU WOULD HAVE THAT, so there would be no need for a central line. GG > but if you had a FLIGHT CREW a cental line would be placed and the patient > mght survive > > From: wegandy1938@... > > Date: 2006/02/25 Sat PM 08:06:23 CST > > To: AmbuBag@..., > > Subject: Re: Hydrofluoric acid > > > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > > edition, is that the nebulized calcium works very quickly.  Of course, > this is > > given along with IV calcium gluconate and/or magnesium. > > > > Calcium choride can be given also, but it is very irritating to the > vascular > > system and is best given through a central line which, of course, most of > us > > do not do.  > > > > There are many, many variations on treatment modalities, depending on > which > > source you read, but all of them involve calcium administration, generally > by > > multiple routes.  > > > > Because of your excellent responses, I am granting you a reprieve from > > Ladonia.  > > > > Gene  > > > > > > > > > Gene, > > > > > > I wonder how long it will take to reverse the effects of HF inhalation > using > > > the nebulized calcium gluconate? I am assuming that it depends on how > long > > > she was exposed and the amount inhaled. Since I am not sure I am still > going > > > to > > > have my airway equipment ready. > > > > > > Also, thanks for coming back to the list and posting scenarios. These > are > > > learning experiences and the spirit of this list should be just that. > > > > > > What time am I leaving for Ladonia? > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 Hey wait, Dudley.... didn't you just describe the French EMS system? It worked great for Princess .... -Wes In a message dated 2/26/2006 10:03:30 PM Central Standard Time, THEDUDMAN@... writes: But Wes, You forget...the object isn't to get the sick and injured to the hospital in an expeditious manner but to do as much to them while we have them as possible.... We can spend 20 to 30 minutes on scene " rsi'ng " a patient...why not set there an addtional 20 to 30 while we insert a central line....maybe we can call for portable x-ray and confirm it too before we lift-off (or drive off) and head to the hospital... Just my thoughts on a late Sunday night, Dudley PS: Have a great week! Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > In a message dated 2/25/06 18:47:41, ambubag@... writes: > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 In a message dated 2/26/06 9:37:39 PM Central Standard Time, flymedic1@... writes: but if you had a FLIGHT CREW a cental line would be placed and the patient mght survive You make a hit and run comment but you failed to sign your post. Are you chicken or are you not really a flight medic? If you are you may want to rethink why you do what you do and treat your patient and not just perform a procedure on a patient just because you can. I doubt if sitting around for 20 minutes putting in a central line in this particular patient is in this patient's best interest. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 but if you had a FLIGHT CREW a cental line would be placed and the patient mght survive > From: wegandy1938@... > Date: 2006/02/25 Sat PM 08:06:23 CST > To: AmbuBag@..., > Subject: Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 But Wes, You forget...the object isn't to get the sick and injured to the hospital in an expeditious manner but to do as much to them while we have them as possible.... We can spend 20 to 30 minutes on scene " rsi'ng " a patient...why not set there an addtional 20 to 30 while we insert a central line....maybe we can call for portable x-ray and confirm it too before we lift-off (or drive off) and head to the hospital... Just my thoughts on a late Sunday night, Dudley PS: Have a great week! Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 But Wes, You forget...the object isn't to get the sick and injured to the hospital in an expeditious manner but to do as much to them while we have them as possible.... We can spend 20 to 30 minutes on scene " rsi'ng " a patient...why not set there an addtional 20 to 30 while we insert a central line....maybe we can call for portable x-ray and confirm it too before we lift-off (or drive off) and head to the hospital... Just my thoughts on a late Sunday night, Dudley PS: Have a great week! Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 But Wes, You forget...the object isn't to get the sick and injured to the hospital in an expeditious manner but to do as much to them while we have them as possible.... We can spend 20 to 30 minutes on scene " rsi'ng " a patient...why not set there an addtional 20 to 30 while we insert a central line....maybe we can call for portable x-ray and confirm it too before we lift-off (or drive off) and head to the hospital... Just my thoughts on a late Sunday night, Dudley PS: Have a great week! Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 26, 2006 Report Share Posted February 26, 2006 Yes, Dudley, and while we're at it, RSI them. And let's do a central line or two, insert a Foley, check for sphincter tone, do a belly tap, and do a CT on the spot. Helicopters DO have CT scanners on them, don't they? That's why they are able to perform the miracles they do. Take a flight medic and put him on a ground truck and suddenly all his powers are blocked out. Ground ambulances are Kryptonite for a flight medic. But get them on that bird and miracles do happen. It's the electromagnetic field generated by the rotors that produces the miracles. I read that in The Sun, so it must be true. GG > But Wes, > > You forget...the object isn't to get the sick and injured to the hospital in > an expeditious manner but to do as much to them while we have them as > possible.... > > We can spend 20 to 30 minutes on scene " rsi'ng " a patient...why not set > there an addtional 20 to 30 while we insert a central line....maybe we can call > for portable x-ray and confirm it too before we lift-off (or drive off) and > head to the hospital... > > Just my thoughts on a late Sunday night, > > Dudley > > PS: Have a great week! > > Re: Hydrofluoric acid > > > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > > edition, is that the nebulized calcium works very quickly.  Of course, > this is > > given along with IV calcium gluconate and/or magnesium. > > > > Calcium choride can be given also, but it is very irritating to the > vascular > > system and is best given through a central line which, of course, most of > us > > do not do.  > > > > There are many, many variations on treatment modalities, depending on > which > > source you read, but all of them involve calcium administration, > generally > by > > multiple routes.  > > > > Because of your excellent responses, I am granting you a reprieve from > > Ladonia.  > > > > Gene  > > > > > > > > > Gene, > > > > > > I wonder how long it will take to reverse the effects of HF inhalation > using > > > the nebulized calcium gluconate? I am assuming that it depends on how > long > > > she was exposed and the amount inhaled. Since I am not sure I am still > going > > > to > > > have my airway equipment ready. > > > > > > Also, thanks for coming back to the list and posting scenarios. These > are > > > learning experiences and the spirit of this list should be just that. > > > > > > What time am I leaving for Ladonia? > > > > > > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 Wes, Are you telling me that there are ground crews in Houston area that are doing central lines? Tom --- ExLngHrn@... wrote: --------------------------------- Oh gee, pardon me. I may just be a dumb lawyer and ground medic, but could someone point me to the DSHS regs where it states that only a flight medic or RN can install a central line? If so, please let many of the Houston area providers know so they can cease doing it. More importantly, can you point me to any scientific reason why a central line is needed? Which reference recommends the installation of a central line? Regards, Wes Ogilvie, MPA, JD, EMT-B Attorney at Law/Emergency Medical Technician Austin, Texas In a message dated 2/26/2006 9:37:26 PM Central Standard Time, flymedic1@... writes: but if you had a FLIGHT CREW a cental line would be placed and the patient mght survive > From: wegandy1938@... > Date: 2006/02/25 Sat PM 08:06:23 CST > To: AmbuBag@..., > Subject: Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > In a message dated 2/25/06 18:47:41, ambubag@... writes: > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 Thought I read that before. -Wes In a message dated 2/27/2006 3:37:59 AM Central Standard Time, FireMedic1633@... writes: Wes, Are you telling me that there are ground crews in Houston area that are doing central lines? Tom --- ExLngHrn@... wrote: --------------------------------- Oh gee, pardon me. I may just be a dumb lawyer and ground medic, but could someone point me to the DSHS regs where it states that only a flight medic or RN can install a central line? If so, please let many of the Houston area providers know so they can cease doing it. More importantly, can you point me to any scientific reason why a central line is needed? Which reference recommends the installation of a central line? Regards, Wes Ogilvie, MPA, JD, EMT-B Attorney at Law/Emergency Medical Technician Austin, Texas In a message dated 2/26/2006 9:37:26 PM Central Standard Time, flymedic1@... writes: but if you had a FLIGHT CREW a cental line would be placed and the patient mght survive > From: wegandy1938@... > Date: 2006/02/25 Sat PM 08:06:23 CST > To: AmbuBag@..., > Subject: Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > In a message dated 2/25/06 18:47:41, ambubag@... writes: > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Yahoo! Groups Links > > > > > > > > > > > > > > > > > > > > > > E.(Gene) Gandy > POB 1651 > Albany, TX 76430 > wegandy1938@... > > > > [Non-text portions of this message have been removed] > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 Thought I read that before. -Wes In a message dated 2/27/2006 3:37:59 AM Central Standard Time, FireMedic1633@... writes: Wes, Are you telling me that there are ground crews in Houston area that are doing central lines? Tom --- ExLngHrn@... wrote: --------------------------------- Oh gee, pardon me. I may just be a dumb lawyer and ground medic, but could someone point me to the DSHS regs where it states that only a flight medic or RN can install a central line? If so, please let many of the Houston area providers know so they can cease doing it. More importantly, can you point me to any scientific reason why a central line is needed? Which reference recommends the installation of a central line? Regards, Wes Ogilvie, MPA, JD, EMT-B Attorney at Law/Emergency Medical Technician Austin, Texas In a message dated 2/26/2006 9:37:26 PM Central Standard Time, flymedic1@... writes: but if you had a FLIGHT CREW a cental line would be placed and the patient mght survive > From: wegandy1938@... > Date: 2006/02/25 Sat PM 08:06:23 CST > To: AmbuBag@..., > Subject: Re: Hydrofluoric acid > > The information I have, from Goldfrank's Toxicological Emergencies, 6th > edition, is that the nebulized calcium works very quickly. Of course, this is > given along with IV calcium gluconate and/or magnesium. > > Calcium choride can be given also, but it is very irritating to the vascular > system and is best given through a central line which, of course, most of us > do not do. > > There are many, many variations on treatment modalities, depending on which > source you read, but all of them involve calcium administration, generally by > multiple routes. > > Because of your excellent responses, I am granting you a reprieve from > Ladonia. > > Gene > In a message dated 2/25/06 18:47:41, ambubag@... writes: > > > > Gene, > > > > I wonder how long it will take to reverse the effects of HF inhalation using > > the nebulized calcium gluconate? I am assuming that it depends on how long > > she was exposed and the amount inhaled. Since I am not sure I am still going > > to > > have my airway equipment ready. > > > > Also, thanks for coming back to the list and posting scenarios. These are > > learning experiences and the spirit of this list should be just that. > > > > What time am I leaving for Ladonia? > > > > > > > > > > [Non-text portions of this message have been removed] > > > > > > > > > > Yahoo! Groups Links > > > > > > > > > > > > > > > > > > > > > > E.(Gene) Gandy > POB 1651 > Albany, TX 76430 > wegandy1938@... > > > > [Non-text portions of this message have been removed] > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 27, 2006 Report Share Posted February 27, 2006 Tom - Yes, there are. I've personally witnessed them, and had them placed on patients I worked. I've never placed one and never been trained to place one myself... but I've known medics that have, have been protocoled to do so, and have done so. Mike > > Wes, > > Are you telling me that there are ground crews in > Houston area that are doing central lines? > > Tom > > --- ExLngHrn@... wrote: > > > --------------------------------- > > Oh gee, pardon me. I may just be a dumb lawyer and > ground medic, but could > someone point me to the DSHS regs where it states that > only a flight medic or > RN can install a central line? If so, please let many > of the Houston area > providers know so they can cease doing it. > > More importantly, can you point me to any scientific > reason why a central > line is needed? Which reference recommends the > installation of a central line? > > Regards, > Wes Ogilvie, MPA, JD, EMT-B > Attorney at Law/Emergency Medical Technician > Austin, Texas > > > In a message dated 2/26/2006 9:37:26 PM Central > Standard Time, > flymedic1@... writes: > > but if you had a FLIGHT CREW a cental line would be > placed and the patient > mght survive > > From: wegandy1938@... > > Date: 2006/02/25 Sat PM 08:06:23 CST > > To: AmbuBag@..., > > Subject: Re: Hydrofluoric acid > > > > The information I have, from Goldfrank's > Toxicological Emergencies, 6th > > edition, is that the nebulized calcium works very > quickly. Of course, > this is > > given along with IV calcium gluconate and/or > magnesium. > > > > Calcium choride can be given also, but it is very > irritating to the > vascular > > system and is best given through a central line > which, of course, most of > us > > do not do. > > > > There are many, many variations on treatment > modalities, depending on > which > > source you read, but all of them involve calcium > administration, generally > by > > multiple routes. > > > > Because of your excellent responses, I am granting > you a reprieve from > > Ladonia. > > > > Gene > > In a message dated 2/25/06 18:47:41, > ambubag@... writes: > > > > > > > Gene, > > > > > > I wonder how long it will take to reverse the > effects of HF inhalation > using > > > the nebulized calcium gluconate? I am assuming > that it depends on how > long > > > she was exposed and the amount inhaled. Since I > am not sure I am still > going > > > to > > > have my airway equipment ready. > > > > > > Also, thanks for coming back to the list and > posting scenarios. These are > > > learning experiences and the spirit of this list > should be just that. > > > > > > What time am I leaving for Ladonia? > > > > > > > > > > > > > > > [Non-text portions of this message have been > removed] > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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