Guest guest Posted July 15, 2011 Report Share Posted July 15, 2011 So... for anyone who has missed it, Tetanus was the answer. The young man is suffering from Tetanus. Due to: - the risk of laryngeal spasm at any time (1) - the need for intubation in 67% of Tetanus patients (2) - the possibility of RSI inducing a spasm and force you to use a surgical airway (2) - the mortality rate of Tetanus being 45% (1 in 2 chance your patient will not survive). (3) ....I would MedEvac this patient emergently. Wes has won it and unfortunately that means he gets a prize from me. Expect a misshapen package, poorly wrapped in brown paper, with almost indiscernible handwriting to show up on your doorstep in 6 - 8 weeks. Try to open in it a crowd. I am, of course, kidding. But I will buy you a drink when I see you at the conference this year. Stay safe out there. Regards, Alyssa Woods, NREMT-B (1) http://emedicine.medscape.com/article/786414-clinical (2) http://emedicine.medscape.com/article/786414-treatment (3) http://emedicine.medscape.com/article/786414-overview > Mine are lagging too. > > Wes > > On the move from my iPhone > > > > > Apparently, my messages have not been getting out to the group, so I'm > > trying this on another computer. > > > > He can't remember the last time he had a tetanus shot. > > > > Now the important question -- does he need the MedEvac? > > > > Regards, > > > > Alyssa Woods, NREMT-B > > > > > > > > > >> ** > >> > >> > >> When was his last tetanus shot? > >> > >> Wes > >> > >> On the move from my iPhone > >> > >> > >> > >>> Ok, when you talk him into removing his socks & underwear, you notice an > >> old puncture wound on his foot. He states it's probably been about 2 weeks > >> since the injury. > >>> > >>> Alyssa Woods, NREMT-B > >>> > >>> > >>> Sent from the itty bitty keyboard on my iPhone > >>> > >>> > >>> > >>>> I said a complete head to toe... > >>>> > >>>> On the move from my iPhone > >>>> > >>>> > >>>> > >>>>> Nope. > >>>>> > >>>>> Pt requests to keep his socks & underwear on, because the room is > >> rather cold. Other than that, your exam is unremarkable. > >>>>> > >>>>> Alyssa Woods, NREMT-B > >>>>> > >>>>> > >>>>> Sent from the itty bitty keyboard on my iPhone > >>>>> > >>>>> > >>>>> > >>>>>> Anyone asked for a head to toe exam yet? > >>>>>> > >>>>>> Wes > >>>>>> > >>>>>> On the move from my iPhone > >>>>>> > >>>>>> On Jul 14, 2011, at 15:16, Alyssa Woods amwoods8644@...> > >> wrote: > >>>>>> > >>>>>>> No DVT. > >>>>>>> > >>>>>>> Any basics that want to swoop in and save the day? > >>>>>>> > >>>>>>> Alyssa Woods, NREMT-B > >>>>>>> > >>>>>>> > >>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>> > >>>>>>> On Jul 14, 2011, at 14:49, " McClanahan, " < > >> chris.mcclanahan@...> wrote: > >>>>>>> > >>>>>>>> Possibly a DVT forming in the leg or just below the bifurcation > >> of the vena cava? > >>>>>>>> Chris > >>>>>>>> > >>>>>>>> From: texasems-l [mailto: > >> texasems-l ] On Behalf Of krin135@... > >>>>>>>> Sent: Thursday, July 14, 2011 12:45 PM > >>>>>>>> To: texasems-l > >>>>>>>> Subject: Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to > >> stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@... writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, > >> must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@... >> krin135%40aol.com> wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@... > >> writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2011 Report Share Posted July 15, 2011 i autoclaved the hell outta a rusty nail a few years ago. i can pretty much guarantee it's the only tetanus-free rusty mail in texas (wink,wink,nudge,nudge) jimmy " too much free time " davis paramedic ________________________________ To: texasems-l Sent: Friday, July 15, 2011 5:53 PM Subject: Re: Mystery Diagnosis 2 So... for anyone who has missed it, Tetanus was the answer. The young man is suffering from Tetanus. Due to: - the risk of laryngeal spasm at any time (1) - the need for intubation in 67% of Tetanus patients (2) - the possibility of RSI inducing a spasm and force you to use a surgical airway (2) - the mortality rate of Tetanus being 45% (1 in 2 chance your patient will not survive). (3) ....I would MedEvac this patient emergently. Wes has won it and unfortunately that means he gets a prize from me. Expect a misshapen package, poorly wrapped in brown paper, with almost indiscernible handwriting to show up on your doorstep in 6 - 8 weeks. Try to open in it a crowd. I am, of course, kidding. But I will buy you a drink when I see you at the conference this year. Stay safe out there. Regards, Alyssa Woods, NREMT-B (1) http://emedicine.medscape.com/article/786414-clinical (2) http://emedicine.medscape.com/article/786414-treatment (3) http://emedicine.medscape.com/article/786414-overview > Mine are lagging too. > > Wes > > On the move from my iPhone > > > > > Apparently, my messages have not been getting out to the group, so I'm > > trying this on another computer. > > > > He can't remember the last time he had a tetanus shot. > > > > Now the important question -- does he need the MedEvac? > > > > Regards, > > > > Alyssa Woods, NREMT-B > > > > > > > > > >> ** > >> > >> > >> When was his last tetanus shot? > >> > >> Wes > >> > >> On the move from my iPhone > >> > >> > >> > >>> Ok, when you talk him into removing his socks & underwear, you notice an > >> old puncture wound on his foot. He states it's probably been about 2 weeks > >> since the injury. > >>> > >>> Alyssa Woods, NREMT-B > >>> > >>> > >>> Sent from the itty bitty keyboard on my iPhone > >>> > >>> > >>> > >>>> I said a complete head to toe... > >>>> > >>>> On the move from my iPhone > >>>> > >>>> > >>>> > >>>>> Nope. > >>>>> > >>>>> Pt requests to keep his socks & underwear on, because the room is > >> rather cold. Other than that, your exam is unremarkable. > >>>>> > >>>>> Alyssa Woods, NREMT-B > >>>>> > >>>>> > >>>>> Sent from the itty bitty keyboard on my iPhone > >>>>> > >>>>> > >>>>> > >>>>>> Anyone asked for a head to toe exam yet? > >>>>>> > >>>>>> Wes > >>>>>> > >>>>>> On the move from my iPhone > >>>>>> > >>>>>> On Jul 14, 2011, at 15:16, Alyssa Woods amwoods8644@...> > >> wrote: > >>>>>> > >>>>>>> No DVT. > >>>>>>> > >>>>>>> Any basics that want to swoop in and save the day? > >>>>>>> > >>>>>>> Alyssa Woods, NREMT-B > >>>>>>> > >>>>>>> > >>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>> > >>>>>>> On Jul 14, 2011, at 14:49, " McClanahan, " < > >> chris.mcclanahan@...> wrote: > >>>>>>> > >>>>>>>> Possibly a DVT forming in the leg or just below the bifurcation > >> of the vena cava? > >>>>>>>> Chris > >>>>>>>> > >>>>>>>> From: texasems-l [mailto: > >> texasems-l ] On Behalf Of krin135@... > >>>>>>>> Sent: Thursday, July 14, 2011 12:45 PM > >>>>>>>> To: texasems-l > >>>>>>>> Subject: Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to > >> stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@... writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, > >> must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@... >> krin135%40aol.com> wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@... > >> writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 15, 2011 Report Share Posted July 15, 2011 i autoclaved the hell outta a rusty nail a few years ago. i can pretty much guarantee it's the only tetanus-free rusty mail in texas (wink,wink,nudge,nudge) jimmy " too much free time " davis paramedic ________________________________ To: texasems-l Sent: Friday, July 15, 2011 5:53 PM Subject: Re: Mystery Diagnosis 2 So... for anyone who has missed it, Tetanus was the answer. The young man is suffering from Tetanus. Due to: - the risk of laryngeal spasm at any time (1) - the need for intubation in 67% of Tetanus patients (2) - the possibility of RSI inducing a spasm and force you to use a surgical airway (2) - the mortality rate of Tetanus being 45% (1 in 2 chance your patient will not survive). (3) ....I would MedEvac this patient emergently. Wes has won it and unfortunately that means he gets a prize from me. Expect a misshapen package, poorly wrapped in brown paper, with almost indiscernible handwriting to show up on your doorstep in 6 - 8 weeks. Try to open in it a crowd. I am, of course, kidding. But I will buy you a drink when I see you at the conference this year. Stay safe out there. Regards, Alyssa Woods, NREMT-B (1) http://emedicine.medscape.com/article/786414-clinical (2) http://emedicine.medscape.com/article/786414-treatment (3) http://emedicine.medscape.com/article/786414-overview > Mine are lagging too. > > Wes > > On the move from my iPhone > > > > > Apparently, my messages have not been getting out to the group, so I'm > > trying this on another computer. > > > > He can't remember the last time he had a tetanus shot. > > > > Now the important question -- does he need the MedEvac? > > > > Regards, > > > > Alyssa Woods, NREMT-B > > > > > > > > > >> ** > >> > >> > >> When was his last tetanus shot? > >> > >> Wes > >> > >> On the move from my iPhone > >> > >> > >> > >>> Ok, when you talk him into removing his socks & underwear, you notice an > >> old puncture wound on his foot. He states it's probably been about 2 weeks > >> since the injury. > >>> > >>> Alyssa Woods, NREMT-B > >>> > >>> > >>> Sent from the itty bitty keyboard on my iPhone > >>> > >>> > >>> > >>>> I said a complete head to toe... > >>>> > >>>> On the move from my iPhone > >>>> > >>>> > >>>> > >>>>> Nope. > >>>>> > >>>>> Pt requests to keep his socks & underwear on, because the room is > >> rather cold. Other than that, your exam is unremarkable. > >>>>> > >>>>> Alyssa Woods, NREMT-B > >>>>> > >>>>> > >>>>> Sent from the itty bitty keyboard on my iPhone > >>>>> > >>>>> > >>>>> > >>>>>> Anyone asked for a head to toe exam yet? > >>>>>> > >>>>>> Wes > >>>>>> > >>>>>> On the move from my iPhone > >>>>>> > >>>>>> On Jul 14, 2011, at 15:16, Alyssa Woods amwoods8644@...> > >> wrote: > >>>>>> > >>>>>>> No DVT. > >>>>>>> > >>>>>>> Any basics that want to swoop in and save the day? > >>>>>>> > >>>>>>> Alyssa Woods, NREMT-B > >>>>>>> > >>>>>>> > >>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>> > >>>>>>> On Jul 14, 2011, at 14:49, " McClanahan, " < > >> chris.mcclanahan@...> wrote: > >>>>>>> > >>>>>>>> Possibly a DVT forming in the leg or just below the bifurcation > >> of the vena cava? > >>>>>>>> Chris > >>>>>>>> > >>>>>>>> From: texasems-l [mailto: > >> texasems-l ] On Behalf Of krin135@... > >>>>>>>> Sent: Thursday, July 14, 2011 12:45 PM > >>>>>>>> To: texasems-l > >>>>>>>> Subject: Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to > >> stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@... writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, > >> must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@... >> krin135%40aol.com> wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@... > >> writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 18, 2011 Report Share Posted July 18, 2011 I haven't been keeping up with this. Why does he need AirEvac? GG Re: Mystery Diagnosis 2 >>>>>>>> >>>>>>>> that is a change. Many of the old off shore workers used to stock up on >>>>>>>> Nyquel because booze was banned... >>>>>>>> >>>>>>>> ck >>>>>>>> >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, >>>>>>>> amwoods8644@...; writes: >>>>>>>> >>>>>>>> Pt denies smoking or drug use. >>>>>>>> >>>>>>>> Both are contraband on the vessel; all medications, even OTC, must go >>>>>>>> through you. >>>>>>>> >>>>>>>> Alyssa Woods, NREMT-B >>>>>>>> >>>>>>>> >>>>>>>> Sent from the itty bitty keyboard on my iPhone >>>>>>>> >>>>>>>> On Jul 14, 2011, at 12:09, krin135@...; wrote: >>>>>>>> >>>>>>>>> ok...so how much does the patient smoke? >>>>>>>>> >>>>>>>>> and how much Nyquel did he bring on board? >>>>>>>>> >>>>>>>>> ck >>>>>>>>> >>>>>>>>> >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, >>>>>>>>> amwoods8644@...; writes: >>>>>>>>> >>>>>>>>> CBC: >>>>>>>>> Hemoglobin-----17 *H >>>>>>>>> Hematocrit-------52 *H >>>>>>>>> RBC---------------5.2 >>>>>>>>> MCV---------------100 >>>>>>>>> MCH---------------32.7 >>>>>>>>> MCHC-------------32.7 >>>>>>>>> Platelets----------276 000 >>>>>>>>> WBC---------------11 000 *H >>>>>>>>> >>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 19, 2011 Report Share Posted July 19, 2011 1. Tetanus has a mortality rate of 45%. 2. Laryngospasm can occur at any time. 3. Laryngospasm can occur as a result of RSI, so you have to be ready to secure a surgical airway at any time. Alyssa Woods, NREMT-B > I haven't been keeping up with this. Why does he need AirEvac? > > GG > > Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@...; writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@...; wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@...; writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 And how does this require air evac? Where is the evidence that air evac will improve this patient's outcome? Can mere paramedic not control a laryngospasm and do a surgical airway? What triggers a laryngospasm? How do you break one if it occurs? Gene Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@...; writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@...; wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@...; writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 Ummm....Gene, have you ever handled a full blown tetanus case? I have, albeit almost 25 years ago...and I still remember how tough it was to handle even in the ICU of a decent teaching hospital. Opisthotonus is NOT a fun thing to watch, however memorable it might be... I, for one, would not want to be responsible for protecting this chap's airway for a two or three hour boat ride from the off shore platform to land, nor would I want to be solely responsible for his airway for hours on end on the platform with no relief or back up....the spasm can be cause by as little as a cough due to airway secretions and is tough to break- IIRC, high dose BZDP and high dose (4 grams loading) magnesium will work but often takes a while...constant infusion paralytics are used in the ICU. All of these probably will not be practical in the field due to limited supplies. Once the diagnosis of tetanus is *SUSPECTED,* as a medical control physician, I would advise for *IMMEDIATE* evacuation of the patient by the fastest means possible, AND would recommend sending a full critical care transport team to retrieve the patient. Consideration for including a field qualified CRNA or upper level EM, anesthesia or surgical resident/fellow (as well as at least one CCRN or CEN, a paramedic and a respiratory therapist) should be undertaken if there is a chance that the team will be weathered in on the rig. yes, I understand that this will take at least a Bell 212/412, AW 139 or BK 117 helo, and not the usual JetRanger for transport- if the weather is 'clear, blue and 22,' then you could get away with two medics and an RT- bounce in with the patient rigged for transport ahead of time, swap one medic for the medic in contact and be skids off in 3 minutes, then treat en route- I'd still want the larger helo!. as a temporizing measure pending evacuation, if a multiplace recompression chamber was immediately available on the rig, I'd have the medic start a modified Table 6 schedule, using the BIBB mask at 100% oxygen, the use of a BZDP (Valium probably, due to its long half life) to help prevent spasms, metronidazole IV is possible, and provide on line medical direction for basic debridement of the wound. Presumably there would be someone besides the medic qualified to run the chamber (Dive Masters and Saturation Divers are usually trained for this and would normally be on any rig that has a recompression chamber). I would not use hyperbaric oxygen in a single place chamber until the airway was secured, as it's tough to salvage a spasmed airway when you are separated by 2 cm of plexi and 30 psig of pressure. ck part of the reason that I *did* qualify as a multiplace chamber operator was that tetanus case when I was an Intern.... In a message dated 07/20/11 01:40:50 Central Daylight Time, wegandy@... writes: And how does this require air evac? Where is the evidence that air evac will improve this patient's outcome? Can mere paramedic not control a laryngospasm and do a surgical airway? What triggers a laryngospasm? How do you break one if it occurs? Gene -----Original Message----- To: texasems-l Sent: Tue, Jul 19, 2011 2:26 am Subject: Re: Mystery Diagnosis 2 1. Tetanus has a mortality rate of 45%. 2. Laryngospasm can occur at any time. 3. Laryngospasm can occur as a result of RSI, so you have to be ready to secure a surgical airway at any time. Alyssa Woods, NREMT-B > I haven't been keeping up with this. Why does he need AirEvac? > > GG > > Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@...; writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@...; wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@...; writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> [Non-text portions of this message have been removed] > >>>>>>>>> > >>>>>>>>> > >>>>>>>> > >>>>>>>> [Non-text portions of this message have been removed] > >>>>>>>> > >>>>>>>> ------------------------------------ > >>>>>>>> > >>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 Ummm....Gene, have you ever handled a full blown tetanus case? I have, albeit almost 25 years ago...and I still remember how tough it was to handle even in the ICU of a decent teaching hospital. Opisthotonus is NOT a fun thing to watch, however memorable it might be... I, for one, would not want to be responsible for protecting this chap's airway for a two or three hour boat ride from the off shore platform to land, nor would I want to be solely responsible for his airway for hours on end on the platform with no relief or back up....the spasm can be cause by as little as a cough due to airway secretions and is tough to break- IIRC, high dose BZDP and high dose (4 grams loading) magnesium will work but often takes a while...constant infusion paralytics are used in the ICU. All of these probably will not be practical in the field due to limited supplies. Once the diagnosis of tetanus is *SUSPECTED,* as a medical control physician, I would advise for *IMMEDIATE* evacuation of the patient by the fastest means possible, AND would recommend sending a full critical care transport team to retrieve the patient. Consideration for including a field qualified CRNA or upper level EM, anesthesia or surgical resident/fellow (as well as at least one CCRN or CEN, a paramedic and a respiratory therapist) should be undertaken if there is a chance that the team will be weathered in on the rig. yes, I understand that this will take at least a Bell 212/412, AW 139 or BK 117 helo, and not the usual JetRanger for transport- if the weather is 'clear, blue and 22,' then you could get away with two medics and an RT- bounce in with the patient rigged for transport ahead of time, swap one medic for the medic in contact and be skids off in 3 minutes, then treat en route- I'd still want the larger helo!. as a temporizing measure pending evacuation, if a multiplace recompression chamber was immediately available on the rig, I'd have the medic start a modified Table 6 schedule, using the BIBB mask at 100% oxygen, the use of a BZDP (Valium probably, due to its long half life) to help prevent spasms, metronidazole IV is possible, and provide on line medical direction for basic debridement of the wound. Presumably there would be someone besides the medic qualified to run the chamber (Dive Masters and Saturation Divers are usually trained for this and would normally be on any rig that has a recompression chamber). I would not use hyperbaric oxygen in a single place chamber until the airway was secured, as it's tough to salvage a spasmed airway when you are separated by 2 cm of plexi and 30 psig of pressure. ck part of the reason that I *did* qualify as a multiplace chamber operator was that tetanus case when I was an Intern.... In a message dated 07/20/11 01:40:50 Central Daylight Time, wegandy@... writes: And how does this require air evac? Where is the evidence that air evac will improve this patient's outcome? Can mere paramedic not control a laryngospasm and do a surgical airway? What triggers a laryngospasm? How do you break one if it occurs? Gene -----Original Message----- To: texasems-l Sent: Tue, Jul 19, 2011 2:26 am Subject: Re: Mystery Diagnosis 2 1. Tetanus has a mortality rate of 45%. 2. Laryngospasm can occur at any time. 3. Laryngospasm can occur as a result of RSI, so you have to be ready to secure a surgical airway at any time. Alyssa Woods, NREMT-B > I haven't been keeping up with this. Why does he need AirEvac? > > GG > > Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@...; writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@...; wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@...; writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> [Non-text portions of this message have been removed] > >>>>>>>>> > >>>>>>>>> > >>>>>>>> > >>>>>>>> [Non-text portions of this message have been removed] > >>>>>>>> > >>>>>>>> ------------------------------------ > >>>>>>>> > >>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 Ummm....Gene, have you ever handled a full blown tetanus case? I have, albeit almost 25 years ago...and I still remember how tough it was to handle even in the ICU of a decent teaching hospital. Opisthotonus is NOT a fun thing to watch, however memorable it might be... I, for one, would not want to be responsible for protecting this chap's airway for a two or three hour boat ride from the off shore platform to land, nor would I want to be solely responsible for his airway for hours on end on the platform with no relief or back up....the spasm can be cause by as little as a cough due to airway secretions and is tough to break- IIRC, high dose BZDP and high dose (4 grams loading) magnesium will work but often takes a while...constant infusion paralytics are used in the ICU. All of these probably will not be practical in the field due to limited supplies. Once the diagnosis of tetanus is *SUSPECTED,* as a medical control physician, I would advise for *IMMEDIATE* evacuation of the patient by the fastest means possible, AND would recommend sending a full critical care transport team to retrieve the patient. Consideration for including a field qualified CRNA or upper level EM, anesthesia or surgical resident/fellow (as well as at least one CCRN or CEN, a paramedic and a respiratory therapist) should be undertaken if there is a chance that the team will be weathered in on the rig. yes, I understand that this will take at least a Bell 212/412, AW 139 or BK 117 helo, and not the usual JetRanger for transport- if the weather is 'clear, blue and 22,' then you could get away with two medics and an RT- bounce in with the patient rigged for transport ahead of time, swap one medic for the medic in contact and be skids off in 3 minutes, then treat en route- I'd still want the larger helo!. as a temporizing measure pending evacuation, if a multiplace recompression chamber was immediately available on the rig, I'd have the medic start a modified Table 6 schedule, using the BIBB mask at 100% oxygen, the use of a BZDP (Valium probably, due to its long half life) to help prevent spasms, metronidazole IV is possible, and provide on line medical direction for basic debridement of the wound. Presumably there would be someone besides the medic qualified to run the chamber (Dive Masters and Saturation Divers are usually trained for this and would normally be on any rig that has a recompression chamber). I would not use hyperbaric oxygen in a single place chamber until the airway was secured, as it's tough to salvage a spasmed airway when you are separated by 2 cm of plexi and 30 psig of pressure. ck part of the reason that I *did* qualify as a multiplace chamber operator was that tetanus case when I was an Intern.... In a message dated 07/20/11 01:40:50 Central Daylight Time, wegandy@... writes: And how does this require air evac? Where is the evidence that air evac will improve this patient's outcome? Can mere paramedic not control a laryngospasm and do a surgical airway? What triggers a laryngospasm? How do you break one if it occurs? Gene -----Original Message----- To: texasems-l Sent: Tue, Jul 19, 2011 2:26 am Subject: Re: Mystery Diagnosis 2 1. Tetanus has a mortality rate of 45%. 2. Laryngospasm can occur at any time. 3. Laryngospasm can occur as a result of RSI, so you have to be ready to secure a surgical airway at any time. Alyssa Woods, NREMT-B > I haven't been keeping up with this. Why does he need AirEvac? > > GG > > Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@...; writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@...; wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@...; writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> [Non-text portions of this message have been removed] > >>>>>>>>> > >>>>>>>>> > >>>>>>>> > >>>>>>>> [Non-text portions of this message have been removed] > >>>>>>>> > >>>>>>>> ------------------------------------ > >>>>>>>> > >>>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 I'm right there with you Gene, I'd make the guy swim! Seriously though, there are a lot of instances where I completely support the routine flogging of air ambulances, but offshore isn't one of them. I can come up with a dozen reasons (and I was: my initial reply was more of a white paper then an email) but ultimately I think that in this case and the offshore environment that the question really needs to be: Why SHOULDN'T we fly these patients? Many of the socioeconomic pressures that lend themselves to overuse of helicopters on ground are reversed offshore with a tendency towards more " routine " transportation for " sick persons " when a more emergent method would probably be indicated. Honestly, if an offshore " medic " (many of which are NOT paramedics) is willing to ring the " medevac " -bell, it tells me that s/he was legitimately concerned about the patient and put their ass out there for him/her. I support that, whether or not the medevac was medically-indicated or -necessary. Austin > And how does this require air evac? > > Where is the evidence that air evac will improve this patient's outcome? > Can mere paramedic not control a laryngospasm and do a surgical airway? > > What triggers a laryngospasm? How do you break one if it occurs? > > Gene > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 I'm right there with you Gene, I'd make the guy swim! Seriously though, there are a lot of instances where I completely support the routine flogging of air ambulances, but offshore isn't one of them. I can come up with a dozen reasons (and I was: my initial reply was more of a white paper then an email) but ultimately I think that in this case and the offshore environment that the question really needs to be: Why SHOULDN'T we fly these patients? Many of the socioeconomic pressures that lend themselves to overuse of helicopters on ground are reversed offshore with a tendency towards more " routine " transportation for " sick persons " when a more emergent method would probably be indicated. Honestly, if an offshore " medic " (many of which are NOT paramedics) is willing to ring the " medevac " -bell, it tells me that s/he was legitimately concerned about the patient and put their ass out there for him/her. I support that, whether or not the medevac was medically-indicated or -necessary. Austin > And how does this require air evac? > > Where is the evidence that air evac will improve this patient's outcome? > Can mere paramedic not control a laryngospasm and do a surgical airway? > > What triggers a laryngospasm? How do you break one if it occurs? > > Gene > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 agreed with the tight quarters...but it is one of the few temporizing measures that *might* be available offshore if the weather was bad enough to prevent urgent MEDEVAC. A Table 6 dive using pure oxy in the BIBB should not be a significant risk factor for a short (less than one hour), low (500 foot AGL), fast (cyclic to the panel, collective in the armpit) flight back to a major medical center, even if the flight is within six hours of breaking the seal. I agree that Table 6 runs about 5 hours, depending on speed of 'descent,' with Table 5 being about half that, IIRC. So in a situation where the patient is sick but not yet toxic nor spasming, AND there is no way to get him off the platform, THEN a chamber dive MIGHT temporize the situation and prevent deterioration pending the weather clearing. As I mentioned, I'd use the BIBB on pure oxygen for the first 30-60 minutes to clear the nitrogen load. I'd then switch to either heliox or trimix (to reduce the chances of oxygen toxicity) until the patient reached 30 fsw equivalent, and then go back to pure oxygen until the 'surface' is reached. There are no good answers *except* to get the patient moved to a full service facility ASAP. for those interested, the USN site with the USN Dive Manual (which is also used by NOAA) is here: _http://www.supsalv.org/00c3_publications.asp_ (http://www.supsalv.org/00c3_publications.asp) ck In a message dated 07/20/11 11:43:53 Central Daylight Time, abaustin+yahoogroups@... writes: I don't think this is a great idea. Most " multiplace " chambers on vessels (aside from the full-on Sat systems) are too diminutive to be terribly useful for medical purposes (aside from those related to diving). Access is a problem, as healthy guys (particularly who are carrying any extra weight) can have problems getting into and out of them, much less sick or spasming guys. You also have the (admittedly minor) issue of putting them in a helicopter after compressing them for four hours. Not a huge risk, but you will likely get some resistance from diving supervisor/superintendent as that is considered verboten for most of these guys (for 24-48 hours depending on the dive). Logistically there are a hell of a lot of other problems that aren't worth going into, IMO. Plenty of people to run the chamber though, that's not a big deal. I think a guy with frank tetanus symptoms offshore is a world of hurt and I doubt there would be enough medications aboard to manage it for the time it would take for a helicopter to get there much less to run the ~5 hours of Table 6. I can't recall offhand, but isn't the dosing something like 1mg/kg of benzos q 3 hours? I'm not even sure I'd have enough for the first dose at the last boat I was on. Austin > as a temporizing measure pending evacuation, if a multiplace recompression > chamber was immediately available on the rig, I'd have the medic start a > modified Table 6 schedule, using the BIBB mask at 100% oxygen, the use of a > BZDP (Valium probably, due to its long half life) to help prevent spasms, > metronidazole IV is possible, and provide on line medical direction for > basic debridement of the wound. Presumably there would be someone besides the > medic qualified to run the chamber (Dive Masters and Saturation Divers are > usually trained for this and would normally be on any rig that has a > recompression chamber). [Non-text portions of this message have been removed] ------------------------------------ Yahoo! Groups Links Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 agreed with the tight quarters...but it is one of the few temporizing measures that *might* be available offshore if the weather was bad enough to prevent urgent MEDEVAC. A Table 6 dive using pure oxy in the BIBB should not be a significant risk factor for a short (less than one hour), low (500 foot AGL), fast (cyclic to the panel, collective in the armpit) flight back to a major medical center, even if the flight is within six hours of breaking the seal. I agree that Table 6 runs about 5 hours, depending on speed of 'descent,' with Table 5 being about half that, IIRC. So in a situation where the patient is sick but not yet toxic nor spasming, AND there is no way to get him off the platform, THEN a chamber dive MIGHT temporize the situation and prevent deterioration pending the weather clearing. As I mentioned, I'd use the BIBB on pure oxygen for the first 30-60 minutes to clear the nitrogen load. I'd then switch to either heliox or trimix (to reduce the chances of oxygen toxicity) until the patient reached 30 fsw equivalent, and then go back to pure oxygen until the 'surface' is reached. There are no good answers *except* to get the patient moved to a full service facility ASAP. for those interested, the USN site with the USN Dive Manual (which is also used by NOAA) is here: _http://www.supsalv.org/00c3_publications.asp_ (http://www.supsalv.org/00c3_publications.asp) ck In a message dated 07/20/11 11:43:53 Central Daylight Time, abaustin+yahoogroups@... writes: I don't think this is a great idea. Most " multiplace " chambers on vessels (aside from the full-on Sat systems) are too diminutive to be terribly useful for medical purposes (aside from those related to diving). Access is a problem, as healthy guys (particularly who are carrying any extra weight) can have problems getting into and out of them, much less sick or spasming guys. You also have the (admittedly minor) issue of putting them in a helicopter after compressing them for four hours. Not a huge risk, but you will likely get some resistance from diving supervisor/superintendent as that is considered verboten for most of these guys (for 24-48 hours depending on the dive). Logistically there are a hell of a lot of other problems that aren't worth going into, IMO. Plenty of people to run the chamber though, that's not a big deal. I think a guy with frank tetanus symptoms offshore is a world of hurt and I doubt there would be enough medications aboard to manage it for the time it would take for a helicopter to get there much less to run the ~5 hours of Table 6. I can't recall offhand, but isn't the dosing something like 1mg/kg of benzos q 3 hours? I'm not even sure I'd have enough for the first dose at the last boat I was on. Austin > as a temporizing measure pending evacuation, if a multiplace recompression > chamber was immediately available on the rig, I'd have the medic start a > modified Table 6 schedule, using the BIBB mask at 100% oxygen, the use of a > BZDP (Valium probably, due to its long half life) to help prevent spasms, > metronidazole IV is possible, and provide on line medical direction for > basic debridement of the wound. Presumably there would be someone besides the > medic qualified to run the chamber (Dive Masters and Saturation Divers are > usually trained for this and would normally be on any rig that has a > recompression chamber). [Non-text portions of this message have been removed] ------------------------------------ Yahoo! Groups Links Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 agreed with the tight quarters...but it is one of the few temporizing measures that *might* be available offshore if the weather was bad enough to prevent urgent MEDEVAC. A Table 6 dive using pure oxy in the BIBB should not be a significant risk factor for a short (less than one hour), low (500 foot AGL), fast (cyclic to the panel, collective in the armpit) flight back to a major medical center, even if the flight is within six hours of breaking the seal. I agree that Table 6 runs about 5 hours, depending on speed of 'descent,' with Table 5 being about half that, IIRC. So in a situation where the patient is sick but not yet toxic nor spasming, AND there is no way to get him off the platform, THEN a chamber dive MIGHT temporize the situation and prevent deterioration pending the weather clearing. As I mentioned, I'd use the BIBB on pure oxygen for the first 30-60 minutes to clear the nitrogen load. I'd then switch to either heliox or trimix (to reduce the chances of oxygen toxicity) until the patient reached 30 fsw equivalent, and then go back to pure oxygen until the 'surface' is reached. There are no good answers *except* to get the patient moved to a full service facility ASAP. for those interested, the USN site with the USN Dive Manual (which is also used by NOAA) is here: _http://www.supsalv.org/00c3_publications.asp_ (http://www.supsalv.org/00c3_publications.asp) ck In a message dated 07/20/11 11:43:53 Central Daylight Time, abaustin+yahoogroups@... writes: I don't think this is a great idea. Most " multiplace " chambers on vessels (aside from the full-on Sat systems) are too diminutive to be terribly useful for medical purposes (aside from those related to diving). Access is a problem, as healthy guys (particularly who are carrying any extra weight) can have problems getting into and out of them, much less sick or spasming guys. You also have the (admittedly minor) issue of putting them in a helicopter after compressing them for four hours. Not a huge risk, but you will likely get some resistance from diving supervisor/superintendent as that is considered verboten for most of these guys (for 24-48 hours depending on the dive). Logistically there are a hell of a lot of other problems that aren't worth going into, IMO. Plenty of people to run the chamber though, that's not a big deal. I think a guy with frank tetanus symptoms offshore is a world of hurt and I doubt there would be enough medications aboard to manage it for the time it would take for a helicopter to get there much less to run the ~5 hours of Table 6. I can't recall offhand, but isn't the dosing something like 1mg/kg of benzos q 3 hours? I'm not even sure I'd have enough for the first dose at the last boat I was on. Austin > as a temporizing measure pending evacuation, if a multiplace recompression > chamber was immediately available on the rig, I'd have the medic start a > modified Table 6 schedule, using the BIBB mask at 100% oxygen, the use of a > BZDP (Valium probably, due to its long half life) to help prevent spasms, > metronidazole IV is possible, and provide on line medical direction for > basic debridement of the wound. Presumably there would be someone besides the > medic qualified to run the chamber (Dive Masters and Saturation Divers are > usually trained for this and would normally be on any rig that has a > recompression chamber). [Non-text portions of this message have been removed] ------------------------------------ Yahoo! Groups Links Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 I don't think this is a great idea. Most " multiplace " chambers on vessels (aside from the full-on Sat systems) are too diminutive to be terribly useful for medical purposes (aside from those related to diving). Access is a problem, as healthy guys (particularly who are carrying any extra weight) can have problems getting into and out of them, much less sick or spasming guys. You also have the (admittedly minor) issue of putting them in a helicopter after compressing them for four hours. Not a huge risk, but you will likely get some resistance from diving supervisor/superintendent as that is considered verboten for most of these guys (for 24-48 hours depending on the dive). Logistically there are a hell of a lot of other problems that aren't worth going into, IMO. Plenty of people to run the chamber though, that's not a big deal. I think a guy with frank tetanus symptoms offshore is a world of hurt and I doubt there would be enough medications aboard to manage it for the time it would take for a helicopter to get there much less to run the ~5 hours of Table 6. I can't recall offhand, but isn't the dosing something like 1mg/kg of benzos q 3 hours? I'm not even sure I'd have enough for the first dose at the last boat I was on. Austin > as a temporizing measure pending evacuation, if a multiplace recompression > chamber was immediately available on the rig, I'd have the medic start a > modified Table 6 schedule, using the BIBB mask at 100% oxygen, the use of a > BZDP (Valium probably, due to its long half life) to help prevent spasms, > metronidazole IV is possible, and provide on line medical direction for > basic debridement of the wound. Presumably there would be someone besides the > medic qualified to run the chamber (Dive Masters and Saturation Divers are > usually trained for this and would normally be on any rig that has a > recompression chamber). Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 I don't think this is a great idea. Most " multiplace " chambers on vessels (aside from the full-on Sat systems) are too diminutive to be terribly useful for medical purposes (aside from those related to diving). Access is a problem, as healthy guys (particularly who are carrying any extra weight) can have problems getting into and out of them, much less sick or spasming guys. You also have the (admittedly minor) issue of putting them in a helicopter after compressing them for four hours. Not a huge risk, but you will likely get some resistance from diving supervisor/superintendent as that is considered verboten for most of these guys (for 24-48 hours depending on the dive). Logistically there are a hell of a lot of other problems that aren't worth going into, IMO. Plenty of people to run the chamber though, that's not a big deal. I think a guy with frank tetanus symptoms offshore is a world of hurt and I doubt there would be enough medications aboard to manage it for the time it would take for a helicopter to get there much less to run the ~5 hours of Table 6. I can't recall offhand, but isn't the dosing something like 1mg/kg of benzos q 3 hours? I'm not even sure I'd have enough for the first dose at the last boat I was on. Austin > as a temporizing measure pending evacuation, if a multiplace recompression > chamber was immediately available on the rig, I'd have the medic start a > modified Table 6 schedule, using the BIBB mask at 100% oxygen, the use of a > BZDP (Valium probably, due to its long half life) to help prevent spasms, > metronidazole IV is possible, and provide on line medical direction for > basic debridement of the wound. Presumably there would be someone besides the > medic qualified to run the chamber (Dive Masters and Saturation Divers are > usually trained for this and would normally be on any rig that has a > recompression chamber). Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 OOPS! I didn't know he was offshore! I had not been following this. Of course he would be flown. GG Re: Mystery Diagnosis 2 I'm right there with you Gene, I'd make the guy swim! Seriously though, there are a lot of instances where I completely support the routine flogging of air ambulances, but offshore isn't one of them. I can come up with a dozen reasons (and I was: my initial reply was more of a white paper then an email) but ultimately I think that in this case and the offshore environment that the question really needs to be: Why SHOULDN'T we fly these patients? Many of the socioeconomic pressures that lend themselves to overuse of helicopters on ground are reversed offshore with a tendency towards more " routine " transportation for " sick persons " when a more emergent method would probably be indicated. Honestly, if an offshore " medic " (many of which are NOT paramedics) is willing to ring the " medevac " -bell, it tells me that s/he was legitimately concerned about the patient and put their ass out there for him/her. I support that, whether or not the medevac was medically-indicated or -necessary. Austin > And how does this require air evac? > > Where is the evidence that air evac will improve this patient's outcome? > Can mere paramedic not control a laryngospasm and do a surgical airway? > > What triggers a laryngospasm? How do you break one if it occurs? > > Gene > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 OOPS! I didn't know he was offshore! I had not been following this. Of course he would be flown. GG Re: Mystery Diagnosis 2 I'm right there with you Gene, I'd make the guy swim! Seriously though, there are a lot of instances where I completely support the routine flogging of air ambulances, but offshore isn't one of them. I can come up with a dozen reasons (and I was: my initial reply was more of a white paper then an email) but ultimately I think that in this case and the offshore environment that the question really needs to be: Why SHOULDN'T we fly these patients? Many of the socioeconomic pressures that lend themselves to overuse of helicopters on ground are reversed offshore with a tendency towards more " routine " transportation for " sick persons " when a more emergent method would probably be indicated. Honestly, if an offshore " medic " (many of which are NOT paramedics) is willing to ring the " medevac " -bell, it tells me that s/he was legitimately concerned about the patient and put their ass out there for him/her. I support that, whether or not the medevac was medically-indicated or -necessary. Austin > And how does this require air evac? > > Where is the evidence that air evac will improve this patient's outcome? > Can mere paramedic not control a laryngospasm and do a surgical airway? > > What triggers a laryngospasm? How do you break one if it occurs? > > Gene > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 20, 2011 Report Share Posted July 20, 2011 I missed that he was offshore. Have been doing other things than reading the list. Of course he would be flown. I worked offshore and know how that is. Just got in in the middle of the movie, that's all. GG Re: Mystery Diagnosis 2 > >>>>>>>> > >>>>>>>> that is a change. Many of the old off shore workers used to stock up on > >>>>>>>> Nyquel because booze was banned... > >>>>>>>> > >>>>>>>> ck > >>>>>>>> > >>>>>>>> In a message dated 07/14/11 12:35:22 Central Daylight Time, > >>>>>>>> amwoods8644@...;; writes: > >>>>>>>> > >>>>>>>> Pt denies smoking or drug use. > >>>>>>>> > >>>>>>>> Both are contraband on the vessel; all medications, even OTC, must go > >>>>>>>> through you. > >>>>>>>> > >>>>>>>> Alyssa Woods, NREMT-B > >>>>>>>> > >>>>>>>> > >>>>>>>> Sent from the itty bitty keyboard on my iPhone > >>>>>>>> > >>>>>>>> On Jul 14, 2011, at 12:09, krin135@...;; wrote: > >>>>>>>> > >>>>>>>>> ok...so how much does the patient smoke? > >>>>>>>>> > >>>>>>>>> and how much Nyquel did he bring on board? > >>>>>>>>> > >>>>>>>>> ck > >>>>>>>>> > >>>>>>>>> > >>>>>>>>> In a message dated 07/14/11 08:21:53 Central Daylight Time, > >>>>>>>>> amwoods8644@...;; writes: > >>>>>>>>> > >>>>>>>>> CBC: > >>>>>>>>> Hemoglobin-----17 *H > >>>>>>>>> Hematocrit-------52 *H > >>>>>>>>> RBC---------------5.2 > >>>>>>>>> MCV---------------100 > >>>>>>>>> MCH---------------32.7 > >>>>>>>>> MCHC-------------32.7 > >>>>>>>>> Platelets----------276 000 > >>>>>>>>> WBC---------------11 000 *H > >>>>>>>>> > >>>>>>>>> [Non-text portions of this message have been removed] > >>>>>>>>> > >>>>>>>>> > >>>>>>>> > >>>>>>>> [Non-text portions of this message have been removed] > >>>>>>>> > >>>>>>>> ------------------------------------ > >>>>>>>> > >>>>>>>> Quote Link to comment Share on other sites More sharing options...
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