Allergy Olympics

[u/Asleep-Palpitation43]

Is it wrong that if I see a patient has more than 10 allergies I IMMEDIATELY assume she's (bc it's always a she) a psych case?

In 24 years I've never been wrong.

You'll never read this in a textbook but add it to your practice today and thank me later👍

[u/tturedditor]

Why is EMS pushing dilt in the field and how much did they give? How old was she? How much did she weigh? What comorbidities did she have?

[u/Asleep-Palpitation43 → u/tturedditor]

Why is EMS pushing dilt in the field🤔Probably because NIH wrote an opinion that it's safe and effective and it's currently the standard pre hospital med in the majority of FL counties for symptomatic AFib with rvr with a SBP >100 that is unresponsive to fluid bolus.

She was 82, weighed 110 pounds, she got 13mg over 3 minutes, she was the healthiest octogenarian I've ever met.

[u/tturedditor → u/Asleep-Palpitation43]

In communities I've worked in I have never seen EMS push dilt in the field.

[u/Asleep-Palpitation43 → u/tturedditor]

And you extrapolated that to "I don't see it, therefore EMS doesn't push dilt anywhere." Very common logical fallacy.

This is her county in FL:

https://www.leegov.com/publicsafety/Documents/LeeCountyCommonTreatmentGuidelines.v04.2016.pdf

Google any county and "pre-hospital cardizem" and you'll likely be able to find their ems policy stating what drugs can be pushed.

[u/tturedditor → u/Asleep-Palpitation43]

I didn't say that. I have just never seen it personally. It just seems excessive for EMS to push in the field IMO unless hospital transport time is lengthy.

You seem to have a chip on your shoulder. I bet you are a beating to work with.

[u/Asleep-Palpitation43 → u/tturedditor]

Anyone who has witnessed an rvr patient with a hr of 180 developing pulmonary edema and starting to panic wouldn't think it's excessive to try to get rate control in the field. As someone who has pushed/prescribed the drug hundreds upon hundreds of times, it sounded like the right choice in the moment, she just responded very poorly to it. It happens

[u/tturedditor → u/Asleep-Palpitation43]

I was referring to a more stable presentation.

[u/Asleep-Palpitation43 → u/tturedditor]

I can't think of many "stable presentations" that are treated with drugs in the field

[u/tturedditor → u/Asleep-Palpitation43]

Your initial comment on protocol said afib RVR symptomatic with SBP > 100. Symptomatic could just mean palpitations. They don't present with florid pulmonary edema with much frequency, and a fluid bolus prior to dilt doesn't make much sense.

You are an insufferable noctor.

[u/Asleep-Palpitation43 → u/tturedditor]

If you knew some of the most likely causes of a fib are dehydration, etoh, infection, you would understand why IVF are indicated in the field for afib. Scary you didn't know that.

If you knew that a fib causes loss of atrial kick and up to a 30% reduction in ef, you would know that hypotension can often result, which is the primary indication for IVF.

Symptomatic could mean palps. But palps don't = unstable.

Do 1000 CXRs on 1000 a fib patients and tell me what % have any degree of pulmonary edema. You'll be surprised how little you know about this most common arrhythmia.💡

[u/tturedditor → u/Asleep-Palpitation43]

You are a toxic noctor trying to twist my words and create an argument. I am highly competent I can assure you. Treatment algorithms and years of experience tell me a fluid bolus is not indicated for the vast majority of cases.

Let's just recap here. I posted about a patient who claimed to have allergies which were in fact not the case. She was crazy. I called her out on it. I pushed dilt. She got better. My comment got over 500 likes thus far.

And somehow you picked a fight about this and insulted me repeatedly? Trying to twist my words?

Get a life.

[u/Asleep-Palpitation43 → u/tturedditor]

Cool revision

As I recall... 1)You didn't know why ems would/could give dilt in the field 2) You seemed to be confused that dilt could tank a pressure 3) you couldn't fathom why one would give IVF to a patient with afib🤭🤦‍♂️ 4) other various laughables

But hey, at least you got 500 likes 👏👏👏

[u/Asleep-Palpitation43 → u/tturedditor]

PS 9,000 comments😳 touch grass, friend. ASAP