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/Asleep-Palpitation43]

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