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Re: Hydrofluoric acid

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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

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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

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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

>

>

>

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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

>

>

>

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,

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

>

>

>

>

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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

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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?

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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?

>

>

>

>

>

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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:  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

>

>

>

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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:  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

>

>

>

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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

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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

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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]

> >

> >

> >

> >

> >

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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?

> > >

> > >

> > >

> > >

> > >

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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]

> >

> >

> >

> >

> >

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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.

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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?

> >

> >

> >

> >

> >

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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]

> >

> >

> >

> >

> >

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Guest guest

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]

> >

> >

> >

> >

> >

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Guest guest

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]

> >

> >

> >

> >

> >

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Guest guest

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]

> > >

> > >

> > >

> >  >

> > >

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Guest guest

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]

> >

> >

> >

> >

> >

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Guest guest

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]

>

>

>

>

>

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Guest guest

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]

>

>

>

>

>

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Guest guest

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]

> > >

> > >

> > >

> > >

> > >

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