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Or how to live for a few minutes, in an episode of ER or Dr. House . Joking aside Saturday I attended, in Chieti, a beautiful course organized by IRC for certification ILS, Immediate Life Support.

The course is designed to provide health professionals, doctors and nurses (and students of medicine and nursing) knowledge to recognize those patients whose clinical situation is rapidly deteriorating with possible detour to cardiac arrest and the management of the same range before the arrival of the resuscitation team, so in a situation but also extra, mainly hospital.

To understand, the idea is to understand that a patient's condition is rapidly deteriorating, understand who and what on and understand how to communicate to the team "advanced" the fundamental news for his prompt action. Then support the patient before the arrival of the advance team and manage, along with this, the patient after arrival.

Personally I found the course very nice and challenging than the usual BLSD , PBLSD and PTC ie with respect to the management of the basic functions and defibrillation in adults and pediatric patients and the management of trauma patients in the emergency "on the road".

I liked particolamente because I could see and experience advanced tools for airway management devices such as sopragrottici

I do not know if you remember but a couple of years ago I told you, a little 'humorously that if you need to intubate a person but you have not attended six years of medicine , then you could use the i-gel. Well, six years of medicine are also used for the i-gel, in reality, but today I had the chance to prove it, even if only on a dummy

Furthermore, the beauty of the course was also advanced management of the patient in terms of drugs and then with, for example, the retrieval of a venous access and the infusion of adrenaline and amiodarone after the third download of the DAE.

Finally, because it allowed me to see and participate in real-world scenarios where really, for a few minutes seemed to be in an episode of ER or, if you will, more seriously, in a real DEA.

Want to see what we did? Here is a summary transcript and revised one of the scenarios that I have gotten.

Instructor: Emiliano Then comes a 75 year old man in PS It 'a patient suffering from diverticulitis comes to important abdominal pain. They call you to assess it.

Me: I wear gloves and personal protective equipment. Scene safety, I guess it's safe. Quick-look assessment. How to find it.

Instructor: You find it just as you see, a little 'semi-recumbent position in which he complains.


I said, Lord, what happened?

Patient: I have a terrible evil.

I: What does it hurt?

Patient: The belly, it hurts.

I: The patient is then conscious.


I: The breath as he is?

Patient: It bothers me, do not let me talk.

Me: Ok, let's oxygen at high flows.

I: Now I find out and do the OPACS (observe, palp, listening, account oximeter).

Me: I observe the chest. The chest expands symmetrically and do not notice anything special observation.

I: The palp. Even palpation produces no pain, I feel it crackles voucher ribs.

Me: I take the stethoscope and auscultated peak apex, base base, and breathe breathe breathe and breathe.

I: Respiratory rate and 28 cycles per minute.

Me: I put the oximeter and the pulse oximeter does not detect anything.

Me: Because, however, the patient declares respiratory problems, as well as the frequency, let oxygen at high flows.


Me: I hit on a finger of the hand for five seconds and the time of perfusion is three seconds, top, which is why you probably do not take the oximeter.

Me: I take the radial pulse which is very weak and conuna frequency of 125/130 bpm. The pressure is 90/60.

I: No venous access. I take a venous access and, while there, I do a venipuncture requiring blood count, cardiac enzymes, EGA, electrolytes.

Me: I have a monitor that connects to connect and request to go get him and a 12-lead ECG derivation. The patient has not catheters.

I: Lord this morning has urinated.

Patient: I urinated last five hours ago, but now I have the urge.

Instructor: First comes the ECG refertato by the cardiologist that is fundamentally negative.


Me: I'm a GCS, the patient speaks to me, obeying my commands so it's a 15.

Me: I'm a Cincinnati, control pupils who are isocoriche isocicliche normoreagenti, ask him to shake hands that do not have asimmettrie in close.

Me: Because this is not yet the analysis, I stick glycemic detects a blood sugar of 95.


I: Now the ladies have to undress. I find it on the head sweaty and pale, the trachea is aligned and the jugular are flat.

I: Chest pain does not, refer back a OPACS fast that nothing has changed compared to the first except that the respiratory rate is further increased.

I: Palpo the abdomen

Instructor: Abdomen evokes pain and a hard board.

I: Basin-axis. On the legs I find nothing abnormal for a 75-year-old. The dorsalis pedis is not detectable. Nothing detectable on the upper limb and posteriorly.


I: Have you had any other illness or operations?

Patient: No.

I: E 'was in the hospital recently?

Patient: I did that shit back there, tube, fluoroscopy ....

I: Colonoscopy?

Patient: Yes

I: What c'aveva? Diverticula?

Patient: Yes, good, diverticula.

I: Allergies?

Patient: No. But they told me that I had so many of these diverticula and then came this morning m'è stomach ache. Forte.

I: It 'also went to the body.

Patient: No, I am not of the body for two days.

I: End of visit.

Instructor: Do you think a patient is critical or non-critical?

I: The frequency is high, very low pressure, the problem is in the abdomen, has diverticula, has a wooden abdomen. Has no signs of bleeding but is in shock.

Instructor: Here comes the CBC reported that 8 of hemoglobin.

Me: I feel the surgeon, is a critically ill patient with a high risk of collapsing soon.

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