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EMSWORLD.com | JULY 2016 53 resides in a nursing home. After reading this article, you know that is a major risk factor for infections such as pneumonia. You hear crackles, but before you grab for the furosemide, which could potentially make a pneumonia case worse, you look at her list of medications. Nowhere is a cardiac medication or diuretic listed. This makes CHF less likely. However, you do see listed multiple pulmonary medica- tions such as albuterol. You realize that pre-existing lung disease is a major risk factor for pneumonia. Next you look at the vital signs. You see the patient is tachycardic with a low dia- stolic BP, corresponding to possible sepsis. After going through the rest of your his- tory and physical exam, you conclude this patient likely has pneumonia with sepsis. You administer a fluid bolus and call a sep- sis alert to the nearest hospital. On arrival, an x-ray confirms the presence of pneumo- nia in the left lung. The ED staff applauds you for avoiding diuretics and giving the needed intravenous f luids. Congratula- tions—you and your team have raised the odds that this patient will survive. R E F E R E N C E S 1. Dobson T, Jensen J, Karim S, Travers A. Correlation of paramedic administration of furosemide with emergency physician diagnosis of congestive heart failure. Australasian Journal of Paramedicine, 2009; 7(3). 2. Jaronik J, Mikkelson P, Fales W, Overton DT. Evaluation of prehospital use of furosemide in patients with respiratory distress. Prehosp Emerg Care, 2006 Apr–Jun; 10(2): 194–7. 3. Nield MA, Soo Hoo GW, Roper JM, Santiago S. Ef fcacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehabil Prev, 2007 Jul–Aug; 27(4): 237–44. 4. Tsuyuki RT, McKelvie RS, Arnold JM, et al. Acute precipitants of congestive heart failure exacerbations. Arch Intern Med, 2001 Oct 22; 161(19): 2,337–42. A B O U T T H E A U T H O R S Kenneth A. Scheppke, MD, is board-cer tified in EMS and emergenc y medicine. He has been prac ticing emergenc y medicine for over 20 years and is the EMS medical direc tor for six fire-rescue agencies in Palm Beach Count y, FL, including Palm Beach Gardens, Palm Beach Count y, West Palm Beach, Boynton Beach, the Town of Palm Beach and Greenacres. For more than 15 years he has trained paramedic s and EMTs as medical direc tor for the Palm Beach State College EMS Academy. He also ser ves as the assistant medical direc tor of the JFK Medical Center emergenc y depar tment in Atlantis, FL. Keith Br yer, BBA, EMT-P, has been employed with Palm Beach Gardens Fire Rescue for more than 25 years. He currently ser ves as the depar tment 's deput y chief of operations. For More Information Circle 39 on Reader Service Card For More Information Circle 40 on Reader Service Card Additional degree programs and online shifts available Boca Raton | Orlando | Sarasota | Tampa | Online 888.854.8308 SCAN HERE LEARN MORE ARE YOU PREPARED? BACHELOR Crisis & Disaster Management MASTER Public Health Administration Business Administration – Aviation Management – Construction Management – Project Management Aviation Science – Aviation Operations – Aviation Security Vital Signs 2016 EMS Conference Syracuse, NY October 13-16 You ' re Invited New Look, Same Great Conference! A Program of the Department of Health Visit us on the web at www.vitalsignsconference.com or call 518-402-0996 for more information. Hope to see you there!