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On a vaguely related note.... Love it! Lock up. Feed the dog. Contact the day care centre looking after the kids. Organize respite for the frail husband...the disabled kid. Ring a relative for a lift home. We are potentially the only healthcare professionals in the spectrum of their care who...

Yup interesting stuff. I've heard a few people talking lately about the idea that duration of cardiac arrest is less and less a predictor of outcome as long as CPR starts early. Especially with aggressive therapies like ECMO, there are some amazing outcomes. I think we're going to see the...

I really hate this street vs book type thing and always have. If some reasonable practice is genuinely acceptable, then why is some utterly different 'theoretical' alternative being taught as gospel? Currently one of the local universities is teaching that pts be rigidly interviewed along...

I don't quite follow. What type of L1 fracture was it? I figure maybe burst? Regardless of what you might feel about SMR, its still indicated in one form or another for unstable injury. You haven't mentioned whether this was an unstable type fracture. Also, my understanding is that the...

I've heard this. I don't think I read it anywhere authoritative but its pretty effective isn't it? Assists sleep/wake cycles and what not? I had to work on it too. I'm an esoteric, nerdy kinda guy and it didn't come naturally to talk to truck drivers or farmers etc. I had to pick up many...

Yup it was. The link you posted isn't the same one (but I don't think it was supposed to be :-)) but contained a lot of the same anatomy. I wish I had been able to jot down a few of his references. But they all changed slides so quickly. I'm sure it'll be up somewhere soon.

At SMACCgold, Rich Levitan had some interesting things to say about the apparent superiority of nasal cannulae over face masks for many purposes (not just the apneic oxygenation during intubation for which he is well known). Personally, I hate face masks. I always have and this trend towards...

Once or twice in the past I have taken palliative or lonely nursing home patients to their destination via some lovely spot to which they've not been in many years. Once to the lakeside and another to the beach, each time unloading the stretcher to sit in the sun with the patient. I stole the...

First is usually introductions and quick look or whatever you want to call it. Specifically look the patient up and down and palpate a radial pulse. You can tell so much in the first 5 seconds this way. Distressed? Diaphoretic? Pallor? Increased WOB? Lethargy? Meaningfully interactive and...

I don't know what it is about threads like this but they just make me want to detail every bit of lint in my workin' pockets. They're oddly compelling. Its the bureaucrat in me I'm sure. Especially when you've had a few beers. I work with a guy who actually carries several huge camouflage...

Its worse when these rules use "brought in by ambulance" as a criteria. How do you take that in the prehospital environment? I've used Ottawa ankle rule in the past. Got the cheat sheet in pocket along with the rest of things I can't be arsed remembering. Its usually a moot point though, on...

I was just so confused by this entire thread until jrm piped up.

Sounds like what would have been ideal for this pt was mechanical CPR to the cath lab. Failing that, I don't see the point of redirecting to the smaller hospital. What more are they going to do and more importantly, what happens when the pt gets ROSC? If you are willing to do CPR during...

Reading of the question aside... talking about haemorrhagic shock mostly in the setting of trauma patients. Was not aware that kind of terminology was in use for any other disease process for which people would have guidelines.

Its not about correlating to a specific blood pressure. Its quite the opposite. The idea is that chasing the same specific number in all patients is a flawed idea as the number alone may not necessarily mean a blood pressure associated with a minimum level of acceptable perfusion state. I...

I'm sure some of us here operate under a protocols/guidelines that recommend permissive hypotension/fluid restrictive resuscitation/hypotensive resuscitation of some sort. e.g. 250ml boluses targeting radial pulse or good mentation. If you do, could you post a link to you guidelines...

Overall: -This is not at all a scenario on which a civilian provider of any kind needs to be tested let alone an underage volunteer. It strikes me as something taken from a scene in a TV show more geared towards drama than realism. -We all make mistakes (I make plenty), but the gramma and...

These are diseases that are either common and nice to know about or because they have relevant sequelae/ mimic serious problem. Certainly not exhaustive. Chronic pain Diverticular disease Cancer- side affects of treatments, common complications, ESP febrile neutropenia. ID - hep c, HIV, TB...

While I do feel morphine is safer than a benzo, the opiate/benzo at equivalent doses (whatever that means) argument was perhaps not one I should have mentioned as it isn't really important to my point and it seems to have confused things. Additionally the type of patient you mention is not the...

I think its pretty hard to say whats wrong with your reports without seeing them and watching you practice. I'd seek more feedback from those who have assessed you and found your writing to be lacking. My two cents on narratives: -Age, gender, relevant medical social hx, hx of the...