So I'm sitting in AMLS class...

[usafmedic45]

Nope, Dr. guy, not Dr. Slovis, but Slovis is a genius!

Ah....Corey is a genius. A very peculiar and, at times, eccentric genius. He's a very interesting and fun guy to talk to.

 

[medicRob]

Ah....Corey is a genius. A very peculiar and, at times, eccentric genius. He's a very interesting and fun guy to talk to.

Did you catch him at an EM conference?

 

[Aidey]

Aidey, would you like me to find out when Dr Guy is teaching the course again? I would be more than happy to get you some details. He wrote the PHTLS textbook and several other books, he is our burn director, and a paramedic.

Thanks, but I can't travel very far for classes and stuff currently. I'm waiting to hear on a job offer, so making plans to fly anywhere for a class months in advance isn't really a good idea.

Although it is very tempting. It was bugging me why I knew his name and 2 seconds of google told me he is the MD with the awesome pod casts. I've never gotten into pod casts because I find it hard to retain info I hear without a visual competent included. However, I may have to start making exceptions.

 

[medicRob]

Thanks, but I can't travel very far for classes and stuff currently. I'm waiting to hear on a job offer, so making plans to fly anywhere for a class months in advance isn't really a good idea.

Although it is very tempting. It was bugging me why I knew his name and 2 seconds of google told me he is the MD with the awesome pod casts. I've never gotten into pod casts because I find it hard to retain info I hear without a visual competent included. However, I may have to start making exceptions.

Listen to "Vandy ICU Rounds" podcast. You will love it.

Also, emCrit is good.

Dr. Guy is also the author of the PHTLS Textbook

 

[BEorP]

Mag for asthma? Huh how does that work? Glucagon for BB OD? Does that work?

Isn't there at least some evidence that supports glucagon for beta blocker overdose? http://www.ncbi.nlm.nih.gov/pubmed/6144498

It doesn't seem like many people in Australia are familiar with this use, but I heard about it previously from physicians in both Canada and the US.

 

[Aidey]

I took ITLS when I was in medic school several years ago, but not PHTLS. I passed up PHTLS for AMLS, and I'm kind of regretting it. A few of the people in the AMLS class were talking about the "new" guidelines of permissive hypotension and not automatically c-spining everyone who looked at a crack in the side walk the wrong way. It would have been nice to spend 16 hours listening to good medicine.

I had a bit of a moment in class today when Ehlers-Danlos was mentioned, and I was the only one who came up with what it was.* I have a feeling I'm going to end up being unhappy if I stay a paramedic forever.


*Well, at least I was the only one that answered after one of those long awkward silences when the instructor said they were drawing a total blank on it.

 

[Aidey]

Isn't there at least some evidence that supports glucagon for beta blocker overdose? http://www.ncbi.nlm.nih.gov/pubmed/6144498

It doesn't seem like many people in Australia are familiar with this use, but I heard about it previously from physicians in both Canada and the US.

Yes, there is. I was repeating comments made by my classmates.

 

[medicRob]

I took ITLS when I was in medic school several years ago, but not PHTLS. I passed up PHTLS for AMLS, and I'm kind of regretting it. A few of the people in the AMLS class were talking about the "new" guidelines of permissive hypotension and not automatically c-spining everyone who looked at a crack in the side walk the wrong way. It would have been nice to spend 16 hours listening to good medicine.

I had a bit of a moment in class today when Ehlers-Danlos was mentioned, and I was the only one who came up with what it was.* I have a feeling I'm going to end up being unhappy if I stay a paramedic forever.


*Well, at least I was the only one that answered after one of those long awkward silences when the instructor said they were drawing a total blank on it.

medicRob owes you a conference. I will make sure that you get to see Dr. Slovis or Dr. Guy speak at some point in the next year. They usually travel.

 

[usafmedic45]

Did you catch him at an EM conference?

I was actually introduced to him by a mutual friend (an EM doc from on the east coast) at a conference a few years back.

 

[usafmedic45]

I had a bit of a moment in class today when Ehlers-Danlos was mentioned, and I was the only one who came up with what it was.* I have a feeling I'm going to end up being unhappy if I stay a paramedic forever.

If you want to totally show off, thats when you start discussing the different varieties of Ehlers-Danlos and their clinical implications. LOL

 

[Epi-do]

Isn't there at least some evidence that supports glucagon for beta blocker overdose? http://www.ncbi.nlm.nih.gov/pubmed/6144498

It doesn't seem like many people in Australia are familiar with this use, but I heard about it previously from physicians in both Canada and the US.

I have actually given it once. It did improve my patient's blood pressure. Her pressure started out somewhere around 50/nothing and was low 90's systolic by the time we rolled into the ER. The hardest part was getting a line on her since her pressure was so low. I ended up having one shot at an EJ.

When we got into the ER, the RN asked why I had given her so much glucagon, so I had to explain to her that it was for the OD. The doc was on the phone, going back and forth between poison control and the pharmacy to figure out what to do for her. They ended up putting her on a glucagon drip, an epi drip, and giving her D5W.

Once I got back to the firehouse, I did some research to find out why the glucagon works. From the very basic understanding that I got from what I read, glucagon uses a "back door" approach to have a similar effect upon the heart as a beta agonist. It binds to the glucagon receptors in the heart and increases heart rate and myocardial contractility, and improves atrioventricular conduction.

 

[Aidey]

If you want to totally show off, thats when you start discussing the different varieties of Ehlers-Danlos and their clinical implications. LOL

I think I would have been lynched. I admit I know what it is because I had a patient with it. I can tell you there are different types, and some are more serious than others but I don't remember what they are.

 

[medicRob]

As for Ehlers-Danlos, there used to be 10 classifications, they took it down to either 6 or 7 types, the only ones I can remember are

dermatosporaxis, kyphoscoliosis, and vascular.

 

[Aidey]

*headdesk*
*headdesk*
*headdesk*
*headdesk*

/repeat

 

[usalsfyre]

*headdesk*
*headdesk*
*headdesk*
*headdesk*

/repeat

(draws up the ketamine in the MAD device) "You may feel a little funny after this..."

 

[MrBrown]

(draws up the ketamine in the MAD device) "You may feel a little funny after this..."

Ambulance Oscar 10 on location.

*Brown mounts kerb in Brown's rapid response unit, grabs the green thomas pack and looks at the fire hydrant spewing water into the air, oh dear, did Brown hit that, hmm that is what happens when you let Brown drive!

How much ketamine should we use? Brown has 400mg in 4ml here, think that will be enough?

Now, whats this funny business, a BP of 68/P is entirely possible, we do not have dopamine so Brown doesn't know a whole lot about it, we have magnesium for asthma and glucagon is a recognised treatment for a beta blocker overdose?

 

[Aidey]

Apparently septic shock should be treated like hypovolemic shock - permissive hypotension and all.

 

[Veneficus]

Apparently septic shock should be treated like hypovolemic shock - permissive hypotension and all.

What???!!!

 

[usalsfyre]

The fail is strong here...

 

[Aidey]

Trust me Vene, I know. I nearly picked a fight, then backed down and got lectured on how it is our job to treat the symptoms and transport. We aren't there to treat the underlying problem, and shouldn't waste time trying to figure out what it is.

I nearly walked out.