Recent content by jwk

That timeline is pretty much a non-starter period. Your arrival time post-arrest likely ate up the bulk of your "10 minutes of the arrest". Then you have to make the call, load staff and surgeon (who is not sitting in the lounge directly across from the helipad), then spin up, take off, land...

I am light years out of EMS and treating OD. But the amount of Narcan used, by my practice, is huge! As a couple have noted, if you're ventilating and oxygenating your patient (I assume SaO2 being used), your apneic emergency has passed. You can always give more Narcan if needed. Remember...

I get the esmolol idea, but haven't seen that routinely used in an arrest, even in the ICU. BUT I think your bolus dose is incorrect. I think it should be 500mcg/kg IVP. Giving just 500mcg is about 1 drop of esmolol.

Don't know - like I said, I'm playing devil's advocate. You and I both know that mixing anything with propofol is technically a huge no-no due to infection control concerns. Yet I see lidocaine and ketamine mixed all the time. I would not use lidocaine to reconstitute powdered meds. I don't...

That brings up another issue. I know a fair number of people that add a little lidocaine to propofol (not a great practice for a number of reasons) but not for other medications, and certainly not as a diluent. Our hospital pharmacy nazis would have a fit, and I'll play devil's advocate - is...

I only know this because I'm old. :) This was from the old apothecary units of measure. As NPO noted, 1/150 of a grain was 0.4mg, which was the routine pre-op dose for atropine, which just about everyone in anesthesia used to give to dry up oral secretions (the less spit the better).

Not sure what you're calling a "grain" but a grain is an actual unit of weight and equals 65mg. A 325mg aspirin tablet is 5 grains.

Med errors with making up infusions can be virtually eliminated by using pre-mixed infusions. They're available for just about anything you would need pre-hospital, although of course they're more expensive. Apparently most low volume IV bags were were made in Puerto Rico. Duh.

Consciousness during CPR is a real rarity, although certainly quite possible (I've seen it once). Sedating a critically unstable patient for any reason is just plain stupid. Ignore all the physiologic/pharmacologic reasoning. Common sense should tell you it's not appropriate. IF your patient...

It really doesn't. Really. I used to do EKG's in the dark ages where we put conductive gel under a metal plate secured to the patient's limbs with a rubber strap. That's where "limb leads" started. There was no such thing as self-adhesive EKG pads, much less something like a defib pad. As...

Ah, the joys of doing it "the anesthesia way". We don't need no stinkin pumps!

Most of these overdoses are from carfentanil or carfentanil/heroin/other drug combinations, not fentanyl. It has legit uses in large animals, because it is so potent. There are a number of other fentanyl derivatives in common medical use, including sufentanil and alfentanil. Like many drugs...

Common sense. Love it!

Not sure a tourniquet of any type would be much use in this type of fracture. Much of the blood supply to the femur comes from vessels proximal to where you could any type of tourniquet. I do a ton of surgery for proximal and mid-shaft femoral fractures and have never seen a tourniquet used...

Honestly much ado about nothing with the methoxyflurane discussions. MOF, Penthrane, Penthrox et al has been unavailable commercially in the US for probably 20 or more years. About the only place penthrox inhalers have been used is down under. It's clinical use in the US and most other...