Recent content by Remi

  1. Remi

    To Degree or Not to Degree. That is The Question.

    As you know, many people excitedly get into EMS and are quickly disappointed with the mundane work, relatively low pay, limited career options, and a perceived lack of respect from the rest of the healthcare industry. I think what happens is that then, when they begin to consider what might be...
  2. Remi

    Airway Management and Intubating without Drugs

    In most scenarios, resuscitation before intubation probably makes sense. Especially if you are bound by protocol or tradition to use an induction agent or a dose of induction agent that is inappropriate given the shocked state. But if you deal with enough sick patients - especially trauma...
  3. Remi

    Airway Management and Intubating without Drugs

    People don't always need to be fully anesthetized in order for intubation to happen. If you are committed to using a full induction dose of any sedative, then yeah, you might have a bad time if they are sick and you don't take the time to resuscitate first. But if it's a scenario where you...
  4. Remi

    Airway Management and Intubating without Drugs

    Why is versed and succinylcholine a terrible choice? I think the vast majority of people who do this routinely would agree that generally, versed is inferior to the other commonly used options. But it definitely has a place in some scenarios.
  5. Remi

    Airway Management and Intubating without Drugs

    “Never had a problem with our current routine but can’t resist fixing what ain’t broke”.
  6. Remi

    Airway Management and Intubating without Drugs

    Only succinylcholine has muscarinic effects, but it does not cause any vasodilation because not enough of it reaches the M3 receptors to have a clinical effect, and M3 stimulation does not reliably cause vasodilation....it also causes vasoconstriction.
  7. Remi

    Airway Management and Intubating without Drugs

    No. NMB does not affect smooth muscle.
  8. Remi

    Airway Management and Intubating without Drugs

    There have actually been quite a few studies showing that using NMB increases success rates and minimizes complications with intubation. You certainly can get NMB-like intubating conditions with sedation alone. I assure you that with enough propofol and fentanyl, you would never be to able to...
  9. Remi

    Airway Management and Intubating without Drugs

    If you are really comparing apples to apples, I don't see how that could be true. I mean, if you are talking about slipping a tube into a patient who is perfectly relaxed after getting some sux vs. one of those scenarios where one person is holding the patient's arms down and another is holding...
  10. Remi

    Airway Management and Intubating without Drugs

    I’d love to see a study on the outcomes there vs. other comparable cities. No other study has ever defended such aggressiveness in prehospital airway management.
  11. Remi

    Airway Management and Intubating without Drugs

    2-3 tubes a shift? X how many paramedics?
  12. Remi

    Changing careers - what to put on an EMT-B resume?

    I’m no resume guru, but the whole point of one is to communicate your work experience and qualifications. Also, anyone potentially hiring you as an EMT is well aware of what skills an EMT possesses. With those things in mind, I would leave out all the bullet points about your EMT skills and use...
  13. Remi

    Should I bite the bullet and tell my county I have juvenile misdemeanor?

    State it. No one is going to care. And keep proof that you did state it. If the record really was sealed (which it probably is), it isn't going to show up on your background check and no one will care. In that case, I would never state it again, but keep proof that you did initially and that...
  14. Remi

    HEMS usage, what do you in the field think about this?

    "Government regulation doesn't raise the price of healthcare. It just raises the price of providing healthcare" OK, sure, if you like semantics…..but what do you think happens when the cost of providing a service increases? The American Hospital Association has said that the cost of compliance...
  15. Remi

    Alcohol induced delirium and Ketamine

    Large doses of ketamine can definitely cause direct respiratory depression, and like any other drug that can, those effects are absolutely more pronounced when combined with other respiratory depressants. Ketamine is considered safer than other anesthetics in this way because 1) it generally...
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