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  1. E tank

    Dizziness while driving

    Figured something like that...thanks...but the consequences of hypocarbia can't be discounted....in this guy...no big deal. He's 30 and bullet proof...but severe hypocarbia with attendant fall in cerebral blood flow in, for example, the elderly or someone with carotid artery disease shouldn't be...
  2. E tank

    Dizziness while driving

    No MM QB here so don't take it as such...but why the etCO2 so low? That a protocol or something? It's a metabolic acidosis.
  3. E tank

    Dizziness while driving

    eh...he's 30....probably made his tee time the next weekend....
  4. E tank

    Dizziness while driving

    If you had iStat ability in the field, absolutely. I suppose you could intuit dka from a finger stick and physical exam and treat accordingly...
  5. E tank

    Dizziness while driving

    Something fishy about that. A hct of 48 after almost 7 L of NS? The sodium and chloride don't make sense either. There should be a significant dilutional effect on on those results that doesn't seem to be there. Have the receiving hospital labs?
  6. E tank

    Dizziness while driving

    7 liters of NS? Looks like the iSTAT was before that...be interested to know what the lytes and abg were after that NaCl load.... Anyway, it's clear what the problem is...anyway...pre-hospital management is...fluid. and a finger stick BG.
  7. E tank

    Sternbach Pain Thermometer

    Nice post...and the reality is that the vast majority of the pain that we (in and out of the hospital) deal with is of the no brainer category. The weird stuff is, mercifully, the exception, at least in my practice. But for those outliers...are really possible for practical application? Folks...
  8. E tank

    Sternbach Pain Thermometer

    I still don't understand what value this has. For starters, acute somatic pain, visceral pain and neuropathic pain are different entities with different qualities, i.e. a broken arm and a wicked kidney stone trip different nociceptors, so unless it's apples to apples, it isn't going to be...
  9. E tank

    Dizziness while driving

    The guy is 30 years old with no history...that we're able to discern. I'd stick with fluid and not do anything to drive his heart rate. Slow him down, get a better EKG and look for something weird like a delta wave. Not so sure I'd call for a rotor just yet.
  10. E tank

    Dizziness while driving

    No one is going to run in some fluid?
  11. E tank

    Arrest Resuscitation

    It's one thing to be skeptical and jaded, it's another to run one's mouth without all the facts. Mutually exclusive most times, in fact.
  12. E tank

    Sternbach Pain Thermometer

    It's a thing... https://www.uptodate.com/contents/myocardial-ischemic-conditioning-clinical-implications
  13. E tank

    Arrest Resuscitation

    New kid? She'll eventually learn to wait for the cath results/ echo before trying to demonstrate she's smarter than everyone else...
  14. E tank

    Sternbach Pain Thermometer

    That a pain scale uses the term for a device that measures temperature betrays a concerning lack of awareness as well....
  15. E tank

    Small vent story with questions about it.

    The reality is that some patients don't need or can't tolerate sedation post appropriate hypnotic/relaxant intubation. Categorizing which patients do and which patients don't is a big part of the battle. Folks with a TBI severe enough to require intubation don't need a lot, if any sedation...
  16. E tank

    Small vent story with questions about it.

    Whatever assessment challenges that paralysis presents, meaningful sedation would present it's own. The issue is that paralysis and appropriate sedation are not mutually exclusive. Sedate appropriately and paralyze. It isn't an either or thing.
  17. E tank

    Small vent story with questions about it.

    I think you could make an argument for sedating and paralyzing the patient and just give him what he needs with reasonable CMV settings for transport and then just let the receiving CC folks look after the details. Again, speaking in a very generic context.
  18. E tank

    Small vent story with questions about it.

    Without knowing what the ventilator settings were and why your patient was intubated, it's really not possible to give a meaningful answer to your questions. But you have the right idea. Managing patients on ventilators is an entire sub-specialty of care and requires formal training and experience.
  19. E tank

    End tidal C02 at BLS level

    And this illustrates a significant point. That a modality is non-invasive does not make it suitable for an application in a setting that might include a BLS ambulance. Misinterpretation and misunderstanding outweighs any benefit you might derive from the technology. Chest rise, fogging a mask...
  20. E tank

    IO Infiltration?

    if it works, nothing else matters.
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