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Your post is a little misleading, I think. The physician issues the order, but the patient (or appreciate surrogate) must also sign the form.

Are these from healthcare facilities like nursing homes? It's very common for them to incorrectly complete the paperwork. Around my parts, it's rare to see the doctors signature. I politely hand it back to the staff and tell them "this is invalid. He/she is a full code." It happens a lot...

They're going to run delta trops in the ER. The sooner that is complete, the sooner they can get a useable clinical result, reduce LOS, and speed up the process. No randomized controlled trials needed to know that the less time a patient has to spend waiting in the ER, the better.

I think so too, which makes sense since that's where the line of conversation was going. I was just commenting that there isn't no point at all.

Probably not. That's not the question I was answering. I was answering your point that it doesn't matter if we check trops.

I disagree. If I could check troponin levels, I could use that to help paint a clinical image in combination with patient presentation and the ECG. Also, it could be used as an intial measurement in delta trops, which doesn't help me, but does help the patient.

Nor do we have the ability to check it in the field (usually).

It's several reasons. The largest factor in my experience is artifact. They don't seem to factor artifact at all. No Life Pack 15, my patient is not atrial paced irregularly at 300 times per minute. She's just got Parkinson's.

Because the algorithms are wrong enough of the time that we can't trust them 100%.

On duty supervisor.

There are many different reasons for low SPO2 readings. Got some patients we actually want readings of 88-92%. Does your pulse oximeter display a plethysmograph? Do some research on reading one and it will help you understand accuracy of readings. It sounds like you're lacking in experience...

Hall does plenty of mundane too. It's not different there as the paramedics are still limited. The only difference with Hall is the opportunity to run 911 calls as a nurse. From what I recall, pay was a major factor. Scheduling was another.

Other than Hall, most SoCal CCT programs are about the same (unless you're considering air). They all more or less run dual EMT and put you in the back of a normal ambulance. Most CCT RNs are used to transfer relatively mundane transports that paramedics aren't allowed to do in California...

Yes. We don't have any N95 shortages and are free to use them whenever, however we are asked to be prudent. We are issued our own personal HALO masks and can use them whenever we want.

Eye pro should be standard covid or not. It's a cultural change, but IMO needs to be the standard. At the college paramedicine program I teach at we require it. N95s my agency only requires on calls with high risk procedures like intubation, nebulization, etc. However, we also have an option...

What do you want to do as a career. Go do that.

SW Missouri

Esmolol is for refractory VF. 500mcg/kg bolus followed by 50mcg/kg/min drip. Ultrasound is currently limited to assessment of wall motion (for determining if PEA is true or not) in cardiac arrest. In the future we will be adding other POCUS exams.

I work in rural SW Missouri. Our largest town has 10,000 people and a total county population of 50,000 over 560sq miles. We are competitive in pay (like actually, when other services raise their pay, we match it). Health, vision, dental, life, and disability insurance is paid 100% by the...

There's no black and white. You treat the most savable person. If the injured person is a green tag with minor injuries, perhaps evaluate the two black tags and see if either of them have reversible causes of death. CPR on a traumatic arrest doesn't make things better, in fact it may make...