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Calcium chloride. I have seen an intensivist and EM doc give empiric calcium in refractory arrest patients. I think there is a good use case for empiric calcium in cardiac arrest which covers hyperkalemia and CCB toxicity; calcium can also increase contractility. Calcium is also pretty benign.

There is no need for IM epinephrine in cardiac arrest secondary to anaphylaxis. The patient needs IV epinephrine which they will be receiving during the arrest algorithm. I have never heard of giving an arrest patient 3-5mg of IV epinephrine. That is a lot of epinephrine. I understand it's only...

EMS is the point of first medical contact. Our job is to treat the patient as a whole and to deliver whatever care is appropriate while we are with them. I believe in getting medications onboard sooner than later when they are indicated and can help change a patient's trajectory. Solu-Medrol is...

I have worked as an IFT paramedic for the past five years. I can honestly say that I've learned more doing IFT than I ever did 911 in the same amount of time. I work for a service that does critical care transport so I am called to manage some really sick patients (i.e. multiple vasopressors...

The kicker here is that I work for the hospital. The RN and myself are employees of the same health system. EMTALA requires that the sending hospital supply all medications that the patient will need in transport no matter if controlled substances or not. Documentation is as simple as notating...

In a perfect world yes, give the bolus and start the drip. But we are at the mercy of the ED physician and RNs who like to run interference sometimes because they don't understand why we're asking for the orders. In my case, the RN tried to get out of giving me a full vial of ketamine for...

Just looking for some experiences from providers who use ketamine for sedation in intubated patients. I had a post-arrest patient from an ED who was receiving ketamine for post-intubation sedation. The ED obviously didn't understand this drug as they weren't dosing it every 5-15mins and they...

I have read that these cheap $30 pulse oximetry units from China do not reflect changes in saturation values as quickly as more expensive models. I also have to question their efficacy during critically low perfusion states. A Masimo or Nelcore pulse oximeter can cost upwards of $800-$1,000...

I know you commonly report on false capture cases. When Medics are taught pacing, they are often taught that you turn up the amps until you feel pulses, improve mental status and symptoms. Are you seeing a lot of false capture cases because providers are afraid to turn up the amps?

There has been a few overdoses from loperamide (Imodium). Little did I know, loperamide is an opiate derivative and overdoses can be treated with Narcan. Here is a news story on these overdoses that happened in my region...

We administer 30ml/kg boluses to make sure the patient has a minimum of 3 liters infused. We may infuse more but this is the starting point for fluid.

Here are the sepsis treatment guidelines from the Surviving Sepsis Campaign: http://survivingsepsis.org/SiteCollectionDocuments/SSC_Bundle.pdf My agency led a pilot study on the use of Levophed in sepsis patients transferred inter-facility. Our protocol, with recommendation of Intensivists in...

The evidenced-based sepsis guidelines call for fluid at 30ml/kg. If the patient is still hypotensive then a vasopressor is indicated with first line being Levophed. I transfer these patient pretty frequently and just had one two days ago with pressure of 75/42, lactic acid of 7.1, bands 21% and...

In school, they make med math out to be 100x harder than it really is. All you need to know are like four simple formulas and some key principles that go along with them and you can figure out ANY drug dose or drip rate. I am not good at math either and cringe when I see dimensional analysis...

Personally, I really dislike having my stethoscope around my neck but only because I find it annoying. My stethoscope is very valuable to me while assessing patients. Many providers like to carry their own stethoscope because they take care of it and don't like to put something in their ears...

Performing a high quality resuscitation is about focusing on quality compressions and defibrillation. One person cannot perform a quality resuscitation during transport. If you want to give your patient the best chance of survival a high quality resuscitation MUST occur. As others have...

During school, I was always taught <120ms is a normal QRS duration. While writing an article on TCA toxicity recently, I found out that the normal QRS duration is, in fact, <100ms. The treatment threshold for treating TCA toxicity is a widened QRS measured at >100ms. Multiple sources state the...

Med math is made way too complicated. I would argue that there is no need to rack your brain with the dimensional analysis. There are 4 SIMPLE formulas that can be easily committed to memory that will allow you to figure out any drug dosage and infusion rate. Learn the few basic principles that...

I am a fan of D10. There are many benefits and it carries reduced risks. Efficacy of D10 vs D50 has been proven the same. This article lays out all of the supporting reasons to opt for D10 (Academic Life in Emergency Medicine) Another article posted 8/27/15 in Emergency Physician Monthly...

In a CHF patient, it is VERY important to treat their hypertension. Pressure reduction in these patients is key to maximizing the hearts efficiency (think decreased afterload and preload) and to reduce the pressure in the pulmonary vasculature which is what allows the fluid to retreat back...