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The ability to quickly auscultate heart sounds is all a matter of practice; most adult murmurs/clicks/rubs are far more subtle than most realize. Within the past week I found a 2/6 murmur that was missed by the entire care team including the adult intensivist. The patient had a good bit of MVR...

I don't think that I have any kind of PTSD from EMS; however it has certainly made me quite jaded to adult care and adult behavior in general. Unfortunately after having worked Fire/EMS and then ED for so long I tend to see a lot of the secondary gain and selfish interest by most people in...

I’ve never been inspired to purchase a radio outside of work, and it shows the alias of who has keyed up anyway so I’m not sure how well people who bring in their own radios would really go. In reality 95% of my communication is done with a cell phone, sat phone, or pager. Unless you are on an...

The base typically doesn’t add any real amount of safety over using the belt on the car seat directly if there is a slot for it. For a short trip I'd rather have mom sitting up than laying on a back board. While we consider labor to conventially be something done laying down often a...

@Tigger I think part of the reason I would be particularly hesitant would be should the newborn become more sick or need more assessment that may not be possible with mom holding. Do you have a picture of the airway chair? It may still be possible to buckle a basic car seat into it.

For clarity when I say kangaroo care I’m referencing skin to skin and the associated cares, not a transport product. If a neonate is well then ideally they are in a rear facing car seat that is correctly secured (I would think the airway chair in many ambulances would probably work well, the...

But without modern care we had much higher maternal and infant fatality rates. Birth may have been happening, but women and newborns also died at a much higher rate. Can you easily assess for PPHN?

Specifically regarding kangaroo care it is only recommended in low risk, full term, uncomplicated deliveries. In my opinion no ED or EMS delivery is going to qualify, something went wrong if they are not delivering in hospital, a birth center, or at home with a qualified provider. All high...

On a transfer I'm on the clock from the time I leave to the time I come back. We don't stay in hotels unless some kind of insane weather occurs, we will get back by a rental car, commercial flight, et cetera. If I agree to staff an out of state transport or deployment our hotel gets paid by the...

Sure, there are sober aggressive people who can continue to aggress with wounds that will only end up being lethal after several minutes or hours. I don't think that these represent the majority of poeple who are shot in self defense though. I've taken care of far more non-deforming 22/32/38...

Hence the statement of most sober humans. You don’t have to work in EM that long to learn that most gunshot wound live for a long period of time.

I think that what is often missed is the reaction to being shot. Most sober humans will stop with the treat of being shot, let a lone a fairly minor GSW. When IQ drops or drugs are involved, the upper brain function decreases too. A situation that may have been handled by a 38 or 32 may now...

I have always worn street clothes to and from work. I’ve always wear civilian clothing since I’m not in the military.

Efficacy of risk reduction strategies versus intervention after trauma. (For example distribution of free bicycle helmets versus intervening after trauma). Number of lives saved in the ED/EMS by tourniquet application versus those of the lay responder/LEO/Military. Efficacy of immediate lay LEO...

There are plenty of people that become nurses in their 50s. If you choose to go the nursing route understand that nursing school is very much a generalist education and you will spend a large amount of time with non-critical care patients. The floor clinicals destroy the soul.

Have you put had an echo?

@Tigger I realized that I may have completely skipped the actual clinical treatment portion of your question. The patient needs to be as close to naked as reasonable. Clothing traps heat so it needs to go. I would think one can easily find water or you could probably just use some NS to wet a...

I think historically temperature monitoring and management has been an area of opportunity within EMS. Still most patients come in without a temperature being taken in the field and I would bet a good number if not a majority of EMS agencies do not have thermometers. Ideally you should have a...

I’ve baths are not the current best practice. Evaporative cooling or temperature targeted therapy devices are preferred. Patients who are cooled too quickly can begin to shiver. This not only can increase temperature but also can worsen electrolyte abnormality. Submersion cooling makes...

Had a patient with a PCO2 of 6, sitting up and conversational. Don’t underestimate the bodies ability to compensate until the point of collapse.