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To understand SpO2 levels better, take a look at the oxyhemoglobin dissociation curve where you can see that the lower it goes, the faster it drops (like falling off a cliff). In my young and carefree days, I was able to hold my breath until I got the SpO2 down into the 70's, but that was for a...

Embolism? Did the HR on the SpO2 match the palpated pulse (just tossing things out there)?

There are two schools of thought about the effects of CPAP on lung fluid: 1) that it physically pushes the fluid back into the capillaries using Starliing Forces, and 2) that as it recruits the alveoli, the fluid is spread out and redistributed, but still exists in the lung. I prefer the latter...

Interesting that the tattoo included a copy of his signature as well (blanked out in the attached pic). Personally, I have a tattoo on my vocal chords that reads, "If you can read this you are too close".

I have heard that some large, urban services rejected adopting CPAP for this very reason. I'm pretty sure that it still stands.

When I did Int'l Medevac, I spoke with a crew in Corner Brook, Newfoundland who did regular transport runs to St. John's for specialty treatment/diagnostics. One way run was about 7 hours. Made for a long day.

I was at that game with my family and Buffalo's finest actually performed the best (and only) tackles at that game. It was 47-3 near the end and Buffalo got their only TD when the Saints opened the gates and gave them one...but I digress

There are other reasons intubate besides providing mechanical ventilation; bronchial toilet being one of them. Risk of aspiration is very high in this demographic, however the concern for not being able to extubate is very real. This is a very tricky issue because even if the patient was a DNR...

Interesting that we haven't discussed the role of waveform analysis to look at whether its a diffusion issue or an airflow issue. You may be able to make a distinction between air trapping, diffusion issues or PE. Lots of online stuff on waveforms. Just sayin'...

There were definite breath sounds at end-exhalation indicating that there was still more air to be moved out but we tried to get out as much as we could. It was a few years ago and the machines could only do so much but we were able to help her out without causing damage to the airways. To...

Many years ago in the early days of EtCO2 monitoring, I had a vented bad asthmatic/nut allergy and after a few hours of venting we watched as the EtCO2 gradually dropped into normal levels. That being said, her BP, HR and other factors were becoming progressively worse. What we realized was...

From experience, I would recommend the "Tarzan" approach and don't let go of the rope until you already have a firm grasp on the next one...its better to be left swinging than falling to your demise. Also, I would stay in the role as a part-timer/per diem even if your next role is in management...

We had the egg crate foam for the larger patients on longer flights. Part of the issue wasn't just the padding but the narrowness of the stretcher, limiting the positioning.

I have seen a few CPAP products being marketed for CPR (here's one from Boussignac told as a very nice story) but I also have an issue with central venous return being decreased fro the constant added pressure. For cases of CPR, I would go with the BVM and consider a PEEP device once the...

And here is more on Ontario paramedicine...they are thinking of giving them powers to direct the patient to the most "appropriate" facility instead of straight to a hospital. I would love to hear what your thoughts are regarding skill set and liability about this proposal...

There is something similar for other allied health professionals in Ontario such that you have to have a job to be considered for a job. I was previously certified as another type of health professional and (get this) if I wanted to get re-certified, I would have to first get a job in the field...

I highly recommend not to use two seals. It should be OK to ditch the plastic one in favour of keeping the nylon one. Also, take a close look at the regulator for any dings that may cause a leak. If there is one, replace the regulator. I used to do a "traveling road show" to regional EMS...

One time use seals: Reusable seals:

As stated above, the plastic washers that accompany the regulators are for a one time seal only, meaning that you should not tighten, loosen and re-tighten. Never place two seals together to make a "better seal". The reusable nylon with brass edging can be re-used. Now here's the reason why...

To echo the above recommendations, because your offerings are limited time is of the essence. That you can minimize as its more in your control. You really don't want to play around while a very serious scenario could be unfolding. If intubation with or without RSI is needed, it can come on...