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It's unnecessary and confounds the neuro exam at a very important time. If there is a return of airway reflexes, extubate.

Differential diagnosis of shortness of breath is difficult, even for emergency physicians, and anyone who says otherwise is ignorant about the topic. Although it's true that these conditions can overlap, the mistake I see paramedics making most often is failure to recognize and treat acute...

"For EMS standards in my area, it's typically a max dose of 4 shocks with a manual defibrillator. 3 on the floor, 1 out the door as they say." In my system that would be a 7 minute scene time. It's a bad idea, IMHO. The patient's best odds of survival are to achieve ROSC prior to being moved.

Are you given any protocols on the use of a Right sided EKG and/or the use of Nitro with it? --- Our protocols recommend obtaining right-sided chest leads with acute inferior STEMI but it's rarely done in practice. I was taught to do a right sided EKG when you have an inferior wall STEMI, and...

I uploaded a video of correct lead placement here: Tom

Routine use for cardiac arrest has been a Class III intervention since 2010. "In some special resuscitation situations, such as preexisting metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose, bicarbonate can be beneficial (see Part 12: “Cardiac Arrest in Special...

Nitroglycerin with a pressure like that and heart failure? You bet. CPAP? It depends. If you're worried the patient might stop breathing you're better off placing the patient in high-Fowlers, standing in back, and using the BVM (a very difficult skill but old school paramedics will know what I'm...

That reminds me. After we handed the patient off to local EMS (which took forever) the pilot looked at the mess we made and said, "We need a new medical kit before we depart." The remaining flight attendants (did I mention that the patient was a flight attendant?) weren't sure how to replace it...

I worked a code on a commercial jet on the tarmac in Savannah. We used the plane's AED and medical kit and crash fire rescue's airway bag. Good outcome.

I personally use lead V1 to classify RBBB and LBBB but I confirm it in lead I. Technically, if you have RBBB in the limb leads and LBBB in the precordial leads (or vice-versa) it's a nonspecific intraventricular conduction defect.

You may be right. I'm no physicist. Just repeating what the folks from Physio-Control said when I asked, "Where does it go?" during a discussion about dumping the charge during High Performance CPR (rhythm not shockable).

Even when you "dump" a charge, all you've done is disarm the shock button. The charge has to trickle off the capacitor over time.

Overdrive pacing won't work for VF. The ventricular rate is already 300-700 and the max rate for TCP is typically about 180.

I agree with those who say relax, pull over, and work the code like a day at the office. In fact we now train for it because our own data showed that 10-15% of our cardiac arrest patient's re-arrested en route to the hospital. For witnessed VF/VT arrests in particular, when you get ROSC, set the...

Typically with RBBB the T-waves are deflected opposite the terminal deflection of the QRS. In this case the R-waves are fragmented and have a lot of voltage so I would take the T-wave changes with a grain of salt and consider it to be non-specific. Definitely not indicative of acute STEMI. The...

Insufficient milliamperes is definitely the number one cause. The skeletal muscle twitching can be impressive. Combine that with a pseudo-QRS complex that gets larger as you dial up the current and it's easy to see how it happens. What paramedics are taught carries no weight with me because...

Very simple. Wide and fast is VT until proven otherwise. Just know that VT can have a frontal plane axis in any quadrant. The most common error is to call VT "SVT with aberrancy" (happens all the time). Your example does not look like SVT to me. In fact it shows RVOT-VT (VT originating in the...

The feedback has to be supportive, non-punitive, and not embarrassing. I would start with one thing your'e trying to improve and don't pick something useless like IV success rates. It should start with system surveillance. For example, you could pull all of your adenosine calls for 2015 and...

There is no consensus definition of Pit Crew CPR (whereas High Performance CPR is generally understood to be "the Seattle way"). In any event, the AHA ECC Guidelines tell us "what to do" but not "how to do it". In the early days of Pit Crew CPR some folks complained that we "weren't following...

My department owns a LUCAS device. We do not apply it until after 5 cycles of Pit Crew CPR (we call these patients "non-responders to Pit Crew CPR") but we don't apply the LUCAS during the sweet spot of the resuscitation. Whether or not the LUCAS can be applied quickly is a matter of opinion...