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Yup

If you have both, you're obviously going to want to use the morphine. If morphine is unavailable or the patient is allergic, use the fentanyl. While doesn't reduce the preload and after load as morphine does, it will help cut down myocardial oxygen demand by reducing sympathetic tone by reducing...

If you're working in a a rural area with extended transport times, its absolutely necessary that you are proficient in not just RSI, but all of your skills. If not, you shouldn't be on a truck in a rural area.

RSI is an option for any medic that has been cleared by the clinical director. Once a medic has competed their probationary period they then must go through an RSI class with the educator. Several CEU's related to RSI are available throughout the year. In addition to this, you must perform RSI...

It's a valuable tool if you know when and how to use it.

Its hard to say without being there. Do you have a copy of the 12 lead? Also it might be worth noting that most people with LBB or any BBB are not told they have one by their physicians.

I think Metoprolol was an appropriate choice here. Pt was experiencing chest pain with an accompany tachycardia and HTN. No reason to think the patient's chest pain wasn't caused by a shortened diastolic time (tachycardia) causing decreased perfusion to the coronary arteries. I might of started...

I too am studying for the FP-C exam. Purchased the ACE-SAT book, however noticed is dated 2008. I'm concerned some of the info may be outdated, anyone have any experience with this? For example, during a CEU class this week the instructor mentioned that the inverse ratios for ARDS are no longer...

They were sedated and paralyzed, per our medical director, then put on our AutoVent. It's an uphill battle getting the admin to buck up for a nice transport vent. The way you've been describing A/C is like SIMV with a set tidal volume.

This is the hospital's doing prior to our arrival. Our patient's are properly sedated/paralyzed upon our arrival.

What's even more disturbing is that we have a band aid station that doesn't even consider doing blood gasses in ventilated patients.

Both A/C and SIMV allow the patient to initiate a breath. SIMV compensates for rate and tidal volume. A/C compensates for nothing. Lets say you want to make sure the patient gets 12 breaths a minute at 500ml. On A/C you are guaranteed 12 at 500. If the patient wants more, they can initiate the...

So how is this better than SIMV w/PSV? In a/c you'll get your mandatory rate and be allowed to over breathe the vent, however the vent will deliver the extra breathes with the full tidal volume, out of sync. In SIMV you'll still get your mandatory rate at minimum and can over breathe the vent...

Doesn't make anyone want to hire you...just to make that clear. It demonstrates a history of being irresponsible. Something not highly sought after in EMS.

I understand if you did it one or two times...it happens. But 15 times?

If you're referring to V4 its to screen for RVI.

How is a/c ideal for patients that are awake? If they're air hungry on SIMV then increase the back up rate. I can see it working for long term trach patients who are accustomed to mechanical ventilation, but not the medical pt who just got RSI'd.

See that's the problem. These docs are not ER docs. They are family practice physicians either moonlighting or by some turn in their career ended up in the ER. It's pretty bad when most of the medics and nurses have a better idea than they do.

The facilities near us don't even bother sedating intubated patients....its almost criminal. They'll leave a fully alert and aware patient on assist/control.

Hmm central line only to monitor CVP? What about pressors? The local hospitals we frequent like to use dopamine as their pressor of choice for anything. Why make a septic patient tachycardic and irritate the heart? Sepsis isn't a pump problem, so you'll need to adequately fluid resuscitate them...