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What is your protocol for using this? What #s are "must transport," or "may clear?"

The RAD-57 oximeter is pretty popular, and the new LP has it built in (as an option). But how are people using this information? In particular, are people using this in rehab at fires, checking FFs before they are "cleared" to return to duty? I've seen so different permutations, but it...

From this study: Epinephrine absorption in adults: intramuscular versus subcutaneous injection. I have the graph reproduced in the blog post that was mentioned early on. Pretty definitive graph - much early & higher epinephrine levels!

I like the idea of pre-loaded epinephrine syringes, and I bet that however often weird scenarios like this come up will be far out-weighed by the reduction in med errors. This forum has a good number of people who have pediatric epi doses "hardwired" in their noggins, but this ain't a typical...

Well, not much more for me to say here! I'm a little boggled by the delay in adopting the IM/thigh route, considering that it has been recommended for years by national and international organizations. Despite Twitter, #FOAMems, EMTLIFE, etc, change moves at a glacial pace in medicine! One...

Good BLS means keeping the HPA axis nice and cool.

Actually, that reference wasn't far off from my follow-up question. I wanted to first see if anyone had heard of the "20-minute limit" for medical calls, and if this was promulgated by textbooks or culture. Apparently, the un-written culture seems to play a larger role. I think I can...

Thanks for the feedback. Funny, no one has a definite reference. For example, I looked in the latest Caroline's, and didn't find a "20-minute goal" mentioned for medical calls. It's possible I just didn't see it (big books!), but I wonder if this is really set down in print in any textbooks...

"Do not spend more than 20 minutes on scene for a medical call." Has anyone heard of this? Better yet, anybody have a reference to a textbook or article that describes this teaching?

I'm sure someone, at some time, looked at it. Doesn't play a part in modern treatment though.

Yes, that would be useful, if that were an important goal. There is no need to "treat a fever" by anyone, let alone EMS. This is not just my wacky opinion, but also the stance of the American Academy of Pediatrics. I went over some of the background and evidence in Fever - does EMS need to...

That was with the LUCAS, AutoPulse, or "other?"

At what point in the code are your systems applying the device? Right at the start, at some point in the first 6-10 minutes, or only after that?

If you guys have any questions about my post, just ask. There is room for an interesting discussion here!

Important distinction!

Just checked, worked fine for me. You can also Google Performance of the RAD-57 pulse CO-oximeter compared with standard laboratory carboxyhemoglobin measurement. http://www.ncbi.nlm.nih.gov/pubmed/20605259

Such guidelines are out there, but they are not backed up by convincing evidence. The NFPA rehab guidelines suggest that a firefighter not be released from rehab if their CO level exceeds 15%. Problem is, the best study out there showed that the RAD-57 devices are less than 50% sensitive for the...

Agree that, as EM, I've never heard of any specific "rule of halves." My guess is that this rule is backed up by the same level of evidence as "GCS ≤ 8, intubate." EMCRIT did a segment with a trauma anesthesiologist (http://emcrit.org/podcasts/trauma-resuscitation-dutton/), and his recc's...

"GCS < 8" is a heterogeneous group. If the patient is hemodynamically stable, but has altered mentation, then you probably don't need to give the same doses of sedative, but it might still be a good policy. Drunks can pick some weird times to wake up and get aggro. Usually, people talk...

Had one during residency. None since (that I know of...) I bet if I were to look over the literature, I would bet that the incidence has been decreasing, for any number of reasons.