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To a large degree, I think we're talking apples and oranges here. Adding benzos to opiods is a great mix, if you are lookng to go down the procedural sedation route. If that's what your protocols call for, great. But in terms of just augmenting analgesia, without affecting LOC, you may be on...

Yes & no. The phenomenon of %20AND%20%28%22reperfusion%22[MeSH%20Terms]%20OR%20%22reperfusion%22[All%20Fields]%29&cmd=DetailsSearch"]spontaneous reperfusion (SR) of a STEMI is well-described, with research studying predictors of SR, prognosis after SR, etc. However, there isn't much out there...

If it works out, it will be a 2.5 minute rant on a #FOAMED podcast - I'll update this thread with a link when it comes out!

The recent study that prompted my original question looked at combining midazolam and morphine, and was pretty well done. I reviewed it at my FB page, but I've copied the text below.

Yup, only 15 medics, but it was enough. We used a qualitative methodology, not quantitative, for various reasons. Generally, such studies use much fewer subjects. For more explanation, I've clipped out the relevant bit from the methods section. If you want a reprint, I'm happy to share!

This is pretty much what I expected to hear. No miraculous recoveries after giving just dextrose.

One of the surprising results I found when I interviewed medics about prehospital analgesia was the belief that it would be helpful to add a benzo to whatever opiod you are giving. (link to study at http://www.ncbi.nlm.nih.gov/pubmed/22971168 The medics offered various reasons, mostly having...

Dang myself. Fixed it in the post ( Using Dextrose in Cardiac Arrest ) Mycroftt, I'm not sure if they attempted to control for technique in that one CPR study. On the other hand, the results were similar to those seen in a study of critically-ill patients, so I imagine it isn't just technique...

There is at least one study looking at finger sticks in cardiac arrest, using the venous blood sugar as the comparison. The capillary level was neither sensitive nor specific for hypoglycemia. Since hypoglycemia was labeled as one of the "5 Hs" in ACLS back in 2005 (but then mysteriously...

It is no longer an official "reversible cause" per ACLS, but many folks are still checking the finger stick in cardiac arrest, and giving D50 for hypoglycemia. Has anyone actually had a "save" that they believe was because of the dextrose? I'm preparing a talk, and I'd love to hear any...

You infuse dextrose to maintain euglycemia. This is more commonly described for Ca-channel blocker OD, but a case report od its use in BB OD can be found at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3550395/.

With a bradycardia and hypotension, and a presumed huge digoxin OD, the first drug I'm ordering is Digibind. For a true dig OD, everything else is just window dressing. I imagine that will take some time to come from the pharmacy, though, so the first drug the patient would actually receive...

If your medical director didn't want you to give ASA when a patient is taking warfarin, they would have written that. Also, warfarin has a long onset of action, so don't worry about the time frame. As for ASA, NTG, or O2 causing spontaneous resolution (SR) of a STEMI, the evidence is poor...

I think we're essentially on the same page. Good advice for all.

If the DA's office or grand jury is involved, it's a criminal matter, and is far more concerning than using the term "diagnosis" imprecisely. OTOH, if it's a civil matter, then the plaintiff's attorney will be hammering me on 1) what tests I got, 2) what I did about them, and 3) what I did or...

What does it mean to establish a psychiatric diagnosis, versus an orthopedic diagnosis, versus a genetic diagnosis? This question ("What do we mean by diagnosis?") is a deep philosophical question, with historical and scientific roots. It can be fun to delve into some of attempts to answer...

I'm late to the discussion, but I wanted to weigh in as a former paramedic, now emergency physician. TL;DR version - this is a great job! Yeah, some doctors make a big stink about discouraging others from coming into the field. Yeah, the money is going down, paperwork is going up, and it...

Yes. Or heck, call them BOTH "clinical impression," which is actually the name of the field I complete in my chart. Doesn't matter what we call it, we're all talking about the same process. Interestingly, in day-to-day practice, I don't often hear physicians use "diagnose" as an active...

The whole article should be open access through pubmed. Yeah, it's fascinating stuff, really counter-intuitive. Appears to be some direct effect of anaphylaxis on the myocardium.

The advantages you mention are only theoretical, even if they are appealing. Go with the evidence we already have. For the safety of an IV epi drip protocol, read http://www.ncbi.nlm.nih.gov/pubmed/14988337. Open access. For the benefit of IM versus SQ, check out my brief review (with a great...