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Epi is used locally in a few conditions. For example, epi is nebulized to treat the airway edema of croup. It is also injected into gastric mucosa under ulcers to staunch bleeding through vasoconstriction of the involved arteries. Anaphylaxis is a systemic disease, however, so I'm not sure...

There is good research about IM versus SQ epi (IM in the thigh is the way to go), and good research about the safety of IV drips of epi (Don't do boluses, lousy safety profile). Basically no research on sublingual injections for anaphylaxis that I've ever found. As for the cheek, no, I've...

There has been research looking at sublingual tablets of epinephrine, but no studies of injected epi, as far as I know. A column in EMS World recently described using a sublingual injection, but didn't discuss any evidence, or provide any references. On the other hand, we have fairly good...

There is actually a form available from the NATA that parents can sign beforehand, allowing the trainer to obtain a rectal temperature. However, at least one study suggests that, in reality, trainers check an oral temp far more often. Anyways, there are a lot of hypothetical concerns with...

Does anyone have experience with being called for a likely heatstroke patient at an athletic event, but having the trainers refuse to have the patient transported until they have cooled the patient? There are some position statements from the athletic trainers that seem to support this...

Getting a 12-lead is "cheating?!" If using a quick, painless, effective, and cheap test is cheating, what is the game we're playing? (Mostly kidding. Mostly.)

There is some evidence for early intubation, just to improve the hemodynamic status, but it only comes after a sequence of other actions in the EGDT algorithm. I wouldn't consider the patient in the OP's scenario to be in the final stages, actually. First off, we don't know the time course...

Okay, I talked to a CC physician, gave her the scenario of a sick septic patient, who has the potential to get to antibiotics and central lines, etc., 1 hour sooner if the helicopter is called. She said "Call the helicopter, no question." There's a reason they call it early goal-directed...

The helicopter issue is whole 'nother ball of wax. I'll defer to local guidelines, resources, etc., when it comes to answering if a particular should be flown. Choppers are expensive, dangerous, and often of marginal benefit. I think many of us agree on these broad principles. That being...

As my mentor Doctor Cottle would say, I have no frakking clue. The dopamine antagonists seem to work via some common pathway nonsense, so I don't have worry about etiological finery. 10 mg * 2 seems to take care of 90+% of HA.

I've used oxygen in the past on headaches that I had thought might be cluster. But even with years in EMS/EM, I'm no neurologist. Now I just hit them all with metoclopramide, go from there.

This patient needs antibiotics and control of the infectious nidus ASAP. While I wouldn't recommend blowing through red lights at warp speed, they need critical care services emergently. Although STEMI, stroke, and trauma are seen as the "big emergencies," sepsis is where big differences in...

The RR might be high due to acidosis, even if the SaO2 is normal. If the patient is acidotic, BTW, laying the patient flat, let alone Trendelenburg/shock position, will impair ventilation. Head of bed 30 degrees is probably your best bet. While the literature on the benefit of crystalloids in...

At the top of page 63: http://www.sponsorhospital.org/protocols/Paramedic%20Protocols%202008%20NHSHP.pdf

Despite this disincentive, some physicians will specifically order, say, just a K+, or just a hemoglobin/hematocrit, since they don't want to deal with a clinically-trivial bump in the WBC or chloride. Everyone gets confused when this happens, and half the time the whole lab gets sent regardless.

It's true that these are drawn fairly frequently in the ED, but I would hesitate to use this as a rationale for rote BGL tests. While they may occasionally reveal an occult, previously unsuspected condition, this can also really complicate the evaluation. Perhaps the clinician hoped that the...

Turns out I don't always know what's going on next door! It seems that both Stamford and Norwalk are using the "Yale" protocol now for patients that are ambulatory on EMS arrival. That is to say, ambulatory patients at the scene of a trauma get a collar, and sit on the stretcher. As I...

The hypothermia is really a form of neuroprotection, and can only be undertaken if the patient is hemodynamically, and electrically, stable. As for post-ROSC antiarrhythmics, it's funny you should ask. We often give lidocaine or whatever after we've achieved ROSC, but there hasn't been much...

Certainly New Haven is using the "ambulating on scene" protocol, as is Hartford, and a few other hospitals in CT. I haven't heard of any hospitals in SW CT going to this just yet, though.

Yeah, my basic take on it is, if you are well enough that the ResQGARD is indicated, you are healthy enough to not need it. And vice-versa.