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The ResQGARD ITD 7 is supposed to work like the ResQPOD, but in spontaneously breathing patients, raising the blood pressure. I have plenty of doubts about the usefulness of this expensive device, but I wanted to hear if folks have had personal experiences with it.

Head up north! Great training in Conway NH, if you can fit in time for the intensive 4-week course. http://www.soloschools.com/

I think a closer comparison might involve a nursing home that your service has a contract with. Imagine if you were asked by your supervisor to avoid making any future comments to the staff at this facility about, say, the quality of their CPR when you arrive at an arrest. The supervisor says...

The compelling part of the essay, and the chief reason I linked it, was the physician's description of the economic and administrative disincentives to risking complaints from EMS. His point is that perhaps EMS has a privileged position, able to control the flow of customers/patients to the...

From "Culture of silence," in ACEP News, June 2013 An emergency physician has written an essay describing what he views as some significant obstacles to giving feedback to EMS crews, and I want to see what sorts of reactions people have to his perspective. Does this strike a chord with folks...

Just wondering - why did you feel so strongly about lowering this patient's BP? That is to say, what were you trying to prevent by dropping the BP? (This is pretty off-topic, I realize.)

An ER physician's perspective: You started a therapy on the patient, and it hurt them. You changed the therapy, and the pain stopped. You continued this second therapy. This is wise medicine. Look, you did the right thing, but you have to make sure you document your findings, document...

(First of all, dissection ≠ aneurysm. A dissection can look somewhat "aneurysmal," but they are distinct entities, different epidemiology, different pathophys, clinical presentation, treatment, etc. ) A LR(+) of 5.7 is helpful, but let me talk a little bit more about where that number came...

This is a common concern, but I have my reservations about how important it is, realistically. Many patients that are brought in on a board are not secured in a manner that would maintain in-line position if they were rolled. How about sitting them up (i.e. semi-Fowlers) if they vomit...

Yeah, that ER doc was me - once. Not doing that again! Spontaneous reperfusion of a STEMI is a good sign, but it hardly means the patient is out of the woods. And despite the impression that NTG or ASA caused the ECG change, the evidence isn't clear what the mechanism is. Nonetheless, it's a...

So true. Another perspective: In my ED, techs (most of them EMT-Bs) record ECGs and deliver them to me & the other physicians. A few of them know enough about ECGs to know what a quality tracing looks like, obtain a small amount of history, and recognize potentially concerning findings on the...

Ask your doctor or pharmacist about tequila. Edit: I usually try to be helpful, add in some pearls from the EMS literature, provide an in-hospital perspective. This post, not so much.

APRV probably fits a surgical/trauma population better - i.e. fewer co-morbid air-trapping conditions. I've never seen anyone on SIMV!

I love it - an impassioned discussion over ventilation! I'll share my amateur perspectives. When I rotated through the medical ICU (at a tertiary/quaternary-level hospital), AC was used 98% of the time. This was the mode used in ARDSnet, it was explained to me, and so was the only...

In what way is the in-hospital ratio concerning? (Perhaps the response should be in a separate thread - this one has wandered enough already!)

According to one study, about 20% of adult patients, who were not being evaluated for dissection, who came to an ED had a difference in systolic or diastolic blood pressure between their arms of ≥ 20 mm Hg. (http://www.ncbi.nlm.nih.gov/pubmed/8823153/). I think the original observation was that...

First off kurtemt, it sounds like you did a good job. Don't get too sucked in to the glucometer reading, though. When the only tool you have is a hammer, every problem looks like a nail! Read up some more on hypoglycemia and on seizures (biiiiig topic!), and keep on at it. You've got the right...

That sounds like a really unwieldy protocol. I wonder what problem it was designed to solve, and if it is actually solving anything. Perhaps they have a lot of diversion problems?

Like most ED physicians who are answering the radio, I usually have to interrupt an exam, procedure, phone call, or coffee to do so. Now, when EMS protocols require my decision, or if it's a complex medical issue that the medic wants my input on, great! That's what I'm there for, it's my job...

I was speaking a bit glibly - if you look back in the literature, you'll be able to find a number of studies that suggested a benefit with nitro, but it didn't pan out. The 2013 AHA STEMI guidelines summarize that "it generally does not attenuate the myocardial injury associated with epicardial...