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I wasn't making any comment on whether certain therapies should be used, but rather just making the point that the vast majority of therapies work only in a minority of patients. I don't think many people, or even some physicians, really understand this point. Most drugs or therapies have...

By a 50% chance of survival, I take it that you mean that, for example, for every 2 patients in cardiac arrest, 1 lives? Another way to put this is, that the Number of patients you Need to Treat (NNT) in order to get one patient with the desired outcome would be 2. I think you should...

Did the examiner perhaps think that morphine was not the right answer because intubation was supposed to be the next proper step? In reality it's a silly point. Giving morphine while preparing for airway control is just fine. And yeah, 5 mg of morphine might as well be a 60x dilution...

Cardiovert for svt (too soon?). Looks like a narrow-complex regular tachycardia with normal sinus activity. All the other schmutz (ST segments, T wave morphology, P wave appearance) seem like rate-related or artifact, and just don't look so interesting. Without any other clinical data, I'd...

Great topic! There is some interesting mix of the conventional/old thinking with newer data. The older thinking suggests that the EMT should have their finger evaluated at the ED. For a long time providers and nurses were told never to use epinephrine when injecting anesthetics in the...

Pretty sure I'm in the running for worst "uniform" ever. My first job in EMS was for the Worst Private Ambulance Ever. On top of terrible equipment, fraudulent practices, dangerous rigs, and co-workers who ended up on the front page for all the wrong reasons, we had shame-inducing uniforms...

Trying to incorporate the internet "meme" ICWUDT was my attempt to be more relevant to the youngsters, with their Twitter and AOL.

Ay dios. ICWIDT

And we didn't even bring up the "lights and sirens" issue!

As an ER doctor, I don't think that, in general, it's worth it. There can be extenuating circumstances, but there are numerous challenges to keeping up quality resuscitation during transport, and I don't have to review those here. And despite the appeal of the mechanical CPR devices, I don't...

Thanks for trying out the policy! Just try to make my life easier at work, and avoid calling it clearance. We passed the policy because it is (correctly) viewed as board removal, but not clearance. Perhaps it seems like a small point, but it's a world of difference to many of the staff. As...

You bet. That's the new policy at my place - EMS and the RN remove the board, while maintaining spinal precautions. I'm moderately surprised that there are still EDs running patient through the CT on a backboard. A good reason for EMS to purchase metal backboards, IMHO. Somewhat...

Inflammation, as in oxidative, long-term stuff? Or something else? If this discussion gets too basic/bench/mechanistic, I think I'll have to bow out!

Like I say, UA may be passé. (Bad link replaced) Unstable angina died last week, at the European Society of Cardiology’s annual Congress in Munich. The term "unstable angina" was 41 years old, and is survived by its close sibling, non–ST-segment elevation myocardial infarction (NSTEMI). The...

I remember trying to understand how to recognize a "non-Q-wave MI" on the ECG, and being frustrated at trying to make an impossible clinical diagnosis. After all, how can I diagnose something that hasn't had a chance to develop yet? Similarly, the UA/NSTEMI distinction has its problems, not...

I understand the reasoning behind keeping the helmet and pads on as a unit - there are numerous radiographic studies, motion-capture studies, and expert opinions - but I do think it's valid to revisit the reasoning and logistics behind deferring exposure until the ED. I also think some of the...

Ugh, just plowed through a bunch of the literature on football (& other helmet/pad sports) injuries. A "crash" course, if you will! It still stands out to me that the injured football player is managed, to a certain degree, unlike most other patients. For example, exposure of the patient is...

Good decision to go to the ED. Aprz, d_miracle36, I think you're on target with your evaluation. I'm guessing that this was an RCA, given the STE inferiorly, and the pronounced reciprocal changes in aVL. Getting V4R, as mentioned, might corroborate that, but there's still plenty of evidence...

I appreciate the perspective of the trainers, but a few things occur to me. 1 - All non-trivial trauma gets uncovered in the ED as the first step; 2 - Even necklaces and earrings/piercings screw up x-rays, let alone clips/rivets/etc; and lastly, 3 - For significant trauma, we're generally...

Adding on Veneficus's comments: Not only are more injuries treated non-operatively, but also many are no longer handled by the general/surgeon. For example, interventional radiology handles many of the heaptic/splenic injuries. So, rather than moving towards the "ED bypass" model for...