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Hey, this was the subject of my first blog post! Prehospital Administration of Tenecteplase for ST-segment Elevation Myocardial Infarction in a Rural EMS System. Great topic.

Well, that is pretty much the position taken by ATLS, so you're in good company! Our ED has a new policy that lets EMS and the RN roll patients off the board when they arrive, rather than waiting for a clinician. It was pretty uncontroversial, given the evidence - nobody benefits from a board...

I agree that keeping geriatric patients off the long board is probably good medicine, and definitely good for your immortal soul! Given the know risks, many EMS agencies are eliminating the use of the spine board if patients are not severely injured. Xenia Fire, in Ohio, has a policy:"Do not...

Wait - use a ROM test, but then apply a collar?

The test requires knowledge of biology, chemistry, physics. The funny thing is, it's really a reading comprehension test on crack. It is often said that true science majors (bio, chem) don't do as well as, say, English or philosophy majors.

So many topics raised in one short paragraph! If you want to be a medic, do it. You should understand that, by itself, it won't help with your GPA, your med school application, losing weight or growing back your hair. But if you want to be the guy with the tubes, drugs, and needles, go for it...

Some people feel strongly about the grapefruit issue, evidently; e.g. "Grapefruit Is Disgusting."

To be sure, they likely need to be started on anti-HTN meds, but it is rarely an emergency, and is usually handled with PO stuff. The high BP will catch up with them, but over the course of months/years, not minutes/hours. Now, if they have hypertension and acute CHF, then blitz them with NTG!

I am a strong believer that common sense and medical knowledge should trump rote protocols. But when you deviate from those guidelines, you really need to have a well-reasoned argument why you did so. There is a good reason why you don't have hypertension protocols. Frankly, the percentage...

There's a short list of non-opiod drugs that naloxone has some effect on. It partially treats the hypotension in cloninde OD, for example, or the mental status depression with an Afrin OD! That being said, I doubt that an ER doc reads the British Journal of Pharmacology, but I did find this...

Looks like an atrial flutter, I agree with the computer. There is some variable conduction, and it looks like it goes from a 2:1 to a 3:1 in the second ECG. One of the ECGs indeed shows NSR with a mess of PACs. I wonder why esmolol versus diltiazem, or even plain metoprolol?

It's tough to look at a cardiac arrest and not do anything. If you stop giving lidocaine, sodium bicarb, atropine, amio, and vasopressin, pretty soon you're all just standing around, watching the compressions guy do all the work. That being said, people have looked at that issue, and I would...

For the non-critical patient, I agree with the other posters - whatever the difference is, it isn't relevant clinically. The issue gets a little more complicated, of course, when the patient is really sick. We see a lot of people working hard to get a finger stick on the cardiac arrest...

Well, if you go too far down that line of thinking, you end up with the "taxi-cab" model of EMS. Just an April Fool's joke? Or a serious proposal?

Well, that's the direction taken by some services. Or even physician only, as with the SAMU system in France. Zmedic, I would only point out one thing: Medics can diagnose, but OEC? I'm not so sure!

Observation and a suggestion: First, the issue of who can diagnose is not quite as thorny and confusing as what a diagnosis is. In all seriousness, there are a number of people interested in the "philosophy of medicine," and the topic of what constitutes a diagnosis is a healthy area of...

Incidentally, does anybody know where the myth/dogma about "only doctors diagnose" first came up? An old textbook, or a quotation from some long-gone luminary? Google wasn't as helpful as it usually is!

The studies showed placebo-identical blood levels. It's difficult to compare the clinical effectiveness in actual anaphylaxis, given the rarity, and urgency, of the situation. As for ipratropium, I haven't read anything on the topic, positive or negative. (Okay, one very rare, negative...

I just want to be clear - it's not my own crackpot opinion! This reccomendation comes from, basically, every reference document and (current) textbook out there. This is mostly based on two studies, one in kids & the other in adults, that showed that IM in the thigh was the only route that...

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