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EM is "high" on burnout, but that's not to say you can't have a long fulfilling career, and truth be told, most do. We all ***** and complain, but it has its upsides, and few actually leave the specialty as far as I know. Ultimately, most would not want to be doing anything else. The thing...

Currently PGY3 EM. EMS influenced my decision to go to medical school - I wanted to know more, do more, and call the shots for the most part, but stay involved in EMS. In undergrad I was able to work part time so that I didn't need loans for cost of living (did 12hrs/week during class and then...

I had a rather interesting case tonight. Man in his 60s is witnessed by family to go unresponsive. CPR by FFs, found to have a pulse by medics (no epi or shocks). Man is older, no possible cause of unconsciousness reported by family. Glc ok. Other than some apparent agonal resps, vitals are...

Mechanism may be a poor predictor, but mechanism is still important for consideration especially when trying to interpret physical exam findings in a stable patient. I may only be a resident, but in my few years of evaluating patients with trauma complaints, I have seen enough patients with...

I'm in the group that thinks US has an extremely limited role, if any. I use it all the time in the ED and it is useful. I'm not as into it as some of my other colleagues, but it does have uses. As far as the prehospital setting and use by paramedics, as deployed and trained in the US, I do...

I'm not completely opposed to the idea of EMS-initiated ABx Tx, but I do not think it should be standing order. Med command order all day every day until it can be demonstrated that paramedics can appropriately identify patients in need of early ABx. And even still, it should be studied even...

You won't be able to diagnose hyponatremic seizures in the field. Fortunately, such a thing is rare. I've never seen it, at least not that I know of. As mentioned benzos might not work or may require higher doses (as in they may work). However, there are cases where patients do not respond...

Top differential: alcohol withdrawal, DTs Other things to consider: coingestion, beer potomania w hyponatremia causing seizures, head trauma, and then other usual causes of seizures that may be coincident to the EtOH. I would not hesitate to drown the dude in benzos. I've gone up to 16mg of...

I would agree. The responder with the highest EMS level of training should be able to cancel the helicopter, even if the flight crew is knocking on the back doors of the ambulance as you finish your assessment. Being flown in a helicopter is not benign. I do think of the method of...

I don't really trust EMTs to be able to draw up epi from a vial. Though it's not really hard to do, it is easy to bend the needle or forget the basics when in an emergency, especially when you otherwise NEVER draw up medications from a vial. I know of emergency departments that use epi-pens...

Only bad things will come of this. No EMS lives will be saved unless a gun is used to make everyone drive safer or wear a seatbelt. And I bet you a prosecutor will be far more likely to persecute an EMSer than a cop. And a jury will be much more likely to convict than they would for a cop...

If there are so many paramedics that a medic can be on scene prior to BLS the majority of the time then consider me to have low faith in the medic training and experience. I don't think they'll be that much better than an emt in a system w low number of medics. A patient teetering on the edge...

"Lower educated" providers make decisions all the time regarding patient care. Most EDs staff triage with RNs. Sure, RNs have much more education than an EMT, but it still pales compared to an doc. (Of course, some EDs do put docs in triage, but this is more of a metric-based intervention...

Depends on the "big" city. Some cities have FF/EMTs work on ambulances, so then you have to compete with guys who want to be FFs so bad, they'll say and do anything (including EMS) to do it. Then some cities only hire paramedics to staff ambulances. Then there are the ones where private...

Small ER with no specialty back up? Does it even have an EM trained physician working? Would that EM trained physician even think of cracking the chest? Without known time of arrest, I think it would be reasonable to load and go - do needle decompressions, CPR, and intubate if possible (all...

Patients sustain all sorts of injuries from CPR. Usually never hear about it because they don't usually get autopsied. Even for patients with the best prognosis, death will occur for the majority.

How did you sit the unconscious patient at 45* to properly assess JVD? If they were supine, some JVD is expected.

Oh man, to have a camera over the shoulder of the person performing a cric every time it is done. The technique was fine for this cric. It may not have been textbook, but I'm doubtful very many crics are ever textbook in performance. (I know, you all do them perfect everytime on a manikin...

Just to clarify: 1. Nope. 2. There wasn't a first, but one of the most important aspects to science is replication, so hopefully there will be ANOTHER study.

Got sued for an MVC that I got into while driving an ambulance. I was an EMT at the time. No one I spoke to really thought that I was really at fault, but by the letter of the law, I was. The suit was frivolous in my opinion and in the opinion of others, but that didn't matter. I did not...