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I suppose it depends on how the propofol is initiated, (example: 40mg bonuses titrate to coma, versus a straight IV in fusion of mcg/kg/min).

Interesting. I knew that ketamine has actions beyond NMDA agonism, but none of what I've read was concrete enough to try to share here to be fair though, i havent looked in a while. Can you share where you found that please ? It seems kind of counterintuitive that ketamine would have GABA...

Greetings from the US, bud. Cheers! Thanks for the insight! Can you share your thoughts on propofol? Why don't you feel that it's "very" cerebroprotective? Also, I don't think versed should ever be in mass quantities, especially in the anesthesia topic. I think there's a reason that it isn't...

Well, it's just that if you RSI a herniating or seizing TBI, you still have to terminate the seizure on the cellular level. Paralyzing them doesn't really help much, (aside from preventing spikes in ICP and rhabdo) cause theyll go brain dead after about 7 minutes of continuous seizure activity...

In theory, no; if you're infusing enough ketamine they shouldn't break the k-hole. However, while I was searching for just the right "cocktail" after running out of narcs one night in what basically was the EMS equivalent of an MCI, every cocktail involving ketamine also had versed involved. I...

I see a lot of versed/Fenanyl protocols, that seems pretty popular. I'm just not sold on it, because the old mantra "anesthesia AND analgesia" isn't being met. Versed simply isn't an anesthetic (at least not at the pitiful doses it's given at). Ketamine does both in one drug; with the caveat...

If I can sidebar: Why are people using ketamine for induction but not for maintenence sedation? Ketamine is excellent for that also (well, it's excellent for pretty much everything).

As with any drug, try to look at the underlying physiology you're working on. Drugs do either one or two things: A) Block some type of physio, or B) Stimulate some type of physio This is relevant because, (and this is really interesting to me) the atrium is the ONLY membrane in the entire...

You guys remember the old "coma cocktail"? Everyone with AMS got thiamine, D50 and narcan. I think people still try to titrate to "awake" (read: combative, piss and vomit covered, etc), when the paradigm has shifted to respiration-driven administration. If they're "altered" with adequate...

Yeah, that's an issue, but in a vacuum (aside from toxic leadership) growing as a provider should be motivation enough.

I'm going to humor you once, and since you're a grown man, I'll give you the benifit of the doubt instead of calling you a massive troll. You're arguing that "crawling" entails someone giving you some answer that you're likely going to forget despite the fact that a) it isn't relevant to you...

Yeah, except you were asking about carrying a "clot buster" without demonstrating knowledge of the body systems they work on. YOU were trying to skip your little rhetorical pyramid. No one has the time, or desire to try to explain the intrinsic and extrinsic clotting pathways to someone over...

Unfortunately, the mentality that manifested here is more common than it should be. Hell, even the fact that someone bothered to venture on to an EMS forum and ask "why" is becoming more and more rare. Some people don't care why, and don't even ask. They take the entry-level training they...

Thanks for the response! That's very useful.

That's an interesting theory. Too bad people don't listen to heart sounds in EMS. (Might be because it wouldn't change our treatment save for maybe becks triad) Let's play the rheumatic heart fever game. If it was caused by group A strep, there would most likely be severe consequences to the...

Yeah the lactate was a dead giveaway, but what's strange is no left shift (the neutrophils were In the normal range), and a left shift normally indicates a bacterial infection. His hypotension may have been super refractory from the ACE inhibitors he was on; remember the renin-angiotensin axis...

I think most people have ditched procainamide. Shame, because (aside from giving people lupus) it has really good utility for weird situatons like WPW/A-fib. Amio seems to be the favorite most of the time, and some systems have even ditched lidocaine entirely for money reasons. Only thing is...

For the one femoral I did, it was landmark. Same for the femoral nerve blocks I did, (for tourniquet pain), landmark only.

I've done them in Afghanistan where IO access is contraindicated and the pressure was so crappy that I couldn't get an EJ. I did put a femoral line in once in lieu of a cutdown, but since I'm not the best with a bedside US, cutdown seemed safer

Lung sounds should be reconfirmed before and after each transition regardless. Now that everyone has ETCO2, there's even less room for an accidental extubation to go unnoticed. A few years back PHTLS said that somewhere around 30% of prehospital intubations were iatrogenically extubated at some...