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Normally I am a fan of having a relaxed patient. But in this case I don´t think I would want him on Versed. I need his muscle power to move air in and out.

ALS scope of practice: Manual airway maneouvres, oro- and nasopharyngeal airways, suctioning/deep suctioning, laryngeal masks, ET-intubation, needle or surgical cricothomy, manual ventilation with BVM, mechanical ventilation, CPAP, needle thoracosynthesis, IV/IO-infusion, defibrillation...

Don´t you worry VentMonkey. We´ll focus on the oxygenation, properly ventilating the patient and anticipating airway compromise, while we wait for RSI. Just wondering what else we can do in those 25 minutes that can be helpful. The Netherlands. What Denmark;)

Offcourse, give me a sec.

Thanks for your input VentMonkey, it sure makes sense. We are an all ALS-system. We are expected to do the clinical reasoning. Maybe it would be helpfull if I explained our system a bit in another thread.

We can do that as a last resort. However, you´d bypass the swelling of the soft tissue of the pharynx and hopefully get a tube in, but it won´t resolve the respiratory compromise due to the inflammatory process in the lower airways and the lungs. I am still thinking about what can be done with...

Yes, RSI is within the scope of pratice of the HEMS critical care teams. I didn{t think of IM epi. That would be an option too.

We are an ALS-unit and we are dispatched to a residential fire, where a resident has been rescued by bystanders. We find a 35yo male with signs and symptoms of chemical and thermal inhalation injury: The patient is awake, with a GCS of 3/6/5, he is hoarse, has 1st and 2nd degree burns to the...

The days that we refused analgesics for the sake of abdominal assessement are over. If the patient is in pain he gets 1G of IV acetaminophen, and either fentanyl (up to 4mcg per kg) or esketamine (up to 0.375mg/kg) until his painscore is lower than 5. We don´t carry more flavors.

okidokie VentMonkey, no problem :D sorry I misinterpreted.

I said: even though this patient is bradycardic, he has a stable circulation. I wasn´t intending to worry about it or treat it.

For the time being an airway is secured by the NPA, and the B is managed by proper ventilations with the BVM. The C is stable, despite a bradycardia. Overall I have an ABC-stable patient, with a lifethreatening TBI. What will save his life is neurosurgery, which is available quickly with a...

I have never seen it in nine years, and only once did I do an interfacility transfer in which the attending physician instructed us (on a writen statement) that a carotid blowout was imminent and that sedation was going to be the only course of action. Our protocols cover 17million people at a...

On our side of the pond Midazolam is widely used as an pre-induction agent in the OR. The dosis is 0,2 to 0,3 mg/kg. As it is a cardiopulmonary stable drug, it tends to be a good option in patients with pre-existing cardiopulmonary disease. In the prehospital setting our protocols provide for...

How do you feel about sedating a patient who is waking up post-CPR with 2,5 to 5mg Versed? The rational behind this would be to reduce anxiety, reduce oxygen consumption, reduce awareness and prevent memories from the resuscitation setting. I know that there are a few contraindications, eg...

usalsfyre, I am trying to understand how these things work on your side of the pond, as I go through the books for the COPR-licensing exam. Nothing more, nothing less. No need to be so paranoid mate.

I have an unused original uniform jacket of the Medellin Fire Department (one of the most prestigeous professional fire services of Colombia). It goes with its uniform belt and a few additional patches of the fire service. The whole package can go for USD 30 plus shipment cost.

Had a 12yo girl involved in a heads-on collission. She was deceased by the time we arrived, but she had indeed tremendeous swelling of one side of her face and jaw.

I work in Europe and I am trying to understand how legal accountability works in paramedic practice in Canada. I´ve read about the laws, but how are they applied to these (common) situations, and how would you resolve these cases: 1. Physically or chemically restraining a combative patient...

I am curious if any of you has had calls involving the side effects or complications of any sort of alternative therapy? To name a few: chiropractic, neural therapy, acupuncture, Ayurveda, naturopathic medicine, chinese medicine, orthomolecular medicine, self-treatment with food supplements...