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Rialto has a population of almost 100,000. The average incidence cardiac arrest is approximately 1 per 1000 people. Based on aggregate cares data, the % of arrests that are bystander witnessed AND primary VF/VT is around 12%. So, we can assume that Rialto treated around 100 arrests and that...

I'm now a doc (just an FYI), and I trained at a busy trauma center. Rollover alone would not be a trauma, a positive LOC + trauma was not enough to be a trauma, and again, elderly or blood thinner + trauma did not necessarily mean trauma activation. However, some of those would be trauma...

I think dopamine and epi are adequate as far as pressers for EMS. Dopamine may not be necessary since push dose epi would be fine in an urban or dense suburban setting. Dopamine is far far more likely to expire than be used on a patient Having work for an ALS service that cover 2 counties...

My experience is that prehospital IV makes no difference in length of stay. At least one small study demonstrated such: https://www.ncbi.nlm.nih.gov/pubmed/9799021. If it is a sick patient, then yes, an IV can save us time for initiating treatment.

Chastise EMS? Or physicians chastising other physicians? Or whatever flavor? Depending on the procedure/intervention, yes people do get chastised in different ways. But, it depends on the circumstances and patient outcome or if any complaints. EMS here is lucky in that they don't get much...

I think it's multifactorial. On some level I think it makes a paramedic feel like they're needed/useful - "since I'm here, might as well...". Part of it is that some think of it as a courtesy to the hospital. Of course you won't see EMS administrators discourage this since it does increase...

Far and away the most common over treatment is the "IV and monitor".

I get to reminisce... (It's been nearly 7 years since I worked as a medic) As a physician, I think most calls are appropriately over-triaged to ALS, but inappropriately over-treated as ALS.

This is another in a long line of inventions, ideas, etc. that are great on paper, but do not pan out in the real world as one would expect. I'm appreciate that the device can do as well as human CPR, but it IS cost prohibitive and i think the start up costs and the costs for ongoing...

Not quite sold on the device, but the idea of something helping to guide the bougie or ETT anteriorly is not a bad idea. Part of learning to manage a difficult airway is know where to aim the tube when you can see the epiglottis but not the cords, which means aiming the tube or bougie...

How busy this station is also has to do with how they count the numbers. LAFD noted the station responded to 17,434 incidents in 2015, the article mentions a call volume of 27,338 for the same year. They're busy, for sure. But, when you break it down on a per ambulance or per apparatus basis...

It is also done by intensivists and GI. And really, it can be placed by anyone. Also, endoscopy can only do so much. In the patient that I placed a Blakemore, he had been scoped multiple times and had a blakemore placed at least once previously. GI did not immediately re-scope him. Really...

Mallord-Weise tears and Boorhaves don't typically bleed much. But, if the person was coagulopathic, that could change. Varices can bleed horrifically. I've also seen MASSIVE hemoptysis due to malignancy. It's possible that he could have had an upper GI bleed. Anyhow, for what it is worth, I...

Pre and post intubation management is a given, no? Are people intubating and not ventilating? For the short duration in the prehospital setting, PEEP is not an absolute necessity. Post ETI sedation is. Inhaled epi probably won't do t anything, so NBD if it's not done. In the ICU, mucolytics...

As a physician (resident), I've worked in a burn ICU. I have seen numerous patients with severe airway burns (been present for the bronchoscopy and have personally seen the how edematous the tracheal mucosa becomes and the sloughing of tissue in the the trachea). One of the more severe cases...

The crude survival for the Australian study was 3.78% (25/660) for attempted resuscitations. 5% was after excluding patients with resusc time <10 min. The English study had 705 patients, but 129 had an ED-only arrest, thus 576 w/ a prehospital arrest. Survival AT 30 DAYS was actually 8.3% for...

I tried to access the articles, but they are not yet posted to sciencedirect. It's tough to tell from the abstracts how exactly they calculated survival. The first study is out of the UK and the 2nd out of Australia. Both countries have a low burden of ballistic trauma and as mentioned...

Man, that was painful to watch.

Methylene blue may also be used for calcium channel blocker overdose. It can also be used in septic shock.

Of course I'm on the ED side, but I haven't used anything too outlandish. But some colleagues of mine have pushed TPA for presumed massive PE and esmolol has been given a number of times for refractory VF/VT. We started stocking intralipid at the recommendation of our toxicologist, but I don't...