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You're lucky to work for such a progressively minded hospital! That's very cool.

Yes, Chase, I'm aware you can't use a Level One on a PICC line. I don't think that's what we are talking about since the paramedics on this forum, who are asking in general about using central lines, have Level One's in the back of their ambulance. So you are saying "The maximal flow rate on...

Chase, as a nurse, how many times do you use a central line when you are caring for your patients? On my last shift in the ICU last night, I probably did so dozens of times. If you are saying that these lines are so dangerous to use, then why do we have them? Yes, many nurses get lazy and don't...

You don't need a pump to use a PICC line. Why do you think that you do? You can run high flow rates through PICC lines and other central lines. Can you run infusions faster through a 16 gauge oeripheral IV? I don't; probably. But that is not what we are talking about. We are not discussing...

"Perhaps where you work, but not here. We do not have Huber needles, nor does any other local agency. I cannot think of a recent time in which anyone I know has accessed a PICC line either. If it's already accessed I'd of course use it." Tigger, you don't need a Huber needle to access a PICC...

How do you suppose that a PICC line is not for volume depleted patients? Are you familiar with using PICC lines? Is this just something that some other paramedic once told you?

Chase, why would a well trained paramedic not be able to properly access a PICC line? You and I both work as nurses and paramedics. What makes you think that a paramedic is going to cause a central line infection? I really don't understand your logic, but if you have a reasonable argument as to...

Okay, but when you show up to an ER with an IO on a patient with a central line that you could have accessed, you will lose credibility points with the staff. I don't mean that you are not in fact a great paramedic, only that you will leave a bad impression among the ER staff who have not see...

What's harder to do, ET intubation or properly using a BVM? Considering how ****ty nearly all medics are at using a BVM, I'd say BVM use is at least as hard as intubation. Sometimes paramedics brag about their intubation skills. Ever hear anyone brag about how great their are at using a BVM...

You should follow your protocols, but there is no reason to be afraid of central lines. With a little bit of education, I don't see any danger in paramedics using central lines. It's too bad some medical directors are not onboard. The last two places I worked allowed central line access.

Yes, I would intubate. This guy needs an airway. Once he's intubated, you can control his oxygenation and ventilation very nicely, which is also going to be important for someone with a head injury like this. If I didn't have RSI, I would see if he could maintain perfect sats with only a mask...

I can't answer the question because the scenario is so weird and hypothetical. More realistically, if parents told me not to work up a child at their home and explained that the child had had a chronic illness, then no, I would not work him up, even if they had no DNR. What you'd have to do...

"My theory here is that the pt induced his tetany and seizure activity through his recovery. By his own admission he had only been taking in water in the last 24hrs with no food, gatorade, etc. So while he was replacing his volume, he wasn't replacing his electrolytes. As a result, while his...

8000 ft doesn't seem very high for HAPE. Altitude sickness should take a while to progress to that stage anyway. Is she actually cyanotic due to hypoxia? What is her SpO2? Do we hear crackles?

Do you mean areas where fire is BLS only? In counties like Riverside and San Bernardino, among many others, the fire department will respond with ALS engines, but they do not have transport ambulance. On scene, the private ambulance paramedic and the fire department paramedic have scene control...

Take it off. Try putting a tourniquet on your own arm and you will realize how incredibly painful they are. Ask yourself, why would you do something that is both unnecessary and harmful (i.e., zero blood flow to the tissues!)? Don't worry about the mythical crush syndrome. This develops long...

Probably not psychogenic. There's a difference between someone who actually believes they are seizing and someone who is purposefully faking.

I'm getting to this late, but I have to say that this article is such nonsense, and so are the opinions of the paramedics quoted in the story. Along these lines, a paramedic recently wrote an editorial for the Washington Post advocating for paramedics to be trained to enter active shooter...

"...One of the more convincing ones I've witnessed." The fact that she was talking and telling you she has a brain tumor while "convulsing" would be an indication that she is not having a true seizure. That said, I have also been fooled a few times, even after years of experience and seeing...

DocBrok, I think you've been oversold on ETCO2. For tube confirmation and monitoring, it is crucial. But beyond that, it is of limited benefit. In those situations were you really do need to know the PaCO2, you need an ABG. You cannot count on the ETCO2 to match the PaCO2 in many patients. In...