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I never said do labs or imaging as a shotgun approach. Nor are they just done to confirm an already know diagnosis. Even the most experienced ER doc can usually only make a reasonable guess based on clinical exams. My point is that for most complaints the NP is going to tell the patient that...

Sure, they can do a better clinical exam. But how far can they get with only that and no labs or imaging? Let's consider a typical call for abd pain. They can make a better guess at a Dx than a medic, but in the end they will just have to tell the patient that they need to go to the hospital...

I'm curious, but what do you guys think that an NP or PA working outside of an ER/clinic, or for that matter a doctor, will be able to do better than a paramedic?

Definitely not a febrile seizure. He needs a lumbar puncture and CT. Another thing to consider is toxic ingestion; i.e. beta blocker, among other things

What if she vomits? That's not unlikely considering how long she's been bagged and that she may have a CVA.

What is "K2"? Do you guys see a lot of Spice? I have never seen it before; never even heard anyone I work with mention seeing it. On the other hand, we do see a lot of GHB. I had never seen GHB in the area I worked previously. It seems that a lot of these exotic drugs are regional. What part of...

When you are new to EMS, you really ought to check pulse and respiratory rates for 30 seconds. Once you have a lot of experience, checking the pulse for 10 seconds is reasonable in most cases. Just by looking at someone for a few moments will give you an idea of what their respiratory rate is...

Aortic dissection or AAA? Many people confuse them.

"True, but where does lower abd pain fit with liver/galbladder issues?" Maybe the patient didn't read the same medical textbook that we have read. It's all speculation until we get the CT result. Interesting to think how an MD in, say, 1960, would have formed a diagnosis with these...

An obstructing gallstone. It's emergent because you can get septic.

Interestingly, some implanted ICD's can do overdrive pacing as well.

LVAD: often no palpable pulse. If you get a BP, my understanding is that it will not be accurate. ECG normal as for patient. Quiet operation, but you can auscultate the hum of the implanted pump. Defib and ALS meds ok. Most will recommend no CPR, but check local protocols. Total artificial...

Unless it's a total artificial heart, in which case, since it's pulsatile, you will get both a BP and a pulse. However, you won't have any electrical activity since the heart has been removed (except for part of the atria). Artificial hearts are bridge devices like LVAD's, and they are becoming...

To the OP, where are you located?

Yes, this was ACE inhibitor induced angioedema. It only took 12 minutes for someone (DE Medic) to figure this out! It's the second time I've seen it, and both times the swelling was isolated to their lower lip. Both patients had also been on an ACE inhibitor for a long time prior to this happening.

BP 175/90. SpO2 99% No fever. Taking lisinopril for weeks. No other apparent swelling. No hives. Pt c/o SOB and is anxious and tachypneic but without labored breathing and has no stridor. Treatment?

You respond to a 65 y/o female who opens the door. The first thing you notice is the pronounced swelling of her lower lip. She appears very anxious and you can barely understand her due to her speech being slurred. She is pointing to her lip and you can understand that she is also complaning of...

That's an interesting study. I do wonder what the details of the four successful resuscitations were.

Do you have a link? Thanks

The recommendation used to be not to do CPR with LVAD's, but just this year the recommendation has changed and I'm told we should do CPR. This is coming from an LVAD program director at my hospital job. I did not get a chance to ask her why the change. Follow your own protocols if you have one...