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Specifically, I don't know. But I do know that it's based on the literature that's out there, and that he's well read and has been involved in some of the research. We have a pre-hospital RSI program in our region, and management of capno is one of his strong areas of interest. He also worked...

Actually, our medical director is insistent that he wants these patients kept at 38-42, with the perfect world constant goal of 40. Once intubated, I think propofol is safer than the other agents, in an appropriate patient. Goes to show what happens when other groups (anesthesiologists)...

Seeing that you are bound and determined we are going to transport this, I would insist on a second provider for the transport, at the very least. Even an EMT-B would be enormous help here, since it it sounds like mom and baby will both need resuscitation.

Because between now and four hours ago, when she presented, they didn't have time to do one. 6 cm and 70%, 4 hours ago? WTH are they waiting for? And she's still in the ED? Sounds like they just don't want to deal with a complicated patient who won't pay her bill. Someone needs to...

Anyone have any experience with Precedex (dexmedetomidine) in the mechanically vented, critical care patient? I do a lot of critical care transport, but most of it is from the smaller hospitals to the tertiary care medical centers. I recently did a job from one major hospital to another (70...

Yeah, if you arrive and find someone pulseless and the family is asking you not to work them, for whatever reason, you should be calling. We have an obligation to the patient and their family. We also have an obligation to the system not to over burden them with useless CPR cases, using beds...

Also in NYS we have the MOLST, which is valid for prehospital use as a DNR order.

Not true. I also work and practice in New York State. If there isn't paperwork, and the family doesn't want them worked, I am immediately on the phone with medical control. Doesn't matter if there is a DNR present or not. On a patient that shouldn't be worked, CPR isn't started until I have...

Why can't you take their word on it? Doesn't family, and their wishes, and what the patient wanted, matter? Don't the family and the patient get a say? There are going to be times when we encounter patients that don't have a DNR in hand, but they should NOT be worked. There should be an...

I teach my paramedic students and new grads to make the decision about death clinically, and not even put on the monitor unless you are starting CPR. As for the wishes of the family and patient, I've called dozens of times and explained that technically the paperwork isn't in order, but...

Sepsis certainly is a possibility, but if you think it is, I question your opinion that she isn't urgent. She meets 3 of the 4 criteria for SIRS. At any ED in my city that makes her an ESI 1 in triage. I'm worried about the bruises and some sort of coagulopathy. Pre-eclampsia CAN happen...

I'm going by what I've read on these posts about California. If I mis-interpreted the way things are, that wasn't the intention. NYC is a free for all. But I'm a 7 hour drive from there, and most of us consider it another world, and things are completely different Upstate.

Keep in mind that different states do things in different ways. In New York, a nursing home call is a 911 call, period. It's billed to Medicare as a 911 call, and we take the patient to the ED, just like any other patient. Sometimes the staff does call the doctor who orders them sent out, but...

So if I try to relay to the hospital staff the acuity of the situation, and they don't want to listen, it's MY fault? Absolutely not. I am an advocate for my patient, and do everything within my power to paint as accurate of a picture as possible to the receiving staff. The fact that you...

Many good points on here. It gets easier with time. I still get frustrated by the little old ladies who wear the one piece dresses, where the top button goes all the way down to the start of the manubrium (about an inch below the neck!) and the dress goes below their knees. You have to hike...

I think a more reasonable option would be to make the BLS provider a 1 year, vocational program, like the practical nursing program, and the ALS provider an associate's degree, with a bachelor's degree as an option for upword mobility. Most areas of allied health are an associate's degree for...

1. There was bloodwork done that was never reviewed prior to surgery that would have negated the need for surgery at all. 2. During a tumor biopsy, healthy tissue was cut into, causing bleeding. The "surgeons are human" argument MIGHT hold water if #1 hadn't happened. They never should...

Any chance she had been using anything else? You say she's on xanax and percocet; I'm just wondering if she's in withdrawal from something.

I see what you mean, about the fire department and the "good old boys" mentality. What I find interesting is that law enforcement doesn't seem to have the same stigma. Gay cops that are out, while perhaps not common, seem to be more so than firefighters. Just an observation.

I've worked at the 2 commercial agencies in my city. One was not terribly accepting, overall of homosexuality. The other, where I am now, seems to be a safehaven for gay men and lesbians. We have what appears to be a significantly higher percentage than does the general population. Most of...