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I realise this is an older thread, but I have very much seen this presentation several times with acute MI. Including a guy with a massive anterior who arrested in triage. This guys presentation with hypertension and chest pain is concerning. Some considerations: * Are there risk factors or...

How much time do you have? I haven't ever taken an EMT-B course, as I didn't train in the states, and I'm not sure exactly what's involved. I did take 60 hours of medical terminology as part of my paramedic training. It didn't seem very important at the time, but is actually quite useful...

There's plenty of patients out there with peak inspiratory pressures exceeding 35 cmH20, even with minimal PEEP.

An ETT also allows greater airway pressures without bypassing the device. The blind insertion devices typically fail around 25-35 cmH20. So it will allow higher airway pressures in patient who need it, e.g. those with high airway resistance, or need for higher levels of PEEP for oxygenation...

Can't you also see this if there's an LAFB, and the posterior fascicle also becomes damaged, e.g. the bifasicular block that progresses to 3rd degree AVB?

There could be issues with the cable for V3 as well. I find people often grab the LP15 chest cable and pull all six leads off at once, which irritates me to no end. It tends to upset patients, and results in damage to the cables that results in early failure. Just a couple of other things to...

Just the normal suggestions here. (1) Check your electrodes. aren't expired or dried out, (2) How is your skin prep? And (3) Check your limb leads. There's a bit of baseline wander in the ECG. Remember that they're used to form the virtual negative electrode in the precordial leads. Probably one...

Out of curiosity, how common is it in the US to be called to a palliative care patient, provide some medication, e.g. dilaudid, haldol, maxeran, scopolamine, etc., and leave them on scene?

Just to answer the questions: (a) Straight DNR - yes. Depending on the laws in your region, it might be a good idea to have a quick discussion about what the patient would like done if the adenosine causes a cardiac arrest, and being very clear about this risk. CPAP - again, acceptable under a...

These are difficult questions to answer. You might want to have a discussion with your supervisor or medical director to clarify exactly what is allowed by statute in your area. The most black-and-white interpretation of the DNR is that it only comes into play when the patient is pulseless, and...

Be careful with this, if you're thinking about treating animals while working in a traditional EMS response role: * Depending on your part of the world, practising veterinary medicine may be a restricted act, and subject to sanction if you're not appropriately licensed. * Does your agency have...

That would be some awesome shunt physiology.

To expand on this for some of the newer BLS providers, you will see plenty of old people, many on beta-blockers who don't present with typical symptoms when they're hypoglycemic. You will see overdoses on insulin or oral hypoglycemics, and many other drugs (e.g. propanolol) that become...

We pretty much do this. If it's a primary mental health complaint, we send a Mental Health Therapist, and a Paramedic in a SUV. They have about a 15% transport rate, the rest of the patients are deferred from the ER.

* I wonder why the sending ER didn't put one of these in? Is there a decent reason not to? http://epmonthly.com/article/pigtail-insertion/ * Also, I'd argue that this isn't completely blind if you have a CXR. Ultimately, isn't it the sending physician's discretion as to whether this goes ALS...

I just want to add another voice to the "be careful of treating atrial fibrillation" bandwagon. We carry metoprolol for this, and I use it very very rarely. It's typically in younger patients, who don't have a history of chronic fibrillation, who can identify a clear, recent onset of symptoms...

Yes, you can do that. It will probably work in most situations, but you have to be aware that there are some fundamental limitations. If you need PEEP or high airway pressures to effectively oxygenate the patient, the King may not be the best device, because at a certain airway pressure you're...

---------- There's a great discussion of these issues here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336134/ (free .pdf / full text).

I agree. If you're suggesting that there's probably subgroups buried in the data that are less likely to benefit from TXA, or more likely to be harmed, even when given < 3 hours, and that there may be groups that have greater benefit, including at time points greater than 3 hours, then I also...