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Agreed. But the NNT looks pretty low, if you read the previously published papers. If you look at the CRASH-2 paper, that's sort of the general idea. The biggest benefit was in patients treated in the first hour. This decreased in the second and third hours, and converted to an increased...

Well, my assumption is that any new-onset event would probably get transported to the ER for more thorough evaluation. There are plenty of people with mental health diagnoses living in the community who access health care via ambulatory clinics, family medicine clinics or outpatient psychiatry...

A few people are asking if it works, well, I think that's been answered already. If you look at CRASH-2, they enrolled 20,000 + patients, in over 250 hospitals, in more than 20 different countries. It's a pretty huge trial, and the inclusion criteria were very broad, and amenable to transfer to...

Just wanted to add, don't underestimate how much time it takes to learn a second language, or how high a level of fluency you're going to need to work EMS. Even if you immerse yourself completely in the language and find a job working with Norwegian speakers, you're probably looking at 2 years...

Thanks! Much appreciated.

We carry it, and give it based on the CRASH-2 guidelines, i.e. recent traumatic injury, HR > 110 or SBP < 90 at any point, believed due to hemorrhage. CRASH-2 showed no real evidence of harm when given early post-injury in a heterogenous group. The MATTERS study showed even greater benefit in a...

The primary indication would be doing a scene call where an infant is delivered. We're 1 - 1.5 hours by ground from a NICU capable facility or an academic hospital, 20 - 30 minutes from a community ED staffed by family medicine. We deliver less than 10 children in a year, but we have a...

I've noticed a lot of pediatric / neonatal threads recently with some transport folks commenting. One of the ground ambulance services I work for has recently purchased a BabyPod 2 for transporting field deliveries. I'm in the process of developing some training materials. I was wondering if...

Edit: thanks for adding references!

Also 8/36 here: http://www.ncbi.nlm.nih.gov/pubmed/25153713

So we carry it. We use it (1) to augment analgesia at 0.2 mg/kg; (2) for conscious sedation at 0.5 mg/kg, and (3) for RSI at 1.5 mg/kg * Although I would consider reducing the dose slightly if they're severely hypotensive or sympathetically-driven. We pretty much use it for all our RSI. The...

This depends on the brand of bougie you're using. In at least one brand, if you bend the distal six inches or so, it's impossible to bend back into the original shape. At best, you end up with the tip oriented in a random direction, e.g. sideways or upside down. You can't really compensate...

We've just started directing this to community mental health, instead of transporting. An RPN from the team responds to the call with a Community Paramedic. The transport rate is very low.

In my area we're able to transport any IV medication that we're comfortable with. We carry TNK on all the ALS trucks, and use it fairly often, as we have limited PCI resources. We also have IV nitro, and access to Plavix, Brilinta and Enoxaparin. Generally we take the hospital's pumps if...

I see that there's a lot of folk with ICU / CCT experience on here, so I'd just like to throw a few ideas out for feedback. * The patient meets criteria for severe sepsis (SIRS + lactemia) * The, "Audible congestion was noted w/ cough. Patient had course crackles throughout. Chest x-ray only...

Usually we just call the cops. We don't have to contact a physician. So, for us, it's a simple as calling on the radio that it's a 9B and we need police. I don't normally need to leave the immediate area to do this. The dead body isn't getting any more or less dead if you hug the wife, and...

We had a presentation once from a neurologist who showed us videos of patients having a variety of epileptic and non-epileptic events while undergoing continuous EEG. We failed badly at differentiating the pseudoseizures (or PNES, if you will) from the true epileptic events. I've also...

It's a great adjunct, either as a lower dose to augment opiates (e.g. 0.2mg/kg), or a dissociative dose (~ 0.5 mg/kg) for procedural sedation. I treated a kid with a mid-shaft femur fracture last year, 100ug fentanyl, 30 mg ketamine, he didn't make a sound as we realigned and traction splinted...

Yeah, you're right - I should have fact-checked before I posted, but I was going for memory and got a few things confused. Re: active transport, I think you need it primarily where you're going to potentially be transporting up a gradient, or you have a risk that the gradient may reverse for...

There's a bit of a discussion on glucose transport here (mostly related to the CNS). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134675/