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Just wanted to added, that this statement I made earlier is a little misleading. Glucose enters intestinal cells via Na+ symport, e.g. SGLT transporters. This prevents glucose from being drawn out of the intestinal epithelia between meals, when intestinal [glucose] may be low, and allows uptake...

Ok. Pulled the paper, a few relevant pieces: "the intracellular concentration of Na+([Na+]i) under prevailing basal conditions is not saturating, therefore increases in [Na+]i alone suffice to increase pump activity by mass action" "stimulation elicited by hormones is only approximately 5% of...

I'd always assumed that because glucose enters cells via Na+ symport, that because the [Na+]intracellular goes up, the Na+/K+-ATPase is stimulated, causing expulsion of sodium, and intracellular accumulation of potassium. I guess another likely possibility, is that that after glucose enters the...

"Of the 152 patients allocated to hospital intubation, 144(95%) arrived at the emergency department without intubation. In 5 patients, there was a decrease in conscious state and loss of airway reflexes during transport to hospital, and intubation was undertaken without supplemental drug therapy...

If you look at the methods, they didn't draw an ABG until after placing an art line and capturing the airway: "In the hospital emergency department, patients who were not intubated underwent immediate RSI by a physician prior to chest x-ray and computed tomography head scan. In these patients...

Yep, but the proportion of patients in the GOSe 5-8 group versus the GOSe 1-4 group was statistically significant (p=0.046): "The proportion of patients with favorable outcome (GOSe, 5–8) was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) in the...

Also, once you hit the ICU, you're intubated, they may be aware this was a prehospital intubation when they go through the chart, but they're almost blinded. It's hard to think that they're going to really modify their care based on where that ET tube was put in. Even more so, in the rehab...

11 more patients that were able to live independently, travel locally, and buy their own groceries in the prehospital intubation group. www.tbi-impact.org/cde/mod_templates/12_F_01_GOSE.pdf I'm not saying being GOSe 5 is a great way to live, but it's a lot better than being a 4. Granted, you...

True, but disability at 6 months was significantly improved, which is probably more important.

I would argue that if a physician is going to be involved in the oversight and direction of prehospital care, then they should know the level of skill and training of *their* providers. Not a group of paramedics in San Diego, King County, or Victoria, Australia. The fact that the group is...

Agreed. I think that you and I see that, but that the physicians, as a group, generally don't. There's not a lot of distinction made between someone who graduates from a six month program, and someone who graduates from a 3 year program, or between the person who does tubes on simman, versus...

For all the pressure to transport rapidly, there's not a much data supporting rapid transport in blunt head injuries. The arguments against prehospital intubation generally focus on: (1) Paramedics are less skilled at intubation than physicians and are more likely to expose patients to...

So I've had a chance to go back through my results, and now I'm a little happier. The ECG I thought was Wellen's syndrome is a good beat. I missed at least one very blatant STEMI, I'm still not sure how. My biggest downfall was failing to consider absolutely small but proportionately large ST...

Your accuracy was: 78 % Your sensitivity was: 67 % Your specificity was: 100 % You had 0 false positive(s) and 8 false negative(s). ================================ Not very happy about the 8 false-negatives :(

There's some great points here. I think the major drawback to paralysing for transport is that you're taking a patient with (hopefully), a functional sedation / analgesia package, and putting them in a new environment with a lot of extra stimulation and stressors, and removing a lot of your...

None. I started in EMS in 1997. My employer issues a single pair of Oakley safety glasses a year, and we have carts with cheaper UVEX safety glasses all over the place. It's been a difficult change for me, but you only have to do so many GI bleed cardiac arrests, and get spat in the face so...

My department issues ballistic vests upon request. They're level, IIB, mine weighs 6 lbs. If we request one, we are expected to wear it, although there is essentially zero enforcement. We were initially only allowed to have internal carriers, after consultation with city police, who advised...

The patient's oxygenating well, appears to be ventilating ok, and is 7 minutes from a trauma center with real doctors. You've got to draw up your ket, sux, and 1:100 epi, prep your tube, get out a bougie, prep a King or LMA, grab out the cric kit, fire an end-tidal on the bagger, and maybe setup...

Nice study. That being said, cardiac mortality was non-significant (p=0.26). There's also no significant difference in the rate of MI, or development of HF. The difference in MACCE is primarily driven by non-cardiac mortality (19/32). This is why I don't like composite endpoints. But, I...

I don't think the effectiveness has been demonstrated yet, but it's a novel and interesting idea.