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It would be nice to be able to think that way, that this is just an educational or frequency issue, but if you look at the data it's really not telling that story. The recent Melbourne study suggests there's a small benefit to neuro outcome in TBI. No mortality impact. This is in pretty close to...

I guess she was heartbroken over the loss.

You can see "curare notching" on capnograph waveforms, but this is just ineffective patient generated inspiration. Never thought you would. All the best.

I think this is the problem I'm seeing. We're giving 0.1mg/kg (max 5mg), which is really 0.1mg/kg for anyone under 50kg, and about 0.05mg/kg for someone who's 100kg. Admittedly, we're giving this with fentanyl and there's some synergism there, but the onset seems pretty slow.

The idea of paralysing the patient during the intubation procedure is to prevent any gag reflex that remains -- depending on the sedative / anesthetic used, the gag may be gone, minimal, or fully present, and to relax the muscles of the jaw. This is particularly useful when the patient has...

Just to add to the above - most patients that need paralysis for incubation don't need long-term paralysis postintubation. I think we often jump the gun on this in EMS.

I think there's been Cochrane's on both atropine in peds send lidocaine in head injury / CVA and there's little evidence for either practice beyond tradition. Defasciculation sounds logical, although I've never seen it done outside of through OR. If anyone has good references on what it does...

We've had it for 10 years. It's great when transport times are prolonged, or cathlab availability is limited.

pm'd

This is a very reasonable and well-thought out post. In my region this associate's versus certificate distinction doesn't really exist. Outside of the US few countries use associate's degrees. Our RNs are either 3-year diploma educated or 4-year BScN educated. Our paramedics have a two year...

Here it's 2 and 5 years respectively. I didn't realise that it was different in the US.

Paramedic: 2-3 years if you include EMT. RN: 3-4 years M.D. (FM) : 8-10 years. M.D. (EM) : 10 - 12 years M.D. ( random obscure specialty + dual boarded + journeyman plumber) 57.6 years. And so forth... Obviously educational time varies with location, but as much as both would probably like to...

I'll be the dissenting voice and suggest that paramedics and RNs actually both have a lot in common. Both are non-physician providers with relatively short educational programs performing acts delegated by a physician. Sure, each profession brings its own perspective to a given situation, and...

Yes. Of the commonly-used medications it has the most rapid onset of effect. It's even quicker given IV, as you would imagine. This carries additional risks and is only usually used in extremis. Yes. Anaphylaxis is an immune system response to a previously sensitised allergen. If you...

Interesting. We used to get the initial 12-lead, fax it if we felt it met criteria, and phone consult with either an ER doc or cardiologist. Based on the patients risk factors and cathlab availability, the physician would direct us to do a ER bypass direct to cathlab or push TNK in the...

I'm interested in hearing how various people's cathlab protocols work. Don't you fax the ECG after you've decide it's suspicious for STEMI, and doesn't a physician read it again? Surely if they see NSR and normal STs, etc., they direct you to the ER instead? Or is their no capability to fax...

The decision to intervene is usually based on the patients level of consciousness, whether their condition is subjectively improving, and whether they're starting to fatigue. There's not a set SpO2, ETCO2, or RR where this is going to happen. Ideally we provide a high enough O2 concentration...

The other thing to add here, is that this isn't an EMT versus paramedic issue. This is an issue about EMS as a vocation / potential profession. This is something we all own. Patient care is rarely, and very rarely optimally, delivered only by a large group of paramedics. On a decent call...

There seems to be confusion in some of these posts about the complexity of a psychomotor skill and the risk/benefit of a given intervention. Most of the psychomotor skills commonly used in EMS are not that complex. The biggest exception is probably intubation which requires a fair amount...

Also, they did eventually go in, and kill him, in Pakistan. Short of putting Obama versus Osama as the main event of the UFC after the Superbowl, what more do people want?