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Serious question, are you guys really using xopenex pre-hospital? Using it often? Even in the hospital setting we get push back due to its cost and I'm not sure how much benefit it has overall, or at least may have more of a perceived benefit than actually does.

Also, just to be clear, I'm also not saying that we would be expected to carry certain equipment or medications to be able to give off-duty. As a physician IF I choose to stop I would give whatever care I could with what was available which would likely just be notifying EMS and comforting...

It's true you would be covered under that acting in a voluntary manner but it doesn't protect you (or anyone for that matter) if you commit gross negligence, and since we're trained providers we automatically know more than the general public and could theoretically be held for gross negligence...

Be careful of this type of thinking as generally you would be expected to act in accordance with your level of training. Obviously would need to check with your state laws for specifics but even if you are acting in a voluntary manner and covered y a Good Samaritan law would still be...

No problem. I was mainly trying to to bring it back to some sort of practical discussion given some of the earlier posts, lol. Don't always have something to add but this happened to be in my field and deal with it not infrequently.

Have seen a few cases of PRES and I think it may have been under recognized in the past. Did they happen to do an MRI on him?

Well no, never said it's a definitive treatment but aside from an emergent pericardiocentesis (whether pre-hospital or in the hospital) it's one of the only few things y'all can do in the field. I'm not talking about flooding them with 2L but give them a 500ml bolus or something to see if...

I'm not really sure what all the above means and not sure if really trolling or just thinking too much into things. Anyway, I would say get this guy to a hospital that has cardiac services, start on aggressive IV fluids and bolus if need be and just monitor his heart rate for now. If you want...

I wouldn't give this atropine or be too worried about a HR in mid 40's at this point. Based on the description he's in tamponade or about to be and about the only you can do at this point is give fluid. So open up the fluid and get him in. Don't limit the fluids thinking it's just going to...

I'm not sure some of y'all really understand these laws. Each state has different laws and not all allow for this sort of thing but I'm only familiar with Florida's version which is referred to as the Baker Act or BA-52. Usually these provisions allow for involuntary evaluation by a mental...

Actually some nitro would probably help here, give a quick spray or something. In the hospital if I have someone in distress with acute pulmonary edema I can usually get them over the acute hump by throwing in bipap, hanging nitro gtt at fairly high doses to start, giving some diuretic and...

Yea I've definitely seen that quite a bit from others getting caught up on something like peripheral edema or lack thereof. If more of acute left sided failure then may not have significant edema. In this case I think just more of acute pulmonary edema (from whatever caused it) and not...

I certainly wouldn't use it solely to be able to use "a little less sedation"

Outside of RSI or extenuating circumstances I would lean away from pre-hospital NMB use. I'll give you that considerations for NMB use in the ICU are probably slightly different than use in EMS, but they still have serious potential side effects and complications. I just think the...

Actually it should be pretty easy in this patient to get an idea of her volume status..... She's got JVD, rales/crackles, known renal failure and hypertensive. I could see you thinking fluids since that's something we do/consider in setting of RV failure and PE but this presentation doesn't...

I think you did fine with this, she's obviously in resp distress and you recognized probably pulm edema/CHF and treated so and got her safely to the hospital. Are you able to see what was done after admission? See if they did an ECHO, willing to bet she likely has a relatively normal EF...

Fluid bolus? Explain

Being in the receiving end, most of the folks I would receive intubated are either post cardiac arrest or intracranial hemorrhages.... both of which we like to get a good idea of their neuro status upon arrival. Granted, where I'm at in an urban/suburban area transport times are pretty...

The only time I worry about NSAIDS in light of hemodynamic instability/ hypotension is there deleterious effects on renal perfusion.

Welcome to the family! ;) Now the real fun begins....