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If anything she at least needs a beta-HCG and likely pelvic and/or ABD US. Woman of child bearing age with abd/pelvic pain will always throw ectopic high on my list. GYN: ovarian torsion, ruptured cyst, endomitriosis, fibroids, PID, complication from IUD, etc... Beyond a detailed history...

While "point specific" pain and generalized pain maybe something to keep in mind when forming a differential I'd caution against using those to decide on your course of treatment... at least in prehospital setting where you have limited data to go on. Recently had an elderly gentlemen...

Thought process change any if the patient has a known bypass tract/WPW?

Just had a recent case here.... guy previously in NSR went into an irregular wide complex tachycardia. Hemodynamically stable, felt a little "funny" and uncomfortable but otherwise stable. HR sustained at least 160-180's with couple bursts up to low 200's. We knew his detailed history...

How was her lung exam, any crackles/rales? What her knee? Any erythema/edema or other signs of injection? EKG really doesn't change my view on a PE either way, not really helpful. But am concerned for hyperK as others have said. Some basic labs and a quick bedside ECHO will tell a lot.

Recently had some discussions over the most recent ACCP guidelines with only a 2C recommendation for thrombolytics with acute PE and hypotension. So what did they do in the ER? If she remained hypoxic and "looked sick" this is someone I'd consider securing an airway on earlier rather than...

Post ortho surgery now hypoxic and hypotensive, definitely PE is at top of list. Bilateral BPs? EKG? Did spo2 correct at all with supplemental O2? Were fluids given? Febrile? Was she getting some sort of DVT prophylaxis at the rehab facility? Lovenox, Coumadin or some other anticoagulant.

Kind of what I figured. Not sure what vents our agency here carries. I know our ER has some very basic ones.

Not sure why people are having an issue with CPAP on a trach..... I put people with trachs on CPAP routinely. CPAP is a mode of ventilation.... it does not just refer to the noninvasive mode involving a facemask. All you're doing is connecting the vent tubing to the trach instead of an ETT...

Well just because a patient has a GI bleed or even in shock doesn't mean they need trauma center services. Like was mentioned above, rarely do these patients go to surgery. If any urgent intervention is going to be done then it will probably be some sort of scope by a GI doc. So as long as...

Yea, they don't need to go to a trauma center. Which "blood thinner" was he on?

Nice. She wasn't jaundiced initially on exam?

What workup was done in the ER? They for sure at least scanned her head and took basic labs.

Nope.

There are numerous situations where this could happen.... maybe their cardiac enzymes became significantly elevated or had new/dynamic EKG changes that warranted a cath. And not every coronary lesion is amendable to intervention. Could have been small distal vessel disease that would just...

It's not necessarily a LBBB. From that EKG the QRS doesn't look all that wide, hard to tell from the pic but what was the QRS duration? Could be an intraventricular conduction delay w/ left bundle morphology but not a complete block. Also, findings of a LBBB in and of itself doesn't...

That's sinus. I see p's in the II rhythm strip and V3. May be a slight IVCD but don't think it's LBBB, doesn't look that wide, but having problems enlarging pic well on my phone. But I agree, sinus with just some artifact.

That's been our experience here as well. Too many times have we coded a patient multiple times, each time on the phone with family who was determined to have everything done until the finally worked there way in to the hospital and saw the futility of it. If family is around we try and get...

No. I see this asked ALL the time by pre-meds and I tell them the same thing. At this stage trying to "get ahead" or prepare by reading those sort of texts (especially something like Robins Path) will be extremely low yield for you and not a good use of your time. Focus on getting a good...

Bayer did have a "quick release" ASA product in powder form that was discontinued in 2010 from what I could find. It contained higher doses of ASA (~850mg) as well as caffeine.... so not the best thing to use as a substitute for ACS.