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Haven't read every detail of each post but was just skimming though the thread.... Really, in general, I agree with JP's advice, if med school is the goal then doing what you can to get that point with minimal delays is usually the best option for most. There's always exceptions and other...

http://emedicine.medscape.com/article/1895577-overview#overview

Was a full neuro exam done? What all was done prehospital? And throwing high flow O2 on is not hyperventilating.

In these sort of cases I would ask for a good neuro exam. And what was her GCS?

Epocrates - free for basic drug database Or Medscape - also free drug database but also get disease info

Definitely agree with the above. May not be able to tell on physical but the history may give a clue and lead you in one direction. We're taught the classic younger patient with a traumatic injury and brief LOC who then feels ok with a lucid interval and rapidly deteriorates a short while...

Yea I wouldn't worry about this. I take care of plenty sick CHF patients in the hospital, a lot of them having multiple co-morbidities including COPD and I just have not had an issue giving these folks breathing treatments if they need them. By history and physical you should be able to...

Anyone here able to use adenosine within their protocols? Would you?

I've never heard that term used.

If I'm involved with a code in the hospital I try and involve the family as much as they wish. Especially in instances where the pt is near terminally ill and undergoing futile treatments while the family has not fully grasped the extent of their illness, allowing them in usually provides...

For clarification.... high blood glucose does not "cause" DKA. DKA is one of the more complex endocrine disorders, but basically the underlying pathophysiology is a lack or relative lack of insulin production. So saying that chronically elevated blood glucose causes DKA is not an accurate...

Were y'all able to do chest tubes as well, or at least needle decompression? If you're going to be doing procedures then you need to be able to handle the complications. From a prehospital standpoint I don't see the need of central lines being put in in the field, especially with the IO if...

Definitely possible, wouldn't be the first thing on my list of blood in an ET tube in a 90yr old though if no there was no hematemesis prior to intubation.

Like was mentioned above there are many causes.... DIC, underlying coagulopathy (she on blood thinners?), airway trauma, PE, diffuse alveolar hemorrhage, CHF, etc.... Varices is a cause of GI bleeding, if the ET tube is in the trachea then variceal bleeding shouldn't really bleed into the...

I definitely agree that ACS can have positive or negative enzymes. And further, not all positive troponins mean it's an NSTEMI. For you guys it's not really an issue, but it is in an inpatient setting where ultimately I'm responsible for the coding/billing and what diagnosis code something...

NSTEMI implies there's been myocardial necrosis/damage with presence of positive cardiac enzymes, Troponin, CK-MB, etc... With UA there may not be positive enzymes.

Have actually had a couple now present clinically as STEMIs after an emotional argument.... truly living up to "broken heart syndrome." Thankfully most of the time things recover over a few months and their EF goes back to normal but first one I saw was pretty impressive.

Takotsubo cardiomyopathy.... after her boyfriend/crack dealer broke up with her.

Depends on the facility and local "politics", but certainly reasonable for the patient to go to the ER and be seen by a physician there. Like what you mentioned, if something changes it may be easier/quicker to get something going from the ER. I'm not as concerned about the timing and rushing...

Agree with Vene, I really don't see a need for an initial "low dose" paralytic prior to the actual full paralytic dose. I've actually never seen that done. The general gist of what you had is correct: -get everything set up and ready -pre-oxygenate -Induction agent -paralytic agent -intubate...