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Doesn't sound like you could have done much more or that anything would have made a difference. Were initial vitals ok? Only thing is I probably wouldn't have given a propofol bolus to someone with a BP in the 50's, especially if they were already obtunded. What other RSI drugs do you...

Most views they use are not "straight on" and so if they're shooting one of their usual views, LAO, RAO, cranial/caudal, etc, there's usually room for someone to do CPR without the c-arm in the way. Certainly not ideal, but doable. And the ones I've been involved with have been fairly short...

I've been involved in active CPR/resuscitation during PCI. These were folks who coded on the table during PCI so usually there was a culprit lesion or dissection the interventionalist was actively trying to fix. CPR seemed to make things a little more difficult and maybe for a couple seconds...

Also keep in mind in either an acidosis or alkalosis the compensatory mechanism will never be enough to return the pH to normal, just isn't going happen. I've seen people look at gas and erroneously think someone is "over" compensating and swung their pH too far the other way.

Outside of overt shock or a peri-arrest situation with presumed life threatening hyperkalemia, I don't think there's a role for bicarb for DKA in prehospital setting. Even in the ICU we don't consider it unless pH is <6.9 or we have cardiac instability/shock or hyperkalemia, and even then...

Was it a confirmed PE by CT angio or some other study? An elevated d dimer in a guy like this isn't terribly specific.

Oh you have much to learn about the interwebs.... :)

Pacing isn't the answer here, and certainly not overdrive pacing. I've seen some papers describing some uses in afib/flutter but the only time I even seen it used/mentioned is in the context of an ICD's overdrive pacing to abort vtach. Others have already mentioned it but recurrence of...

Veneficus already hit on the issue with the pt's respiratory status and questioning the reasoning for BVM and I certainly agree. Resp rate and tidal volume are the factors determining ventilation. Likely this person is septic as others have mentioned and has a high minute ventilation as a...

If becoming a physician is the ultimate goal then I would probably advise not going the medic route and focus on the direct steps you need to reach that goal.... not sure of your college experience, but keep in mind there a significant and specific pre-reqs you need to do even before applying...

Little different impatient. A lot of times patients are on O2 and they don't need to be, so it's a constant struggle at times to get nurses to stop putting 2L NC on everyone. We also at times have to prove there is hypoxia in order to get insurance to cover home oxygen so we may have them...

See my above post

Have not

Sometimes these patients can be tricky and you really need to look at their meds and some other factors. What diabetic meds is she on? Sulfonylurea, metformin, insulin (short or long acting), etc... Has she missed meals? Does she have renal insufficiency? Metformin has low incidence of...

Again, this is highly subjective and not sure what you're definition of a "Podunk community hospital" is, may be different from mine. A lot of our community hospitals around here routinely do open hearts and complicated neurosurgery cases, not to mention have full service ICU's so a chest tube...

Honestly without knowing more about the hospital capabilities I would err on the side of going to the trauma center. Yea, it may be a needless extra 30min transport, but it may save a potential transfer later on anyway if the closer hospital finds something they can't handle and has to...

I think he was referring to getting shot.... "lead poisoning"

At least where I'm at it's main use here is when we have a difficult wean from the vent. Allows us to do a sort of "awake/sedated" wean and extubate. Definitely not used that much at all here, but have had to use it a few times on pts that can come off the vent but just need a little more...

Why the analgesics and sedation? Unless you were referring to pacing.

http://emcrit.org/podcasts/paralytics-for-icu-intubations/ Some good info and a friendly debate on the use of paralytics for intubations in the ICU.