Search results

Yeah I'm speaking about rural areas specifically, and honestly only from some anecdotal experience (my first EMS experience was in a rural spot where the medical director was also an outpatient doc and an ER doc) and from what I read about. My guess would be that a hospital busy enough to hire a...

I think the biggest problem is that midlevels, much like physicians, tend to not want to work way out in the boonies. Especially if they've done extra EM training and are likely to be able to grab a job in a more desirable location. The other issue I could see is that these CAHs tend to have...

At that hospital I mentioned they had a "neuro robot" that was basically a portable video chat/computer so they could consult Jefferson (the regional neuro center) for stroke management in the ED before they were shipped downtown. I could see that happening for rural emergency departments and...

Yeah it really is. It's a super popular specialty now, though, at least in my school. So maybe in the next 5-10 years it'll start to change. I doubt you'll ever see the CAH's staffed with emergency physicians though, there's just not enough patients to justify it.

If I remember correctly, it's still close to 50% of EDs that are staffed with family medicine or internal medicine doctors. Obviously they're mostly rural, but even where I worked in suburban PA (30 minutes from downtown Philadelphia) there were EDs that had family doctors working.

So for big MCIs like you describe I agree, there are lots of patients and you can't transport them all rapidly, so it makes sense to bring the doc to you. Those happen pretty rarely though, and while its good to practice for them and be prepared when they happen (both on EMS and on the...

I think the biggest hurdle with pre-hospital physicians is that, even if they do show improved outcomes (which isn't terribly hard to believe, even given the limited equipment, though I only got to skim EpiEMS's studies), is that you can't realistically put enough docs on the street to have a...

Atropine and bicarb used to be part of standard ACLS back in the day, so maybe the physician was using an older algorithm. I still see glucose given every so often, despite it being taken out of the protocols and ACLS guidelines.

It can be, but rebound pain doesn't = appendicitis. The current guidelines for acute appys tate "no physical exam findings, together or alone, can confirm a diagnosis of appendicitis". All these patients are getting imaged, so don't stress over an in depth assessment of the abdomen. Don't ignore...

For what it's worth, I got into DO school with a 3.4 GPA and a 3.3 science GPA. And my charming personality, of course. If that is Vene, that's unfortunate. I didn't realize the stigma against some European schools was so strong.

While you're not completely wrong, academic medicine can be very pedigree based. As a DO, there are some programs and even specialties that are just going to be out of reach for the immediate future, even if you have a 260 Step 1 and straight honors. I don't say this to crap on DOs, since I'm in...

Do MCAT practice questions and tests. They can give you a good feel of where you are in the material. EM is easier to do as an MD but it's very doable as a DO. Where I worked in the Philadelphia area, I'd say about half the docs were DOs, but I think there are less DOs on the West Coast. You...

I'm a first year medical student at a DO school who spent about 5 years in EMS beforehand. I did volunteer EMS while in undergrad, which was for a humanities degree which I half assed. The volunteer experience let me go straight to 911 when I graduated, then I got hired by a fire department...

My point was just that antibiotics for trauma is outside the scope for civilian EMS in the US, so it was an example of taking a course that had stuff outside your scope and then deciding to inappropriately use it in the field. I could just have easily used "put in a chest tube" as an example...

TCCC has recommendations about pre-hospital antibiotics for a variety of different traumas, at least the military one does.

That's not necessarily a bad thing. It's good to get an appreciation for the care beyond your scope of practice, and it can only make you a stronger provider, assuming you don't start trying to dose patients with antibiotics yourself.

That's what we used to do at work. Basically we'd say "as long as you can stay awake and breathing, we won't give you Narcan". We were flexible on the awake part, but either way all the patients were very cooperative (for obvious reasons). We invented this rule after a certain night shift...

Where I worked, most younger arrests were secondary to drug overdose, especially opiates. But short of obvious signs there's really no way to know, especially since many chronic drug abusers will have other health problems.

According to the ACLS guidelines for at least a few years now, narcan is not indicated for cardiac arrest. Presumably you are performing CPR on these patients which means that the patient is being ventilated in some capacity, which means trying to restore the breathing before getting ROSC is...

How rural is your service? Interestingly (or perhaps not that interestingly), I'd have no real argument with EMS giving abx for these conditions, all of which tend to be very easy to diagnose and all of which very obviously require antibiotics. You guys also have the advantage of more...