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Basically, a combination of medications that includes a paralytic given in order to facilitate intubation.

With an avg of 20 hours a week of work, I used to take part in 4 per year. Full-timers would typically take part in 4-8. There would also be a number of ETIs that would be done with etomidate only or with nothing at all if they were comatose enough.

Thinking back, I don't think I saw any cases. But, with a more simplified knowledge of disease, most paramedics wouldn't even know it exists as I did not. Even in medical school during 3 months on surgery, I don't recall seeing a case (pre or post op). Didn't see any patients during 3...

Truth. Apparently a great way to get experience with a BVM is to attend electro-convulsive (shock-treatment) therapy, but only so many places actually do it. Realistically, it'd be ideal to have all EMT students go to the OR to practice bagging, but it is likely not practical.

There is a HUGE difference between being "coherent" and having "decision making capacity". A patient can be coherent enough to tell me to go "F' myself", but whether or not I listen to them is based on whether they have "capacity".

This thread is about trauma patients, not cardiac arrest. Now, if you're talking about trauma arrest, then its questionable whether you should be working the patient at all. But, supposing that there is reason to work the trauma arrest, why would you trauma strip the patient in public and not...

I've never had a problem cutting clothes in the back of the ambulance. I've never thought "oh, I should have done this in the middle of the street". I guess I would say it is a pet peeve of mine seeing someone being stripped in public. If they're sick, you should be working on getting going...

Good update. I think this is a good teaching case in many ways. First, a reminder to look at the whole clinical picture and not anchor on one finding. Two, from a prehospital perspective, this gives a glimpse into how decisions are made in hospital (e.g. MI =/= PCI). And it could also be...

You're anchoring on the ECG and conforming a portion of her SSx into an ACS diagnosis, while ignoring the change in mental status (which is essentially the chief complaint). Only in certain circumstances are you going to get a change in mental status with ACS/MI - drop in cardiac output leading...

There is a lot of things to consider. Infectious or metabolic etiology would be high on my differential. SSx of MI overlap with many many other disease processes. CP itself has a pretty long list of causes - costochondritis, aneurysm, pneumonia, PE, esophageal spasm, GERD, pneumothorax, etc...

To be honest, the story doesn't sound cardiac (AMS without hypotension or severe hypoxia) and 12-leads don't really help identify a cause for the overall clinical picture. Though STE in aVR may be considered a STEMI equivilent, but I'm not so sure in this case. Could the patient have triple...

The sad thing is that I highly doubt this is a problem limited to DC FEMS. How many other places does this occur, and we just don't hear about it. The main reason we hear so much about DC is because they've been under increased scrutiny since Rosenbaum. Anyhow, I try my hardest to give...

1. To feel good about ourselves and/or to increase billing. 2. In most cases, yes.

Sgarbossa = actually pretty relevant to prehospital paramedic practice Anion Gap = a little relevant for critical care/interfacility paramedic practice (minimal to no relevance for prehospital) Delta ratio = not relevant

phillyfirenews.com - I'm sure one of the PFD firefighter/EMTs will begrudgingly answer your question.

More pay will not come with more respect, unfortunately. Two routes to that: decrease supply of medics (e.g. increased training/education requirements) or unionizing.

As mentioned, amiodarone (at least in prior formulations), was absorbed by PVC. However, it is a slow process with negligible change in dose during the first few hours. The amount absorbed depend in part upon amio concentration and infusion rate. Basically, glass is not needed in the...

Where are you getting your information from? In emergent situations it is not uncommon for physicians to have parents removed from the ED in order to care for a child against the objections of the parents. In less emergent conditions, hospital and physicians can and do petition the court...

Vagal stimulation? If patients are frequently vagaling when you rectalize them then you're doing something wrong. You don't need to tickle their ribs and you don't need more than one finger when you do it.

Anion gap ratio? What the hell is that? Are you talking about the delta ratio? I can tell you that not even medical students learn about that (anion gap, sure; delta ratio, no). I haven't even heard it brought up in EM lectures that I've attended. Jesus Christ, of all the things to cite as...