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Hm. Maybe I'm overestimating the size. I'm just mentally comparing to a big Cordis and have a hard time imagining one of those in an arm. (Although yes, I have seen it.) I suppose veins are distensible. Do you do the dilation with a tourniquet on?

Yeah. But you can't squeeze a pot roast into a keyhole even if you use a funnel. Veins don't dilate and fitting an 8.5fr catheter into most of the upper extremity veins I've seen under ultrasound would be pretty questionable. I'd worry about destroying the vein. Is there data on the success...

Does anyone have experience with those RICs? I have a hard time imagining cramming something that size into a peripheral vein.

That's because it is institution dependent. There is a sweet spot that balances feasibility with sterility. I have seen departments whose protocol for cultures was so stringent that cultures often simply didn't happen. On the other hand there are places that don't bother with any real effort at...

There is no great mystery to cultures, but some patients are difficult to get any blood from, and getting STERILE cultures takes some doing -- I presume even more so in the field. To me a sincere attempt at a sterile culture requires sterile gloves, a chlorhexadine prep, a hat and mask, and a...

Cultures drawn before antibiotics IF it will not delay antibiotic therapy. I agree that some of the details may be challenging, particularly drawing sterile cultures, which is even difficult in the hospital sometimes. Contaminated cultures cause a bunch of headache. Obviously it would be a...

As this topic has come up before, for your interest: http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30469-1/fulltext No benefit on mortality. Not very long transport times though.

Usually more due to leaks in the circuit than dead space. A well-sealed circuit (e.g. an ETT with no cuff leak) should have very little difference in inhaled versus exhaled volumes.

I would go by aliquots of 50 or so (less if they are really shocked, maybe more if they are stable but in severe pain) and continue to load them until they are happy. There is not much sense in saying that any opioid is more or less effective than other; their potencies differ, but so does the...

That's not a very heavy fentanyl dose. Your problem may be one of quantity. I presume you were giving 2mg or more of morphine at a time?

What doses?

I mostly still see it in two cases: 1. Cardiac patients. I don't think there's legitimate reason, it's just what the cardiologists are used to. 2. ED patients, seemingly on the theory that it's less prone to abuse than Dilaudid.

I favor hydromorphone to morphine. Fentanyl for short, Dilaudid for long.

Christopher Watford had the best explanation of the artifact here: http://www.ems12lead.com/2014/03/10/understanding-ecg-filtering/

They're in every state. I wrote a short piece about them here.

The long-term care ombudsman can be a useful one -- are you familiar with them?

Could have seized, I suppose.

With respect, do you think this topic is important enough to warrant the amount of effort you're putting into it?

Well, there's no better way to find truth than to go look for it. Couple small studies on severe... - COPD https://www.ncbi.nlm.nih.gov/pubmed/7750309 - and asthma https://www.ncbi.nlm.nih.gov/pubmed/16187465 Not much of a gradient; while they highlight the gradient in the first study, it is...