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This is absolutely NOT what should be happening, and I will die on this hill. This patient, as described, is critically ill and needs to have a physician at the bedside immediately. Playing hero and doing all this stuff without notifying a physician to come to the bedside is poor practice and...

Two, in my opinion. 1. Unvaccinated patients expose me to an infectious disease far more than would be otherwise required, both in terms of absolute cases and average associated viral load. 2. In a setting where suboptimal care is being delivered due to a lack of staff/resources/beds/whatever, I...

Is treating everyone a condition of retaining privileges to practice? Yes. Did anyone who trained before March of 2020 know that these were the expectations before entering the field? I would argue no. In fact, its funny that you mention being mandated to get a vaccine halfway through life, as I...

So this is something I’ve been musing about for a long time. If you take this line of reasoning, why shouldn’t I as an EM physician/intensivist/nurse/paramedic be able to choose not to treat you? If you end up in the hospital, as you state, it’s not only your problem but it’s also mine now. So...

They usually come stiff out of the box. You can just open and close them a couple of dozen times to loosen them up. Alternatively, there is one hex screw that secures the two cutting blades of the scissors that you can loosen. You’ll know it’s the right one because it’s the only hex screw that a...

This is fascinating. Just goes to show regional differences in EMS. I’m not going to comment on the merits of holding the wall with a patient, but I can see the need for signatures to verify that the patient was appropriately handed over to whomever. 2 in hospital examples from recent memory...

Who would sign your PCR to document handover of care (if you took them out to the waiting room against the ER’s wishes)?

Nice to see it’s a guideline, and not a rule. My concern in delaying transport is cases where further field interventions wouldn’t help to stabilize the patient. First example that comes into my mind is a STEMI, where reperfusion is really the only thing that will stabilize the patient or help...

Don’t like that as a general rule. Why?

One thing that was mentioned above but that I think is worth repeating is immediate post-ROSC care. I have seen too many times where crews get through the arrest, get ROSC, then just sit there and don’t really know what to do next and watch as the patient re-arrests. 1 round, 1 epi, ROSC...

I don’t believe the magnitude of this effect for one second. First off, non-randomized data. But all that aside, the notion that ANY intervention can increase survival/neurologically intact survival >4x compared to standard of care is unfathomable. Treatment effects just aren’t that large in...

I have seen a lot of people speculate on this being an “overdose” of ketamine. 5 mg/kg rounded up to 500 mg is an increasingly common agitated sedation dose given in EDs, and there is some literature and FOAM etc. that supports the dosing. Now we can argue the semantics of what an overdose...

Agree 100% with you. I think that’s why I hedged with “avoid tubing him in the field”. He maybe needs to be intubated now, almost certainly with further decompensation, tough to say without seeing the patient myself in person. However, I think there are probably very few EMS providers who can...

Interesting case. My first priority would be rapid extrication and initiating L&S transport to a an ER that’s hopefully capable of cath and has more than a podunk ICU. EKG: appears grossly regular narrow complex tachycardia without obvious p-waves. STE in aVR with reciprocal STD in V4-V6 lead...

Outside of a few very obvious examples, how can you reasonably expect the layperson to know if something is emergent without medical training? That foot pain could be osteomyelitis. The back pain could be a dissection. The sore throat could be a PTA. It's easy to d/c someone home with...

Because you just turned an isolated extremity fracture into iatrogenic respiratory failure? Bagging and narcan administration are not 100% benign interventions.

Very interesting case. Lots going on here. First, what’s the rhythm? A rhythm strip would be helpful. Probably Afib RVR with ventricular rates between 100-150. If the patient was unstable, something to keep in mind was cardioverting the patient out of this may be appropriate. There is also a...

@CCCSD @NomadicMedic Use the ignore button. I was just like y’all and got worked up every time I read one of these posts, but with the ignore function, I never see them in the first place. Makes the rest of the forum experience so much more enjoyable, and you miss out on literally nothing.

Not for the patient I just don’t get how there are providers on this forum and elsewhere who strive to get better and advance themselves and their education, and then you have some individuals who can’t even be bothered to do the bare minimum when they have a dying patient right in front of them.

The incompetence of some paramedics and EMS crews is staggering.