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Have to have an unrestricted medical license to carry prescription meds for terminal use in another person.

Nice exaggeration there. Of course I treat my patients. I just don't force them to let me treat them. If they don't want my help and all they want is some nice conversation on the way to the hospital so be it. It's their life, not yours or mine. People have the right to be ignorant if they so...

Big difference between kids and adults (legally anyways). It's not my job to be their mommy. If their heart is about to explode but they insist on walking (despite me telling them it will kill them) then have at it. I can't (nor should I) force anything on a patient. I can simply give them the...

I bench seat people frequently. The caveat being our new trucks had shoulder straps in the bench positions (but I did it before we the new trucks too). I'll also walk a patient in if they are going to triage. If they refuse the cot but aren't going to triage (rare but happens), I'll grab a...

I worked in both Fire based and EMS only systems. I worked with just as many :censored::censored::censored::censored:ty providers in EMS only as I did in the Fire services. The only real difference was that the fire based guys were more fun to be around.

Gets easier with time. Depends on your area. Here, if I am on duty, I don't have a duty to act until I am assigned a call. Now, we can volunteer to help if we're not already on a call, but if we don't we aren't opened up to any sort of liability.

Fixed that for you. :D

What do you mean by this? Do you mean you should be calling the same physician for orders all the time? If that's the case I very much disagree, you should be calling where the patient will ultimately be treated, and hopefully the physician you spoke with will be the one seeing the patient.

M&M doesn't end once residency is over. Attendings present cases as well. This is another logical fallacy (exactly like the "same at 65mph"). I'll be honest I used to feel the same. But having gone through the process I promise you the overwhelming majority of residents/attendings would...

We have it for Fentanyl, Valium, and Narcan. Only time I really use it is actively seizing patient. I don't see any good reason to drill these patients initially. Give them a dose IN and get your line once the seizing stops. If it doesn't stop, well then we can talk about an IO.

The Delayed Sequence stuff is what I see the vast majority of the time, which is fine most of the time. I don't know of any services here that push their induction and paralytics at the same time (if I'm going to truly RSI someone I mix my induction agent and paralytic in the same syringe)...

Not to mention that most services with paralytics don't even do true RSI (paralytic pushed with induction agent). I agree with everything you've said. As I've progressed I question more and more the utility of pre-hospital intubation with so many other options.

Yeah no. Paralytics assist with actually getting the tube in (assuming you actually wait long enough), a paralyzed patient is at higher risk for aspiration (hence NPO recommendations for elective OR cases). Totally agree with on cric pressure though, I think it's bunk for preventing aspiration.

Principle is sound, but in life most intensivists aren't going to consider pressors in sepsis after only 3 - 4 liters. The way I have been taught is actually fairly similar to Dr. Weingart's (from emcrit) preferred method. We don't like CVP, we use ultrasound. We give continuous fluids (large...

Not sure I get get the warm and fuzzies from pre-hospital use of levo. There are concerns of putting through a peripheral line, dopa is much safer in this aspect. Not to mention if you really think the patient was septic then I wouldn't expect much from one liter. These patients tend to get...

Pupillary size is a function of both limbs of the ANS.

The increased serum potassium is due to the acidosis (H+/K+ exchange), but as said these patients are losing a ton of potassium in the urine. So while their serum potassium remains high (as long as they remain acidotic) if you looked at total body potassium it is likely profoundly low. That...

Occipital lobe doesn't control pupil size and a injury in this area is likely to cause visual deficits, not blurriness. Blurriness is more likely a lens problem or (less likely) a subtle disconjugate gaze.

Yes early on the body will try to compensate for the elevated H+ by exchanging it for K+, so potassium can be elevated. Regardless of labs however they are likely potassium deficient and generally it is added to their fluids because once you start hydrating and giving insulin/dextrose they will...

This. Need to add bicarb to a hypotonic solution (D5W, D5-1/2NS, 1/2NS, etc.).