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Sorry going to disagree with you here. Patients have a right to know who is doing what and should have the opportunity to say no. Next year when I have students I will absolutely let the patient know ahead of time and ask their permission, even though we have the same deal (this is a teaching...

We consent here for students managing the airway. Honestly that's a bigger hurdle here than the OR staff. Though, I do agree most the docs here are leery letting students/medics intubate anything other than the healthy ASA1's. I am a future anesthesiologist and even I struggle at times to...

I'm sorry, but there is a reason community shops end up sending a good number of patients to large academic facilities, and a number of times those patients end up with a common disease that just happened to have an uncommon presentation. This happens more frequently than most realize...the...

I didn't say that, however there are no systems that are going from having a separate EM specialty to one where it is incorporated somewhere else, in fact the opposite is true. Again, the more we learn the more it is necessary to specialize. Also, we haven't even talked about preference...

Reasonable. And having thought about it I'll give you the interventional cards rolled into vascular (Though EP should be a function of Cards still...as I already said the access is a monkey skill and not what makes that fellowship challenging). Though IR does much much more than just...

Only one on your list that is reasonable.

Who would pick these up? It's interesting you picked these because for the most part these aren't separate specialties....most of these fall under CAQ's (Certificate of Added Qualification). Derm/Path for example is CAQ many MOH's surgeons acquire so they can read their own biopsies. Pain...

I'll bite. Name one specialty you think is unnecessary and why.

Nope. As I said above, I'm a minimalist, and I have reasonably short transport times (8 - 10 minutes). I'm the same way in the hospital as well, do I really need that central line/foley/a-line etc, etc, etc. Amazing how the further along in training you get the more you just want to leave the...

Theoretical. Only a handful of cases in the literature and even those cases it is unclear if it was actually the Narcan that caused it. And I work in the in non-prehospital realm, so I am well aware of what goes on after the patient is transferred (both in the ED and beyond. . .)

Yeah, your going to have come with more than that, Narcan (used properly) is an incredibly safe drug, and hell used incorrectly is still safer than most drugs out there. What makes you think it isn't safe?

Leading thought right now is it is an over-riding of the normal response to dropped pre-load. Pressure receptors in the volume depleted ventricle sense a false high pressure and thus activate a response opposite of what is helpful (vasodialation and bradycardia).

See it with spinal anesthesia occasionally.

I'll agree with those at the hospital, everything you did I think was appropriate, just should have been done enroute. I'll admit I am biased, in my own practice as a medic I have a pretty firm rule that the only thing I do on scene is a 12-lead (outside of an arrest of course), and even that I...

Eh? Narcan is one of the safer drugs out there. . .

Disagree with the too specialized crowd. There is no way you could have a generalist in the sense that they used to exist. Medical knowledge has advanced to the point that it really is necessary for the highly specialized providers.

Agree to an extent, but this isn't only inherent to RCT's. Again, I think applying RCT results to the gen. pop does actually give you the best chance of getting the best practice (predicated that it is in fact a decent study). Also, I have yet to see a study that doesn't give their...

I don't think that was really his point. Frankly randomized controlled are as good as it gets. That doesn't mean they (as he points out) are immune to flaws or misinterpretation. In this case specifically I'm not sure why he is picking on this one. I didn't realize people were taking the...

Apparently you all work with more receptive IRBs than I do. . .

Absolutely agree with you, but IRBs (in my experience anyways) are hyper-sensitive to ethical/libility issues. Valid or not, giving a placebo to a victim of cardiac arrest could open a HUGE can of worms from an ethical/liability stand point.