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  1. R

    Budesonide ?

    My initial understanding was they are contraindicated, as LABA monotherapy was associated with decreased outcomes in acute exacerbation, though a quick search on UpToDate says that fomoterol may have a similar onset time as albuterol “but has not been sufficiently studied for routine use in...
  2. R

    Budesonide ?

    Fomotorol and other LABAs are usually contraindicated in acute bronchospasm unless there’s some new data I haven’t seen. Symbicort is a long term control medication, not for acute exacerbations. Inhaled steroids alone for croup make sense, but I’ve never seen them used. If a patient is sick...
  3. R

    EMTs and Paramedics in the Hospitals

    Makes sense. All my experience is very Northeast based, and from what I've heard having a high concentration of doctors like the NE tends to mean less stuff gets done by APPs/medics. Also critical access hospitals are less of a thing round these parts, especially given that I can see the Empire...
  4. R

    EMTs and Paramedics in the Hospitals

    Just out of curiosity, what kind of places are having a medic or an RN intubate in the ED? The only non-doctors I've ever seen intubate in the ER have been APPs (CRNAs, and rarely NPs and PAs), but admittedly all my experience is in more urban areas. I agree with @Peak that paramedic...
  5. R

    AMR Hiring SoCal?

    I think you're biggest issue was also my biggest issue with EMS and why I left--being a paramedic is a profession with minimal self-governance. You're a poorly to moderately payed widget, completely interchangeable with any other paramedic at any time. Even being a supervisor is basically just...
  6. R

    2nd degree heart block - does it warrant code 3 return to the hospital?

    I'll have to read the full study when I get a chance, but the abstract specifically only mentions less than 90 minutes and greater than 90 minutes. Regardless (and you're probably right--and faster is probably better in clot retrieval too), I would argue that you'd save considerably more time...
  7. R

    2nd degree heart block - does it warrant code 3 return to the hospital?

    With the exception perhaps of vtach, I don't think there's a single cardiac rhythm that means, by itself, that you must transport lights and sirens. Even vtach doesn't mean that, but I think most people would be forgiven for transporting emergently with that patient. Mobitz type 1 is almost...
  8. R

    AMR Hiring SoCal?

    Have you ever thought of going back to school? CRNA, PA, NP, Doctor, etc? If you're looking for significant education and an ability to do cool procedures on a fairly regular basis (and not have to worry about if you're actually helping the patient, like with routine RSI) I just don't think...
  9. R

    Almost 2 years since EMT course

    Do you have your state cert or did you end up with no cert at all? If you have your state cert you don't need to retake the entire course to get your NREMT, and you probably don't even need it for a hospital job that's in your state.
  10. R

    Hypertension in a BLS scenario

    They might feel worse too--your body gets used to a certain blood pressure (say a chronically non-compliant patient with a pressure of 200/110), and the rapid drop from giving an antihypertensive can cause hypoperfusion of the brain and make the patient altered, give them a headache, and in the...
  11. R

    Hypertension in a BLS scenario

    Asymptomatic hypertension, at any number (ANY NUMBER), is not an emergency. You can take them in BLS, you can roll them to the ED in a barrel, you can have them take a taxi. ALS is probably the most dangerous way to transport these patients because they might be tempted to treat the patient (I'm...
  12. R

    Medic gigs around the orlando area in florida

    My buddy worked for American Ambulance down there as a medic--he made like $14/hr, which sounds awful, but they did some 911 (Orlando Fire did the rest) in addition to IFT. This was a few years ago though, like 2012.
  13. R

    TVP as prerequisite for Push-Dose Pressors (?)

    From listening to EmCrit, I get the feeling that Scott Weingart has very strong feelings about what the capabilities of an emergency department should be, including things like having ultrasound in the department, being able to treat cardiac arrests beyond the scope of ACLS (with things like...
  14. R

    Why aren't all EMTs are least trained with ALS?

    I think the national standard for AEMT covers about 90% of what people would find useful on the vast majority of EMS runs. I think it's something like: albuterol, epinephrine IM, glucagon/dextrose, naloxone, nitrous oxide, nitro/ASA, plus IV/IO access + fluids, CPAP, and supraglottic airways...
  15. R

    Why aren't all EMTs are least trained with ALS?

    Like @Tigger said earlier, that's the model that most Commonwealth countries use (Canada, UK, Australia, NZ). They have a basic paramedic level which operates on what we'd call AEMT (which is usually a 3 year degree), and then advanced paramedics who do what we'd call ALS. I'd be all for this...
  16. R

    Why aren't all EMTs are least trained with ALS?

    There are studies that show mortality benefit to ALS, mostly chest pain/cardiac patients and respiratory patients. I agree with you about symptom relief, though I'm of the mind that most of the basic symptom relief meds (ondansetron, diphenhydramine, ketorolac, acetaminophen, etc) should be...
  17. R

    Why aren't all EMTs are least trained with ALS?

    I think you're speaking to a very rural coverage area, which has a very different need in regards to ALS--especially when many of your patients are going to be transferred to larger regional care centers by you, or may have 30-60 minute initial transport times. If you have a ten minute...
  18. R

    Why aren't all EMTs are least trained with ALS?

    Since I finally get to look at this stuff from the other side in the ED, I can share some of my experiences. I remember how stressed people (myself included) would get over whether or not certain patients were ALS or BLS patients. Was their pressure too high for an EMT to ride it in? This...
  19. R

    Lights and Sirens Use

    https://www.ems.gov/pdf/Lights_and_Sirens_Use_by_EMS_May_2017.pdf
  20. R

    Learning Pharmacology (another language?)

    I recommend a medical physiology textbook (like Costanzo's). For whatever reason, medical school textbooks are actually reasonably priced, and it's not super long. Pharmacology is just fiddling with physiology, so if you understand phys, the only hard part of pharm becomes just memorizing all...
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