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  1. R

    COVID & Future of EMS

    True, and it's certainly not something that could be rolled out nationwide overnight. But hopefully there may be a push to expand paramedic education to allow for this kind of thing outside of a select few systems like we have now. And to be honest I don't think for-profit ambulance companies...
  2. R

    Educate me more on troponin

    To add to what NPO said: Cardiac troponin is released from myocytes (cells in the heart) when they are stressed or damaged. The most common cause of this is cardiac ischemia from acute coronary syndrome--NSTEMI or STEMI--but it can be from anything else that causes cardiac damage. Sepsis often...
  3. R

    COVID & Future of EMS

    Telemedicine is great if you're a doctor checking in on one of your diabetics and just need to tweak their insulin dose a bit or to answer some very basic medical questions. But it's not going to be a substitute for anything that should end up in the ED. Though it could have cool implications...
  4. R

    How can I get better?

    I was in a similar position and went to medical school--if you want to really want to be on top of your game in terms of medical knowledge, there's really no substitute for med school + residency. Also, EMS is a new (ish) subspecialty of emergency medicine and there are increasing opportunities...
  5. R

    Coronavirus Discussion Thread

    Yeah I've noticed that too. I don't think there's any one source that we can individually rely on right now for COVID, but his is definitely the most comprehensive all in one place.
  6. R

    Coronavirus Discussion Thread

    A lot of the website is a bit excessive for EMS, but Josh Farkas at the Internet Book of Critical Care has a section on COVID where he discusses the prothrombotic state that patients seem to be in. Obviously it's based on very flimsy evidence but that's about as good as it gets right now.
  7. R

    End tidal C02 at BLS level

    I wouldn't have known what hypercapnia was if it punched me in the face when I was an EMT-B. And I have my suspicions that my old partner who once asked me what a pulmonary embolism was didn't know either.
  8. R

    Who's fully staffed?

    My old job (suburban Philly) was never fully staffed. There were a zillion medic jobs nearby so there was a decent amount of turnover everywhere, and we were very busy so we had more than most. You could make a decent wage by EMS standards, but the local career fire departments and police...
  9. R

    Privatized EMS in Placentia CA

    Requiring an EKG to administer Zofran seems to me to be at the same level of doing an endoscopy after giving ibuprofen. I'm pretty sure the complication of QT prolongation was seen when patients were given IV doses of around 32mg, and it was still not terribly significant.
  10. R

    Did working in EMS make you more or less religious?

    EMS made me less religious and pushed me more politically leftward, though my guess is that's because I already trended that way to begin with. Religion was never a big enough part of my life for me to notice a huge change though. There are plenty of people who had the opposite happen to them...
  11. R


    Ah gotcha--yeah that's the one. I only saw like a 2 minute clip that didn't show the initial assessment of the patient, just her on the gurney and then the intubation itself.
  12. R


    One of my friends showed me the clip of the RSI on First Responders Live (I think), and while it was a very smooth RSI, I still can't figure out what the indication was to intubate what appeared to be a relatively stable patient. I don't think I have access to watch the show itself, but does...
  13. R

    To Degree or Not to Degree. That is The Question.

    I think you make a good point about the general huge overuse of ALS in situations where it is not beneficial (in my personal opinion, due to the pathetic standards of BLS education), but I think that's a separate issue from the degree argument.
  14. R

    the 100% directionless thread

    Our protocol was to consider needle decompression (uni or bilaterally) before calling it. I think the biggest issue is that a 14G IV cath is not really adequate to treat a hemothorax, even if you place it midaxillary, it's so tiny. It seems like a reasonable step though--needle decompression is...
  15. R

    Ibuprofen vs APAP

    You make a fair point, and I guess I don't really have a great rebuttal to it. The best time to use NSAIDs and acetaminophen is probably when doing event medicine, which I think is not a terrible reason to add them to the scope of practice, given how common that is. My main complaint was...
  16. R

    If you could go back to the start of your EMS career and give yourself advice, what would it be?

    There are places where you can have a good job with room for advancement as a single role medic. There are, however, many many many more places where this is not the case. I would also argue that everywhere I've worked the salary for nurses has been higher, sometimes hilariously higher. It's...
  17. R

    Ibuprofen vs APAP

    I never understood the idea that patients aren't going to see significant relief in the timespan of an EMS transport with PO meds. You're correct that they won't in the twenty minutes you spend with them, but that doesn't mean they won't get pain relief after you drop them off in the ED. Who...
  18. R

    Airway Management and Intubating without Drugs

    I would argue that knowing how to take care of sick people includes the ability to put people on CPAP, which has been standard of care for quite some time and can avoid a significant amount of intubations. It’s been a BLS skill in most places since like 2014.
  19. R

    Airway Management and Intubating without Drugs

    Yeah, sorry, my point was "you're likely going to drop the pressure regardless of what you do, so don't think that using ketamine is going to save your patient who is hypotensive". Like you said, some drugs will drop it more than others, but you should always anticipate the hypotension.
  20. R

    Airway Management and Intubating without Drugs

    I think barring some fairly rare situations (airway burns, laryngospasm, some sort of traumatic airway disaster), you always have enough time to take a few minutes to beef up the pressure and maximize your oxygenation/CO2 before you drop the tube, even if you have to bag for a short amount of...