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  1. Smash

    Looking for data/research: ambulance crashes.

    Before I get off my own behind and look for myself, I thought I would ask... Does anyone have, or know of, any data or research into ambulance crashes. I'm particularly interested in the relative risk of driving lights and sirens compared to normal day to day stuff. Anything on fatigue would...
  2. Smash

    Jacket for a Gorilla

    Ok, I don't usually post here, but I have a question a little out of left field. I am a big unit: 6'2", 255lbs. I am broad across the shoulders and back, and unfortunately have a very long reach: i.e. I have monkey arms that are longer than they need to be. I therefore have trouble...
  3. Smash

    A re-conceptualisation of acute spinal care.

    If anyone has read the above article by Hauswald in the latest edition of EMJ I would love to hear from you via PM. Many thanks Smash
  4. Smash

    Looking for an article

    Can anyone help? I'm looking for articles on check lists for rsi or mother high risk procedures. In particular:J Trauma Acute Care Surg. 2012 Dec;73(6):1399-403. doi: 10.1097/TA.0b013e318270dcf5. A standardized rapid sequence intubation protocol facilitates airway management in critically...
  5. Smash

    Help with some articles

    Hi everyone. I'm looking for some help getting hold of some full text articles: if anyone can help out could you please PM me? The articles I'm after are: Ducrocq, N. et al (2012) Comparison of Equipressor Doses of Norepinephrine, Epinephrine, and Phenylephrine on Septic Myocardial...
  6. Smash

    ECG Gurus (and everyone else)

    Ok, have a look at the attached image. I'm sorry it's a little small, but I'm a bit of a r'tard with images. Now I don't want to get into a deep and meaningful conversation, I just have one simple question: If this ECG belonged to a middle aged male with symptoms consistent with ischemic...
  7. Smash

    The bad news keeps getting badder

    For epinephrine in cardiac arrest: Hagihara, A., Hasegawa, M., Abe, T., Nagata, T., Wakata, Y., & Miyazaki, S. Prehospital Epinephrine Use and Survival Among Patients With Out-of-Hospital Cardiac Arrest. JAMA: The Journal of the American Medical Association, 307(11), 1161-1168 A large look...
  8. Smash

    Textbook Wishlist

    Hello. I'd like some opinions please. Imagine you want to set up a small library of textbooks. You want to cover physiology, patho, pharmacology, cardiology and ECGs, airway, adult and pediatric emergency medicine as a minimum. The target audience is EMTs with a minimum of 3 years at...
  9. Smash

    C-Spine precautions for penetrating trauma.

    For the "OMG he's been shot/stabbed, tie him to a lump of wood, STAT!" crowd... From the Executive Committee of Prehospital Trauma Life Support, published in the Journal of Trauma - Injury, Infection and Critical Care, September 2011: PHTLS Recommendations There are no data to support...
  10. Smash

    Impedance Threshold Devices during cardiac arrest

    Anyone using these? I'm sorry if you are, they are a complete waste of time and money: Aufderhide TP et al (The ROC Investigators) A trial of an impedance threshold device in out-of-hospital cardiac arrest. New England Journal of Medicine. 2011 Sep 1 ;365(9):798-806. This was a blinded...
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    An easy one for the weekend

    Tell me what you would do with this patient. It's not a diagnostic conundrum, but I'm interested in decision making and treatment pathways. It's 05:00 and you are called to a "Can't get off floor" job. The patient is reported to be a 68 year old male who is also reported to have "breathing...
  12. Smash

    Intraosseous access in cardiac arrest.

    Another IO thread for y'all, this time with a snazzy poll (I hope; never tried that before) I'm interested in finding out how people utilize intraosseous (IO) access in cardiac arrest. I'd like to know if it is routine, only used if IV access is difficult or prolonged, or never used at all...
  13. Smash

    What kind of hair ties are best for EMS work?

    So I have long hair, which I keep pulled back in a pony tail. At the moment I just use regular elastic hair ties to keep it back, but I'm wondering if there are some that would be better for EMS? I think I should look at getting some Teflon coated ones for stain resistance, but they would have...
  14. Smash

    Clopidogrel/heparin for ACS

    Good morning. I was just wondering how many here have either clopidogrel (Plavix) or heparin for use in cases of suspected ACS? If you do, is this used via standing order or physician contact? What are the protocols or parameters around using either of these? Finally, (and most...
  15. Smash

    Oxygen, anyone?

    Juuuuuust in case anyone was still laboring under the misapprehension that O2 is some sort of benign panacea: Effects of oxygen inhalation on cardiac output, coronary blood flow and oxygen delivery in healthy individuals, assessed with MRI. European Journal of Emergency Medicine 2011, 18:25–30...
  16. Smash

    Earthquake in New Zealand

    My thoughts are with our colleagues in New Zealand following the devastating earthquake that struck the South Island today. I hope Mr Brown and others will let us know that they are ok as and when they are able.
  17. Smash

    The Importance of Being Spinally Immobilized

    We all know how important it is that patients get a c-collar and LSB if they have been in a car crash, witnessed a car crash, driven past a car crash, saw a car crash on the TV news, or heard about a car crash from an old college buddy whose wife's cousin was nearly in a car crash last week. If...
  18. Smash

    Sepsis and Acute Respiratory Distress Syndrome

    Right, clever people, riddle me this: If your patient has sepsis is he/she more likely to develop Acute Respiratory Distress Syndrome (ARDS) if the focus is respiratory as compared to a different focus (eg uro-sepsis) Humour me, and pretend that the government has shut down Google so I can't...
  19. Smash

    Post cardiac arrest management.

    Hello. I'm curious about post cardiac arrest managment. How does everyone go about managing the post return of spontaneous circulation (ROSC) patient prior to and during transport to hospital? Namely: -How do you manage time/transport? Do you throw the patient straight on the gurney...
  20. Smash

    Evidence, EMS and You...

    We seem to be on a roll with navel gazing threads examining the great questions of Life, The Universe and EMS lately, so I thought I might get in on the act. I've noticed a large muber of posters referring to experience as the gold standard of developing patient care, to the point of same...

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