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    Low dose Ketamine

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    Adenosine in WPW

    I'll try to do it concisely (note, please read the above responses, but read below it you can't fully digest all the info): Accessory pathways are made of nerve fibers. The AV node is made of muscle. This is by design, because it allows for conduction to slow down from the atrium to the...
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    Low dose Ketamine

    I've done it overseas. It hasn't caught on in North America yet. Shame, cause it's legit.
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    Trauma Scenario: Thoughts? RE: RSI/Intubation

    I agree both to this, and your previous sentiment about taking minimalist approaches to airways that need tubes. Not everyone needs a tube, or RSI for that matter. But when you need RSI, you NEED it. Over the years there's been many more "risk adverse" adjustments to airway guidelines (which...
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    Ketamine for Post-intubation Sedation. Experiences?

    I agree wholeheartedly. I came back singing the praises of ketamine's versatility, only to he greeted with "that's a cat tranquilizer". Now it's the goddamned flavor of the month. There were instances where I would have much favored propofol, but didn't feel like waiting 20 mins for someone to...
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    Ketamine for Post-intubation Sedation. Experiences?

    I've used it in serial boluses, and maintenence infusions, in conjunction with versed. I've used it extensively for induction/maintenence, PSA for fracture reductions, chest tubes, and minor surgical procedures, difficult dental extractions, and low-dose for tourniquet pain that was not...
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    How reliable is capnography?

    I've found that printing the strip helps with seeing the shark fin better as well; sometimes you see shark fin wave forms that end up being normal after you print em out.
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    IV Solu-Medrol

    There's tons of things that we do in the field that have shoddy scientific backing, but at least in the spectrum of allergy/anaphylaxis, they should most definitely get solu medrol. Following the epi/benadryl, inhibiting mast cell formation (and thus preventing additional histamine release) Is...
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    Looking for I-gel thoughts

    They're passable at best. Half the time they turn the airway into a bloody mess. You can pass an OG tube through them though, and we get decent C02 in cardiac arrests most of the time. The straps that come with them are garbage though. Tape the crap out of em to secure it.
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    Why not shock a trauma code?

    Ven was always there to drop some knowledge bombs, at the cost of some sarcasm; which is win/win in my book
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    Anorexia is an excellent indicator for appendicitis. Distension may be from the associated peritonitis. But, there's about 1834 other things that cause anorexia and peritonitis, so until we get CT scanners and I iSTATs, treat for the worst case scenario----- ..... which is probably the same...
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    Stroke vs aneurysm

    A good, quick tool for subarachnoids is keurnig's sign, which is "guarding" with the legs (much like in abdominal injuries) with neck flexion. As a rule of thumb subarachnoids will present much like afebrile Meningitis, outside of history taking.
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    Not your typical epileptic

    80% of our seretonin is found in the gut. Zofran is so popular because it antagonizes those peripheral seretonin receptors, which in turn prevents vagus nerve stimulation. As a contrast, drugs like Phenergan work peripherally in the gut as well as centrally in the CTZ. As far as I'm aware...
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    Subcutaneous emphysema that looks like angioedema

    Were his lips and tongue swollen along with his face?
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    Renal failure and Sepsis/hyperglycemia

    You've gotta try to protect the kidneys in any shock state; even more when theyre in any kind of renal failure. The old mantra "brain, heart, kidneys" still holds true, and probably always will. Letting them become ischemic/lower GFR further is way more dangerous than "overloading" them...
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    Any Military Medics out there?

    If I encountered people like that while I was still in, I would have crushed them. There's a reason the infantry guys nicknamed me "doczilla". The civilian and military sectors are both behind in their own respective ways. There's only three things I've advocated since I've gotten out, and...
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    Guess what it is

    In general, the prehospital management of appendicitis will depend on if you suspect sepsis or not--- then you'll be treating the sepsis in general. A good chunk of appendicitis can be managed with antibiotics as monotherapy as it is. Maybe if EMS gets empiric antibiotic abilities one day...
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    Any Military Medics out there?

    There's stuff out there, like NEMSA, they do an accelerated transition program for military medics
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    A-Fib's Biochemical Origins

    Generally, there's two explanations for tachyarrythmias: Irritability Or Excitability For irritable tissue, (ischemia, injury, toxicity) cellular changes with ion gates and sequestration/leakage of things like calcium and potassium can change the resting membrane potential; making cells...
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    Neurogenic pulmonary edema

    So, he's altered, so CPAP is off the table. Nitro isnt a bad idea, if you think the wet lungs is contributing to/the underlying problem. Of course in restrospect, you don't wanna mess with the pressure in a bleed, but no one could have saw that coming. As far as RSI, with a GCS of 3, are you...