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  1. J

    STUDY: BLS better than ALS for trauma, stroke, respiratory distress

    Do you speak to people like this in real life? I don't think I've been anything but polite, and I expect the same from you, although you are an anonymous set of fingers somewhere in the internet. Enjoy your discussion.
  2. J

    STUDY: BLS better than ALS for trauma, stroke, respiratory distress

    But that assumes that a nonrandomized retrospective trial with data derived from billing codes is sufficient to conclude that there is a causal link between ALS care and poor outcomes in the first place. I think you will find that conventional wisdom, especially among clinicians, is that such a...
  3. J

    STUDY: BLS better than ALS for trauma, stroke, respiratory distress

    What problem? This is the crux of the issue; saying they found a "problem" requires accepting that ALS care caused worse outcomes; and that requires accepting that the methodology used here says anything about causality. If all the paper did is identify an association between ALS care and...
  4. J

    STUDY: BLS better than ALS for trauma, stroke, respiratory distress

    Again, unfortunately this research is being spoken about as if it implies causality - by the lead author herself, posted on YouTube, with the Harvard emblem emblazoned on it. If this study were more closely tailored to a specific clinical scenario or intervention, it could indeed be question...
  5. J

    STUDY: BLS better than ALS for trauma, stroke, respiratory distress

    It's funny...I just got an e-mail that there's going to be a 40 minute round-table with the author at this years ACEP conference next Monday. I'm sorry I can't go.... On a careful re-read, the paper does indeed dance around implying causality. The author does really heavily suggest she is...
  6. J

    STUDY: BLS better than ALS for trauma, stroke, respiratory distress

    Except that the claim that pure statistical methods can tell us anything about causality is NOT all that well accepted. As far as I know, conventional scientific wisdom still suggests that it cannot. This topic actually seems fairly ill-suited to study using non-randomized study design, given...
  7. J

    12-Lead EKGs

    If I'm seeing this right on my phone, I think(?) Tom might have been refering to the elevation in AvR, which can indicate proximal LAD or left main disease. One finding that might actually make a difference, because it suggests the treatment may be CABG rather than stenting. Oh, and another...
  8. J

    Trauma Codes; To Work or Not.

    OP, You almost certainly did well. It sounds like you are beating yourself up about this, and understandably given how close to home it was. Don't worry about if you performed perfectly, or followed your protocol exactly. Calls like this are almost universally not-quite-by-the-book, given...
  9. J

    Nervous about operating an ambulance

    You aren't alone. To me, this was by far the most stressful thing about working in EMS (especially for the years before I had a GPS). Getting from the scene to the hospital is the hardest, since your alone and can't read a map. I can navigate very well with a map, but on my own in the driver...
  10. J

    Creative suctioning

    Have never done this myself, and I realize you may not have a meconium aspirator, but for what it's worth: And I have used just the suction tubing, but honestly I'm usually still somewhat underwhelmed with the success.
  11. J

    Paramedic school student resources Emcrit Ercast Smartem Some of this is beyond medic usefulness, but still plenty of ems relevance
  12. J

    High-Flow Nasal Cannula, Non-intubated

    To tell you the truth I wasn't really sure when it came around, but I was pretty sure it's growing use in the emergency world is a relatively new development. It looks like vapotherm started making their machine in about 2000. I don't know if that qualifies as new or not, but medicine does...
  13. J

    High-Flow Nasal Cannula, Non-intubated

    Just a clarification (for others reading especially, as I suspect you knew this). the phrase "high flow nasal cannula" usually refers to the newfangled humidified thingamagig that will flow more like 60 LPM. I know that 15 LPM is "high flow" for a nasal cannula compared to the usual 2-4ish...
  14. J

    Why can't COPD pts be on a non rebreather mask?

    And really, the most important organ (or at least the most intolerant of ischemia, even for very short periods) is the one inside your skull. If they're awake, they're definitely perfusing their brain.
  15. J

    STEMI transfers

    I've always wondered about this, especially now that I'm in a state where this sort of "keep them in the system" bypassing actually occurs. I was suprised the first time I saw it. It seems scuzzy to me. I have done this once, sort-of. We bypassed several hospitals with a transfer form...
  16. J

    Collar, or no collar? Gsw to the head.

    Agree with above. This is the situation for which there is the best evidence of harm from backboardimg: not just pain/airway difficulty etc., but actually a suggestion of increased mortality. Follow your protocols, but if they say immobilize penetrating trauma without evidence of neuro...
  17. J

    What would you do in this situation?

    The presention of this scenario is very strange and I doubt anyone is getting a realistic picture of how events unfolded. That said, a reminder You need not just more leads, but also different mode. There is much unsupported dogma in ems, but "you can't diagnose a stemi in monitor mode" is...
  18. J

    EMS Agency Ebola Plan

    It's interesting that they chose to flank ebola with two diseases which, though they have a similar R0, have totally different disease characteristics. hepatitis and HIV take many years to infect their 2ish people, and do so primarily through extremely intimate contact, as opposed to the 1 week...
  19. J

    Ebola: first case hits the US

    Sorry, I don't want to turn this into a back and forth, but a clarification - if you follow the link I posted, which is for in the hospital even, the first bullet under "aerosol generating procedures" says: " Avoid AGPs for Ebola HF patients." Sandpit Medic has posted the stuff specific to...
  20. J

    Ebola: first case hits the US

    Saying ebola is similar to HIV or Hepatitis may be a bit of a stretch....and based on the objective evidence that multiple healthcare professionals equipped with proper PPE have still managed to contract ebola, I'm not sure that "nothing to worry about" is really a proper phrase. The CDC told...