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    Out of Hospital ECLS (Extracorporeal Life Support)

    With the advent of portable ECMO devices, I think that you'll see this become much more commonplace in the critical care transport arena in the next ten years or so... Right now I mainly see people referred to ECMO facilities and start on ECMO once they arrive. Here's one such portable...
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    use of atropine and RSI

    Systemet thanks for a thorough review of current literature. There doesn't seem to be good evidence for either premedication with atropine or withholding such....
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    How freely do you use Naloxone?

    Perfect post. +1
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    Mini Scenario

    Thank you for this interesting post.
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    Out of Hospital ECLS (Extracorporeal Life Support)

    Out-of-hospital ECLS is perhaps useful in extremely rural areas, but far fetched from my perspective. In our suburban area, very few hospitals (only tertiary care/regional centers) have ECLS now. One of our flight services can bring ECLS to an outlying hospital, but I am not sure this has ever...
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    use of atropine and RSI

    It might have been unproven or controversial many years ago, but a preliminary internet search returned several articles published recently that all indicate that bradycardia is a common problem with pediatric (<8-11 years old) intubations and that premedication with atropine is indicated...
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    Physicians' Impression of Pre-Hospital Pain Management

    True story. Sad to see that this post was revived! Things are in general better in our system now, a year later, with fairly widespread acceptance of prehospital pain management. As far as dosing, our new protocols allow 1 mcg/kg fentanyl up to a total of 3 mcg/kg, and/or morphine 0.05 mcg/kg...
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    Physicians' Impression of Pre-Hospital Pain Management

    Sorry for the delay. I've been away from the forum, occupied with other things. Indeed it was a kidney stone.
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    Prehospital use of Ketamine

    One of our air providers uses it for intubation. I am not sure if they use it for analgesia or painful procedures, but have definitely seen good results with it in the hospital. Possibly of interest to others, I really like West Michigan Air Care's MAI protocol chart and the discussion that...
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    Worst Monitor Interpretation Ever.

    Pacing is an option, and a fairly expensive one, but one of the most common features on monitors sold in the USA. We don't use it very often, but it can be lifesaving so I assume that's why most areas have it. It's also a recommended ACLS intervention for symptomatic bradycardia...
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    Worst Monitor Interpretation Ever.

    What if the bradycardia is from hyperkalemia? Or from an MI? "Unstable" bradycardia will often present with chest pain, diaphoresis, shortness of breath and other symptoms also associated with myocardial infarction. Do you want to use a temporary "bridge" treatment that may make their...
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    Worst Monitor Interpretation Ever.

    So you are going to start pacing and then turn off the pacer to get a 12-lead later? Let's get the 12-lead now! As someone said above, the patient has a pulse and a problem so get a 12.
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    From the research I've read, there's been no direct correlation between magnesium and it's anticonvulsant effect. Otherwise, no one has proven how it stops the seizure. There's some peripheral nerve block, and some vasodilation, but we're not really sure which pathway stops the seizure (the fact...
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    Unknown Toxin - Wanna Sniff?

    Here's a good one: Does anyone remember the story about a fire chief "taste testing" the substance leaking out of a tanker? Believe it ended up being milk. I can't recall the details though.
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    Triage question

    We don't have to call it 'triage'. The key thing is you have an organized approach to a multiple patient scenario, whatever the scenario.
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    Triage question

    Yep, consider it the same thing. You and your partner were not enough resources to handle three critical patients, so you need to triage. Think about yourself trying to treat two patients... More need than resources available = MCI. Once more units arrive it may not be an MCI anymore. When...
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    packs and supplies for SAR

    I like the Kigali packs if you can find them. I think Remote Medical has them, but there are some other cheaper suppliers (where I got my last one from a while back). I second most of what's above. Pack light! Everything should have 2 or more uses. Mission-specific planning is key. When we do...
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    Respiratory vs. Stretcher

    Another t-shirt: "If it's a-glowin' we get a-goin'..." Agreed with all that said "no running!" It's unsafe and unprofessional. It won't allow you to assess the scene, and might even cause an accident that prevents you from getting to the scene. Walk quickly with a purpose but be careful.
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    Going for the EJ

    I don't know why everyone is talking about EZ-IOs! The EJ is a peripheral IV site. In my protocols and my mind, it's preferred to an IO.