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  1. M

    Here it is: PARAMEDIC-2 study paper - Epi vs. placebo A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest Gavin D. Perkins, M.D., Chen Ji, Ph.D., Charles D. Deakin, M.D.,et al. for the PARAMEDIC2 Collaborators* Abstract Background Concern about the use of epinephrine as a...
  2. M

    ET vs laryngeal tube Pragmatic Airway Resuscitation Trial abstract

    If it hasn't yet been formally peer reviewed, it will be. This will be published.
  3. M

    ET vs laryngeal tube Pragmatic Airway Resuscitation Trial abstract Results: Of 3,005 enrolled patients, 1,506 were assigned to initial LT and 1,499 to initial ETI. Patient characteristics were similar between treatment arms. Seventy-two hour survival was significantly higher for LT than ETI...
  4. M

    Sedation for Conscious Cardiac Arrest Patients

    The only agent i'd consider is ketamine. But, by and large I agree with jwk. If the patient is in cardiac arrest, there are much bigger fish to fry. They are unlikely getting enough perfusion to have any recall. Even in the case of survival, the anoxia that occured prior to CPR is likely...
  5. M

    Chest pain in the young and tiered EMS

    As a EM physician and former paramedic, I say if 12 lead EKG is not STEMI or grossly ischemic, or exhibiting an arrhythmia, then triage to BLS (if OK in your system, send along a copy of the 12 lead with BLS). Treating this as ALS is a waste of resources and everyone's time, even in an...
  6. M

    Dream to become an EMT/EMS can my NON felony record stop me?

    As other have said, it will be tough. There are plenty of people in EMS who have been arrested or have had addictions, etc. It sounds like you were in a rough spot for a long time. Resisting arrest, theft, and simple assault could maybe be explained away if it was just one time, but with...
  7. M

    Why are we placing ETTs at all?

    I’m an EM doc and I wouldn’t do a pericardialcentesis except in the most dire situation (cardiac arrest or peri-arrest). I wouldn’t want a paramedic doing it out side of arrest (or at all, actually). I have had patients with large pericardial effusion with echo evidence of tamponade, but...
  8. M

    Why are we placing ETTs at all?

    ETI is associated with harm or equivocal outcomes. The best study showing benefit was the one out of Australia that barely reached statistical significance. There have been a few retrospective studies showing benefit (one out of King Co.), but they have their drawbacks. Generally, most...
  9. M

    Why are we placing ETTs at all?

    There's another side where a paramedic "over treats" and causes a poor outcome or adverse event when a expedient ride would have been more than enough. I think one could argue that in an all-ALS system, there are a greater proportion of patients harmed by paramedics than in tiered systems. And...
  10. M

    Morphine for headaches ?

    I think I've only once ever ordered an opiate for a migraine and it was a few hours in to their treatment after giving reglan, toradol, benadryl, fluids, and compazine. My experience is that reglan is a the best first line medication. Honestly, I do not think EMS should get into the habit of...
  11. M

    Studies on Tiered vs. All ALS?

    There are few studies that look at tiered systems and the ones that exist have many limitations. I don't have time to try and dig them up. is the place to start digging. I think what you are looking for doesn't actually exist.
  12. M

    Another mechanical CPR study abstract

    My personal thoughts on mechanical CPR is that its best utility is freeing hands for other tasks or for return to usual duty of personnel who would other wise be doing compressions. Its best use is NOT for improving survival. Prehosp Emerg Care. 2018 Jan 18:1-7. doi...
  13. M

    IO vs IV for cardiac arrest: recently published research

    Some valid points brought up (though there seems to be a weird tendency among some here to assume that the authors didn't think of biases associated with the study design, results, etc. and somehow attempt to control for such biases or acknowledge such.) These studies ARE limited by design, and...
  14. M

    IO vs IV for cardiac arrest: recently published research

    No definitive answers as these are retrospectives analyses, but these articles raise questions that should have been answered before the movement toward "IO first" in cardiac arrest that many services have adopted. ----- Intraosseous Vascular Access Is Associated With Lower Survival and...
  15. M

    Rialto Fire: 71% Neurologic Intact Cardiac Arrest Survival Rate?

    JEMS article indeed. And also their facebook page had similar vague language. The table actually cleared things up a bit when I found it.
  16. M

    Airway Management in Head Trauma (Scenerio)

    Ketamine could also produce hypotension, though unlikely in this scenario. A single dose of etomidate is likely to have negligible effects. I'd use etomidate.
  17. M

    Rialto Fire: 71% Neurologic Intact Cardiac Arrest Survival Rate?

    "This article describes the RFD's journey toward increased SCA survival-a journey that, in 2016, resulted in a 71% (Utstein) survival rate from sudden cardiac arrest (SCA) in Rialto. " Sorry (not sorry), the above is disingenuous. The majority consider survival from cardiac arrest as survival...
  18. M

    Rialto Fire: 71% Neurologic Intact Cardiac Arrest Survival Rate?

    First, good job on the apparent improvement in ROSC. (Based on the numbers seen, you don't know if the survival to discharge has improved, but you should know soon.) I think something that is important is that when you go to the press, especially a trade journal, you should have all your...
  19. M

    Rialto Fire: 71% Neurologic Intact Cardiac Arrest Survival Rate?

    Looks like they don't really know what they're talking about. There really isn't much special about them. They're touting their ROSC. I'll bet that they can't pull this off year after year. Next.
  20. M

    Rialto Fire: 71% Neurologic Intact Cardiac Arrest Survival Rate?

    As mentioned by others, the reporting of cardiac arrest survival is pretty standard. Most layman news sources don't get too specific about the criteria, but I bet that the number presented is based on the usual template (Utstein) unless the medical director and QA/QI folks have no clue as to...