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  1. Remi

    It hit home

    Wow....very sorry to hear that.
  2. Remi

    Adulting advice needed.

    A lot has been said here about the financial aspect of getting started out on your own, and that really can’t be stressed enough. This is because while money is far from everything, what you do with your money is one of the very few things in your life that you have complete control over, and...
  3. Remi

    To Degree or Not to Degree. That is The Question.

    An associate's degree (AA, AS, AAS, ASN, etc.) is typically about 60 or so credits and takes four semesters (traditionally two years), which is half of what a bachelors degree (BA, BS, BSN) requires, which is 120 or so credits typically taken over 8 semesters and 4 years. An AA or AS is usually...
  4. Remi

    To Degree or Not to Degree. That is The Question.

    I do support moving to a AAS degree for paramedics, with the program centered around one or two semesters of A&P and a semester of pharmacology, as well as a basic clinical statistics / research course and writing courses. I don't think this is much of a leap, since most paramedic courses are...
  5. Remi

    To Degree or Not to Degree. That is The Question.

    I took my EMT-B while on active duty in the Army and when I got out, I used my GI bill to pay for my initial paramedic program (a 10 month certificate) that I finished in 1997, and I've been involved in pretty much this same discussion almost constantly since then. In the interim, I earned a...
  6. Remi

    Airway Management and Intubating without Drugs

    If the sole cause of the hypotension is vasodilation (i.e. propofol in a non-bleeding patient), then yes, neo or vaso tends to work really well. In a sick patient though, vasodilation induced by induction agents is not usually the sole cause of peri-induction hypotension and inotropy can be...
  7. Remi

    Airway Management and Intubating without Drugs

    Having prefills is nice, but I wouldn’t say not having them defeats the purpose. It shouldn’t take long at all to mix up an infusion, but it should be quite a bit quicker to make a syringe and give a bolus. It literally takes seconds to make a syringe of 100mcg/ml of epi or neo, if you know...
  8. Remi

    Privatized EMS in Placentia CA

    Why not?
  9. Remi

    Privatized EMS in Placentia CA

    Who requires an EKG before administering zofran?
  10. Remi

    Ibuprofen vs APAP

    Pretty much every study shows it doesn’t work any better than PO.
  11. Remi

    Ibuprofen vs APAP

    I'd turn the question around and ask why would you bother giving a drug that isn't very potent and takes an hour to reach peak effect, when you can give more potent drugs that reach peak effect within minutes? To be honest, in the EMS environment I am just not very concerned about the type of...
  12. Remi

    To Degree or Not to Degree. That is The Question.

    As you know, many people excitedly get into EMS and are quickly disappointed with the mundane work, relatively low pay, limited career options, and a perceived lack of respect from the rest of the healthcare industry. I think what happens is that then, when they begin to consider what might be...
  13. Remi

    Airway Management and Intubating without Drugs

    In most scenarios, resuscitation before intubation probably makes sense. Especially if you are bound by protocol or tradition to use an induction agent or a dose of induction agent that is inappropriate given the shocked state. But if you deal with enough sick patients - especially trauma...
  14. Remi

    Airway Management and Intubating without Drugs

    People don't always need to be fully anesthetized in order for intubation to happen. If you are committed to using a full induction dose of any sedative, then yeah, you might have a bad time if they are sick and you don't take the time to resuscitate first. But if it's a scenario where you...
  15. Remi

    Airway Management and Intubating without Drugs

    Why is versed and succinylcholine a terrible choice? I think the vast majority of people who do this routinely would agree that generally, versed is inferior to the other commonly used options. But it definitely has a place in some scenarios.
  16. Remi

    Airway Management and Intubating without Drugs

    “Never had a problem with our current routine but can’t resist fixing what ain’t broke”.
  17. Remi

    Airway Management and Intubating without Drugs

    Only succinylcholine has muscarinic effects, but it does not cause any vasodilation because not enough of it reaches the M3 receptors to have a clinical effect, and M3 stimulation does not reliably cause vasodilation....it also causes vasoconstriction.
  18. Remi

    Airway Management and Intubating without Drugs

    No. NMB does not affect smooth muscle.
  19. Remi

    Airway Management and Intubating without Drugs

    There have actually been quite a few studies showing that using NMB increases success rates and minimizes complications with intubation. You certainly can get NMB-like intubating conditions with sedation alone. I assure you that with enough propofol and fentanyl, you would never be to able to...
  20. Remi

    Airway Management and Intubating without Drugs

    If you are really comparing apples to apples, I don't see how that could be true. I mean, if you are talking about slipping a tube into a patient who is perfectly relaxed after getting some sux vs. one of those scenarios where one person is holding the patient's arms down and another is holding...
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