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This should be addressed in your protocols, since there is no real national standard. Some places may want new neuro stuff for less than 4.5 hours, while some EDs prefer that EMS calls for everything < 6, 10, or even 12 hours onset. In general though, I think most EDs prefer that EMS be fairly...

Holy cow that was insightful. Thank you Christopher!

Late to the game, but this is hyperkalemia. The QRS is wide, but V1 and V6 do not show clear LBBB or RBBB morphology. Both the QRS downstroke and the upstroke are slow, consistent with hyperkalemia. The T waves are "peaked," but more importantly they are narrow and symmetric. The sine-wave...

That isn't analgesia, it's procedural sedation. Which is cool, if that's what you're shooting for. The recent evidence, however, suggests that benzos have no role in augmenting analgesia, or in "sparing" higher doses of opiods - for a quick review see "For better pain control, add a benzo...

This is a great discussion! Love to hear all the different points of view. One thought - most emergency staff are pretty good at suturing up kids, mostly since kids are so good at jumping off stuff, falling down, or misusing sticks. Chins, eyebrows and lips are fairly routine in the ED! So, we...

Ok, a few issues here. First off, and most importantly, aortic dissections and AAAs are two different creatures. Different epidemiology, presentation, management. Dissection involves the thoracic aorta, associated with Marfan's, hypertension AAA involves the abdominal aorta, associated with...

If it's sepsis, it's fluids, antibiotics, pressors, intubation, and source control (e.g., if it's an infected gallbladder it gets yanked or drained, if a PICC looks like the source, it gets pulled...). If this ECG is a fair representation of what you saw, then no specific therapy is...

Truly asking here - why isn't this an example of "STEMI-seen-in-PVC?" The ST elevation in the PVCs in lead II exceeds 25% of the preceding S wave. E.g. http://hqmeded-ecg.blogspot.com/2009/11/stemi-best-seen-in-pvc.html EDIT: Never mind, I just figured out how to Google image search. Dr...

I'm just checking - it was really a 10 week estimated gestational age? If so, there was absolutely nothing to be done for the fetus - the only patient was the woman. Even at double that (20 weeks EGA), the odds of fetal survival are zero. As for freezing, I'm pretty sure that you felt far worse...

Because they are getting antibiotics. You just need to make sure they don't have an allergy to e.g. penicillin.

Even if it looks like a "simple pain crisis" at first, both children and adults with sickle cell disease can develop acute chest over the next few days. No one suggested it here, but it bears some emphasis - just don't let the parents of a febrile kid with sickle cell (± chest pain) decline...

Great discussion so far. I'm not going to leap in with my DDx yet, but I will say that I'm glad no one has suggested that this patient could follow up with their PMD for this. Clue to my DDx: One of the pediatrics professors in med school would say that you only need to ask the parent in this...

We might have crossed paths at some point - I worked for a private ambulance in Tamworth/Madison, as well as volunteered for Bartlett-Jackson, and spent 2 days working for Tinker! At least when I worked there, you did your 911 calls, but after those, you worked in the ED. If the trucks didn't...

Twitter is also great for this, since you can follow some great conversations about new evidence and old controversies in EM/EMS.

I actually worked as a medic there for a period. If you have some general questions, I might be able to help answer them. PM or public, either is fine.

Frisbee I know nothing about. FrisBIE, on the other hand, I know well. Progressive EMS, very close contact with medical control, and a good mix of 911 and in-hospital work. Awesome place for a certain kind of medic.

Many researchers consider the that to be the main problem as well. This can also be a problem for most any piece of diagnostic equipment as well, true. The BP cuff, for example, an often be initially misleading. However, the CO-oximeter devices (RAD-57) are a particularly difficult issue...

Yes!

Well I used to be a brand-new EMT! Those ED nurses can be pretty intimidating at first. Don't worry abut the grumbling, though. Keep being friendly and professional, and they'll take a shine to you soon enough. Listen, you did great. You got a change in mental status + change in vital signs...

Also late to the party. I think you guys are picking on the wrong person. I'm sure the plaintiff has very few resources, and is not paying for a lawyer out of his own pocket. Almost certainly, a lawyer is working for a contingency fee, perhaps as high as 50% (and maybe only after legal fees)...