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Ugh, its been a while. This place still smells the same though. Like Cidex and red bull, and nicotine. Maybe Irish Spring too. What does 2023 look like out there for those of you using ketamine in the field? what are the doses dictated by your protocols? What are the indications? Are you...

Thank you. Good info.

I'm curious how often you folks are seeing these narcan nasal antidote kits used, specifically by family members or friends of overdose patients? If the patient gets reversal before you arrive, is it presenting any particular issues for you in the field? My hospital is the ICU referral...

Ok, I went to Wikipedia and I'm not quite right. It looks like it involves a pump that exchanges H+ and K+. But either way, you pee out K when you are alkalotic and volume depleted.

I would not go overboard with fluids in this patient, but she certainly does need volume. For several reasons. And I think it's reasonable to give her a judicious fluid bolus in the field. A couple of points- this patient is markedly hypertensive. That is a vascular response to her low...

Interesting point. For those outside the US using penthrox - do you screen for MH before use?

The nephrotoxicty reports come from its use as a general anesthetic agent. The concentration breathed to induce general anesthesia is far higher than the concentration needed for the analgesic effect. The "dose" would be measured in exposure hours (we call them MAC-hours) to the anesthetic...

Hefty doses of precedex are also awsome in these patients, although clearly not an option in the prehospital environment.

This is an important learning point. When you disect into a coronary, any of them, blood flow is severely compromised to the associated myocardium. And frequently these patients infarct some of their muscle before flow can be surgically restored. They often present with crushing chest pain...

Ummmmm, what in the hell is going on in this thread? :eek: And who wrote this kid's physiology textbook?

Just to give you guys some perspective on how absurd these CMS mandates have become: A few weeks ago I admitted an obese patient with ischemic cardiomyopathy and an EF of 20%. She was in respiratory failure from volume overload, on a background of severe COPD, and may have had pneumonia. She...

Yeesh. I didn't read every word, but there is a lot of misunderstanding of study conclusions on the part of the authors of this opinion piece. They are trying to draw a lot of black and white from studies that were neither powered, nor designed to look for definitive conclusions. There are...

Just wanted to make a quick couple points... Absolutely. Insulin, usually given with dextrose, does cause intracellular shift of potassium. And in a pinch, both are generally readily available in most patient care areas. Practically, however, I have found insulin:d50 therapy to be very...

There are only 2 ways to effectively get potassium out of the plasma. You can pee it out with diuretics, or you remove it with dialysis. The remainer of the treatment algorithm serves only to temporize until you can do one of those two things. CaCl will stabilize the cardiac membrane...

A very important clue hidden in there. This is what clinically symptomatic diastolic heart failure often looks like. Especially in a little old lady with longstanding diabetes and hypertension. Recall that diastolic failure is not a failure of the pump, but a failure of the heart to relax...

I am probably not the right person to ask about this topic. I chose to practice full-time critical care because I did not enjoy anesthesiology. It was challenging and exciting in the first 3 years of residency. But by year 4, I had moved on and was ready for a different role. Which is how I...

If anyone ever happens to pick me up and I neeed pre-hospital analgesia, there are only 2 things I want you to give me: 1. Ketamine in 20 mg increments until I'm comfortable. Or... 2. A penthrox inhaler Unfortunately, those are both hard to come by in the US EMS world. .

I waffle a lot on this question. On the whole, I'm not convinced prehospital intubation does much to save lives. Anecdotally, there are likely cases in which it helps. But to play it out statistically, it probably makes little mortality difference in the grand scheme. That being said, I...

One more point here. Generally, hypothermia protocols have only been shown to benefit patients who suffer out-of-hospital cardiac arrest and subsequently remain comatose after resuscitation. If you load a patient up on versed simply because you resuscitated them, you take away the ability...

I mostly say milrinone because it does not carry quite the risk of dysrhythmia which we see with the beta agonists. And overall, I find it to be a relatively effective inotrope, though you may have to offset the dilator effects with a constrictor. I do still see a lot of steroid usage with...