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Interesting hearing others' experiences treating GSWs. As a half-time paramedic (straight nights) in a large but not particularly dangerous American city, I personally run about two a year. The hospital (L1) I work at receives probably one or two a week. There are two other hospitals in town...

No argument here. But if you want to know how someone could go 7 minutes w/o noticing significant mentation changes, I think you've found your answer.

One of the great disservices charting provides to our patients.

Somehow I was picturing you rounding on the pt every 2 hours and finding him asystolic every time. Sternal rub, ask how his pain is, move on. :D

I've not found this to be true.

Nail on the head, I think. ASA, like chest compressions, is not very sexy. People would rather nerd out about mixing mag. But since I suspect most people are still remembering to give it to suspected ACS patients, I'm not sure its importance being overlooked really hurts care. What do you think?

Great discussion all around. Here's the 3% protocol -- thanks for your patience. So the the actual infusion rate is 100ml/~3min, q 10 min.

Agreed re: bolus. Also agree that the specific rate is very important; i'll report back when I have more. That might make more sense. It seems people (myself included) play fast and loose in talking about fluid "boluses" whenever crystalloids are administered wide open w/o a specified drip...

I will reach out for the exact protocol. I believe it's given quicker than 10 minutes. Running a burette wide-open for a few minutes isn't a bolus because it's not pushed? Do you think the term 'fluid bolus' is widely misused/misunderstood then?

Not in a pt. with severe acute exercise-induced hyponatremia. This is a very specific clinical context; these are not geriatrics with severe kidney disease, they're healthy 30 year olds who went from baseline to serum sodiums in the 110s in only a few hours. Rapid correction is indicated.

Yes, it's a neat service - met a few folks who have worked there. Not sure if they have other therapies available for other abnormal labs, although I believe they check trops.

Peds facility. I would get skewered for bringing this very sick kid to a non-peds center. Ideally we would intubate but I'm scared just thinking about it. What are others' thoughts re: airway management? Uncontrolled arterial bleed? Closest.

Grand Canyon National Park medics uses hypertonic saline for field treatment of severe acute hyponatremia, confirmed via field lab testing. I believe the protocol allows for several 100ml or so boluses for those with serum sodium <130 or so. I would have to dig a little for the exact details.