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Just looking for some experiences from providers who use ketamine for sedation in intubated patients. I had a post-arrest patient from an ED who was receiving ketamine for post-intubation sedation. The ED obviously didn't understand this drug as they weren't dosing it every 5-15mins and they...

What is the recommended expiration of sublingual nitroglycerin after opening? I was told the bottle should be discarded after every use which I have never heard of before. I have only seen discard 6mo after opening at the earliest and have also read that with new formulations nitro is stable for...

HFNC has been achieving great results for pre-oxygenation and maintaining oxygen saturation during intubation. I have used a HFNC in a few select patient's with pretty good results as well. One example patient is a CHF exacerbation, increased work of breathing, tachypnea at 28min, was on CPAP at...

I was in PEPP class today and one of the instructors told us that we are not able to use in-line capnography for monitoring tube placement due to the dead space that is created with the EtCO2 filter line adapter. It was told that we can apply it to initially verify but then we have to remove it...

Just a Facebook page and website I came across that has pretty good posts so thought I would pass it along. It looks pretty new but so far so good. facebook.com/medic1pharmacology http://www.medic1pharmacology.com

This is a pretty good article from medic1pharmacology.com on, "Inter-facility Considerations for Management of Nausea and Vomiting". I am always proactive in assessing my patients for nausea as an IFT Paramedic. Many times a patient doesn't always report their nausea and suffer unnecessarily...

I am gearing up to take the CCP-C exam in the very near future. I have been preparing by using a variety of different materials including the UMBC CCEMT-P textbook, misc Youtube and online sources, and the CCP-C review app for iOS. What are some of the best resources to use? I am most curious...

I had a patient recently from a small community hospital that leaves me shaking my head so I wanted to seek other opinions on the case. Patient was in her 70s, found at home alone on the floor after several days with no heat. Patient came into the ED hypothermic with rectal temp of 95.4F...

Can someone advise if EMTALA governs inter-facility transfer of in-patient's. EMTALA has to be one of the most unclear regulations. Some sources say EMTALA does not apply to in-patients yet certain cases have found that it does apply, and other sources say that all inter-facility transfers...

I got an FiCO2 alarm on my LifePak 12 today for the first time. I've never seen this alarm before. The patient's EtCO2 was within normal values for condition (29-33mmHg). Specifically, the alarm indicated "FiCO2=9" and another time "FiCO2=12". What exactly is this alarm saying? Thanks.

43 yo male is at a cancer treatment center receiving a blood transfusion (1 unit PRBCs) for low H&H secondary to cancer complication. Patient received the entire unit of blood at which time he became SOB and faint crackles were noted in the lung bases. RN reports and patient gives impression of...

A short clip of MD State Police medevac making a river rescue in West Virginia. https://www.facebook.com/photo.php?v=732903083399202&set=vb.169015883121261&type=2&theater

What is the common practice for securing controlled medications on your unit. At my agency, the controlled meds are in a locked compartment but the key to open it is kept in plain sight only a few inches away on the action area. This totally defies my own logic but no one else seems to see a...

Somehow I just found out that IV acetaminophen was FDA approved in the US in 2010. I had an L&D transport and the patient was given IV acetaminophen. Are any EMS agencies carrying the IV form? I can only imagine the cost per dose.

Came across this site that is a good tool to promote Paramedicine http://whatisparamedicine.com

Had a minor dispute about what the proper action is on a witnessed arrest this evening so wanted to seek opinions. The scenario is: transporting a patient and patient arrests. What do you do first treatment wise? Shock or CPR? I informed my preceptee that she should shock immediately. An EMT...

I have a question regarding phlebotomy. The standard phlebotomy practice is to NOT leave a tourniquet in place for longer then one minute prior to drawing blood. Once a vein is found if taking longer than one minute, the tourniquet is supposed to be removed, site cleansed, and then reapplied...

Had a patient today on a Lasix drip. It was the first time I had ever encountered or heard of a patient being on a Lasix drip. Dose was 10mg/hr and was mixed 1:1. Patient was admitted with CHF/Cardiogenic shock which resulted in renal failure. Pt. had anasarca, needed dialysis, etc. Pt. also...

Interfacility transfer of a 75 y/o male from a small, rural ED to a tertiary hospital as a direct admit. Pt. has been experiencing chest pain for the past week which has been occurring with mild activity and relieved with rest and a nitro patch. Early in the AM, pt. developed chest pain at rest...

Short video by The Wall Street Journal at Shock Trauma in Baltimore, MD. http://live.wsj.com/video/inside-a-trauma-unit-a-ballet-of-organized-chaos/017E2016-AFA8-43F2-BC67-6CE88C7ABCDD.html#!017E2016-AFA8-43F2-BC67-6CE88C7ABCDD