Here's my thing. We aren't completely adrift out here. There are guidelines that are either for or are applicable to EMS. We have to utilize these as a) they are actually somewhat vetted and b) have some consistency out there. A lack of consistency makes for error prone environments. We can't fall victim to just "doing what you think is right" for every last issue. And that is the issue I have with this particular employer, they've gone so far out in left field that there is no way to stay up on what is supposed to be done as it flies in the face of what literally everyone else does. Not to mention the amount of ego at play, a drive thru testing site was set up staffed by vollie EMS at one point and there was of course mention of being "first in the state." Who. Cares.
Sudden onset shock due to a massive systemic release of WBC's and cytokines causing organ failure.
Something like Compartment syndrome?
My understanding was that the thing about NSAIDS and worse outcomes was a hypothesis based on anecdote and that there was no objective evidence at to support the link. Is that still the case?
I'm not the least bit shocked that an agency would advocate "scrounging", but I'm a little surprised they were dumb enough to distribute it in writing.
This is what we are seeing in our level 2 trauma ED also. About half of the patients under 60 are presenting with abdominal pain/distress. They seem to deteriorate faster, and have a higher mortality, than those that present with respiratory symptoms. We're still running about 5-7 days for test results, and private tests were only made available to us a few days ago (before that we were begging the state).
I get the no nebs, but why not BiPAP? I would imagine the alternative is a tube, and a vent, and aren't we trying to keep people off a vent unless they medically need it?
There are questions about the expiratory port filter efficacy on our BiPap. We have 50+ rooms, but only a few are negative pressure, and a fairly open layout. So they've made the decision to not use BiPap with any potential Covid until we have clearer evidence. I've never seen any situation this fluid, changing by the hour as to policy and entire procedures. It's frankly exhausting.
I read some stuff out of New York last night. Theyre still avoiding NSAIDs cause of the anecdotal french evidence,and cause of down stream renal failure.
The thing about BiPAP and CPAP is that even if your expiratory filter works perfectly, there's still a significant risk of aerosolization from mask leaks.
I want to say one of the docs on the podcast I had listened to eluded to the fact that they were wanting to allow the NIV patients the chance to self-position/ self-prone and had seen some positive results.
