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    Can We Talk About Methadone?

    It also has very favorable pharmacokinetics. Relatively slow time to peak effect and long half life with a clinical effect of ~24hrs. MMT centers can distribute a dose daily. Unfortunately, in this scenario that means he probably hasn't experienced the peak respiratory depression yet, and if he...
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    Renal failure and Sepsis/hyperglycemia

    Here's a summary of 2 recent papers looking at this topic. Fluid Administration in End-Stage Renal Disease for Severe Sepsis and Septic Shock
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    Matt Walsh wrecks this dude who claims to be an EMT

    Not sure how this changes anything or contradicts what I said. The definition of gender isn't something that a political faction wanted to change, but rather based on interpretation of modern research (over past 60ish years). Support by major medical societies demonstrates my point that it isn't...
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    Matt Walsh wrecks this dude who claims to be an EMT

    I've been unable to find an authoritative medical or psychological body with a stake in the topic who disagrees with that definition.
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    Matt Walsh wrecks this dude who claims to be an EMT

    In a quick 5 min search, all these societies define gender and biological sex to be different in their guidelines or statements. American Academy of Child and Adolescent Psychiatry American Academy of Pediatrics American Congress of Obstetricians and Gynecologists American Psychiatric...
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    Matt Walsh wrecks this dude who claims to be an EMT

    The majority of medical and psychological societies support defining gender as separate from biological sex with more and more literature demonstrating benefits with transitioning and gender affirmation. At what point does it not become a political discussion? Its hard to believe that these...
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    Humoral EZ/IO and Lucas Devices

    The epinephrine doesn't get metabolized during its venous return to the heart nor is the risk of fat emboli significantly higher in tibial than humeral.
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    Family Blames NY Medics, NYPD and Hospital for Dad's Death

    There are always at least 2 sides to every story. I can't imagine a surgeon would want a written consent to be signed in this scenario. Probably someone insisted they "need to see dad before going into surgery." A 20 million claim seems a bit preposterous.
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    Train accident

    Interested in hearing what happened at the hospital after. Can't imagine a scenario of "transport went uneventful after" a tension pneumo and tamponade without definitive treatment.
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    Appendicitis.... Cardiac issue

    The daily ASA in a pediatric patient should get you thinking that this person has a serious chronic illness (eg. hx congenital heart disease with some conduit/shunt, prior stroke, stent, vasculitis/Kawasaki disease).
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    the 100% directionless thread

    Pretty much draw up fentanyl all the time while not wearing gloves without a worry in the world.
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    the 100% directionless thread

    (Me dropping patient off in ICU from OR) Me: Yea, intraop course was unremarkable. Except well I guess we did do like 30sec of compressions following induction, but that was to circulate some of the meds a bit better. ICU: So you mean the patient arrested? Me: I mean technically, yes...But it...
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    New Cardiac Scenario

    Conveniently our pulse oximeter on the truck broke?
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    5 year old difficulty breathing

    The patient is 5y/o. That BP is normal, and HR is maybe just a bit high. Would you give 1L of fluid? If you think epiglottitis as others had mentioned, would you wait around to intercept with a paramedic to RSI? Not so easy
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    Intubation and the unconscious

    If you were hesitant about using induction agents initially you should continue that thought. 5mg and 100mcg have a high likelihood of hemodynamic instability (especially with no stimulation of DL and endotracheal intubation following) in a patient like this. That patient's BP is likely only...
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    Scenerio 4

    Obviously your post is abridged of information that you gathered from the patient about their history. However, after reading a few of these posts I would recommend really focusing on history taking and developing an assessment with differential. From there, people (colleagues, ED staff, random...
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    Patient centered approach at clinics

    CTMC is a hospital/freestanding ED? If it is then that's not a true 911 call and they are required by law to have an affiliation in place to transfer to PCI capable facility. The goal is to improve outcomes and get patients the care they need sooner by streamlining the transfer and hand off process.
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    Patient centered approach at clinics

    Nothing is more frustrating than trying figure out a new patient who has never been to your hospital system's complex medical history at 2am on a Saturday morning and having to wait until 10am Monday when the competing hospital's medical records (that he/she has been admitted to 30x) or their...
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    Abbreviation question

    I find that people may write WNL when they mean unremarkable.
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    Paramedic to RN bridge….. options?

    Well this thread evolved interestingly. To provide a different perspective, I would say I find myself frequently asking a RN "what do you want to do?" or "what orders do you want?" to which he/she may reply "Well I already did XXXX, so can I have an order for it?" Majority of time it's a...