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I don't really get the controversy. Are people using brass knuckles for sternal rubs? I've tried multiple techniques, and personally I find the sternal rub to be the most reliable.

Nothing about his grammar sounded like prototypical "ebonics". You saw a black poster and inappropriately and improperly ascribed his poor grammar & spelling to a black dialect. You would not have said ebonics if you did not know he was black. That is what makes it racist. Anyhow, live and...

Yeah, that ebonics comment was telling. Transport jockey, your racism is showing.

I generally agree with the notion that soot in the airway and/or singed facial/nose hairs should not be an indication for intubation. Nor should isolated facial burns. Add on respiratory distress, voice change, sloughing of oral mucosa, etc. and then you have some solid reasons to intubate. I...

If you have the skills (having the drugs and an RSI protocol does not equal skills), then you intubate this patient all day, everyday, and twice on Sunday.

The amio+bystanderCPR was compared to Lido+bystanderCPR and placebo+bystanderCPR. So, it is possible to say with confidence that the difference was due to amiodarone (or lidocaine, as they were equivalent). Amiodarone fared better than lidocaine for EMS witnessed patients, so I think that...

I do not think this is at all definitive in its conclusion. This should be the start, not the end. (That is not to say that one would not be justified in stopping the use of anti-arrhythmics in most situations.) There were trends that lead me to believe that the "not significant" findings...

For a 35 minute transport, I'd go with versed and fentanyl. Could also do versed and morphine (I've only done this when working in the Burn ICU as that was a preference of the attending surgeon). Just because a sending facility is using a particular regimen doesn't mean you have to go along...

Decorticate posturing has numerous causes, though we are all told brain injury/herniation and other causes are usually left out. Even as a doctor (not a neurologist), the differential is incompletely taught. Regardless, I've seen many seizures over the years and I've seen decorticate posturing...

Another question would be how many of these arrests are you either the first or second medic directing care? There's evidence that 2 medics is ideal. If one shows up to arrest after arrival of the first due medics and you stand there handing them stuff or are just doing CPR, should that count...

I think most people tend to over-estimate procedural frequency and proficiency. Anyhow, two of my old medic (911) jobs had an e-PCR with a search function where I could look up the codes and patients that were intubated where I was a primary crew member, and it was possible to look up...

Did anyone else hear a mic drop at the end of this masterpiece? After how many medical directors, one finally calls out the city, the dept, AND the union to their face and in public. So much gold. I hope change happens, but I suspect this will go no where...

This is the sort of patient that is ripe for a publishable case study for EMS, EM, and toxicology. It take some effort to do, but this is potentially great teaching case.

File under: No ****. Circ Cardiovasc Qual Outcomes. 2016 Jan 26. pii: CIRCOUTCOMES.115.002317. [Epub ahead of print] Paramedic Exposure to Out-of-Hospital Cardiac Arrest Resuscitation Is Associated With Patient Survival. Dyson K1, Bray JE2, Smith K2, Bernard S2, Straney L2, Finn J2. Author...

The hypotheses generated in the discussion section is the result of brainstorming for an explanation of the findings. It is not evidence. If (IF) one can intubate well, it should not matter if it is done in an ED or in the back of an ambulance in the scenario of post-cardiac arrest. Granted...

I know there is data showing delays to hospital arrival are associated with poor outcomes, but that is for trauma. Taking time to secure an airway post medical arrest is not unreasonable. If there are multiple people on scene (hopefully there is for an arrest), you can set up for the RSI...

http://www.jems.com/articles/print/volume-41/issue-1/features/detroit-s-efforts-to-improve-ems-response-includes-dual-role-fire-ems.html "So, while firefighters began receiving medical first responder training, Detroit’s EMTs and paramedics began attending the fire academy. Eventually, Jenkins...

I prefer to have a good, solid indication for narcan (empty bottle of percocet or a needle in the arm are preferred). But, there have been situations where it was questionable and narcan administration saved the patient from a. intubation and/or b. an expensive work-up for altered mental...

This is one of those things that I find interesting (and promising), but I'm also quite skeptical. ECMO takes time to set-up (from equipment to final placement), and it generally requires a cardiothoracic surgeon. Though some EM docs have trained to do it (E.g. Sharp Memorial Hosp in San...

Heart sounds aren't that useful. I listen to them on nearly every patient I see, but I can't think of a time where it changed my management. There are MANY times where I listen and do not hear anything abnormal and then read an echo report that shows stenosis or regurg of different valves...