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Oooh, I want to play.

To intubate or not really depends on skill and experience of the crew. BVM will be sufficient, but I would not fault a well trained and experience crew with attempting to intubate. In the ED, experience, skill, etc. is the difference between "why didn't you intubate" and "thank you [for not...

I'm at a hospital that sees a lot of penetrating trauma arrests and we do femoral lines by landmark only, which can be very fast. There are times you nail the vein on the first pass of the needle, but other times you're poking around forever and getting nothing. The trauma service doesn't use...

My experience with K2 is usually the patient being some degree of decreased mentation up to being comatose, hypotensive, and tachycardic. Seizures, combative, etc. have been seen. When I know it's K2 (package on pt., or bystander confirming K2 use), I'll take a semi-conservative approach -...

This is one of those thing I find to be quite laughable, yet so sad. Not that fast-food workers think they deserve a living wage (I think ALL workers deserve at least a living wage, and I'm sure most of them do not think only they are worth such), but that so many EMTs and medics think that...

My concern used to be with giving a steroid to the pt. withouth a COPD/asthma Hx who is wheezing and suspected to have pneumonia. I posed the question to multiple docs and none had a good answer, and I don't recall ever finding a good answer when perusing pubmed or texts. Now as a doc (though...

Interesting study, it raises good questions. But I'm skeptical of its validity, though it appears they really worked hard to control for confounders. This is based on billing data, and I'm not too confident that billing is going to capture patient acuity or level of care provided as well as...

Actually, there is NO EVIDENCE. I've yet to find even an abstract to support the practice (and I've looked). Simply, there is NOTHING efficient about sending fire apparatus with paramedics. There's no efficiency involved with sending an ALS SUV when there are already ALS ambulances (e.g...

Congrats! I hope to see more of this from yourself and others. Great to see a social site help academic pursuits.

As pointed out, there is a big difference between aggressive and progressive and they are not one and the same. You want to be progressive? Throw out ET tubes and laryngoscopes, throw out paralytics, throw out epi for cardiac arrest, throw out anti-arrhytmics aside from adenosine. Fire most...

Immobilization and positioning goes a long way for controlling pain. I see all sort of injuries that can have pain managed with basic measures at certain times, which are very much a part of the continuum of pain control. Pain control does not equal meds all the time. Most patients with...

As usual, talking heads talk... It's amazing that any EMSer would ever consent to being on a show since every EMS know-it-all will gladly step up on to their soap box to go on about how the subject EMS is awful and then go on about how great they are. As a doctor and former medic... BLS the...

Because chaz90's EMS system does not carry roc.

Just use vec as the paralytic. You can go up to 0.3mg/kg for more rapid onset, but of course it will last much longer than the typical 0.1mg/kg dose. Would not do succs at all in dialysis patients. Too risky, even if pre-treating with calcium (no idea if it would actually work, but it's a...

The few I know off the top of my head: Lowell General Hospital Paramedics - Lowell, MA Lawrence General Hospital Paramedics - Lawrence, MA Worcester EMS (UMass Memorial) has a chase car in Shrewsbury outside of Worcester Chester County Hospital Paramedics (Medic 91) - Chester County, PA...

It's probably case-by-case. But, for me, I don't really care. So many variables of "experience" - one medic with 20 years experience is not the same as another with 20 years. Depending where one has worked and average hours worked per week, it is totally possible that medic with 5 years...

Isn't Austin a nice place to live? Don't most medics want to be busy and see a variety of calls? It's a busy system, but it's not THAT busy. They have a career ladder. They do "community paramedicine". Protocols seem on-point. They track outcomes. They have an involved medical director...

Actual need for a gastric tube in the prehospital setting is rare. Anyhow, the gastric tube should be placed orally (nasal route is a risk factor for VAP). To help you can have someone perform a jaw thrust or you can use your nondominant hand to grab the mandible and distract it anteriorly...

Align ear to sternal notch, ramp them up if need be (at least sniffing position, if possible), and bimanual manipulation of the larynx PRN. Those have helped me more than anything else and you will get far more milage from those than a bougie. My favorite airway book is the out-of-print...

Part of the argument that many (like me) have for tiered systems is as much about providing the best experience for the paramedic in to maximize outcomes as it is for targeting the right resources to the right patient. This doesn't change just because the setting is "rural". If a population is...