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Thank you so much! That means a lot to me... As I've said before to you, I'm a paramedic first and a Respiratory Therapist second. There are times when the knowledge does benefit you in a 911 system. Just curious, anyone know of flight companies in your area that run RN/RT or Medic/RT? Provided...

@VentMonkey A good overview of PRVC http://www.respiratoryupdate.com/members/PRVC_Pressure_Regulated_Volume_Control.cfm PRVC is aka as variable pressure control, volume control plus... and whatever a manufacturer feels like naming on their vent! haha

So it took me a long time to figure this out, but I eventually got to wrap my head around this. And yes, decelerating flow is one of the mechanisms that PRVC used to prevent increased peak airway pressure. But, to increase flow in PRVC, you gotta know the concepts surrounding PRVC. PRVC works...

Another thing I forgot to mention is pressure support in SIMV... a good pressure support setting in SIMV goes a long way as well. Typically, I start at a pressure support of 10 cmH2O and titrate from there.... definitely helps with muscle fatigue and air hunger.

Don't get me wrong; I'm a big advocate for assist/control. I don't care what the FP-C exam says about "patient's spontaneously breathing should be placed in SIMV." Assist/control, when good settings are inputted, can do amazing things for patients. Decreased muscle fatigue, normalization of...

Sadly, it seems that a blanket of lab values and radiology trumps patient history and interview :(

Ah, PRVC... the 'mindless' mode. You know, in the respiratory profession, it seems that many RTs revert to PRVC because of its automative functions. BUT, it's rare to find personnel who really understand PRVC and what it is doing for the patient. Here's a challenge: You have a patient who is...

G Great point about thinking carefully about initiating spontaneous modes, etc. Again, I am always suffering from 'identity loss' and frequently forget that the ICU is a different place than in the back of an ambulance or aircraft. Generally, these patient's don't have a ventilatory problem...

**sigh** Just another example of how EMS education is 20 years behind...

I'm always worried when we consider ketamine solely for pain management... call me what you may, it just seems like there are a number of mental side effects that are unnecessary that go along with ketamine. My experience with ketamine has been with patient's not tolerating bipap in the ER...

Hey so there is a adage traditional in the EMS world that patient's with abdominal pain should not receive analgesia because it may "mask" the assessment made by the physician. I.e. once the patient gets to the hospital they are no longer in any pain, soooo lets send them home. Not a good idea...

What are your thoughts on administering analgesics to patients experiencing abdominal pain? Is there evidence to support withholding narcotics to someone in obvious pain? How has technology changed this? I know my answer, but I'm curious what they're teaching in school nowadays.

When we started doing "Sepsis Alerts" in my previous EMS company, it seemed that I could make anyone fit the criteria to call it in, start bilateral IVs, give 500 cc of fluid, and potentially start a pressor if their BP was low. I know it goes without saying, but I'm afraid we all get tied up in...

Have we forgotten that history of present illness is still an important diagnostic tool? Verses these "criteria" and protocols.

Sedate the patient if they are combative with altered mental status or not sedating them would potentially result in an extubation. :) Had a situation like this....post cardiac arrest after 30 minutes of V-fib... patient started sitting up and swinging his arms and was obviously out of his...

Okay, so without looking at anyone elses' posts and giving you my clear cut opinion... this is a grab and go case. Sounds like he has a clear case of cushing reflex and will have the potential for neurosurgical intervention. Airway of course is a definite, but also a priority, doesn't seem to be...

Although I don't have any thoughts specifically about ETCO2 and CVA (unless there is LOC changes; use to monitor ventilation), ETCO2 is a great tool for Sepsis! I know JEMS put out an article talking about ETCO2 levels less than 27 mmHg usually means lactate levels >4.0.

Very much so. It's kinda hypocritical of me to quote "ACLS Guidelines", especially if you're a thinking medic who follows your brain and not some protocol. I will say that SpO2 can be misleading, even with a great pleth waveform. Think about the on-loading and off-loading of oxygen to/from the...

Here in NC we carry Newport HT70 for interfacility transports. Pretty bulky but does give more options that ATVs. I can do AC, SIMC, VC, PC, and PS...switch it to NIV and do CPAP/BiPAP. Can even do a descending ramp on my flow rate. Cool stuff... fairly cheap ~$9000

My first impression of course would be electrolyte imbalance, but it appears her K+ stayed WNL. There obviously seemed to be an underlying cardiac pathology that seems to be exacerbated by changes in blood glucose. Was the patient discharged with the EKG staying pretty consistent to this? I know...