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  1. V

    So where does that leave us?

    The first thing I found in my mailbox this morning was a rather damning assessment of fluid boluses in pediatric patients. Not exactly surprising or news to the intensive medicine community. The addendum to the article showing short term benefit with increased long term mortality...
  2. V

    Those PALS folks are probably having seizures now.

    Current pediatric fluid bolus guidlines increases mortality in a multinational study with thousands of patients enrolled and a control group.
  3. V

    wanted to share this

    Leonardo is undoubtably one of my biggest inspirations. So I figured I would share this. "New exhibition will pit the...
  4. V

    Would you look at that! A study talking about harmful affects of hyperoxia.

    Oxygen Therapy in Critical Illness Precise Control of Arterial Oxygenation and Permissive Hypoxemia Daniel Stuart Martin, BSc, MBChB, PhD, FRCA, FFICM, Michael Patrick William Grocott, MBBS, MD, FRCA, FRCP, FFICM Disclosures Crit Care Med. 2013;41(2):423-432. "Supranormal arterial...
  5. V


    Alphabet soup courses. From time to time this topic comes up and I think it has been a while since we have talked about. These classes serve 2 purposes, and make no mistake, the main purpose is to make money. The more insignificant purpose is to provide minimal "training" in order to...
  6. V

    not the panacea of medicine? Sorry if you don't have medscape, but it is interesting not because of the the treatment, but the pointing out multiple times of the problems of random controlled trials and thinking they...
  7. V

    Life and death

    In one of the other threads there was a lot of talk about using lights and sirens when responding to or transporting "critical" patients. I realize this is something of a subjective term, but I would really be interested in hearing how many of these patients you actually see. I incuded a...
  8. V

    "I saw it once on TV..."

    It seems not a week goes by that somebody isn't asking for a youtube link as a place to learn clinical medicine. My favorites are how to deal with children and how a live birth works. But there have been others like how to perform everything from IV starts, to patient assessment, to...
  9. V

    thought this was worth posting

    "Tauranga's longest serving paramedic has decided to call it a day after a 48-year association with St John. Paul Sullivan, 66, will climb aboard an ambulance for his last shift tonight."
  10. V

    I hate austere medicine

    For the record. The only secret to it is being really knowledgable in mechanisms and desired effects of standard treatments. You learn that by being involved in the academic ivory towers of medicine. Not by a short course on "if you see this then please do that." However, today when...
  11. V

    NG/OG tubes with intubation

    an NG tube prehospital is not standard or even a majority practice in EMS.
  12. V

    Pick 5 meds...

    A few days ago I was asked by a US EM and medical director, with my experience, if I had to pick only 5 medications for use in an austere medical practice, what 5 would they be? What 5 would you pick? Why?
  13. V

    Not a gun thread

    Thanks to the efforts of DT4EMS and one or two others I have seen spring up, coupled with some very big names in the business calling the issue of assaults and injuries to EMS providers to the front and center, the hot topic in EMS right now seems to be what to do about it. On FB, one of the...
  14. V

    Is EMS treatment a farce?

    Sounds very extreme doesn't it? But is it? Today I am dealing with renal replacement therapy in peds. While that may sound like something more related to the ICU than EMS, there is a common theme throughout that raises questions. That is: Fluid overload increases mortality in critically...
  15. V

    How stupid are nurses?

    That got your attention didn't it? Rather than hijack another thread on what it takes a nurse to work in the prehospital environment, I thought we could talk about it here? Let us agree that working in the prehospital environment is not a part of fundamental nursing education. Let us...
  16. V

    Competence and alcohol

    I saw this post in another thread and rather than hijack it, I figured I would start a new discussion. For many years in EMS, it has been taught and advocated that ETOH not only conceals pain and injury, it also automatically disqualifies a person from being a reliable historian or self...
  17. V

    Cl liberal solutions and mortality

    Today in my daily reading I came across this study: Association Between a Chloride-Liberal vs Chloride-Restrictive Intravenous Fluid Administration Strategy and Kidney Injury in Critically Ill Adults Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M JAMA. 2012;308:1566-1572...
  18. V

    Give aspirin to trauma patients?

    Sounds rather counter intuitive doesn't it? But is it? Reuters Health Information Antiplatelet Therapy May Protect in Severe Blunt Trauma Dec 31, 2012 This arrived in my mailbox and found its way to my "to...
  19. V

    Really most sincerely dead.

    I had an interesting experience yesterday. I was part of the first randomized testing group for a practical exam being developed for doctors as part of a residency selection process. (place must remain anonymous) But it basically is a preemployment test. While officially I cannot...
  20. V

    IV lido instead of morphine in ED for renal colic?

    Effectiveness of Intravenous Lidocaine versus Intravenous Morphine for Patients With Renal Colic in the Emergency Department Hassan Soleimanpour, Kamaleddin Hassanzadeh, Hassan Vaezi, Samad EJ Golzari, Robab Mehdizadeh Esfanjani, Maryam Soleimanpour Disclosures BMC Urol. 2012;12(13)...