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Interesting case. With the recent falls, and the sudden decrease in LOC you have to wonder if she's jumping into some sort of arrhythmia. I'm also wondering if the c-collar and board could have had something to do with it. Some folks will desat pretty quickly, maybe a vagal response. Who...

The National EMS Memorial Bike Ride is searching for a logo for the 2009 ride to replace the 2008 logo (the biker in the ribbon, not the Muddy Angel) We have had several artists show us their work and would like to offer folks an opportunity compete for the honor of being our 2009 symbol. The...

17 Days Hey everyone... 17 days until the National EMS Memorial Bike Ride. We've got well over 100 riders and even have a couple coming from Ireland. Good stuff! It's not to late to register, whether it's as a rider or a wingman (support team)

I'm throwing my lot in with the group re albuterol. There is no evidence that albuterol is helpful in CHF and, as has been discussed here, may be harmful. Morphine: There are a grand total of zero studies looking at MS in CHF. Test on healthy volunteers show that it only reduces preload by...

We carry both and I simply don't use morphine anymore. Fentanyl seems to give better pain control, causes less nausea, does't drop pressure and has a shorter half life. What's not to love. We carry Nitronox as well, but I generally only use that to reduce patellas and such.

Thanks all. You're all preaching pretty much what I'm saying with my service, just thought I'd reach out to see if I was missing something. A lot of money for something that isn't going to make a difference in outcome.

I think folks are too caught up on the 64 pressure. If the person is only complaining of dizziness, then (s)he is still perfusing pretty well in spite of a little hypotension. I would certainly give 0.3 of epi IM (rather than SC). This pt does not seem to be in extremis, so I would personally...

Is anyone out there routinely using side stream CO2? I ask as we're having a little debate within my service. There are folks that think it's the end all, be all and then there are the folks--well, mainly me--who don't see it changing care or outcomes. :excl:Note that I'm talking spontaneous...

It's really not a matter of over thinking...a beta-2 is simply not going to reverse airway constriction secondary to edema, and may increase preload. Personally, I think medics need to do a bit more thinking on how they address respiratory issues. All the wheezes is not asthma and all that...

Interesting isn't it? There is a theory that a rapid influx of O2 in an arrest patient somehow triggers apoptosis. There's a doc (in Michigan or Minnesota I believe) that has allegedly demonstrated this in animal models and, also allegedly, demonstrated better cardiac arrest outcomes (again, in...

Thanks for the correction re HIPPA/HIPAA -- I always do that for some reason :) You're also right about covered entities. Of course I am assuming that they bill Medicare and therefore transmit info electronically. In NH, all services are required to have a business assoc. agreement with their...

I would have to say that that photographing a victim constitutes, if not an outright HIPPA violation, then at least a breach of public trust. Even if the pics were for "training" then sending them out to others was most definitely a HIPPA violation and the person or persons should expect a...

Can't quite agree with you on that one as it's not uncommon for the wheezes to precede or even mask the rales. Basically if they're afebrile with no hx of COPD or asthma, but do have pedal edema or a CHF Hx, I'm hitting them fairly aggressively with NTG. BTW, what' with all the censored things...

Here's the statement I'm referring to. It's taken from Circulation, Volume 112, Issue 24 Supplement; December 13, 2005 Here's another interesting article that shows high serum epi levels can stimulate coronary thrombosis. It's a dog study, but interesting nonetheless. Certainly something to...

Interesting about the albuterol. All of the studies I've looked at give albuterol a "meh" and caution that it may also increase preload. As far morphine, there is absolutely no studies that support the efficacy of morphine in CHF and it's associated with a higher number of intubations as well...

My suggestion is to watch your weight, and get both cardio and resistance training with a focus on your core. Heart attacks are one of the more common ways for an EMS provider to die on the job and back injuries are endemic in the industry. I don't have all of the down time or the ability to...

16 States Represented in the National EMS Memorial Bike Ride Hi All, The 2008 National EMS Memorial Bike Ride is still open for registration. So far we have riders and support people from 16 different states signed up--We'd sure love to have them all represented!

New Hampshire is now at: http://www.nh.gov/safety/divisions/fstems/ems/ And Sue Prentiss' email is suzanne.prentiss@dos.nh.gov The old ones will still work for a few months

You should learn the calculations the "right" way and use the quick methods (clock, et all) as a means of cross checking your answer. Personally, I don't think any prehospital provider should be hanging vasoactive meds without a pump. All it takes is one positional IV or someone "opening up"...

I hate to say this, but your preceptor skipped NTG because he didn't know what he was doing as evidenced by administering 100 of Lasix. The problem many medics have is that they automatically assume that rales=fluid overload. This is often not the case and many of these people have a relative...