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Thanks. That article says it’s a reperfusion injury due to hypercontraction. Kind of hard to picture though. You could imagine how a large dose of cocaine could cause super tachycardia and greatly increased contraction leading to ischemia. But it’s hard seeing how your own body could trigger...

Can someone explain “myocardial contraction band necrosis?” I get that a sympathetic surge is believed to be the underlying cause, but why would this cause myocardial cell death? There are lots of things that can stimulate a sympathetic response, so why would it cause damage to your heart?

"The brain-heart interaction is well recognized after neulogical insults, particularly after a SAH, and is thought to be catecholamine mediated. SAH-associated myocardial injury is a type of neurocardiac injury that involves myocardial dysfunction associated with subarachnoid bleed...

I knew that myocardial injury can be associated with subarachnoid hemorrhage (ST and troponin elevations), and years ago I saw a patient with this presentation, but until reading this article I didn't realize this was so common. (Unfortunately only the abstract is available here.)...

Don't know anything about it, but I'm pretty skeptical of the whole idea. It must be insanely expensive to run.

"My personal thoughts on mechanical CPR is that its best utility is freeing hands for other tasks or for return to usual duty of personnel who would other wise be doing compressions. Its best use is NOT for improving survival. " Agreed. Standing up in the back of an ambulance doing CPR...

Remi, you are a nurse anesthetist, so I'll defer to your expertise. If you have a patient who easily accepts an OPA, why not attempt to intubate? If they gag while you are making the attempt, you can abort the attempt. Does this not seem reasonable? A guy like this really needs an airway if...

Coming to this late... Why not intubate even if you don't have RSI since you were able to place an OPA with no gag? Bagging this guy w/o an ET tube is likely to cause all kinds of problems for such a long transport. Besides the fact that, as most of the previous posters agree, he needs to have...

Yes, and it's important to understand that concept and also malingering.

Chronic pain syndrome Panic disorder Suicide risk Bipolar disorder Pseudo seizures Malingering Just a few off the top of my head. As a both an EMT and a medic you'll be dealing with a lot of psyche issues. As you may already know, a good EMT has to have some understanding off and compassion...

When people speak of cookbook medics, they don't so much mean medics who strictly follow protocols, but ones who lump patients into specific categories and then give them all the same treatment. I.e., giving nitro and aspirin to a 25 y/o complaining of chest pain with no indication that the pain...

The problem I see when I work in the ER is that both physicians and nurses freak out over a BP like 240/120 but asymptomatic. They don't consider that the patient who tells them he's been noncompliant with his meds for months has likely been walking around with that BP for months as well...

LOL. I'll let Brandon answer that for you.

Brandon, a guy comes into your hospital with a chief complaint of a lac to his finger. In triage his BP is 240/120. He states that he has not been taking his BP meds in months. He has not other medical history and has no other immediate complaints. Your MD, your nurses, and the medic who...

Tracheal deviation usually isn't visible on physical exam. But Google some chest x-ray images of tension pneumos and you'll see how obvious it is on a CXR.

As I stated in my post, there are many reason why this patient could be presenting the way she is. With all due respect, if you worked in an ICU, I think you would have a better understanding of why it would most likely not be in this patient's best interests to be on a vent in an ICU.

For an altered patient in a nursing home, infection/sepsis would be at the top of my differential. Since this patient is also a little hypoxic, they may well have pneumonia. Aspiration pneumonia is common in elderly patients with dementia. Of course, there are many other reasons for why this...

Aspiration pneumonia/sepsis. It's always aspiration pneumonia when you're living in a SNF. Above all, clarify the code status. Get the family contact info and bring it to the ER. This patient should never get intubated or end up in an ICU.

Great stuff, Brandon! Threads like these make me keep coming back to this site! I especially like your post on pulmonary HTN. Okay, now I have to think of something to ask...