the doctors out, but i know something!

While perusing the the twitter sphere I found this tweet... Ultrasound in every service.My #ECCU2015 pick with Drew Harrell MD @tingles005 @paramedic_al https://t.co/CUAHCNagaI pic.twitter.com/mQs1Tj6eZc — Word on the Street (@wotsukrobl) December 11, 2015 It really caught my eye thanks to the paper I just wrote and shared  here . Point of Care Ultrasound (POCUS) has great utility in acute care and it will probably be the only imaging modality that could reasonably  be put in an ambulance. Sonosite and Philips  just released pocket/tablet form US devices that could easily be kept next to a cardiac monitor. If Philips is listening they will realize they make EMS cardiac monitors and US probes that could be added together... just an idea.

Please feel free to comment, on the topic or my grammar! This paper has already been graded. ;-) Prehospital Ultrasound in Undifferentiated shock, Cardiac Arrest, and the End of Resuscitation. Nicholas Jackson Southern Maine Community College For years ultrasound was an imaging modality for sonography technicians who acquired them and the radiologist who reviewed them. With the rapid rate technology has evolved and developed we now have point of care ultrasound. Point of care ultrasound allows physicians in the emergency department and office setting to acquire diagnostic quality imaging at the bedside. While physicians have a vast array of transducers, protocols, and views The question remains, Can paramedics perform the same feats to help our patients? In this paper we will review the “Focused echocardiographic evaluation in life support (FEEL)” protocol, the “Prehospital Evaluation of Effusion, Pneumothorax, and Standstill (PEEPS)” protocol, and assessment of non shockab...

#AAEM15 Winters: 18% Inc in mortality per 5 seconds of pause during CPR. http://t.co/QpVVdvYx7F — San Antonio EM (@SanAntonioEM) March 2, 2015 Excuse me? you said what? "In patients with cardiac arrest presenting in a shockable rhythm during the ROC PRIMED trial, shorter pre- and peri-shock pauses were significantly associated with higher odds of survival. Future cardiopulmonary education and technology should focus on minimizing all peri-shock pauses." (Cheskes et all., 2013) Decreasing peri-shock pauses is a good thing.  Fig. 2. Cheskes et all., 2013 The less time we are squeezing the chest, the less time the victim is perfusing and the less their chances of survival.  To  maximize perfusion, the 2010 AHA Guidelines for CPR and  ECC recommend minimizing pauses in chest compressions.  Expert consensus is that a Chest Compression Fraction (CCF) of 80% is achievable in a variety  of settings. ( Meaney et all., 2013) A viable...

Terrible things happen to good and/or undeserving people.  The drunk driver walks away from heaps of scrapped metal.  Parents do the exact opposite of take care of their children. One persons stupidity leads to another persons demise.  Sometimes people just die because of unintended side effects. I had the misfortune to help with one of these cases the other day.  A young female, no medical history.  Only medication was oral contraceptives (Now I'm hoping as I write this that it doesn't turn into the catholic churches next stand against contraceptives).  Started complaining of not feeling well a few days ago and had fainted earlier on the day I met her.  When I met her she was already intubated and waiting to go to a major hospitals.  She had coded a half dozen times already.  In EMS we have this silly notion of an "EMS code save" which means very little for people we treat.  It just means that we got them to the hospital with a...

The first thing I have to say about a Critical Incident Stress Debriefing(CISD) is that they are like civil fight clubs. They have a very sensitive, confidential nature about them, so like fight club it has 2 rules. You don't talk about the CISD.  You DO NOT talk about the CISD. Jk...

     You're called to residence for an unknown medical.  Short response time to scene.      Once you arrive you gain access by unlocked door and find patient slumped to the right in a kitchen chair and moaning "oh my head, it hurts" over and over.  Patient responds to speech by only continued moans.  Patients medications suggest significant cardiac history.  Patient rapidly moved to stair chair and moved to ambulance.  While moving patient from the house he stops moaning and is no longer responding to voice, only painful stimulus.

From the ME EMS Protocols : A. Preperation - Mix NOREPINephrine 8 mg in 250 ml NS.  B. Dosing - Starting Dose is NOREPINephrine 0.03    μg(mcg)/kg/min. Titrate by 0.03  μg(mcg)/kg/min every 3-5 minutes. Usual dose is 0.03-0.25  μg(mcg)/kg/min. Usual max dose is 0.6  μg(mcg)/kg/min. Absolute max dose is 3  μg(mcg)/kg/min C. Titrate to maintain SBP greater than 90 mm Hg. For 2013 the  Medical Direction and Practice Board decided to move away from Dopamine to  Norepinephrine. I am no doctor (yet) but I'm guessing it has to do with some of these studies  ( 2 , 3 ).   A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock -   Daniel De Backer, M.D., Ph.D., Patrick Biston, M.D., Jacques Devriendt, M.D....  for...

So I just passed my AEMT class which is good. It was far more intense then my EMT class. I failed my first attempt on my practical exam because I wasn't as prepared as much as I should have been and nervous. (it's 0.4mg of Narcan... NOT 4mg.)   So now I will be driving for 4 hours to go to the nearest ALS practical on 7/21. I have until then to perfect my technique and get my knowledge base up to par. I feel I'm almost there, I just need to fine tune my skills. So here are the things I need to perfect. Medical assessment /medical medications. I can go through the steps. I have to think more about my secondary review (and make sure I use the right Epi dose -.-) Supine immobilization   I'll be bringing my own spider straps to immobilize with. I personally can not make a Pt "flip proof" with 3 straps. IV medication bolus  I spaced on Narcan... never again though. Never. Again. I know every dose I can use as an AEMT. Pedi I/O  I still don't know . I...

I sat in the ER watching the nurses and doctors work when shouts for help were heard from the hall. I jumped up with everyone else and ran to the hall. Down the hall a nurse was pushing a man in a wheelchair. His feet dragging, his head rolled back as he gasped for breath. In what felt like seconds the man was moved from the hall to the trauma room and on to the bed. I watch from the hall as the nurses hurry to start IVs and EKGs. I know I could be a part of that flurry of activity if I knew what do. I could have set up the 12-lead and understood what the ST elevation meant. I could have started that IV he needed for life saving fluids and medication.  As a basic the most valuable thing I've learned and the thing pounded into me by almost every medic I've worked with is that I know almost nothing. I am still a baby in EMS, and I want to grow up. I want to work with a medic and have them be confident that I can do all of the basic life support needs of our patient and then star...

So myself and a fellow redditor Irunongames  have started working on a mobile electronic Patient care report app, but we want it to be much, much more then that. It works for Pt transfers and Pt charts, the end result is a serious under taking but would be awesome if it worked. So for now give us some feed back! Loading...

So I live in a state fortunate enough to have digital run reports (I'm sure some angry old medics are just waiting to troll me right now.) However, I don't see a point at the moment. I don't see why the local ER's are using EMR ether. I mean it would be really cool if we actually utilized it ... Unfortunately we don't. everyday medic have to print out their report using 2-5 pages of paper, then they fax it to the ER using another  2-5 pages of paper! That doesn't include the 2 page quick report we have to leave the hospital. Then we have cardiac monitors to worry about! those things will spit out 2-3 feet of readings if you don't watch them.  I do a lot of patient transfers at the moment. (It isn't all that fun but it pays the bills and that's good enough for now.) When you do a transfer especially a Phych transfer you always need three things. The Patient, hardest one to forget. However sometimes they don't wanna go and try to run the othe...