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Since you bring up EBM, here is an article on EBM from the British Medical Journal that I found interesting. http://www.bmj.com/content/327/7429/1459.abstract

Allow the patient to equilibrate for two minutes after each position change before rechecking pulse and BP. A pulse increase of 20 points or more is considered a significant finding, and IIRC, is a more reliable measure than changes in systolic BP. And of course, if they're already hypotensive while lying down, don't friggin' stand 'em up.

Associate of Applied Science. It is a very common occupational education degree in the United States (RN, RRT, Paramedic and so on). Regarding my credentials: The way I look at it is that I am willing to discuss most of the topics with as little or as much detail as needed or encountered. Therefore, it does not matter to me because I believe I am fairly adapt at discussing subjects with laypeople up to physicians. I would not want somebody to hold back or attempt to distill information based on their interpretation of my credential, education, experience or intelligence. In fact, I would rather somebody discuss topics without any pre-conceived notion of my education or intelligence. "Raw" and dynamic dialogue without such barriers often leads to some of the best discussion IMHO. Take care, chbare.

Crap Dwayne.....this means I have to do something today........Blah..........lol

Even with my previous statement I do use it quite a bit in the ER. It's helpful is someone comes in with vague complaints and your not quite sure what is going on. Orthostatics can be positive for more reasons than just dehydration. If I get someone who is orthostatic and I can't explain it due to hypovolemia from vomiting/diarrhea, they are getting a rectal exam to see if there is a GI bleed. I don't think you'll find this being done in the ICU but possibly in admitted pts. It's a quick and simple test even if there is no consensus on what it means. Edit: I've also used it to determine if therapy has been successful. If I'm treating someone for dehydration and they are orthostatic but after X ccs for fluid they are no longer orthostatic, then I know their tank is being refilled.

Does anyone find this ironic that in a day and age where EVERYTHING we say and do revolves around evidence based medicine, and it seems ERDoc has found one last Anecdote to debate.....I was slightly astounded, but not surprised that I could not find two pieces of evidence that confirmed each other. Not that I searched very hard mind you. But something that is used often by many fields, I would think would be easier to find. Cheers.

Crap. Am I going to have to change my profile?

The short version of a long and tedious comedy of errors story...After said 14 hour flight (should have been about 7) which ended up at midnight in the destination city. This was after an allegedly simple respiratory patient not tolerating altitude very well. Additionally, our "destination"..allegedly rehab hospital was in actuality a hole in the wall roach infested nursing home. So , after fighting with the doc and getting the patient actually admitted to a hospital.......the only place to eat was a restaurant right next to the strip club...apparently the only two places open after midnight that we could find. And the dancers got off duty right as we arrived. They flocked (waddled) to the same eating establishment that me and my partner were visiting. Well.... exhaustion does funny things to the brain, and I already have some difficulty keeping my mouth shut... so after some poorly thought out comments ...its always funny to see two full grown men in flight suits getting yelled at by a glittered covered stripper who outweighs them. This is in between getting hit on by the waiter (who was wearing makeup). On a good note, the food was decent. And we didnt end up in jail.

Well that really all depends there are enough privates in the area that will hire just about anything with an emt-b cert and a pulse. most fire departments and contract agencies will not hire without the paramedic, FF II or both. just check your yellowpages for the private EMS agencies and if that is what you wanna do have at it