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Unconscious patient, who's diaphoretic, with no history available, other than a medic alert reading "IDDM", who's vital signs are "normal", with a bG of 120 mg/dl (6.7 mmol/L). What am I thinking? - I can't rule out a traumatic etiology. I can't apply NEXUS / Canadian C-spine rule. Thus the patient gets immobilised. - I'm concerned about this patient's ability to control their own airway, and their aspiration risk, if they're GCS 3. I'd be considering advanced airway management. - In the absence of respiratory depression naloxone is unlikely to be of benefit. - I'd love a 12-lead along the way. - This could be about a billion things more likely than (1) relative hypoglycemia, or (2) an equipment error. With a glucometer reading 6.7 mmol/L, I'm not giving D50W. Otherwise shouldn't I'll be giving D50W to every patient with a GCS of 3. And that's just silly. Perhaps I should push tenecteplase on everyone with chest pain and isoelectric STs, just in case there's an equipment error with the LifePak?

In the box, there should be no sharp corners on any of the compartments, everything should be heavily padded with rounded corners. There should be a 3-5 point restraint device for the medic, not a simple lap belt. All equipment and stretchers should have mounts that hold them in place during a 40+mph crash --- see Dr. Nadine Levick's ambulance crash videos. The box should not be spot welded together, and should not collapse in a rollover.

I am not trying to sound like a jerk, but I learned this lesson a long time ago: You decide what kind of day you will have every day. You can not let others control your life, which is what you do when your blood pressure goes up over what someone else said or did. The minute you show any emotion because of what someone else did, you have given them control of your day, it is like you are a puppet on a string. Example: If I said something mean about your momma right now, it could piss you off to the point of you punching me. But on the other hand, you could say "crotch does not know my momma, he has never even met me, so therefore he is trying to piss me off and control my day". Let it roll off of your back, its not worth being upset about. I worked for a large urban system that was on 24/48s and the shifts were brutal with the normal EMS abuse you would expect. I went to work cussing and I came home cussing. Then they switched to 12-hour shifts, and I figured out I could transport 6 patients, or not transport 10 patients. Once I quit argueing with the dumb patients and just started transporting, all the stress was gone, and my smile returned. When I saw that change I realized I had been letting others control me.

So you don't advocate a passing score of 64 or 60%? that's what one of my last ACLS classes consisted of. Had a person take the test, failed it at 60%. They appealed the score, saying that they had a learning disability which made test taking difficult. The director of the class asked them to answer the questions they had gotten wrong, she read the questions. This would have been ok had the person not have gotten the answer key to review their answers prior to being re-tested. If you lower the score bar, then you would end up just like,.... wait for it..... ahem..... wait for it.... scroll down....... keep goin keep scrolling keep on scrolling Here comes the answer Chicago Fire department!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I can see not using tap water if you live/work in an area where the tap water is not drinkable. Makes good sense. As for me, where I work, the techs set everything up before we ever get to the room. So just because it is set up, I use the saline on the suture tray. I still use sterile setups because I think the pts expect it. In this day, where pt satisfaction decides if you have a job or not it's sometimes beneficial to do things even if they don't make a difference medically.

Airway management consist of more than an ETT Subtle changes are often important, the difficult part is figuring out WHICH subtle changes are important. Don't be afraid of opiates, the dangers are way overstated. It's ok to give NTG without IV access. It's NOT ok to give NTG without an EKG Take your suction to the patient. You'll use it more than you ever imagined. Very few patients can't stand a liter of fluid No matter how scared of foley caths you are, UO is a DAMN useful parameter to know.

Because EBM says it's not a better solution and there is no risk. Try reading the studies.

As is releasing all of the depth on the thorax before doing another compression.

The new 2010 ECC guidelines and supporting evidence clearly show that FASTER is better than SLOWER. Specifically, it states " To provide effective chest compressions, push hard and push fast. It is reasonable for laypersons and healthcare providers to compress the adult chest at a rate of at least 100 compressions per minute (Class IIa, LOE B " This is different than the 2005 guidelines that recommended a rate of about a 100. The guidelines also state: "The number of chest compressions delivered per minute is an important determinant of return of spontaneous circulation (ROSC) and neurologically intact survival. " The studies that support this are: Abella BS, Sandbo N, Vassilatos P, Alvarado JP, O’Hearn N, Wigder HN, Hoffman P, Tynus K, Vanden Hoek TL, Becker LB. Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. 2005; 111:428–434. and Wolfe JA, Maier GW, Newton JR Jr, Glower DD, Tyson GS Jr, Spratt JA, Rankin JS, Olsen CO. Physiologic determinants of coronary blood flow during external cardiac massage. J Thorac Cardiovasc Surg. 1988; 95:523–532. The first study showed the following ROSC rates based on compression rate 40-72 compressions/minute : 40% ROSC 72-87 compressions.minute: 58% ROSC 87-94 compressions/Minute: 76% ROSC 94-138 Compressions/Minute: 75% ROSC Considering that this is the total compressions delivered in a minute, not compression RATE (as in, this is the total compressions delivered even accounting for pauses, ventilation, scratching ass, etc) When you count the ventilation pauses and a goal of 20% hand off time or less each minute...if you screw up at all you will drop below 87/minute total compressions each minute. The take home message is this: You will not decrease ROSC by going to fast, but you will significantly drop it if you go to slow. So.. a little fast (up to 138 min) is perfectly OK. I hope this helps. Could not disagree more. Respectfully, the evidence is more compelling that ever supporting the change, and with the stuff I have seen being done, expect even more changes coming out in 2015. Oh , and FWIW, the updtates are every 5 years. And for what its worth.... the evidence is clear that WE (Health care providers of all levels in and out of the hospital) are as much at fault for the poor outcomes as anyone. WE became to focused on toys, and not on quality CPR. And for what its worth, ROSC rates are improving. Both in places like Seattle, but in smaller services too. Seattle just broke the 50% ROSC mark for VF arrest (the holy grail for the past 50 years of resuscitation science). I have a large portion of the science documents if you are interested. Or you can look at my science behind CPR lecture if you want too. Its on slideshare.com.

I totally understand crotchity's point... when your not sure, just give drugs until something happens Good lessen for the younger generation eh?

Quite conundrum crotch: If you would you not hire another engineer = that is engineer discrimination and stereotyping based on educational history. But: You would hire a "older" over a "younger" = defines age discrimination. PS crazydocbob ... follow your heart, follow your dreams.