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Hooch is crazy... Anyway... Man this is a really legitimate, but tough question.. How to teach critical thinking. You know I think the problem is that we teach EMT's flowcharts and acronyms. Then in scenario's we try to test them on concepts which involves critical thinking. I really think critical thinking has to be taught on the street. I just keep asking "Why", until they cant stand me anymore. I think it is a little unfair to expect critical thinking in the classroom unless they are taught pathophysiology.

She's on a propofol drip with normal coags. As chbare said, this lady is on positive pressure ventilation so a tension pneumo is almost a guarantee. This lady requires a chest tube. A pigtail would be acceptable if your facility had them. So, the ICU accepts the pt and off she goes. As others have said, the moral of the story is to be gentle with the narcan, especially in people on chronic narcs. It may be funny to slam them just before they get to the ER to watch them puke all over the staff (I'm not saying that is what happened in this case) but you can also cause some real problems. There is no guarantee that this case would have turned out differently but something as simple as pushing a huge dose of narcan caused this poor woman to require intubation, a central line and a chest tube as well as a hugely expensive visit to the ICU billed to the generous taxpayers of the state.

It's a fact that a majority of scenes start out safe but end up deadly. And if the scene becomes threatening, you'll be thankful when I'm there with my gear and 100+ hours of combat training. We allow OC and TASERS in the car where I live. We even allow rifles without any sort of license whatsoever. We're hicks, though.