ERDoc

What is something you should be looking for on the EKG in a patient like this?

Yes we can.

What in the ABG points to rhabdo?

How long has this guy been on a Propfol drip for?

Good luck Eyedawn. I will be surprised if it makes it past the first page.

Nope, I think you got it. I just wanted to hear the thought process so that others who were not familiar with ABGs would be able to understand how you came to the conclusions. Your pH is 7.3 which tells you that you are dealing with some form of acidosis. The pCO2 being low at 26 tells you that you have some sort of respiratory compensation for a metabolic phenomenon. How about the pO2? Sorry chbare if I am stealing your scenario. What are the other labs such as chemistry, UA, etc?

Share with the rest of the class how you came up with metabolic acidosis. What is his lactate level? Does anyone want to make any vent changes? What about his abx choices?

OK, that is pretty funny. I think we could consider it an agonal rhythm.

No, absolutely not. We should not be talking about ALS or BLS. We should be talking about medical care. Enough with this division of levels crap. Everyone should be working at the same level and providing the highest level possible (read: paramedic). Experience means nothing without education. All it means is you just keep doing things wrong and don't know you are doing it wrong. A proper education involves learning the diadactics first and then having a sufficient number of clinical hours to gain the experience. This is exactly what would be obtained from making the paramedic a four year college degree. It could be set up similiar to a medical school model. Your first 2 year are didactics and your second 2 years are clinicals. You come out with a BS in paramedicine (or whatever nifty title you want to give it) and a LISCENSE to practice. This would raise the bar on quality by keeping out those that should not be doing the job (whackers, buffs, firemonkeys, etc), which in turn would help make the pay better. It would also help EMS get more respect in the medical profession. You don't become better by making it easier. Why is it so hard to understand this?

I'll be awarding myself +5 for beating the math professor.

](*,) Some people will just never get it.

That is exactly what any COMPETENT provider should be doing. Anything less is malpractice. There is no other way to look at it.

I would have to disagree with dividing up the 85 billion. The person who came up with the idea may have a good idea, but they have poor math skills. Dividing the 85 billion dollars among 200 million 18+ Americans would give each person a whopping $425. That's right, divide it up and each person could buy themselves a Wii, but would not be able to pay off their mortgage, student loans, etc. Good thing this person isn't running for president because they would be running on flawed principles (haven't we seen this somewhere before). In order for each person to end up with $425,000 we would have to divide up 85 TRILLION dollars. Even if we add the 700 billion bailout package that is currently being debated to the 85 billion for AIG and divide it up, each person would only get $3925. Sorry to crush everyones dreams.

Rid, as always you bring up good points. However, we still do thoracotomies on trauma pts despite it's dismal success rate. Despite the low success rates of thoracotomies and CPR, we still do them because they have a better success rates than the alternative (which carries a 100% mortality rate).

You're getting warmer, unfortunately providing rehashed media coverage of a real journal article does not quite cut it. The media often does not understand research and misunderstands the results. The articles that you provided you have also misunderstood and show just the opposite of what you say. As reaper said, get the original article published in JAMA and you will see how badly you have understood it. You then provide an article that show cities with save rates up to 45%. Hardly the .01% you talk about. I think this shows we need to do more research to see how we can reproduce these result on a larger population and not give up on something. As asys said, the problem here is the not-not knowing. Enjoy the chatroom.

:glasses4: The truth is out there, Fox Mulder. :glasses5: You make the statement, you provide the evidence. Until you supply papers to back up your statments, what you say means nothing. If you want to have an intelligent conversation based on EBM you have come to the right place, but if you are not going to play the game by the rules, then stop. Based on your posts I would guess that you do not have a clue as to what EBM is. Please let the rest of us know where you work so we can avoid calling 911 in that area. If I had to guess I would say Naples, FL.

I'm going to give you the benefit of the doubt when you ask if it was excessive and assume that you were being sarcastic. I think these guys got off lucky. They should have had their cards pulled permanently. A young girl died because of their actions, or lack thereof. There is no was to tell if she would have died from her injuries if she were treated properly, but the fact that she survived for several HOURS without care makes me think that she had a chance. I will admit though that I don't understand where the punishment for Bullock and Huntsman came about. They were called to the scene after the ME called and said she was breathing. Did I miss something?

What does everyone think of John McCain calling off the debate to go to Washington and Barak Obama's response?

Wow. First, welcome to the city. Second, if you want to become a respected member here you will quickly learn that when you make assumptions/generalizations like these you need to back them up the facts. Evidence here mean finding a study to support your statements. "My instructor told me so," does not count as evidence based medicine. While CPR sucess rate is dismal, there are still those who survive. The research is improving all the time. We are learning that things that we assumed in the past are wrong (stacked shocks anyone). With proper research and enough time I truly think we will see an improvement in morbidity and mortality. The reasons that you point out are exactly why we need to educate the public and first responders/PD on how to perform effective CPR. I am also a supporter of public access defibrillation, despite it's poor performance in the literature so far. I think if we refine the methodolgy, in time, we will get better results.

MrBird, I wouldn't drop it. It has the potential to be a good discussion as long as all involved play nice. Like you, I would be interested in the the opinions from the inernational members. Let's face it, even though they may not have a vote in the election, we live in a global community now so it will affect everyone.

Well...in Whoville they say, That the Grinch's small heart Grew three sizes that day!

Another reason for the lack of political threads is our diverse membership. We have people from all over the world who will not be involved with the vote.

I think it has more to do with the KISS principle. Why use more equipment than you need to if you can do the job with less. If I can cleaerly see the cords, why would I want to put something else in the way that may obstruct my view? The most important factor in intubation is positioning. The pt should always be in the sniffing position, assuming you don't have to worry about c-spine. I have found that a large percent of providers (both hospital and prehospital) don't actually know what the sniffing position is. Another nice option is the GlideScope, but I can't see too many companies shelling out the big bucks for this nice little toy. I've used it a few times on manequins and have been quite impressed.

I agree with Dust, WTF???? Since when do paralytics get them "down far enough?" Paralytics do not provide any sedation. In a just world this medic should have to see what it's like to be paralyzed and tubed without sedation. Part of RSI is sedation. Once you have them tubed, keep them sedated enough and you won't have to use any more paralytics. It sounds to me like this medic is the kind of guy that gets off on saying, "Yeah, I get to paralyze people to save their lives." I wonder if he was one of the 12 from Naples, FL, lol. As for the helicopter crew, again, WTF????? I hope these parents took that medic for everything he had. I know we do not have the whole story, but why are they intubating a pt with femur fxs? It sounds to me like those morons are 100% responsible for that 15 year old's death.

Having drained many abscesses, as I watched this video all I could think was, "Dude, they're not wearing gloves. Yuck."