ERDoc

We can give you general advice (pretty much what you already posted). The best people to make the decision are the student and her PCP or neurologist. They know her much better than we do.

Anecdote is not evidence.

There are examples for both sides, as has been pointed out by Scuba and Mikey. We can sit here and go around on this merry-go-round AGAIN or just drop it and get back to worthwhile discussion.

Great minds think alike.

I think that is the most important part. A 5cc saline bolus will probably be shown to improve outcomes if given soon enough. At some point, dead is dead. The problem is there is no way for us to know when that is so we have to go through the motions.

I don't think any of us are saying to call 911 immediately. Not all seizures need to go to the ER, especially in people known to have seizures. You also have to honor the patient's wishes, but keep in mind that you still need to take care of her properly. I think the school needs to have a conversation with her and get in writing a plan for what to do when she has a seizure.

Not necessarily. Everyone is different. Muscles may be fatigued but they can still twitch.

Even people in a postictal state can respond to their name. I don't hear anything unusual in the way you explain her seizures and postictal period. I really can't find anything in your description that can't be explained. For brain biopsies, they are doing needle and sterotactic biopsies which are outpatient procedures. They are also using a technique called minimal shave method, where they shave a half-inch square area. Some people just have bad protoplasm and she could be one of them. People with CP tend to have a lot of other bad things going on.

She doesn't sound like your typical person faking seizures. Without medical training I would recommend you not try to determine if they are fake or not. Assume they are real and treat her as you are supposed to. Many people can tell when they are about to have a seizure so she may know one is coming and put herself into the wheelchair so she doesn't fall. When you say that it took X amount of time for them to "come out of it," do you mean they were postictal? If so, everyone is different. I wouldn't find it suspicious for a 15 min positical period. The paramedic may have been asking those questions just to get a full assessment and had no ill thoughts.

I would like to have seen a glucagon only arm. With all of these studies with poorer outcomes with epi, you have to wonder if epi isn't the problem.

I don't see a problem with filling out the paperwork before the transport, as long as it is accurate, especially on pts you know. If something changes, then the paperwork should be documented appropriately. Obviously vitals can not be filled in beforehand. Back in the dark ages before HIPAA, we used to keep copies of the PCRs for dialysis pts so that we didn't have to bother them every time getting their history. As for the nap, I have a problem with that. If you are in the back with a pt, you should be awake at all times. Are you sure she acutally napped and wasn't just trying to joke around? If she turned care over to you once the pt became aggressive, you should have been the one doing the documenting at that point. What did you document on that legally binding paperwork? As for the issue of not doing an assesment/monitoring, what is required by your company/protocols? What was the pt transported for? Something benign like a routine doctor's visit or a wound care appointment doesn't really require much. You have created the environment that you think you will be in. You have to decide how to handle it as an adult. I'm not saying you shouldn't say anything when there is something that puts the pt in jeopardy, but as the FNG you need to pick your battles wisely. Learn from the experience, young padawan. Always observe other providers and see what they do right and wrong and learn from it. Not everything needs to be made an issue out of.

No, just no. The machines provide important information about the pt, that the pt cannot provide. Treat the pt and the machines as appropriate.

This is a damned if you do, damned if you don't situation. I've had several people with head injuries and STEMIs and the cardiologists want a head CT and nothing that will affect bleeding (ASA, heparin, brilinta, motrin, toradol) until the CT is negative.

Welcome. It sounds like you are somewhere on the east coast, which could be a good thing. There is probably a volley squad somewhere near you. This would be a great way to find out how you will react to bad situations before making a career choice. If medicine is something you love, but find that situations in the field bother you, look into a career in the hospital/office. We don't see nearly half the bad shit that is seen in the field and it is a much more controlled environment once you are out of the ER.

I'm not convinced that any of this is afib. I can see things that could easily be argued are P waves. Other than the PVCs, it's really hard to interpret this. I wouldn't fault them for the collar. Using CCS or NEXUS, he seems to require a work up.

Were you moving when any of those EKGs/rhythm strips were obtained? If you have a head injury, it would be best to hold the aspirin. I'm not sure where ntg has a role here.

You made my brain hurt and it's too early think. I don't think there are good answers to those questions (at least backed up by literature). My feeling is that we know the most important thing is to preserve coronary perfusion pressure, which means good, continuous CPR. If you have that going, anything else is icing on the cake.

I'm talking as far as the concerns for decreased cerebral flow with an LMA. You do bring up some concerning variables however. In the field, you have to deal with gastric distention from an overly aggressive firefighter bagging the pt before you got there. I still think an LMA is the best way to go in most situations until you get ROSC, then drop in the ET tube.

You need to really think about what you want to do. EMS is a lot different than Fire and PD. You are half public safety, half medicine. There are many people out there that enjoy the public safety aspect but hate the medicine aspect (including talking to pts) and they generally don't make good providers. They are better off being fire or PD.

I know evidence outweighs opinion and experience but with the number of LMAs being used in the OR, I find it hard to believe that we haven't seen a problem, assuming one exists. You would think that something like this would be pretty easy to study. I would do it in a place with high survival rates the first time around and then if there is a difference, run the study in more average areas.

What? You're breaking up! You must be having a major communications breakdown!!

I think we've debated this before but it's always fun to do it again. What if you explain everything to the pt, including the fact that they could go unresponsive and die but they say that even if that happens, they don't want you to do anything. What do you do then?

Huh, too bad I can't convince my wife to become an EMT.

So, I'm curious how this family argument turned out.

http://aop.sagepub.com/content/46/1/97.short Given me a call Mobey, I'll give you orders for it. EMS here doesn't carry it,