AZCEP

If you are able, eliminate the QRS complexes from the strip. This can be a bit of a mental challenge, but when you do it you will see the flutter (saw-tooth, picket fence, etc.) waves go through the QRS without being disrupted. Aflutter tends to be more regular due to the reduced rate of atrial stimuli going through the AV node, but that's not an absolute.

Aside from the obvious "if it bleeds, it leads" journalistic style of the article, interesting might be a bit of an overstatement.

Wow croaker. Tough night there? There is no specific mention of a need to confirm asystole in 2 or more leads. Doing so is not absolutely wrong, but there is more focus on the need to start/resume compressions. The utility of doing so also needs to be considered within the context of the situation. Asystole as the presenting rhythm might lead you to considering not initiating resuscitation. Asystole as a development of treatment should probably lead you to continuing efforts until you are able to determine how responsive the patient is to those efforts.

Not altogether uncommon to find yourself doing more "stuff" since you have more time with the patient anyway. Having worked in a mix of short and long transport time areas, my tendency is to do more enroute, or in my ambulance than sitting on scene and having to fight with everything getting the patient out. You might find yourself becoming better at doing things while moving at some point too.

Well done sir. That was what I was thinking as I read the original post. God forbid we have to think about what we are doing though.

I just recertified, and after a year and a half lapse, had to retake the exam-written and practical. This is not a route I would recommend, but it wasn't all that difficult either. The CBT left me a bit tense about what I thought I had known, but I had a result in 24 hours so I didn't have to dwell on it too long. The practical wasn't too bad either, and official results were available in about a week. If you have the recertification paperwork, I'd suggest going that route. For the transition period to NRP, most places won't have this up and running for a couple years. NREMT has it as a requirement by 2016, if memory serves.

Generally, you have 1 calendar year to get your three attempts in. I can't relate that using the full time is helpful though, as the fewer attempts and less time from the end of your initial course seem to relate to better results. The review sites/courses are useful but if it is a matter of the practical tripping you up, they won't be as helpful as they are with the CBE. Good luck all the same.

10% of pt's weight in pounds = roughly 5 mcg/kg/min. Quick and easy when using a 1600 mcg/mL mix. If I need it in a hurry, I go this route. When time is allowed for more accurate calculations, I'll work the whole thing out on paper. Of course, I've never been granted the blessing of having a "working" pump for this situations either.

I fear there has been a bit of misinterpretation in what I posted. Using lidocaine to reduce the development of ectopic beats, in the setting of a presumed AMI, is reasonable. It should not take precedence over managing the underlying problem, but reducing the occurrence of ectopic beats, and rhythm, should be a consideration. Limit the ischemia/injury, limit the development of dysrhythmias, and maximizing the cardiac output are still measures to shoot for with an active MI.

First off, nice situation to be thrown into without much help from your colleagues. Typically, if the patient's presentation does not include significant discomfort, which this patient's doesn't sound like it did, NTG should not be considered. The ECG tells you it might be a bad idea to throw a fixed amount at them, so I think you did the right thing. Lidocaine is still extremely useful for the AMI with ventricular ectopy. This patient made it pretty easy for you to make that decision so kudos.

Yes it would be IM, though check local protocol for acceptable uses. It might be useful to consider a racemic epinephrine SVN as well since the swelling can be in more than just the tongue.

Thank you for your service. That out of the way, let me make a couple comments. Your current MOS might help you in meeting some of the requirements for a paramedic program. You might want to contact the MN certifying agency to find out. NREMT might also be able to give you some direction with this. You will not have an easy time finding a hospital-based program that will accept the GI bill for payment. The benefit to the facility doesn't justify having the administrative expense to make sure everything is in place for it. The facility that I taught for tried to fulfill the requirements a few years ago, and it just didn't prove to be worthwhile for us. I can't imagine it has gotten any easier in the last 3 or so years. If you are unable to start until May 2012, you will likely need to find an accredited program. As I understand things currently, the easiest way to achieve accreditation is to be a college/university. The costs of becoming one of the selected few is probably going to keep hospital programs from pursuing it very rigorously, though I hope I'm wrong. Good luck to you in the meantime.

The slovenly appearing individual will remain until standards are raised to the point they are no longer able to get by within the system. Pulling them aside will only create the impression you are trying to stroke your own ego to them. I will suggest that there are doctors/lawyers/politicians that suffer from the same lack of demonstrating the level of maturity we would like them to. Maybe writing a note to the offending department's duty supervisor would be of some use, if only for the short-term.

I feel for you Mike. I really do. Unfortunately this is not unique to EMS, or medicine in general. Everyone wants to be viewed as the most important, credibility be damned. One question: were these knuckleheads students in your facility, or providers passing through the dept.? Students can typically be sent on their merry way, as I'm sure you would have.

Good point chbare. I would add 2-3 mL of saline to a full volume of 5 mL, if the SVN can handle that much (or I can get it put together without spilling it all over myself). I don't really ascribe that it would be a "good" idea PCP, just that it would be reasonable to give it a try.