chbare

I just wanted to emphasise a few points. For example, oxygen will not be all that helpful. In fact, in some cases, we may administer a mixture of 20-30% mixture Oxygen and 70-80% Helium while we try to decrease obstruction with other methods. Also, the absence of wheezing is not always this disastrous silent chest everybody assumes. A person can present with relatively milld symptoms and no wheezing, only to have significant airflow obstruction. This may not even be appreciated until you assess the PEFR and even perform bedside spirometry and you note a significant ice-cream scoop on the flow/volume loop. Asthma is much more complicated and subtle than many assume. My post was not necessarily related to the topic at hand. If somebody is having trouble with their asthma and I just happen to be a first aider, I will most likely call an ambulance, provide emotional support, obtain a history and transfer my findings to the EMS crew. All this craziness about giving this MDI or that MDI to a patient is not all that relevant as you have pretty much stated. Perhaps, it would apply in some rural situations or outlandish disaster scenarios, but for the most part, I'll wait for EMS. ERDoc, I am not a huge fan of cancelling orders. While I do believe inhaled bronchodilators are over utilised in the hospital and outside of the hospital, I would need to present a solid case before cancelling an order and I don't believe in going behind a physicians back. What I am not keen on is arbitrarily ordering scheduled bronchodilators on patients. However, I don't necessarily use the absence of wheezing to determine the absence of obstruction. For example, I have mild to moderate obstruction and had likely gone 30+ years with asthma until I was diagnosed a few years back during a PFT. I had crap peak flows and air trapping without any wheezing, but for years I would cough and often clear my throat. I didn't really know how bad I felt until I was treated.

If somebody improves on oxygen, I will still assess their PEFR. If it is low, I will treat regardless of an "improvement" on oxygen since oxygen does not reverse airflow obstruction. Also, using an MDI with a spacer may have similar efficacy to low volume nebulised delivery. Since albuterol is considered a rescue medication, it may be life saving in that it can potentially prevent further exacerbation. Remember, a patient can present with an unremarkable physical exam only to have a critically low PEFR and significant airflow obstruction.

How exactly does oxygen shut down the respiratory drive in acute, severe respiratory distress? Also, how are you quantifying and qualifying the statement that you've "seen this happen?"

Let us not forget the primary reason for RSI. Patients in the field are assumed to be non-fasting and at high risk for aspiration. The classical purpose for RSI is to prevent aspiration. My take on RSI is cautious at best. Assuming we can somehow manage to educate people how to perform this produre safely with sound decision making, what happens after the intubation? Another thread here really demonstrates our general inability to manage patients post-intubation. How many services have the tools and education to properly manage people post intubation?

Agree with increased WOB, but just want to nit pick a bit. Poiseuille's law is only a gross approximation. It is a reasonably good approximation when considering incompressible, Newtonian fluids and laminar flow patterns, but a gross approximation otherwise. However, I agree with the "spirit" of it's relevance.

Dwayne, from a respiratory point of view, intubation will significantly increase airway resistance. Add this onto a patient who may already be fatigued from working so hard to compensate along with the underlying electrolyte derangements, and this patient will likely require some type of support. Clearly, the scenario does not call for a ventilator, but this patient will need ventilatory support. Often, when we are forced to intubate DKA patients, they are fatigued to the point of exhaustion and a full support mode may be required while we fix the metabolic and underlying electrolyte derangements. At a later time we can place the patient into a "spontaneous" mode for liberation and a spontaneous breathing trial when we have re-established homeostasis; however, spontaneous modes still provide support in the form of CPAP and PS. T

Off topic, but some perspective. Often, people with compensatory respiratory patterns who require intubation require full support modes of ventilation such as assist control to ensure they can maintain respiratory compensation. I've seen a few poorly managed DKA patients where flight crews intubated and ventilated with "normal" rates and "normal" PeCo2's. Clearly, these patients had significantly deteriorated metabolic and acid/base wise from their initial presentation.

LOL My mouth is shut, not a word.

It's been a while, welcome back bro.

I feel like such a tool. My profession distilled down to nothing more than being a human calculator. At least I have respiratory as a fall back.

AHA re-examines the guidelines and recommends changes if needed every 5 years. The last changes occurred in 2005. Typically, it takes about a year or so for said changes to proliferate.

Every 2-4 years? Where did you pull that number from?

Worst case scenario? http://emedicine.medscape.com/article/794583-treatment#2

"F. William Engdahl is the author of Seeds of Destruction: The Hidden Agenda of Genetic Manipulation. He also authored 'A Century of War: Anglo-American Oil Politics,'" LOL, thanks for the evening entertainment.

We "poo-poo" studies when the people who orchestrated said studies deliberately falsified data, data that could not and has not been reproduced. Oh, there may have been something about lawyers paying somebody $600,000 + dollars to falsify the data. Also, sometime we "poo-poo" when people make the following connections regarding their impressions of causality:

We also fly paramedic/RN. Our PIC's have absolutely no patient contact save for helping load on occasion. Often, the PIC will know nothing about the patient medically except weight unless safety issues are identified. Take care, chbare.

Associate of Applied Science. It is a very common occupational education degree in the United States (RN, RRT, Paramedic and so on). Regarding my credentials: The way I look at it is that I am willing to discuss most of the topics with as little or as much detail as needed or encountered. Therefore, it does not matter to me because I believe I am fairly adapt at discussing subjects with laypeople up to physicians. I would not want somebody to hold back or attempt to distill information based on their interpretation of my credential, education, experience or intelligence. In fact, I would rather somebody discuss topics without any pre-conceived notion of my education or intelligence. "Raw" and dynamic dialogue without such barriers often leads to some of the best discussion IMHO. Take care, chbare.

Unfortunately, that is not likely to work. I don't know why this idea continues to make the rounds, but this method is unreliable at best. Take care, chbare.

Ummm...am I reading this right? You went out and put all these lights in your Nissan? I assume this is your personal vehicle? You did all this based on a guy nicknamed "Mr. Hollywood," You Tube videos and television shows? Bro, you may want to consider taking some time off. When people start putting light bars in their POV's, I think they are taking their hobby or work much too seriously. Take care, chbare.

Fixed that for ya mate. Don't worry, I make the occasional typo as well.

Signs and symptoms of PTSD have been documented in ancient literature from several hundred to several thousand years BC. Nothing new about it. However, the pejorative statements people make about PTSD patients are quite harmful and do little to describe the facts about this problem. Attached, is a link to a study on PTSD documentation in ancient literature, and this study was done outside of the United States, because I would not want to use anything from the "pharmaceutically" tainted literature in the States... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990839/ Take care, chbare. On a side note, I am not sure I would say I suffer from PTSD; however, I have had a few nightmares relating to experiences I've had in both the United States and Afghanistan. Also, I remember being out walking and had a minor incident shortly after returning from Afghanistan. Apparently, there was a foot ball game and when one team won, a massive fire works show started (Homecoming I believe). There was a sudden, large boom and for an instant I though it was an IDE/VBIED and went to the ground. Had I been a little more aware of the fact that the game was going on, I do not think it would have taken me by surprise. I have had no other incidents since and generally think I am doing just fine. However, I can appreciate what some of these people who experienced "real" action may be dealing with. Take care, chbare.

I believe it's Licensed Massage Therapist. Take care, chbare.

On the right track. A 3 lead typically will not record diagnostic quality data. Many of the XII leads will transition to diagnostic when you perform a XII lead. Therefore, definitively diagnosing a STEMI'S based on 3 lead data would be exceptionally difficult and possibly low yield at best. Personally, I do not see much use for moving the three lead all around the place when you likely have other priorities and in this case not really educated to do XII leads under "normal" circumstances. Hang in there OP. Take care, chbare.

You still don't seem to understand. There are no absolutes in science. One of the major defining characteristics of a theory is the ability to test it for possible inconsistencies. In fact, solid theories such as general relativity are being tested to this very day. This is why allot of pseudoscience and all religions are not "scientific." It's pretty hard to test a theory if it cannot be tested or potentially proven incorrect. Also, you do not seem to understand this individual component concept you talked about. A medication is not simply the combination of it's individual components when considering their effects. Let's do a basic example: I expose you to elemental Chlorine and you would soon die. I expose you to elemental Sodium and "boom." I pull a valence electron from Sodium and give it to Chlorine and I have a "stable" molecule of Na+Cl- that can de dissolved in water to produce thing like the IV crystalloids we all know and use. It would be quite myopic to make assumptions based on examination of individual components without good observations that are peer reviewed and reproducible. You have yet to present us with links to evidence and your conclusions based on the examination of said evidence. Remember, even with a good theory, you need to show us the money at the end of the day. Feel free to do so and we can have a discussion. Take care, chbare.

Take care, chbare.