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Check out this interesting lecture on cardiac arrest in young athletes: http://www.emsonline.net/tuesday.asp?date=...-02_Drezner.flv

Here's an interesting lecture on whether or not you can use capnography to guide you in ventilating a patient: http://www.emsonline.net/tuesday.asp?date=...0-08_Warner.flv

I wonder what SF medics think about this show after all the bashing they took in the local media last year.

Doc Harris wrote, "Stats kicked the crap out of me." Yeah, you, me, and everyone else too!

This is an interesting lecture by a Seattle physician. He talks about the city's claimed 48% survival rate (hospital discharge) for witnessed out-of-hospital VF cardiac arrests. http://www.emsonline.net/tuesday.asp?date=...erg_Cardiac.flv

http://en.wikipedia.org/wiki/Louise_Woodward http://en.wikipedia.org/wiki/Shaken-baby_syndrome

Sorry, my bad. Try this one: http://www.cnn.com/2009/CRIME/05/20/alabam...ting/index.html The whole situation is pretty sad actually. Not to say that they didn't deserve to be fired. Beating up an accident victim?!

Apparently these Alabama cops were fired for bad c-spine techniques. http://www.cnn.com/2009/CRIME/05/20/ala ... index.html

From eMedicine (the complete article is at: http://emedicine.medscape.com/article/767624-overview) Causes Hypovolemic hyponatremia develops as sodium and free water are lost and replaced by inappropriately hypotonic fluids, such as tap water, half-normal saline, or dextrose in water. Sodium can be lost through renal or nonrenal routes. Nonrenal routes include GI losses, excessive sweating, third spacing of fluids (eg, ascites, peritonitis, pancreatitis, burns), and cerebral salt-wasting syndrome. Excess fluid losses (eg, vomiting, diarrhea, excessive sweating, GI fistulas or drainage tubes, pancreatitis, burns) that have been replaced primarily by hypotonic fluids Acute or chronic renal insufficiency, in which the patient may be unable to excrete adequate amounts of free water Salt-wasting nephropathy Cerebral salt-wasting syndrome seen in patients with traumatic brain injury, aneurysmal subarachnoid hemorrhage, and intracranial surgery. Cerebral salt-wasting must be distinguished from SIADH because both conditions can cause hyponatremia in neurosurgical patients, and yet the pathophysiology and treatment are different.4 Prolonged exercise in a hot environment, especially in patients who hydrate aggressively with hyposmolar fluids during exertion. Severe symptomatic hyponatremia has been reported in marathon runners and in recreational hikers in the Grand Canyon. Euvolemic hyponatremia implies normal sodium stores and a total body excess of free water. This occurs in patients who take in excess fluids. Psychogenic polydipsia, often in psychiatric patients Administration of hypotonic intravenous or irrigation fluids in the immediate postoperative period In a recent meta-analysis, administration of hypotonic maintenance intravenous fluids to hospitalized children has been associated with an increased incidence of acute hyponatremia compared with administration of isotonic maintenance fluids.5 Infants who may have been given inappropriate amounts of free water Ingestion of sodium phosphate or sodium picosulfates and magnesium citrate combination as a bowel preparation before colonoscopy or colorectal surgery6 SIADH Hypervolemic hyponatremia occurs when sodium stores increase inappropriately. This may result from renal causes such as acute or chronic renal failure, when dysfunctional kidneys are unable to excrete the ingested sodium load. It also may occur in response to states of decreased effective intravascular volume. History of hepatic cirrhosis, congestive heart failure, or nephrotic syndrome, in which patients are subject to insidious increases in total body sodium and free water stores Uncorrected hypothyroidism or cortisol deficiency (adrenal insufficiency, hypopituitarism) Consumption of large quantities of beer or use of the recreational drug MDMA (ecstasy) Hyponatremia can be caused by many medications. Known offenders include acetazolamide, amiloride, amphotericin, aripiprazole, atovaquone, thiazide diuretics, amiodarone, basiliximab, angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, bromocriptine, carbamazepine, carboplatin, carvedilol, celecoxib, cyclophosphamide, clofibrate, desmopressin, donepezil, duloxetine, eplerenone, gabapentin, haloperidol, heparin, hydroxyurea, indapamide, indomethacin, ketorolac, levetiracetam, loop diuretics, lorcainide, mirtazapine, mitoxantrone, nimodipine, oxcarbazepine, opiates, oxytocin, pimozide, propafenone, proton pump inhibitors, quetiapine, sirolimus, ticlopidine, tolterodine, vincristine, selective serotonin reuptake inhibitors, sulfonylureas, trazodone, tolbutamide, venlafaxine, zalcitabine, and zonisamide.

I just try the link myself and it also didn't load. I'm not sure if the site is down or what the problem is.

Yeah, drug screen would be important. The title "dancing queen" makes me think of ecstasy. Some kids who use that stuff drink way too much water because they are afraid of becoming dehydrated.

Do these labs indicate kidney failure? If that's the case, then she may be having a hypertensive crisis that is causing cerebral edema or infarction. Perhaps all this began with a UTI and lead to a kidney infection? I really need to learn lab values! Hopefully I'll be in nursing school in a few months.

Oh, I forgot to give credit to Tom B's xlnt blog, which is where I found the link. Here's a link to Tom's blog: http://ems12lead.blogspot.com

Here's a great website from UCLA. It tests you on distinguishing STEMI's from STEMI mimics. http://www.emergencymedicine.ucla.edu/ECGChallenge/

http://www.islandpacket.com/news/local/story/830326.html

"I'm sorry, but how can anyone justify not working this code? "Traumatic arrest" does not equal "we can't do anything about it." Not in the least! Unless this patient had "injuries incompatible with life" (like decapitation, transection, ejection of brain matter, etc) which it doesn't sound like he did, this patient needs an ED assessment and potentially an OR. It isn't up to us to decide what can and cannot be done for this person when he gets to the hospital." I'd have to respectfully disagree. It is up to us to decide. We all know that if he is a traumatic full arrest, he has just a tiny slither of a 1% chance of surviving, esp. since it's blunt, not penetrating trauma. Obviously you have to follow your local protocols, which in my case would mean picking up my cell phone and talking to my base hospital. What good will an ED assessment do? Are we ambulance drivers too stupid to figure out that he's dead? Of course, if he still has agonal breaths or if you're not sure if he has a pulse or not, then yes, work him up.

Like "Saved," this ought to be good for a few laughs. I'll be surprised if it goes on for than a few episodes before it's cancelled.

Geez, you guys are harsh. Fire a 20-year veteran, and in this economy? Yeah, he did something incredibly stupid, but a two-week suspension is enough punishment if this is the first time he's gotten into trouble. I wonder if perhaps he was temporarily put in dispatch for a work-related injury, and then wasn't properly trained. It's unlikely that a professional. experienced dispatcher would have done this. Reminds me of the thread from a couple of months ago---remember the nurse who was supposed to triage calls and ends up refusing to send an ambulance because the caller was rude?

http://www.gatheringofeagles.us/www/2009/p...sentations.html ...and here are the ones from 2008: http://www.gatheringofeagles.us/www/Presen...sentations.html

Fiznat, Kern County, CA, still uses ammonia inhalants.

Thanks to Vent for leading me to this great website: http://home.pacbell.net/whitnack/The_Death...rive_Theory.htm

"I've already gotten a 'stern talking to' about asking questions that are 'too complex for where the class is at this point'."

My understand is inferior + right-ventricular MI's actually do quite well with treatment because the R ventricle is more likely to recover from ischemia. An MI that causes cardiogenic shocks obviously has a high mortality rate, but not so when the hypotension is due to the R ventricle being involved. The myocardium is "stunned" from the ischemia, but it is less likely to infarct. I'm not sure if this has already been said, but besides the classic triad of hypotension, clear lungs, and JVD, other signs that are suggestive of an MI with R-ventricular involvement are bradycardia, AV block, and new-onset AF. A few months ago I had a patient with all the above signs (except no block). Unfortunately, my service still does not have 12-leads, otherwise I would be able to share an interesting strip with you.

This comes as no surprise..... http://www.latimes.com/news/local/la-me-la...0,1004865.story Villaraigosa budget proposal to include 10% salary cuts L.A.'s mayor is expected to seek salary cuts even from the police and fire departments, traditionally exempted from such moves. Villaraigosa is attempting to close a $530-million budget shortfall. By David Zahniser April 19, 2009 Los Angeles Mayor Antonio Villaraigosa plans to unveil a budget proposal today that calls on nearly every city agency to scale back salary costs by 10% as part of his effort to eliminate a $530-million budget shortfall, officials said Sunday. The mayor is expected to seek reductions even at the police and fire departments, which traditionally have been shielded from cuts, while moving to merge three other city agencies and find private companies to run city parking garages. Villaraigosa tells unions concessions needed to avoid layoffs Details of any salary decreases are still unknown, in part because Villaraigosa is negotiating the specifics of a plan to offer early retirement to thousands of city workers. He also is holding salary talks with police and firefighter unions. "Everyone's got to participate" in the effort to cut costs, said Villaraigosa spokesman Matt Szabo. "We can't balance [the budget] without police and fire. We just can't." Szabo said a 10% reduction in salary costs would free up at least $200 million -- roughly the equivalent of laying off 2,800 workers. Most of those layoffs could be avoided, he said, if city employees comply with Villaraigosa's request for unpaid days off, no raises and a larger contribution toward employee health and pension benefits. A group of city unions is pushing instead for an agreement that would allow workers to retire as much as five years ahead of schedule. "It would help pump money into the economy when it's needed most," according to a statement from the Coalition of LA City Unions. Villaraigosa's budget proposal calls for three smaller agencies -- the Commission on the Status of Women, the Human Relations Commission and the Commission for Children, Youth and Their Families -- to be merged into a single department, Szabo said. That effort is expected to save $600,000 in the fiscal year that begins July 1. Far more financially significant is the plan to lease several city parking garages to private companies. The mayor hopes such a move could free up $80 million next year. The budget also calls for the city to begin work on finding private operators for the city's Convention Center, the Los Angeles Zoo and hundreds of city parking meters. Those proposals, however, won't generate money until the 2010-11 fiscal year. The potential for cutbacks is serious enough that the city's firefighters union has hired a polling firm to determine whether voters would favor a quarter-cent sales tax hike to pay for firefighters, paramedics and 911 operators. "I don't know what's going to be revealed by the mayor's budget . . . but we're sure as heck worried about it," said Pat McOsker, president of United Firefighters of Los Angeles City Local 112. david.zahniser@latimes.com Times staff writer Phil Willon contributed to this report.

Does anyone know the # of reported cases of intracranial placement of an ET tube after nasotracheal intubation? I wonder how many cases went unreported....