Can you diagnose STEMI on a rhythm strip?
Paramedic Humphrey has just responded to the residence of a lovely 72-year old woman who fell in her home. As he engages her in conversation, he makes a point of asking whether she "tripped", or whether she had any preceding symptoms that may have induced her fall. She responds, "I don't think I had any symptoms." Humphrey is not convinced that he wants to do a 12-lead EKG on this patient, as he is fairly confident that this is a mechanical fall, so he decides...
Anaphylaxis: Keys to Prehospital Success
INTRODUCTION Anaphylaxis is a life-threatening condition for which prehospital intervention has been definitively shown to improve both short-term and long-term patient outcomes [1, 2]. It is also a condition that is vulnerable to management complacency among providers, as reactions occur in varying degrees of severity and are frequently mild. The lifetime individual risk for anaphylaxis is estimated to be between 1-3%, and recent evidence suggests that its incidence is rising [5]. Furthermore, this number is likely underestimated due to underdiagnosis, and failure of reporting [3, 4]. The reaction is...
IV Catheter Size: How much of a difference does it make?
Resuscitation protocols almost ubiquitously state the need for two large-bore IVs for rapid fluid administration. The fact that more fluid flows through a larger tube shouldn't surprise anyone. It's the reason that straws at fast food restaurants are so much wider than normal straws -- larger diameter means more gulp per suck. It's also the same reason that firemen use larger attack lines (ie. 'deuce-and-a-half'; 2.5") for commercial fires as compared to residential fires. Big fires need big water. If you're like...
Low SPO2: O2 Problem or CO2 Problem?
Let’s talk gas. As you lean over your keyboard breathing right now, you are inhaling a mixture of atmospheric gasses consisting primarily of oxygen (21%), nitrogen (78%), and carbon dioxide (0.04%). The total weight of the atmosphere on you is exerting a particular pressure. When you rise in altitude, the amount of atmosphere above you decreases, so the pressure does as well. This pressure is relatively constant depending on your altitude. Each gas present in the atmosphere contributes to this...
Dopamine vs. norepinephrine for septic / distributive shock?
When New York rolled out a massive protocol update in 2014, our fire department was fortunate enough to be able to add a few more trays to our drug box. Among the newcomers was norepinephrine, which was not unreasonably placed next to our existing stores of dopamine. Prior to this point, we had relied on dopamine as a pressor in the prehospital setting (in large part due to a lack of options). Thus, when the choice was offered to us, providers began...- 1
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